Healthcare Technology Featured Article

May 13, 2016

The Health IT Evolution: From Data to Decision-making


In the past three decades, healthcare information has largely migrated from paper-based records to computerized data storage and communication, providing stakeholders with faster access to more information.  As a result, healthcare providers are often faced with the following questions:

  • Do providers and patients now better understand what actions they need to take to achieve better health outcomes?
  • What can be done to take the next step—transforming HIT from systems that store and present data to systems that more often improve human decision-making? 

Through the lens of my 34 years of experience in medical imaging, I’ve examined how technology can transform provider and patient behavior in the context of radiology.

Bringing the Radiologist and Patient Together

Historically, radiologists have been “doctor’s doctors,” meaning that they provided consultation to referring physicians and rarely directly to the patient.  The growth of interventional radiology has increased direct patient contact with interventional radiologists, but today diagnostic radiologists often have less contact with patients and referrers because they perform fewer patient-facing procedures, and PACS systems have resulted in less face-to-face contact with referrers seeking results in person.

Virtually every published study investigating how patients feel about direct interaction with radiologists has shown that a significant plurality, if not the majority of patients (and family members), value access to the imaging report and a conversation about their imaging results with the specialist who interpreted the exam.  Communicating with a patient creates a service event that is memorable and advantageous for all involved.  There are already regulatory requirements for providing mammography patients their results in the form of lay letters and many practices now provide patients the mammography clinical reports. The next step will be routine delivery of imaging results directly to consumers’ personal health records, enabling patients to view, store, and share their medical images.  Patients will be able to then launch web-chats with imaging consultants.  As a result, patients will better understand their imaging results and required follow-up. 

Appropriately-designed registration software and processes also create an opportunity for both the healthcare system and patient to better understand legitimate imaging screening needs. The United States Preventive Services Task Force (USPSTF) and other organizations now provide guidelines for imaging screening, including exams such as mammography, bone densitometry, CT lung cancer screening, abdominal aortic aneurysm ultrasound screening, and breast MRI.  Other tests that have more controversial screening indications include CT coronary calcium scoring, CT colonography, and perhaps prostate imaging (ultrasound or MRI) in high risk patients.  As the use of health information technology (HIT) improves and expands, it will help radiologists comply with imaging screening procedures at the point of care. 

Better Communication. Better Choices.

Growing healthcare deductibles have resulted in patients spending more out of pocket dollars for imaging and other healthcare services than ever before.  Some estimates indicate that the percentage of the typical American’s income spent on out-of-pocket costs for healthcare has nearly doubled, from 5.3 percent a decade ago to 9.6 percent today. Simply stated, patients are now consumers and increasingly selecting their providers.  Without any direct patient contact, imaging practices leave the consumer little reason to make intelligent choices about the imaging provider or whether imaging is preferred over other healthcare options.  New applications will help patients select their imaging providers and schedule exams based on both clinical and financial considerations.

Physician Job Satisfaction and Performance

Radiology residencies, which were once one of the most sought after residency programs, are dropping in popularity for a variety of reasons.  Medical students cite financial and social motivations for selecting their fields of residency.  Among those who do not choose diagnostic radiology, the lack of patient contact is frequently cited as their motivation to pursue other specialties.  Furthermore, burnout among radiologists is on the rise, in part because of the stress related to working on the image interpretation assembly line.  A radiologist today may need to view over 100,000 medical images a day, far in excess of what is known about human limitations.  The next generation of radiologist workstations will provide the benefits of cognitive computing.  Computers will help triage medical images and medical imaging exams, so that the radiologist’s attention is directed to the most important images first.  In addition, computers will generate differential diagnoses that will update as the physician interprets images, and even prompt physicians to provide information that may narrow the diagnostic possibilities. Technology will help track changes on medical imaging exams over time and even automatically present relevant prior images of the anatomy of current interest.

Summary

While the last generation of HIT has provided greater access to health information, the next generation will provide both consumers and providers greater assistance in understanding what actions to take.  Computers will become cognitive assistants influencing not just how patient information is stored and communicated, but also the decisions providers make at the point of care—ultimately transforming the way we deliver healthcare.

Dr. Reicher is a board-certified diagnostic radiologist and Fellow of the American College of Radiology. He is known for his numerous scientific publications, inventions, and presentations in the fields of neuroradiology, musculoskeletal MRI, and health information technologies. In 1992, he co-founded DR Systems, Inc., a leading provider of information and image management solutions for health care enterprises. In addition to serving as Chairman of DR Systems, he is the co-founder/Chairman of Health Companion, Inc., co-founder/board member of Health Beacons, LLC, and councilor for the California Radiological Society, as well as the past President of Radiology Medical Group, Inc., and past CEO of Imaging Healthcare Specialists, LLC. Dr. Reicher received his undergraduate degree at UCLA in Biochemistry and his medical degree at UCSD.




Edited by Stefania Viscusi





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