A New Starting Point
By Beth W. Orenstein
Radiology Today
Vol. 21 No. 9 P. 10

COVID-19 accelerates changes in radiology.

Change is rarely easy. Many people, perhaps even most, including radiologists and those who support them, prefer to operate the way they always have. There’s safety in the known.

Granted, says Rich Dewit, head of US sales and marketing for Bayer Radiology, as a field, radiology has always been a bit ahead of the curve and adopted new technology faster than some of its medical cohorts. “Radiology was one of the first to embrace digital tools; one of the first to move from film to computer-generated images read on a monitor, instead of a light board; and one of the first to embrace a standardized platform for imaging,” Dewit says. However, while radiology has always tried to be on the forefront of innovation when it comes to technology, it has had its struggles moving into and staying ahead of the future, he adds.

“Change is challenging,” agrees Kimberly Evans, vice president of imaging for ChristianaCare in Wilmington, Delaware.

Dewit and Evans are two of 11 members of the AHRA’s new Imaging Innovation Council (IIC), formed at the end of July, to help members and corporate stakeholders pursue and promote innovative ideas and programs that address gaps and opportunities within the imaging community. “The IIC is a unique forum that brings together multidisciplinary thought leaders to advance the imaging field through research, dialogue, and engagement,” says Dewit, who is serving as the group’s chair. “The IIC is focused on understanding the real challenges that imaging professionals are facing, and through collaboration of AHRA and corporate members, our primary goal is to develop innovative ideas that can lead to actionable outcomes and create a positive impact on the imaging community and, ultimately, patient care.”

As part of the kickoff, the council held a panel at the AHRA virtual annual meeting to provide a preview into the discourse and thoughts of IIC representatives. Other members of the IIC include Jacqui Rose, AHRA president and director of medical imaging, telecommunications, IT, and lab at Premier Health, Upper Valley Medical Center, and Miami Valley Hospital North in Ohio; Terry Bucknall, AHRA Education Foundation chair; David Fox, vice president and chief operating officer of Baxter Regional Medical Center in Mountain Home, Arkansas; Karen Holzberger, senior vice president and general manager of diagnostic solutions at Nuance; Jason Newmark, vice president of diagnostic services at Baystate Medical Center in Springfield, Massachusetts; Darren Selsky, franchise leader and senior director of global marketing at Hologic Inc; Martin Silverman, vice president and general manager of the northeast zone at Siemens Healthineers; Jason Theadore, CEO of Banner Imaging in Chandler, Arizona; and Chris Tomlinson, AHRA past president and enterprise vice president of radiology/imaging, clinical lab, pathology, and emergency and hospital medicine service lines at Jefferson Health in Philadelphia.

Recently, Dewit, Evans, and Tomlinson shared their thoughts with Radiology Today about what they believe to be the biggest changes and challenges facing the imaging community, as the world moves forward during and after the COVID-19 pandemic.

Patient-Centered Care
The top item on Dewit’s list of anticipated changes that radiology will have to deal with in the next five to 10 years is the role of the patient. In the past, he says, patients would likely go for imaging tests wherever referring physicians sent them and simply wait for the results to come back. Once they heard from their referring physician, they would follow his/her recommendations as to the next steps for diagnosis and/or treatment.

“Today, we’re seeing patients take a more active role in their care,” Dewit says. “They are asking more questions and ultimately want to help decide the best diagnosis/treatment paths for themselves.” Information is more available to patients than ever before, allowing them to be more involved in their care, Dewit says. While they may not understand everything they see and read, they still want to have a close-up look at their results and a hand in the decision-making process. “We call it patient empowerment and patient experience,” he says.

Dewit says people who work in radiology care must be prepared to work more directly with patients as coequals. If they don’t, he says, they risk losing their patients to those who will be more open and attentive to patients playing a more active role in their health care decision-making.

Tomlinson says, as with all health care departments, radiology must also find new ways of engaging with patients post COVID-19. Patients must be able to schedule their appointments for imaging studies or consultations online. They must be able to fill out the necessary paperwork ahead of time from the safety of their home computer or smartphone so that, by the time they show up for their CT or MRI, all they have to do is notify staff that they’ve arrived.

“This is something that health care has been bad at adopting,” Tomlinson says. “But COVID accelerated things.” COVID also accelerated the need for televisits, he adds. And radiologists need to be able to embrace and adopt remote access communications with their patients. Tomlinson says radiology has slowly been adopting this idea but must embrace it now and likely will need to maintain it, even after COVID ceases to be a significant health threat.

