Patient pathways and better outcomes: The future of radiology

In ancient Roman times, all roads led to Rome. From one monument in central Rome, all roads began and distances were measured. Today, the patient is at the center of care—with success measured in wellness, improved outcomes, reduced variability, increased quality and higher patient engagement and patient satisfaction scores. Monumental for sure. But how do we make the patient journey better and how do radiology departments engage to help the process? Global radiology leaders weigh in.

The roads of healthcare are busy with healthcare professionals, physicians, physician assistants, nurse practitioners, nurses and technologists carefully and diligently driving patient care. But across the globe, roadblocks abound, along with potholes, poor signage, information barriers and a lot of breakdowns in care. Healthcare suffers from being disjointed, riddled with inconsistencies, harboring misaligned incentives, disabling care decisions due to siloed data and holding onto old, inefficient structures and outdated thinking. Patients and clinicians alike know we need change.

To repave the road, and re-route the right caregivers to the right patients with the right care at the right time, we need to conceive and drive widespread change. Where to begin? And what is radiology’s role?

The metamorphosis of radiology

Radiology plays the key role of jumping in to investigate disease—diagnosing, staging, monitoring and following it over time and offering expertise and consultation on disease states. This discipline is now in a stage of profound metamorphosis. “The picture of the doctor’s doctor, the radiologist, is changing. We serve that role as well as being the patient’s doctor,” says Neuroradiologist Jeffrey Sunshine, MD, PhD, vice chairman of the department of radiology at University Hospitals Case Medical Center and CMIO of University Hospitals in Cleveland.

Building the value of radiology and the radiologist, in particular, sits at the root of efforts by professional associations such as ACR and RSNA to empower radiologists to be larger contributors to care teams. ACR proposes that success hinges on answering one question: How can we deliver more value to patients? ACR’s Imaging 3.0 initiative is a call to action to all radiologists to assume leadership roles in shaping America’s future healthcare system through five pillars: imaging appropriateness, quality, safety, efficiency and satisfaction. They must drive change processes—focusing on value vs. procedural volume. This hinges on information integration and the patient being at the center of care. (Journal of the American College of Radiology, Volume 11, Issue 1, Pages 7–11, January 2014)

Decentralization and specialization. With more radiologists having subspecialized in areas of such as neurology, cardiology, gastroenterology or vascular surgery, Peter Leander, MD, senior physician and regional chief medical officer at Region Skåne, a large Swedish healthcare provider, proposes they may decentralize, becoming part of the department their specialty complements. Equipment could remain centralized in a radiology department but expertise for reading and interpretation would lie within the area of specialty. Radiologists would become stronger members of multidisciplinary teams. Or perhaps some rads would be reporting radiographers while others with specialized skills would perform interventions, interact with patients and carry on research. No matter the future course, Leander recommends “leaving old stuff behind, old exams, things that are not progressive. Focus on new, complex things that offer more value. We need patients to know what radiologists do for them, what value we add.”

Similarly, Giorgios Karas, MD, PhD, a neuroradiologist and head of the department of radiology at Sint Lucas-Andreas Hospital in Amsterdam, advocates that radiologists move beyond being reporters of images into care integrators, interacting with the patient, offering suggestions for care. “There are plenty of turf wars with other specialties trying to take radiology exams away. We need to move into the area of clinicians. We are doing this already. We know who the best surgeons are, we see their work if they are not. Jumping the S-curve [the success curve] won’t happen overnight, but it is time to move slowly in that direction. It is a natural revolution that will reward the ones who want to step forward.” (Jumping the S-curve: How to Beat the Growth Cycle, Get on Top, and Stay There; Harvard Business Press, 2011)

Presenting information in an understandable way. Creating better reports is another item radiologists say drives value. “Write a good report, in short format,” Leander urges. “Many reports are just too long.” He blames that on radiologists, as well as a lack of conclusions and too much confusion. “We need to report based on disease state, such as with colorectal cancer, offering to the physician the facts he or she needs. If we build standard reports and improve on the details as best practices change, we offer greater help to specialists and build our value.”

Sunshine adds an exclamation point to the need for better reports. “The trend is real: Radiologists can no longer provide narrative-only reports. Physicians want structured information and reports coming out of radiology. We will see how this will change outcomes.”

Fredrik Gustavsson, Sectra CTO, agrees. To create effective integrated practice units, we must gather data and present them effectively to clinicians as well as measure the results, Gustavsson urges. “We need to monitor patients better, without overloading individual caregivers with information. Working along care pathways looks to accomplish that goal—interjecting greater standardization of care, reducing variability and introducing measures to track how we are doing. This allows organizations to see how they are effecting outcomes. But to get there, information needs always to be presented in an understandable and actionable way. Radiology needs to be sure they are streamlining the process, not slowing it down, and providing actionable output.”