Grabbing a Seat at the Alternative Delivery Table
Gregory M. Kusiak, MBASavvy imaging providers across the spectrum of care have begun to formulate strategies for attracting potential partners with which to ally in alternative care-delivery models. While using analytics to demonstrate the value that one’s organization can bring to the table is key, promoting the interoperability of the systems used to generate and store raw data (and, more important, analytics) is equally vital. Gregory M. Kusiak, MBA, says, “Without the interoperability card, radiology practices—and all other providers, for that matter—may as well just dab at their eyes with a handkerchief while at the negotiating table.” Kusiak is president of CMBS (Arcadia, California;, a full-service practice-management company. CMBS is a subsidiary of the Hill Medical Corp, which provides radiology services at three California imaging centers (two in Pasadena and one in Glendora). The Hill Medical Corp. also serves one hospital and the breast centers of three additional hospitals. RadAnalytics recently sat down with Kusiak (who also serves as practice manager of the Hill Medical Corp) to discuss interoperability and its implications for alternative health-care delivery. RadAnalytics: How would you define interoperability?
 Kusiak: Interoperability means the ability of disparate health information system (HIS) units to talk to one another within and across organizational boundaries. It involves seamlessly integrating data and information within each organization and among all providers that participate in any given delivery model. In an interoperable environment, data and analytics are presented in a consistent fashion and move freely, inside and among all providers, via uniform user interface. Any participant who accesses the system can access that same repository. RadAnalytics: Why is this important? Kusiak: Whether you are talking about an accountable-care organization or another type of model, participants must be able to add value to the equation. That value comes from coordinating, delivering, documenting, monitoring, and reporting patient care, not only in terms of the quality of the care that is being delivered, but in terms of the costs incurred in providing this care. Interoperable systems are the conduit. Proprietary access—in which, for instance, two radiologists can see certain patient information in a referring physician’s HIS, but a third radiologist cannot—does not fly in an alternative delivery model because it puts some players at a competitive disadvantage. Besides adding value, interoperability removes the barriers and levels the playing field. RadAnalytics: Can you offer some specific examples of how interoperability might apply in a radiology setting? Kusiak: One of the things we are doing in our practice is improving our ability to connect our systems and those of referring physicians, so that we can push exam results out to them. These physicians have a wide range of needs where interoperability is concerned, and not all of them are at the point where they completely embrace the concept—but they are getting there. 
Consider this: When systems are interoperable, analytics pertaining to a practice’s referral volume, modality mix, and payor mix can be matched up against the needs of other participants in the model by looking at their requirements. You can say, ‘We saw 5,122 patients in a particular time frame for mammography screening, but based on the information to which we have access, 8,400 women were eligible; how are we going to improve the rate of patients seen?’ The possibilities are really endless. RadAnalytics: What are some of the concerns and/or obstacles that might be encountered on the road to interoperability? Kusiak: HIPAA is a major issue. There is a conflict between easy access to data across various systems and preserving patient privacy (as mandated). Organizations are at the point, now, where they want to share information and do what is best for all parties concerned, but they fear the regulators. Protection therefore merits discussion up front, before there is even any talk about establishing interoperability. There is no getting around the fact that protecting information can be costly. For example, it takes thousands of dollars to establish a secure link for pushing radiology exam results out to physicians’ electronic health records. I believe, however, that this is an expense more and more providers will bear in order to enjoy the competitive advantage of interoperability. Julie Ritzer Ross is editor of RadAnalytics