Improving value and outcomes: McKesson radiology GM shares thoughts on company’s role

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 - Ashish Sant
Ashish Sant, General Manager of Radiology, McKesson

The pressures on providers in an era of evolving payment models and ever-evolving technology could not be more demanding. In order to be successful, providers will need strong solutions from their technology partners.

McKesson is providing just that. McKesson recently released their latest version of McKesson Radiology Mammography Plus™, an embedded breast imaging workflow in the PACS for mammography, and includes support for Digital Breast Tomosynthesis (DBT).

imagingBiz caught up with Ashish Sant, General Manager of Radiology at McKesson, ahead of SIIM 2016 to ask about where the company is going and how it plans to assist radiologists.

McKesson has been around for a while, and is well known in the radiology world. Given all the healthcare changes in recent years, how is McKesson trying to help radiology move forward?

Sant: We have seen a lot of pressure on the industry in the move from volume to value. Helping customers improve outcomes has always been our focus, but being able to prove that the role of the Radiologist is critical in a patient’s outcome has been a relatively recent shift.

The perception is that Radiology is not as involved in direct patient care, but the truth is that without the essential information provided by Radiology, patient care would be impacted. We ensure the Radiologists have the right clinical information beyond just the images to help them make a better, faster diagnosis and improve the care pathway for the patient.

But that’s just one aspect of the Radiology business. The second is the significant cost pressure that Radiology has felt over the last several years, along with the overall pressures on hospitals due to reimbursement cuts and lack of significant imaging growth.

There was a time in the early and mid-2000s when CT was creating a lot of growth in imaging volumes. At that time, volume increase meant revenue increase. That landscape has changed significantly and there’s now a downward pressure on imaging. Reimbursement is going down year over year, and with alternate payment models on the horizon, may no longer be strictly tied to volume. At McKesson, we  help Radiologists and Radiology departments improve their operational efficiency and productivity so they can get more out of the investment they have made and can better utilize their assets.  In this way we are helping Radiology departments strengthen their financial health.

McKesson Radiology is an all-in-one PACS covering multiple modalities, including specialty workflows such as breast imaging. Why was that important to McKesson?

Sant: There are two reasons this was important to us: the first related to clinical outcomes and the second related to cost.

From a cost perspective, we often find customers have previously invested in specialty software and workstations that are separate from their PACS. While this has provided them the functionality they were looking for, it has impacted their productivity. With McKesson Radiology, for example, we offer a comprehensive breast imaging solution natively within our PACS, including support for Digital Breast Tomosynthesis. The software for Mammography is one-and-the-same as our PACS and doesn’t require dedicated additional hardware except for the FDA approved displays for Mammography reading. As DBT is growing in adoption, it doesn’t make sense for a Radiologist to be moving back and forth between workstations to do their interpretations, and it is expensive to maintain the separate software and hardware. With the McKesson solution, our customers can leverage their existing PACS investment. And beyond the cost savings, a unified solution simplifies the IT and administrative work as well.

Looking at the clinical side, a single reading environment for the Radiologists just makes sense. Our goal for radiologists is to help them stay productive in their “reading cockpit” by providing them with tools that can meet their imaging needs within the PACS environment. By embedding specialty workflows within the PACS reading workflow, a Radiologist reading DBT will have access to all the priors for the patient, whether they are mammography images or ultrasound or anything else that is relevant, along with all the pertinent clinical information from ancillary systems. We provide strong EMR integrations on the PACS workstation so that prior clinical data for the patient  is easily available to the Radiologists, whether it is lab results, medications or ER notes. All of this information provides a broader patient context to the Radiologists towards a more comprehensive diagnosis.

Mammography is just one example of an embedded workflow we support. There are other workflows are embedded in the McKesson Radiology, such as Quality workflows. Examples would be peer review, timely reporting of critical results, and providing a workflow for ER discrepancy reporting.  So you see that with McKesson Radiology, the goal of an all-in-one PACS makes sense from many different perspectives.

Considering McKesson’s support of mammography workflows specifically, it seems that the introduction of tomosynthesis has created a storage challenge for many customers. How does McKesson handle these storage issues with tomosynthesis?

Sant: This is a very similar situation to several years ago when we went from film to digital across the healthcare enterprise. The underlying network and storage are areas that hospitals have to evaluate before moving to new modalities and technologies. McKesson provides specific guidance during the assessment phase of an implementation, and we also help align the Mammography goals with the overall enterprise imaging strategy. It’s very important for us to provide this kind of customized feedback to help ensure that an implementation of our products is successful. From a networking perspective, in terms of both application design and underlying infrastructure, we provide our customers with specific guidance on what they need to do in order to incorporate mammography into their overall infrastructure strategy.

This area continues to remain a concern for many of our customers just because of the size of the data generated during DBT acquisition. Mammography also has more stringent data retention policies compared to general imaging, and this is something we understand very well. With retention management tools available in the PACS, it is easy for our customers to extend the retention policies to Mammography studies.

Even with these challenges, a progressive enterprise can incorporate mammography and DBT into their enterprise infrastructure and storage strategy.

You’ve mentioned the need to get data from outside the radiology department into the hands of the radiologist. Can you elaborate on the importance of ensuring interoperability within a hospital enterprise?

Sant: Interoperability has become a key focus throughout healthcare enterprises, not just in imaging.  The U.S. government is even talking about things like data blocking and how regulations can help improve compliance of non-imaging data exchange.

Within imaging, continued evolution of standards such as DICOM and interoperability frameworks like IHE are playing a key role. This is where McKesson has shown a continuous commitment year over year by taking a role in helping develop the standards—we have McKesson staff working on IHE committees, for example—and we’re also showing our commitment by actually implementing these standards into our products.

Specific to mammography, IHE has come up with a profile for Digital Breast Tomosynthesis where McKesson has been a very active participant. We are not playing the role of image creator or acquisition device, but we do play a role in image display and image management or archiving, and both fit into the PACS capabilities we provide to our customers. We have demonstrated this commitment to our customers by participating in industry events that have showcased our dedication to these standards, such as participating in an IHE-DBT Connectathon in January 2016 and again at HIMSS in the Interoperability Showcase. In both places, we were one of the few PACS vendors demonstrating the mammography DBT profile. We support both the need and evolution of interoperability so that image exchange and workflows could be streamlined across systems within a hospital.

This has all been useful information. Is there anything else that you feel sets McKesson apart from other vendors?

Sant: What McKesson is known for in the PACS industry is for providing a solution that is high quality, high performing and allows radiologists to be very effective at handling hundreds of cases every single day. That is an area where we have continued to focus as we have brought capabilities like DBT into the mainstream PACS product. It’s incredibly important to us that McKesson Radiology helps to support Radiologists’ productivity. Usability of the product and efficiency for the radiologist, whose time is extremely important, has been a hallmark of McKesson’s past success and continues to remain a focus area for us going forward.

This interview was edited for clarity and space.