At the 98th meeting of the Radiological Society of North America in Chicago on Nov. 26, 2012, Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston and associate professor of radiology at Harvard Medical School, discussed the future of imaging informatics in the face of meaningful use.
Current state of informatics
According to Dr. Dreyer, the payment models of the last decade have determined healthcare and informatics business models, and those business models have, for the most part, determined the healthcare industry's innovation.
For instance, the fee-for-service payment model has incentivized volume but been neutral on value. Dr. Dreyer argues that the steps a radiologist will take when analyzing a difficult case will depend on how he or she is incentivized.
"If the radiologist has no incentive, he or she could do nothing. With a volume incentive, the radiologist could be incentivized to provide the ability to order more images. With an outcome incentive, the radiologist may be pushed to instant message the referring physician to discuss the case and guide them through it. With a patient-first incentive, the radiologist may extend the instant messaging functionality to patients," said Dr. Dreyer
According to Dr. Dreyer, the effort a radiologist exerts for a case depends on the incentive. Those incentives will need to shift for newer, innovative payment models to be successful.
Health and imaging reform
According to Dr. Dreyer, health and imaging reform has been pushing more physicians and radiologists towards outcome and patient-first incentives.
"The federal government has been experimenting with payment alternatives such as bundled payments and accountable care organizations to shift risk from payors to providers. This will extend the risk to service lines, including imaging," said Dr. Dreyer.
This new movement differs from capitation in the monitoring and reporting, which places more focus on quality, safety and access, according to Dr. Dreyer.
Meaningful use
CMS' meaningful use program is one of the ways the federal government is focusing on quality, safety and access with healthcare, said Dr. Dreyer. By urging providers to use certified electronic health record technology, the federal government is hoping that safety and quality of healthcare will increase while the cost of healthcare will decrease. According to Dr. Dreyer, physicians and radiologists need incentives to have a patient-centric focus in their healthcare decisions and that is what meaningful use is — an incentive.
Dr. Dreyer pointed out that more than 50 percent of physicians and 80 percent of hospitals have enrolled in the meaningful use program, with payments passing $7 billion, from when meaningful use legislation as part of the HITECH Act was first passed in February 2009 to when the most recent regulations — stage 2 of meaningful use — were released,
"What does this mean for radiologists? Well, nearly all radiologists are eligible for the program. In 2011, 32 percent of radiologists said they planned to participate, and in 2012, that percentage has doubled," said Dr. Dreyer. "While meaningful use can be a challenge for radiologists, there are various exclusions and temporary exemptions available. The thing to remember is that the stages of meaningful use are important."
The stage 2 regulations for meaningful use have two specific objectives for imaging:
• Image ordering measure: Physicians have to use certified electronic health record technology to order more than 30 percent of imaging exams.
• Image results measure: Physicians have to use CEHRT to receive more than 10 percent of imaging results.
Opportunities for innovation
While these regulations will not be required until 2014 or later, Dr. Dryer believes that the problems the objectives address — and the challenges to radiologists they present — can become points of innovation for the radiology industry, especially in access, communication and utilization.
1. Access. According to Dr. Dreyer, imaging information in the healthcare industry is too compartmentalized. "It is locked down and inaccessible. RIS [file formats] and picture archiving and communication system functionalities need to converge into EHRs so that enterprise-wide imaging sharing — and image sharing beyond independent institutions — can begin," said Dr. Dreyer.
2. Communication. Image reporting is unstructured, unmanaged and unidirectional, which is raising issues in quality, safety and relevance, said Dr. Dreyer. For this reason, he believes innovation in radiology will need to push for structured, multimedia and interactive communication between radiologists and other physicians.
3. Utilization. According to Dr. Dreyer, payors regulate the use of imaging via pre-authorization, which makes it difficult for radiologists to participate in the management of images. "[We] need to provide tools to assist the radiologist in utilizing, managing and incorporating national imaging guidelines directly into CEHRT," said Dr. Dreyer.
Dr. Dreyer concluded his presentation by commenting on the futures state of radiology and healthcare in general. "There are four metrics that I see as being important: productivity, profitability, performance and presence. The future of healthcare technology will hinge mostly on performance and presence. [Going forward], quality and relevance can drastically increase," said Dr. Dreyer. "Productivity may take a hit for a while, and if you hinge your profits to productivity, you may see decreases. However, if profits are tied to quality and performance metrics, there will be better outcomes in the long run."
