With the worlds of radiology and imaging informatics changing with dramatic speed these days, it is no surprise that everyone affected by those changes—including radiologists, administrators in radiology groups and hospitals, referring physicians, and all the healthcare professionals whose work connects to or directly involves imaging informatics—is struggling to keep up.
It is in that context that HCI Editor-in-Chief Mark Hagland wrote his November/December cover story on imaging informatics, interviewing a number of healthcare leaders and industry experts on all the policy, operational, clinical, and information technology changes sweeping the industry these days. Among those he interviewed was Luis Saldaña, M.D., CMIO of the 24-hospital Texas Health Resources, based in Arlington, Texas. Like the vast majority of hospitals and health systems in the U.S., Texas Health Resources (THR) is in the middle of a long, complex journey towards a new world of interoperability, integration, and the optimization of imaging informatics and of supporting practicing radiologists towards practice transformation. Below are excerpts from Hagland’s interview with Dr. Saldaña this autumn, in the preparation of that cover story.
My core conceptual premise right now is that everything is changing all at once in this area: the policy landscape is changing, reimbursement incentives are changing, radiological and other clinical practice is changing, and all the technologies around imaging informatics are changing—and that, as a result, healthcare leaders are having to move forward along numerous dimensions at once. What do you think?
I agree with your general premise. As you said, it’s really part of the bigger landscape. Things are changing fast. And certainly in that realm, certainly a lot of assumptions need to be revisited. I think the economics of imaging in general has changed. A lot of ideas have been turned on their heads. And people have to think about how we manage things going forward and make them work for us.
And I would argue that radiologists’ practice has been changing for at least a couple of years now. To me, it all started when they started outsourcing reads to India and other places, because that turned that function into a commodity. Commoditizing the read somewhat marginalized the radiologists. Now in terms of the informatics, they have a ton of efficiencies, which is both good and bad, because they’re able to read many, many more studies per hour. And what is productivity? Is it studies per hour, or is there more value in talking to the referring physician about the case? Which delivers more value?
The mandate that until recently had been set for Jan. 1, 2017, involving the requirement that ordering physicians make use of clinical decision support and appropriateness criteria—do you think that that mandate, whenever it is actually implemented, will further change the landscape of physician practice?
Actually, the ACR [American College of Radiology] was the big driver on that, but, like you, I wonder whether its implementtion might further undermine their own economics in radiology.
Health information exchange has really lagged, with regard to the widespread sharing of images. What are your thoughts on that?
Yes, it has. We get caught up in talking about the technologies, whether VNA or HIE, but they’re all workarounds to barriers around interoperability. Let’s say you’re a trauma surgeon who’s accepted a patient from a rural hospital. You just want to see the images from the CT scan. You don’t care how you see them. Nowadays, we often see a CD disk. That’s such a shortcoming, and we have to get around that. We shouldn’t be spending a fortune to do that. There’s no excuse for someone today to have repeat imaging. It used to be standard practice, because that shouldn’t be happening any longer.
What is your and your colleagues’ leading edge in this area right now, at THR?
We’re trying to ensure value and reliable outcomes. And with regard to imaging, we’re trying to deliver value. So we’re looking at bundled payments, and are doing care redesign, to make sure we’re delivering reliable outcomes, and we’re trying to deliver efficient and effective outcomes [ as facilitated by reliable image storage and transfer]. We’re not there yet in terms of having an enterprise-wide VNA. We have HIE capabilities, and we’ve started to leverage those, but we’re not there yet. Meanwhile, we’re working on both the VNA and HIE sides of this, and we’re probably going to look at a solution that combines the ideas of VNA and HIE.
What’s going to happen in the next few years, both at THR, and in the industry, in your view?
For sure, the new 2017 regulation will have an impact, whenever it is implemented. The second thing that will happen is, we at THR will be focused on what that looks like in our care delivery model of the future. In other words, what’s it going to look like to order imaging studies in the future? Are we going to check into radiation dosage exposure for the patient, or what value might come out of the diagnosis? So how do we weigh all those things in our system? So it’s going to take a long time to figure out what that will look like in our system.
And at THR, you’ll be involving the radiologists in those discussions?
Yes, absolutely. The technology will no longer be separated from the technology and implementation. There will be new technology, but we have to make our investments wisely. I think more and more, we’ll be working with our existing technology partners, asking them to help us solve these problems. We have an HIE with Medicity, and we’re going to be asking them to help us solve problems, to help us prevent repeat imaging, to make the process more efficient and effective. So provider-vendor collaboration, and provider-provider collaboration, in the world of value-based care, will be important.
And you yourself continue to practice clinically, part-time, correct?
Yes, that’s correct; I’m an emergency physician. But I may be drawing that clinical practice to a close at some point in the relatively near future.
In the context of everything we’ve discussed here regarding radiology practice, physician practice, policy and reimbursement changes, and technology, what would your advice be for CIOs, CMIOs, and other healthcare IT leaders be for the next few years?
Be thoughtful. Be sure to keep to the big picture. Don’t build just to build, and don’t build fast just to build fast. Be collaborative, and find out what folks in your region are doing. We need to leverage collaborations more and more.
