If it seemed clear last year at RSNA 2014, the clarity this year at the annual RSNA Conference, held every year at Chicago’s vast McCormick Place Convention Center, was unmistakable: change is here.
In conversations with industry leaders like Rasu Shrestha, M.D. and Joe Marion; in interviews with innovative leaders in patient care organizations, like Tarik Alkasab, M.D., of Massachusetts General Hospital; in the press briefings and presentations of all the major vendors in the imaging informatics space, including Agfa, McKesson, Siemens, and GE Healthcare, it seemed very clear: everyone with whom I spoke recognizes that we are at an inflection point in radiology and imaging informatics, and we’re passing into a new phase in U.S. healthcare.
It’s obvious where this is all coming from: the push from the purchasers and payers of healthcare towards value-based care delivery and purchasing and away from the old fee-for-service, purely volume-driven system, is being triggered by massive changes in demographics, with the rapid aging of the U.S. population (and especially the Baby Boomers), and a frightening explosion in chronic illness. As the Medicare program’s actuaries noted last fall, we are projected to go from spending a total of $3.1 trillion a year on healthcare in the United States, to $5.5 trillion, within a decade. That is astonishing—and alarming. And finally now, the specialty of radiology is being affected, as healthcare’s purchasers and payers lower the boom on repetitive and/or potentially unnecessary imaging procedures, procedures that are helping to drive up overall U.S. healthcare costs.
And even though the Center for Medicare & Medicaid Services (CMS) mandate that was supposed to begin January 1, 2017, has been pushed off for a time (perhaps six months?), the reality that ordering physicians will be required to make use of clinical decision support and appropriateness criteria when ordering diagnostic imaging procedures only makes sense, cost-wise, patient safety-wise, and in every other way. Meanwhile, increasingly, radiologists themselves are being brought into peer review regimens that are based on medical evidence and specialist consensus, and that, too, is a good thing.
In short, the old days of largely unaccountable, purely volume-driven healthcare production and reimbursement are over. And that fact is reflected in the cast of the RSNA Conference shifting inexorably more towards an emphasis on informatics, as the easy annual purchasing of MRs, CTs, and PETs simply is no longer sustainable for hospitals and medical groups. Indeed, as one healthcare journalist colleague told me this past week, “This really is becoming more and more of an imaging informatics show every year.”
Even the top keynote addresses at the conference reflected the changes sweeping the U.S. healthcare industry these days. For example, there was the RSNA Daily Bulletin’s Monday headline, “Radiology Must Embrace Innovation.” The Daily Bulletin quoted Ronald L. Arenson, M.D., RSNA’s president, as having said on Nov. 29 that, “While some of you may feel like we are already living in a ‘strange new world,’ the point is that change is upon us. Like Earth in the 23rd century, our profession has reached a time of great challenge. It’s a time that requires us to be bold explorers and to seek our own version of ‘new life and new civilizations,’” Dr. Arenson said, referencing Star Trek language, under the heading of his keynote address Sunday, “Going Boldly Into Radiology’s Technological Future: Why Our Profession Must Embrace Innovation.”
For healthcare IT leaders, there is both wonderful promise, and some measure of peril, in that observation. On the one hand, the time is now, as never before, to create enterprise-wide, and indeed, beyond-enterprise-wide, systems for storing, sharing, and analyzing the vast numbers of diagnostic images being created by modality machines in diagnostic imaging procedures, to support rapidly evolving population health and accountable care delivery and payment systems. And there is great, great clarity in that. The days of radiology department-centric PACS systems are clearly over. Indeed, PACS (picture archiving and communications systems) technology has become almost fully commoditized at this point, particularly, as the PACS market matures. More broadly, pioneering patient care organization leaders are finally building vendor-neutral archive systems that are encompassing all of the “-ologies,” as they say—not just radiology and cardiology, but also pathology, dermatology, How information exchange for the 21st century.
