Digitization of Medicine

In the era of medical cost containment, radiologists must continually maintain their actual and perceived value to patients, payers, and referring providers. Exploitation of current and future digital technologies may be the key to defining and promoting radiology’s “brand” and assure our continued relevance in providing predictive, preventive, personalized, and participatory medicine. The Association of University of Radiologists Radiology Research Alliance Digitization of Medicine Task Force was formed to explore the opportunities and challenges of the digitization of medicine that are relevant to radiologists, which include the reporting paradigm, computational biology, and imaging informatics. In addition to discussing these opportunities and challenges, we consider how change occurs in medicine, and how change may be effected in medical imaging community. This review article is a summary of the research of the task force and hopefully can be used as a stimulus for further discussions and development of action plans by radiology leaders.

In the face of Medicare cost containment, all medical subspecialties must strive to eliminate waste and improve both the effectiveness and efficiency of patient care. Radiology has the added challenge of combating commoditization by finding ways to add value . Radiology must continually maintain its actual and perceived value to patients, payers, and referring providers. In the business world, this is considered “branding”; maintaining brand value is a constant responsibility of the organization . Exploitation of current and future digital technologies may be the key to defining and promoting radiology’s “brand” .

The three core services of radiology—scheduling, imaging, and reporting—can all be commoditized. Even image interpretation could be affected by computer-aided detection software. But before searching for new avenues of value added, a business struggling with commoditization should start with determining how existing products and services can be redefined to better meet its customers’ needs . Specific strategies include standardization, bundling, and customization—these strategies address the manner in which the same services are delivered, without actually changing the substance of those services. Standardization of reporting has certainly been an important topic in radiology and is discussed later; standardization of scheduling and imaging should also be important goals. One example of bundling radiology services would be to enable a referring clinician to click “schedule the recommended follow-up study” on the same page as the report where the recommendation was made, therein bundling the services of reporting and scheduling. An example of customizing radiology services would be to have a computerized order entry system that allows the provider to check the box “measure tumor volume” or “automatically fax report to my office.” In the non–health care setting, consumers have come to expect these standardized customer conveniences from online retailers, and the same expectations should apply to medical care. Failure to incorporate existing digital technologies into current radiology practice only enables the competition (within or outside radiology) to be the first to redefine how commoditized services can be delivered better. One aspect of radiology that cannot be commoditized is personal consultations (for patients and referring physicians) . How can digital technologies be used to make radiologists more effective consultants? Picture archiving and communication systems (PACS) may have made it easier for radiologists to isolate themselves, but digital technologies applied in the right way can also improve interpersonal interaction.

In many ways, efficiency in radiology has been driven by PACS, and this efficiency has become the envy of other clinical services. Radiology’s success to date has largely relied on building a wall around radiologists so they could focus on interpretation, report generation, and turnaround times. We envision that PACS would continue to provide radiologists with efficiencies in the future; however, the walls would have windows allowing radiologists to communicate with referring clinicians and patients. “Skype”-like (Microsoft Inc, Redmond, WA) technologies can easily be incorporated with PACS workstations to permit such online communications. Patient digital photographs and video-clips can be integrated with medical imaging examinations and serve as additional sources of clinical information that can enhance the interpretation of imaging studies.

Referring clinicians in the future will face more data than any one physician can cope with (clinical, genetic, laboratory, radiologic, etc). Genetic screening will hopefully identify patients at risk for future disease, and those patients will need a lifelong monitoring plan and possibly even prophylactic therapy. If disease is later detected, primary treatment and follow-up will be necessary. Who will keep track of the massive amount of data that will be generated in the life of this patient? Who will analyze past and present data when acute situations arise, warranting prompt diagnosis? The existence of different medical specialties speaks to the fact that one human physician cannot know everything. A single physician cannot be expected to decipher the massive amount of data that modern tests are yielding, and this flood of information will only increase. Within medical specialties, online knowledge databases have been developed to assist in point-of-care clinical specialist decision-making. More data are yet to come, and these fragmented online databases will be inadequate.

There is clearly a need for a centralized information management system, and why not have a single medical specialty to serve as the shepherds for the flow of data, providing patient management and diagnostic decision support? Radiology is arguably in the best position (from an informatics standpoint) to take on this potential role. If radiology does not vie for a greater clinical presence, taking the opportunity to rebrand itself in this medical informatics role (either in part or whole), another specialty will. But how can the field of radiology effect these current, let alone future, changes? Radiology cannot expect to get reimbursed for new services unless those services can be shown to improve patient outcome and/or reduce cost. So, who is going to take the plunge in making the necessary digital technology investments and do the requisite research? Redefining the role of the radiologist in current and future practice will require the concerted effort and buy-in of multiple institutions. Rather than asking, “What can a radiologist do?” we will have more creative freedom by instead simply asking, “What needs to be done?” with all the patient information that is coming our way.

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Radiology report

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Radiology Lexicon

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Reporting’s Future

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Near-term Challenges and Opportunities in Radiology Reporting

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Computational biology

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Near-term Challenges and Opportunities in Computational Biology

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Imaging informatics

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CAD

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Communication Technologies

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Linking Imaging Phenotype to Patient/Disease Genotype

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Near-term Challenges and Opportunities in Imaging Informatics

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How changes occur in the practice of medicine

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Translation

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Articulation

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Standardization

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Anticipation

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Competition for the Role of Medical Informatician

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Near-term Challenges and Opportunities in Effecting Change

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Conclusion

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Digitization of Medicine

Radiology report

Radiology Lexicon

Reporting’s Future

Near-term Challenges and Opportunities in Radiology Reporting

Computational biology

Near-term Challenges and Opportunities in Computational Biology

Imaging informatics

CAD

Communication Technologies

Linking Imaging Phenotype to Patient/Disease Genotype

Near-term Challenges and Opportunities in Imaging Informatics

How changes occur in the practice of medicine

Translation

Articulation

Standardization

Anticipation

Competition for the Role of Medical Informatician

Near-term Challenges and Opportunities in Effecting Change

Conclusion

References

Further Reading

A Picture Is Worth A Thousand Words

A Retrieval-Based Computer-Aided Diagnosis System for the Characterization of Liver Lesions in CT Scans

Academic Radiology in the New Health Care Delivery Environment