Patient satisfaction is going to be a larger part of the equation for all of health care, Dewit says. “Patients just seem to be having more and more of a voice in terms of how their care unfolds, and the patient experience and satisfaction in hospitals seems to be getting higher and higher levels of attention than in recent years,” he says. Not only acknowledging their voices but also listening to them will be crucial for the success of all departments, including imaging, as we move further into the 2020s, he says.

Next on Dewit’s and Tomlinson’s list is AI. “We all hear a lot about AI, but we believe that many providers in the imaging arena do not fully understand AI and what the benefits are of their investing in it,” Dewit says. “There’s a decent number, maybe higher than 50% of imaging professionals, who couldn’t tell you what AI is exactly and how it can play an important role in their imaging department.”

Many small and community hospitals don’t know what to do with AI or even how to get started adopting it, Tomlinson says. However, he notes, AI can be used for everything from helping to determine who is the best qualified radiologist—generalist or subspecialist—available to read a particular study when it pops up on a worklist to what the appropriate follow-up for incidental findings is, while ensuring that the incidental findings don’t end up getting lost in the system. AI can also play a role in reviewing appropriateness criteria and helping radiologists determine which study is most appropriate for a patient’s presentation, Tomlinson says. With AI, he says, providers could adopt a program that only requires patients to get preauthorization if an ordered study falls outside of radiology societies’ accepted appropriateness criteria. He believes such a system could save time and money.

Dewit and Tomlinson think that radiology providers and manufacturers need to focus more on AI in the future and adopt it fully. If they don’t, they say, the health care industry may be moving on without them.

New Business Models
Tomlinson expects AI to play a role in better patient care and economics, as well. If AI can match patients to the most useful study sooner, it can help reduce time and waste in the system, he says. For example, if a patient arrives at the emergency department and the attending physicians suspect he has appendicitis, doing five studies and four lab tests plus surgery to arrive at a diagnosis will likely waste a great deal of the hospital’s time and money, Tomlinson says. If, rather than bouncing from study to study, AI shows a clear pathway to follow, allowing an answer to be found more quickly and accurately, everyone would benefit. The patient would avoid unnecessary care, while being treated sooner, and the hospital—which likely gets reimbursed per episode rather than on a fee-for-service basis—benefits by spending its resources more appropriately, Tomlinson says.

Dewit says providers and vendors must move past the traditional model of a selling/buying transaction and work to create relationships that better align needs and outcomes. “Some of these needs/outcomes are directly related to financial topics, but others can indirectly relate through areas like quality improvement, workflow efficiency, and clinical effectiveness,” he says. “Building trust and more open dialogue on how we can help each other is ultimately better for the imaging patients we serve.”

Change Is a Must
What will happen to hospitals and health care providers who don’t adopt these changes and give them their due? Dewit suspects that smaller vendors and facilities have the advantage of being nimbler and able to adapt more quickly. If larger organizations don’t embrace change and aren’t a catalyst for it, “they may not be able to pivot that quickly and could become victims of their inability to do so,” he says. People may find some comfort in continuing to do what they have always done, Dewit says, but they must learn to be more entrepreneurial if they are to not only survive but thrive in the future.

Evans agrees: “Our mission is to continue to serve our community. To do this most effectively, we must be agile and work differently. If we fail to adapt, we will find that we limit our ability to care for our community, and that is not acceptable.” Like Dewit, she sees “working in the same way we always have before” as the biggest challenge facing imaging.

“We need the vision to know what needs to change to better meet our mission,” Evans says. “Change is difficult for people, but it is imminent.” She also believes that communication is key. “Our employees can feel lost and adrift if we do not share and communicate well,” she says.

The members of the IIC believe that these changes would have happened regardless of the COVID-19 pandemic. However, Evans adds, “the pandemic has propelled us in 2020 to act and to do so with unprecedented speed and agility to make necessary changes to meet the demand of the crisis. The pandemic has given us a new starting point.”

Tomlinson hopes that the IIC can write helpful and encouraging position papers and white papers that don’t take a position for commercial reasons but for bettering the industry. “This isn’t about selling anything to anyone,” he says. “It’s about how we help folks on the front lines to think through how to better their practice with concepts and ideas.”

— Beth W. Orenstein of Northampton, Pennsylvania, is a freelance medical writer and regular contributor to Radiology Today.