Farewell to RSNA 2014: Have We Reached an Inflection Point?

Dec. 22, 2014
Attendees at RSNA conferences of two decades ago could scarcely imagine what the hottest conversations would be like at RSNA 2014, as the radiology and imaging informatics world swirls with change

After having attended nearly 20 RSNAs, I have to say, it’s been fascinating to see the evolution of the RSNA Annual Conference (sponsored by the Radiological Society of North America). Held every year the week after U.S. Thanksgiving at the vast McCormick Place Convention Center in downtown Chicago, the RSNA Annual Conference experience has been like a gestalt for what’s been going on in the healthcare industry—radiology practice, radiology administration, and imaging informatics—for many years.

Indeed, RSNA 2014 was touted as the hundredth anniversary of the conference. Frankly, I’ve wracked my brain trying to imagine what the very first RSNA conference must have been like in 1914, but am coming up with blanks—! But that’s another story for another blog.

In any case, what I can say is that there’s been an obvious sea change in the past 20 years. Twenty years ago, RSNA was still a radiologist-centric, modality-centric conference, on the exhibit floor. And it was all about the latest new bells and whistles on MR, CT, PET, nuclear, etc., machinery.

Well, so much has shifted in U.S., and even international, healthcare since then. If anything, the imaging informatics element has become, if not dominant, at least certainly very prominent, on the exhibit floor at McCormick Place, taking up more physical—and conceptual—room each succeeding year. And with organizations going through second- and third-generation PACS (picture archiving and communications systems) solutions and now, with the adoption of vendor-neutral archives and universal-viewer solutions and all sorts of other important technology taking place, in an operating environment focused on cost-effectiveness/cost savings, efficiency/throughput, and federal and private-payer reimbursement reduction, the world is changing quickly.

Certainly, imaging informatics vendors, some of which are modality vendors as well, have been busy reframing and re-reframing their product offerings and strategies of late. I met with executives from Agfa, Philips, Siemens, McKesson, Cerner, TeraMedica, Nuance, and other vendor companies, and every single vendor I spoke with has actively been reframing some of their messaging to the industry, as well as in most cases, altering or adjusting their product line offerings. I have to say, every vendor executive I spoke with had quite a plausible “elevator speech” to make regarding why what their company was doing these days, why it made sense for the industry, and how it might potentially contribute to reshaping the imaging informatics market.

And a fascinating market it is, with standalone RIS (radiology information system) solutions beating an ongoing retreat in the marketplace, in the face of increasingly agile and comprehensive EHR (electronic health record) and PACS systems that are eliminating the need for standalone RIS capabilities, particularly as accountable care and other aggregative arrangements move forward in U.S. healthcare.

Indeed, as industry luminary Joe Marion told me last Thursday, RIS as a completely standalone phenomenon is now fading fast, and everybody knows it. Joe also said this: “What’s being called the ‘decomposition of PACS’ is becoming more and more accepted as a concept. What that means,” he said, “is that people are asking the question, ‘Why do I have to replace everything?’ The one exception” to the trend of knitting together disparate systems, is this: “There’s been a reconvergence of image display. So, whereas in the past, you had a PACS workstation, a clinical workstation, a mammography workstation, and an advanced visualization workstation, vendors are integrating those now so that you don’t have so many workstations.”

As a result, Marion cited the example of Agfa, where, “In the past, what they used to call ‘agility,’ they’re now referring to as ‘Agfa Enterprise Imaging’: so you’ll have the same user interface, the same tools, across the whole enterprise. Philips is working towards that, too, with a common viewing platform,” he noted.

Meanwhile, the folks at Merge Healthcare, chief strategy officer Steve Tolle noted, announced two weeks ago the offering of a new hosted solution for ambulatory customers that follow the athenahealth model of a subscription-based system, with ClearData as the hosting partner.

All these developments would frankly have been astonishing 20 years ago, when RSNA was still focused on modalities, and to the extent it was focused on imaging informatics at all, was focused on radiologists and radiology chairmen (and in those days, they all were chairmen) picking out their first PACS systems, which were conceived as a “value-added” solution for the radiologists. So much has changed in the world, and radiologists are finally beginning to be pulled, inevitably, into the swirling vortex of healthcare reform, reimbursement reform, and increased demands for accountability and transparency, just as other specialists have been.

And then came the spring thunderclap…

And then, seemingly out of nowhere, came a legislative development this spring that has the potential to totally revolutionize how referring physicians and radiologists interact with each other, and how the practice of radiology ultimately works.

At the end of March, the U.S. Congress passed yet another “SGR fix” bill—a bill designed to once again forestall inevitable Medicare reimbursement cuts to physicians, based on the long-ago-passed sustainable growth formula that has never been fully realized for doctor pay under the program. Slipped into the legislation—passed at the end of March and signed into law by President Obama at the beginning of April—was a provision requiring that, beginning in 2017, all referring physicians who order diagnostic imaging exams will have to document that they have made use of clinical decision support tools in their imaging ordering, at the point of ordering.

While vendors are rushing to help facilitate these capabilities, one company, the National Decision Support Company, or NDSC, is set to reap a bonanza from that legislative change alone. Created by the American College of Radiology (ACR) as an independent licensing and distribution partner for its clinical decision support tools, NDSC had already been facilitating clinical decision support for ordering/referring physicians when the legislation was passed this past spring. Now that use of CDS at the point of ordering has become a federal mandate that will need to be acted upon within a little over two years, things are full steam ahead for NDSC and frankly, for anyone involved in CDS in the imaging arena. Indeed, what NDSC and the ACR are doing on the referring physician side complements beautifully the Nuance/ACR initiative around CDS for radiologists, on the radiology side, as I reported about last week in interviews with Keith Dreyer, D.O., Ph.D., and Lincoln Berland, M.D. And of course, true CDS at the point of ordering or diagnosis can only be made real, and workable, in the context of agile and usable information systems.

“The times, they are a-changin’,” as the folk singers sang. All these changes in the radiology and imaging informatics arena really would be genuinely astonishing to attendees 20 years ago, and certainly 25 years ago, at RSNA 1994 or RSNA 1989. Yet when one ponders the situation thoughtfully, who could ever have believed that diagnostic imaging, a very expensive, if incredibly important, aspect of the healthcare delivery system, could remain forever unaffected by the swirling eddies of change already turning into a gigantic vortex of disruption, in U.S. (and global) healthcare more broadly?

So, as the ancient Chinese proverb would have it, we are all “cursed” to be living in interesting times. And it will be fascinating to see what the Zeitgeist is like at RSNA 2015 and RSNA 2016. For this journalist and industry observer, 2014 has felt like an inflection point in the radiology/imaging informatics world. Only time will tell whether that will have been true, but it certainly is interesting times we’re living in, to be sure.

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