Twenty years ago, medicine and surgery rounds used to start in the reading room. Sitting in a dark room with a viewbox and an alternator, a senior radiologist greeted visiting clinical teams every day and reviewed their patients’ films.
With the advent of digitization and picture archive and communication system (PACS), the last 20 years saw a rapid evolution of radiology. We read studies faster than ever, and radiology workflow focused extensively on the interpretation of images and the associated diagnostic report.
Recently, there has been a revival patient-centered care and communication. Communication is the new radiology workflow.
I had the pleasure of writing about the importance of communication in radiology in a previous post. Just this month, a group at Beth Israel Deaconess Medical Center writes in American Journal of Roentgenology that despite our focus on critical value communication, the bulk (52%) of errors in radiology communication actually occur outside of results.
While most communication errors did not cause patient harm, 37.9% did affect patient care. The radiology value chain, of course, begins as early as the decision to image and extends well into appropriate follow-up imaging of identified lesions (Enzmann, Radiology 2012).
Maybe it’s time we as radiologists take ownership of the whole imaging process, from the decision to image all the way to follow-up.
In The Four Steps to the Epiphany, Stephen Clark describes an “Earlyvangelist,” with the prefix “early” referring to a champion a the very early stage of a product adaptation cycle.
Since our emphasis is on problem and not the product, a different term might be more appropriate. I will refer to this person as The Visionary.
The Visionary comes from the “problem end” of informatics. The Visionary is observant and asks good questions. She has a pain point. She knows when things just don’t look quite right. She may not know what the solution looks like. She may not even know that a solution exists. Marketers like Visionaries because these people see problem and can see the potential of the new purchase.
The Visionary is what all radiologists interested in informatics should be. We see the clinical problem in a way that no software developer and no administrator can see. Sitting down and accepting the status quo runs the risk of burying the problem forever.
In September, the American Board of Radiology (ABR) released a set of expanded options for satisfying Part 4 Requirements for its maintenance of certification (MOC).
The biggest change includes the ABR’s willingness to include additional areas (16 of them) of involvement in departmental quality and safety other than Practice Quality Improvement (PQI) as qualifying requirement. Continue reading
In part 1 I presented an updated data set for Pennsylvania hospital financial performance and compare it against my 2010 analysis.
Is your hospital profitability suffering? Is it being squeezed by a competitor? Or, is your hospital the one doing the squeezing? Is it even making money?
As physicians we don’t often ask ourselves about the bigger organizational strategy. However, it is hard to ignore the reality that hospital policies affecting us are often informed by numbers so hard to understand that sometimes we just pretend that logic doesn’t exist.
Maybe it’s time to do something about that.
Image credit: mindwerx.com
Fifteen years after the publication of Institute of Medicine’s landmark report To Err is Human, healthcare process improvement (PI) is finally beginning to take root. Quality improvement (QI) has become a pillar of healthcare for both academic clinicians and private practice alike.
The workhorse of the Donebedian adage of “structure + process = outcome” is on standardization. In a world of static, well-defined products, proper application of PI can dramatically reduce variability.
While incremental improvement continues to be necessary in healthcare – we are a long way away from a six-sigma industry – continued standardization and scientific research alone are no longer sufficient to evolve healthcare.
This TV commercial caught my attention a few days ago.
In the TV spot, the narrator outlines the number of images a radiologist must parse through to find an abnormality. To help, IBM will teach its Watson “to see.”
Therein lies the problem: Seeing is not enough. Continue reading
The terminal destination of all products and services is commoditization. So that’s a simple answer, though one that’s not all that simple. The management journal Harvard Business Review dedicates several classic articles on the process of commoditization, including global competition, process modularization, and, simply, the natural resting place of a mature product.
So where does radiology sit in the natural growth process? More importantly – as junior residents – what have we gotten ourselves into?
Taking radiology to the cloud is not a new concept. It has already been discussed here and here, with lowest hanging fruit use-case being cross-institutional image sharing.
The excitement for cloud is certainly abuzz in the non-healthcare market. Several days ago, @TheEconomist tweeted a message ending with “the whole IT business will change.” They were referring to the maturing migration of technology into the cloud.
What caught my eye was not the tweet itself, but the accompanying graphic, illustrated by Satoshi Kambayashi.
From @TheEconomist. Copyright belongs to illustrator
A winged piggy bank with the General Electric logo receives a boot in the loin, eyes wide open with surprise as if he didn’t see it coming at all. General Electric, of course, is one of the biggest vendors in radiology hardware.
So are radiology practices ready to kick GE, too?
In an article titled “The Robot as Radiologist,” Dr. Douglas Green from Univ. of Washington acknowledges the rapid advances in computational image recognition and advent of IBM’s Watson. He concludes the commentary by taking solace in the fact that, at least for the time being, artificial intelligence is complementary rather than substitutional to human radiologists. I wholeheartedly agree. However, Harvard Business Schools gurus do not.