Editors Note: This article was originally published by Erkan Akyuz on the Medical Imaging Talk blog and is republished here with permission.
For radiologists, much of their hard work goes unseen. For example, take a radiologist who pulls up a dozen images from the vendor neutral archive, carefully compares a number of studies from one patient, goes into the RIS and makes notations about findings, and then documents a number of specific details for the final report. Details noted might include a specific or differential diagnosis, impressions, and other information that will be sent to the referring physician and synched to the patient's EHR.
"When we start with exquisite renderings of anatomy and hypersensitive recognition of physiology, how is it that the product we deliver to the world is often just words on a page?" asked Geraldine McGinty, MD, FACR, American College of Radiology president, in a post on her blog.
The lack of visibility of radiologists' work is one reason that radiologists have been speaking for some time about how to make the value of their work more apparent to the public, and why the ACR launched its Imaging 3.0 initiative last year.
As best-selling author John Maxwell said, "A leader is one who knows the way, goes the way, and shows the way." In the initiative, the ACR called on radiologists to take the lead in enterprise medical imaging and value-based care initiatives. Let's follow up on the Imaging 3.0 conversation as it is today.
What is Imaging 3.0?
To give some background, the term was first coined by the American College of Radiology (ACR) about a year ago, which calls on radiologists to play a strategic role in the evolution of healthcare as it changes. Communication is a key component, according to McGinty, "Essential to the Imaging 3.0 philosophy is the imperative to communicate the value of imaging to our colleagues and most importantly to our patients."
What is its purpose?
Imaging 3.0 initiatives are designed to help radiology departments respond to changes as value-based, not fee-for-service, models of care become the norm. Imaging 3.0 highlights ways that IT solutions, such as data mining, clinical decision support (CDS) and communication tools can support moving to value-based care models.
"The legislation that passed requiring the use of CDS in Medicare was a giant step towards aligning payment policy with Imaging 3.0," McGinty said in an interview. "What we need to do is continue to build the toolkit that our members can use, especially around the areas of image sharing and structured reporting. We also need to continue to fight back against reimbursement cuts so that members are not consumed by worrying about how to pay their staff and can focus on innovative practice methods that put patients first."
What actions have radiologists been called upon to do?
Radiologists have called upon to act as leaders within healthcare and communicate more about their value, to both colleagues and patients. As part of this effort, they should be documenting the care they provide that may have previously gone unnoticed. Value-based care models mean that radiologists will continue to be expected to provide better care to patients, but at a lower cost.
- Lead. The ACR continues to urge radiologists to become leaders in shaping America's future healthcare when it comes to imaging policy. The value of imaging is no longer judged by the quantity of images but quality; not volume but value. The Centers for Medicare and Medicaid Services (CMS) determine quality by looking at, for example, procedures using fluoroscopy that include documentation about radiation exposure. Many of the ways in which radiologists provide quality care are not readily visible. Therefore the ACR is calling upon radiologists to speak up and be vocal within healthcare about the value of imaging.
- Document. The care that radiologists provide before and after studies is taking on added weight and needs to be thoroughly documented in their radiology information systems (RIS), picture archive and communication systems (PACS) and patients' electronic health records (EHRs)—which hopefully are already linked via the enterprise medical imaging system. For example, a radiologist may work with the radiologic nurse and the patient's family to develop the appropriate care plan that will help the patient understand the procedure and recuperate from it. Work to improve patient care should be apparent.
- Communicate. Furthermore, Imaging 3.0 asks radiologists to talk to and empower their patients. "The initiative asks radiologists to go beyond interpretation to assure appropriateness, document the quality and patient safety that radiologists provide, provide actionable reporting with evidence-based follow-up recommendations, and empower patients," said Bibb Allen, Jr. M.D.
"We have been so energized by the response of the radiology community," says McGinty. "Despite very real challenges associated with cascading payment cuts we are seeing examples of practices all over the country that are living the Imaging 3.0 concept." The ACR has a number of examples on their Imaging 3.0 website.
Hospital leaders have an important role to play as well. They should intentionally connect with their radiology groups to understand the value that's being delivered. For example, Dr. Samir Patel documented more than 9,000 hours of non-clinical work that his group did for their health system.
"Make radiologists part of the planning around new payment models," says McGinty. "Radiologists, using clinical decision support with consultation, can significantly drive appropriate imaging utilization in a way that is collaborative and educational and will be important in shared savings models like ACOs."