Managing Radiology's Enterprise Value
Osman Ratib, MDAccording to Osman Ratib, MD, chief of radiology at Geneva University Hospital (GUH) in Geneva, Switzerland, tomorrow's radiology enterprise will go well beyond diagnostic work-ups. Ratib is multilingual and multidisciplinary, and his view of the future is one in which clinical and organizational demands will lead to new radiology solutions that satisfy multiple caregivers. It will include more imaging tools and better information for referrers, as well as a larger role for radiology in the planning and execution of surgeries and other clinical treatments. Surgeons of the future, he predicts, will actually project radiologic images generated by advanced modalities in the radiology department onto the bodies of patients during endoscopic surgery to guide the whole process with greater accuracy and safety. Molecular imaging will lead to highly individualized patient-specific treatments, and cancer-staging, as well as surgery, will become more accurate through the use of molecular and volumetric renderings, he adds. When Ratib talks about maximizing radiology's enterprise value, he is talking about these clinical aspects as game-changers. But he also acknowledges the importance of everyday value metrics such as workflow and turnaround time. These are already being tracked with computerized dashboards that can cumulatively display metrics and perform cost/benefit analysis in real time with the click of a mouse, he says. These tools will be more widely used as radiology departments and imaging centers acknowledge their importance, he adds. Ratib says another critical avenue for maximizing enterprise value will come through research to determine which imaging procedures actually benefit the patient the most. Less expensive tests like ultrasound may not save money if advanced imaging like PET would reveal anomalies or lesions not otherwise detected, he says. "All the studies show if you don't get the most accurate diagnosis, you pay a lot more in the long run," he says. "Yes, every PET study is expensive, but if you're a radiation oncologist, there's a 15 percent-to-30 percent chance of a staging error with the wrong measurement." A $2,000 PET scan in the beginning, instead of ultrasound, might save $100,000 in treatment costs later on, he adds. "What's most costly in health care is an erroneous or delayed diagnosis—anything wrong at the beginning has a huge impact at the end. If you do the test with the highest discriminative power to begin with, you save a whole lot in the lifetime of the patient." Ratib acknowledges this notion is almost impossible to sell to payors and politicians who think short-term and low cost. That's why research to prove the point is badly needed, he says. "The concepts are out there but they're hitting a lot of resistance. We don't have the data today." Network Medicine Portability and networks are another factor in managing enterprise value, Ratib says. "Physicians are basically nomads, they want to take all their stuff with them," he observes. Laptops, BlackBerries, smart phones—the whole range of portable devices can now receive images and radiology reports far faster and more efficiently than 10 years ago, Ratib says, and they are freeing doctors to work at the patient's bedside or from home. "These things have penetrated clinical requirements," Ratib says. "We couldn't do without them. It's like emails." They also are giving patients greater access to their health records, images, and radiology reports, Ratib notes. But networking means more than portability. "We have to use industry models to become more efficient," Ratib says. That means heavier reliance on widely used protocols and on working in networks, he adds. "The medicine of tomorrow will be the medicine of networks. You will have highly specialized physicians available across networks. The trend is having networks of enterprises. Health care enterprises now are multicentric, never in one big building. You will have six departments of radiology rather than one team in one location. That seems like that's a burden, but people like to work in networks, and there is professional networking coming on the same scale as social networking," Ratib says. Need for Research As networking and portability grow, the emphasis on image delivery is shifting from PACS to RIS, Ratib says. "In the beginning PACS was about serial workflow, pushing and routing images to locations and pre-load and pre-fetch. That's done, and now we need access to all images in every department. There are commercial RIS systems that operate on a worklist basis. You log onto the system and work your way down the worklist. You can do that from anywhere. That's another level of flexibility and availability of images that makes it easier to have them in parallel. You can sign reports from home on your portable devices," Ratib says. Another advantage that Ratib says he expects to develop from networking, but one that hasn't happened yet, is the ability to mine patient records for blinded megastudies on the appropriate use for imaging tests. This leads back to his earlier comments on whether advanced exams are more cost beneficial long-term than less expensive tests. The need for evidence-based imaging research is such that megastudies should be done widely, Ratib says. But he says overregulation of patient information is now preventing this. Ratib's final thought concerning the management of enterprise value has to do with who will control the imaging enterprise. Will it stay in the hands of radiologists, or will control of imaging shift to nonradiology specialists who take command away from the radiology department now that images are so widely available? "People are concerned that we are losing control of what we're doing," Ratib says, "but my strategy has always been to provide people with imaging tools that make life easier for them." George Wiley is a contributing writer for HealthIT Executive Forum.