There is also great promise in clinical decision support systems for ordering physicians and in peer review systems for radiologists, as healthcare IT will be essential to the success of creating, maintaining and supporting not only those systems themselves, but all the clinical and people processes around them.
But there is also a measure of peril built into all this, in that CIOs, CTOs, CMIOs, directors of imaging informatics, and others, will increasingly held more tightly accountable for the outcomes of the implementation of those systems. And the major set of complications in all this for healthcare IT leaders is consolidation, on all fronts—including consolidation on the part of provider organizations, on the part of payer organizations, and on the part of vendor organizations. How can one make savvy IT purchasing decisions, when consolidation and industry tumult are massively affecting every one of those spheres? For many healthcare IT leaders these days, life seems like a constant game of three-level chess.
Out of necessity, healthcare IT executives are turning to novel strategies. As Joe Marion, principal of the Waukesha, Wis.-based Healthcare Integration Strategies consulting firm, one of the most respected consultants in the imaging informatics arena and a regular blogger for HCI told me last week, “The other factor that’s really gaining popularity is streaming technology, as opposed to client-server; in essence, you move all the processing horsepower back onto the server. In the current PACS environment, all the images come into the server, and they’re literally sending the images to the workstation. That’s history. The one that’s most known for that is Visage, but they’re winning a lot of business in what they refer to as the deconstruction of PACS. So instead of purchasing a total replacement, buy their capabilities and replace PACS. Sutter Health and Shands Hospital are pursuing that path. Viztek, acquired by Konica, has similar technology. Fuji has a similar product, a new version of Synapse.”
Clearly, it will be more important than ever for healthcare IT leaders to be as intellectually and practically agile and nimble in the coming months and years, as the old, time-worn strategies just won’t work anymore. And it will be extremely important for everyone, including radiologists themselves, to show leadership going forward. As Rasu Shrestha, M.D., chief innovation officer at the 20-plus-hospital UPMC (University of Pittsburgh Medical Center) Health System in Pittsburgh, told me last week, “[T]he market is changing, reimbursement is changing. So it’s time for everybody to wake up and smell the roses. We’re moving away from the old value-based metrics, based on report turnaround time and productivity (how many studies we produce). Quality metrics, and satisfaction scores, all of those phenomena are evolving forward,” he emphasized to me. And it is clear that Dr. Shrestha and his UPMC colleagues intend to continue to be among the pioneers in this arena, as in so many others.
Given the huge number of elements involved in this landscape, it is understandable that many are feeling off-balance and even confused right now. But as I’ve been saying in different contexts for some time now, the fundamentals of all this are quite clear: healthcare leaders need to consider the broadest trends evolving forward in U.S. healthcare (and indeed, even in global healthcare), and prepare to align their organizations with those policy, reimbursement, business, clinical, and other trends. The handwriting really was on the wall for all this at RSNA this year—or perhaps, on the stairs at the main entrance to McCormick Place showed (see photo). “INNOVATION IS THE KEY TO OUR FUTURE,” was this year’s slogan.
So, is all of this daunting, on some level? Yes, most certainly.
But honestly, I see this as an extremely exciting—if challenging—time in healthcare—a time when we as a U.S. healthcare system are finally beginning to bring everything together to solve the complex bundle of quality, cost, efficiency, clinician effectiveness, patient experience, and responsiveness to community, issues, that must be solved going into the second half of the second decade of the 21st century. One really could view this as a glass half empty or a glass half full. But for those healthcare and healthcare IT leaders participating in RSNA 2015, many, fortunately, saw it as a glass half-full—a landscape with opportunity and challenge, but one that is positively challenging everyone in healthcare to move forward together to resolve the biggest issues facing us as a healthcare system and as a society. And RSNA 2015 reinforced that, to a degree that was quite noteworthy. It will be fascinating to see what the landscape feels like in a year from now, at RSNA 2016. But for now, everyone deserves a break from pounding the floors at McCormick Place, before the annual whirlwind revs up again.