M.D. Dignity Health

Peggy Sanborn

Healthcare transformation and change is not a “new” phenomenon. What is different is the pace of innovation and its ultimate cascade into all aspects of health care. Combined with an elevated consumer expectation for value and convenience, innovation will be as impactful to the healthcare industry as we have seen it be in other institutional industries (think banking, education, and travel).

"The shift to value-based care and a consumer-centric focus is motivating health systems to alternative sites of care"

Kodak introduced the first digital camera in 1975 and it took until the late 1980s to have widely-available commercial cameras. The transition from film to digital ushered in a new era of sharing and ubiquity–any image anywhere. Radiology, the specialty responsible for making and managing medical images, quickly took advantage of this new technology. Picture Archive and Communication Systems (PACS), the digital camera of sorts for radiology, initially appeared (replacing film) in the mid-1990s. Within 10 years, traditional film as the media for imaging in hospitals became the exception.

Although initially driven by the cost in film savings, PACS, by providing “any image– anywhere”, offered clear business value. Radiologists could be centralized, consolidated, and specialized. An exam could be moved and interpreted by a physician offsite. The opportunity to reduce the number of repeat exams, along with the potential to reduce the overall physician manpower demand, was an opportunity to reduce cost for the health system as well as for patients and payers. Looking back on the early 1990s, these opportunities were viewed as a threat by many radiologists who felt efficiency meant replacement. What we have seen, though, is the change in overall work provided by radiologists as a result of the more complex imaging studies, (e.g. a single CT scan in 1990 might have been 20 total images, whereas today it could be 2000). As an aside, artificial intelligence (AI) is creating a similar debate. Like PACS before, we believe AI will be a tool and not a replacement for physicians and providers.

Historically, hospitals have been the primary resource for complex imaging due to the need for specialized radiology capabilities and the high cost of the technology. Patient convenience and cost were secondary considerations. Even with the innovations in technology, it is a relevantly recent advancement to create ready access for the consumer/ patient. Many patients and community providers still complain exams are not easily available, resulting in delayed clinical decisions and unnecessary repeat imaging exams.

The shift to value-based care and a consumer-centric focus is motivating a shift by health systems to alternative sites of care, including developing access that is more distributed throughout the community and priced more competitively. The anticipated acceleration of access through “patient portals” is also addressing some of the challenges, such as privacy/security concerns, quality of image resolution, and speed of image retrieval.

Another example of how advances and innovation in radiology are impacting health care delivery can be seen when evaluating the evolution of teleradiology. The rate of change in radiology was, by comparison, glacial! It took almost 20 years to change the practice of medical imaging. Telemedicine, a close cousin in terms of tech infrastructure – the need to move and store clinical information through a digital construct and to enable efficient and timely communication between caregivers – allows for a more immediate adoption in the broader telehealth clinical areas and can lower the cost for adoption more broadly. We are already seeing needs in the rural and urban markets being met by providers working remotely, including the areas of eICU, telestroke, behavioral health, and other specialty consult areas.

The transition to care that is more competitive (many alternatives for patients and payers to select from) and the increased transparency related to quality, patient experience and cost, is creating new challenges for physicians and health systems. In the imaging arena, consolidation has extended beyond the individual practice. Quality, efficiency, and reporting issues have created a need for large investment for the ever-increasing technology infrastructure. Many radiologist practices are becoming part of hospitals or corporate entities (e.g., Radpartners, Envision, and Mednax to name a few). However, others would argue all care is local. As a large, multi-state health system, Dignity Health continues to not only evaluate the risks and opportunities, but also to partner in the deployment of new models of care and the integration of technology and innovation into our clinical operations. Many large health systems are of a like-mind and see the potential of investing in these transformative opportunities.

The move to put control in the hands of the patients we serve will enable a sustainable value proposition for the successful health systems of the future. This means making the necessary investments, and taking the risk to integrate the many technological advancements and innovations in care. Leading health systems, are advancing our digital access and communication, moving to more distributed delivery models, and selectively investing in complex imaging equipment to ensure a rationale deployment of scarce capital.

The future of imaging will meet demands for fluid access to information, consultation, and the often overlooked patient ask – reassurance. Providing expertise and excellence in clinical providers, sometimes on a remote platform, and demonstrating value in the services provided will be crucial. To meet this demand, health systems and other providers of imaging services will need to view care from the consumer lens and create a distributed, community-based network of access points.