Bellwether or Anomaly?

Scott Grier

Nervousness and uncertainty were hallmarks of RSNA 2009, held at the immense McCormick Place Convention Center in downtown Chicago, Nov. 29-Dec. 4. Everywhere, there were signs that the RSNA conference, which annually combines scientific sessions for radiologists and radiologic professionals with massive exhibit hall displays of modality, PACS, RIS and other technologies on the convention hall's exhibit floors, had come to what might be a turning point in its history. For many years fat and happy, the conference (and its sponsor, the Oak Brook, Ill.-based Radiological Society of North America), was hit by a multifaceted whammy of the economic downturn, the prospect of healthcare reform, and even more importantly, the prospect of significant reimbursement reform, and cuts in radiologists' pay.

Combined with a shifting vendor market, these elements made for a strange brew at RSNA 2009. Though at press time, the RSNA organization has not yet released final attendance numbers, observers say the exhibit floor foot traffic was clearly lighter. There was also a palpable sense of anxiety at the conference, as radiologists, imaging IT professionals, other clinicians and executives, and vendors waited to find out what the impact would be of both comprehensive federal healthcare reform legislation and ongoing reimbursement reform. A lot of them have already had significant cuts.

“Vendors (were) offering not so much new technology as refinements of their current technology, particularly with regard to making their products more user-friendly.”

Asked whether the imaging vendor market has yet bottomed out in terms of sales and prospects, Joseph Marion, principal at the Waukesha, Wis.-based Healthcare Integration Strategies, and someone who has attended virtually every RSNA since its inception, says he is not sure. “What I do think is that it's really going to be devastating if they fully enact government-run healthcare, he says. “That could be devastating to the imaging industry.”

Similarly, another veteran of many past RSNA conferences, Scott Grier, principal with Preferred Healthcare Consulting of Sarasota, Fla., says that vendors in the PACS/RIS sector “are still not selling at a high enough volume to consume the time of their people and then need outside consultants, which tells me that business is down.”

Uncertainty seen everywhere

The “telltale day,” as Gerard Barrilleaux who is director of imaging services at Louisiana's Baton Rouge General Hospital calls it, was Monday, Dec. 1. And activity exhibit floor activity, he says, was down. Barrilleaux, who has attended at least 18 RSNAs, says this year he saw “vendors offering not so much new technology as refinements of their current technology, particularly with regard to making their products more user-friendly.” As an example, he cites the integration of mammography.

Barrilleaux says community hospitals like his will continue to push forward with the technology development that is clearly needed, while they read the tea leaves for future trends. For example, following PACS implementation several years ago, his organization brought image availability into surgery, and expanded referring physicians' access to images and reports. Among the advances at Baton Rouge General: moving report turnaround times from an average of 12-18 hours, to fewer than three. For many hospital organizations, he stresses, there is still a great deal of work to do in the imaging informatics arena, as well as in the modality area, to keep up with current trends, let alone move into advanced areas.

Meanwhile, in terms of PACS and RIS, he says, “I keep seeing new vendors appearing, even though I just don't know that there's enough opportunity for those new people.” So what should CIOs be thinking about now with regard to imaging vendors and other issues?

Marion says they have to position themselves for vendor neutrality, in terms of protecting their data. “Philips, for example, has had this iStore storage capability they acquired with Stentor,” he says. “The concern there is that it's all proprietary, and there's a huge cost to reverse that. So the net of that is that I think vendor neutrality is a huge aspect for CIOs to consider, protecting their investment and protecting their data. I also think they'll have to get creative in how they manage that data.” Some companies are developing scenarios for better storage strategies, which Marion points out will be needed in the near future as hospitals and health systems find their storage capabilities stretched to the limit.

“I think vendor neutrality is a huge aspect for CIOs to consider, protecting their investment and protecting their data.“

In the meantime, all the stakeholders around imaging and imaging management - clinicians, department managers, IT executives, other executives - will need to respond to whatever reimbursement and process changes come out of federal healthcare reform and reimbursement reform in 2010. And most industry observers and policy experts believe some of the reimbursement changes, including utilization-rate assumptions built into Medicare payments for modality utilization, could be considerable, and very difficult on radiologists and on imaging.

Only time, and policy developments, will tell. As for RSNA 2010, the conference's near-time future could be strongly shaped by the winds of change. Will RSNA 2009 be looked back on as a harbinger of major change? Or is it merely an anomaly on a long and ever-winding road in terms of the evolution of radiology, imaging, and imaging management? The atmosphere at RSNA 2009 brings to mind the title of a 1981 book on pre-World War I Austrian history by Frederic Morton, A Nervous Splendour: Vienna 1888-89. Whether in years to come we look back on RSNA 2009 and think of a vanished past or not, remains a question whose answer hangs in the balance.