RSNA 2016: Doing the Undoable in Radiology

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Everywhere I looked this year at the RSNA, I saw signs that radiology is doing what previously may have appeared impossible. Frustrations have abounded during the past five to 10 years around interoperability problems with health IT, finding a fit for radiology in the Medicare Shared Savings Program (MSSP), and getting the optimal patient information from the referring physician to make a diagnosis.

This year, there was evidence that progress is being made towards all three of those elusive goals: the radiologist who deposited a $28,570 MSSP check in his bank account, the emergence of new tools to smooth participation in government quality programs, and a strategy to supplement the patient histories provided by the referring physician.

In his RSNA 2016 keynote during the opening session, Robert Wachter, MD, author of The Digital Doctor: Hope, Hype, Harm at the Dawn of Medicine’s Computer Age, referred to radiology as the canary in the coal mine for all of the rest of medicine, a warning of the potential disintermediating effects health IT could bring to all medical specialties in time.

Referring to the two types of challenges inherent in change (technical and adaptive), he called health IT “the mother of all adaptive change.” “In adaptive problems, people are the problem and people are the solution,” he explained. “Leadership is about mobilizing people with the problem rather than anesthetizing them.”

Wachter described the four stages of health IT adoption as:

  • digitizing the health record;
  • digitizing the parts, ie enterprise-to-enterprise communication, third-party apps, and patient-facing systems;
  • gleaning meaningful insights from the data; and
  • converting the insights into action that improves value.

The $30 billion federal IT incentive program achieved the digitization of the health record, which Wachter compared to building the first set of railroad tracks on the Transcontinental Railroad. Now that Silicon Valley has jumped back into health IT, things will get even more interesting, he predicted.

That brought him to health IT’s “productivity paradox”—a reference to the massive investment in IT in the ‘70s and ‘80s and the concurrent slowdown in productivity. We’ve all seen physicians in doctor’s offices across the land struggle with integrating this new tool into their workflow.

Radiology is ahead of this curve, having digitized its data and achieved stunning productivity advances during the past 15 years. Now it is digitizing the parts and on its way to gleaning meaningful insights from its data.

Keep going, radiology. You can do it, and when you get there, you can help bring the rest of health care along with you. Don’t forget what Wachter said about adaptive change—people are the problem and the solution.

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