Improving Cost-Efficiency, Safety in Hospitals via Imaging Clinical Decision Support
8 Problems Surrounding Meaningful Use
Current state of informatics
According to Dr. Dreyer, the payment models of the last decade have determined healthcare and informatics business models, and those business models have, for the most part, determined the healthcare industry's innovation.
For instance, the fee-for-service payment model has incentivized volume but been neutral on value. Dr. Dreyer argues that the steps a radiologist will take when analyzing a difficult case will depend on how he or she is incentivized.
"If the radiologist has no incentive, he or she could do nothing. With a volume incentive, the radiologist could be incentivized to provide the ability to order more images. With an outcome incentive, the radiologist may be pushed to instant message the referring physician to discuss the case and guide them through it. With a patient-first incentive, the radiologist may extend the instant messaging functionality to patients," said Dr. Dreyer
According to Dr. Dreyer, the effort a radiologist exerts for a case depends on the incentive. Those incentives will need to shift for newer, innovative payment models to be successful.
Health and imaging reform
According to Dr. Dreyer, health and imaging reform has been pushing more physicians and radiologists towards outcome and patient-first incentives.
"The federal government has been experimenting with payment alternatives such as bundled payments and accountable care organizations to shift risk from payors to providers. This will extend the risk to service lines, including imaging," said Dr. Dreyer.
This new movement differs from capitation in the monitoring and reporting, which places more focus on quality, safety and access, according to Dr. Dreyer.
Meaningful use
CMS' meaningful use program is one of the ways the federal government is focusing on quality, safety and access with healthcare, said Dr. Dreyer. By urging providers to use certified electronic health record technology, the federal government is hoping that safety and quality of healthcare will increase while the cost of healthcare will decrease. According to Dr. Dreyer, physicians and radiologists need incentives to have a patient-centric focus in their healthcare decisions and that is what meaningful use is — an incentive.
Dr. Dreyer pointed out that more than 50 percent of physicians and 80 percent of hospitals have enrolled in the meaningful use program, with payments passing $7 billion, from when meaningful use legislation as part of the HITECH Act was first passed in February 2009 to when the most recent regulations — stage 2 of meaningful use — were released,
"What does this mean for radiologists? Well, nearly all radiologists are eligible for the program. In 2011, 32 percent of radiologists said they planned to participate, and in 2012, that percentage has doubled," said Dr. Dreyer. "While meaningful use can be a challenge for radiologists, there are various exclusions and temporary exemptions available. The thing to remember is that the stages of meaningful use are important."
The stage 2 regulations for meaningful use have two specific objectives for imaging:
• Image ordering measure: Physicians have to use certified electronic health record technology to order more than 30 percent of imaging exams.
• Image results measure: Physicians have to use CEHRT to receive more than 10 percent of imaging results.
Opportunities for innovation
While these regulations will not be required until 2014 or later, Dr. Dryer believes that the problems the objectives address — and the challenges to radiologists they present — can become points of innovation for the radiology industry, especially in access, communication and utilization.
1. Access. According to Dr. Dreyer, imaging information in the healthcare industry is too compartmentalized. "It is locked down and inaccessible. RIS [file formats] and picture archiving and communication system functionalities need to converge into EHRs so that enterprise-wide imaging sharing — and image sharing beyond independent institutions — can begin," said Dr. Dreyer.
2. Communication. Image reporting is unstructured, unmanaged and unidirectional, which is raising issues in quality, safety and relevance, said Dr. Dreyer. For this reason, he believes innovation in radiology will need to push for structured, multimedia and interactive communication between radiologists and other physicians.
3. Utilization. According to Dr. Dreyer, payors regulate the use of imaging via pre-authorization, which makes it difficult for radiologists to participate in the management of images. "[We] need to provide tools to assist the radiologist in utilizing, managing and incorporating national imaging guidelines directly into CEHRT," said Dr. Dreyer.
Dr. Dreyer concluded his presentation by commenting on the futures state of radiology and healthcare in general. "There are four metrics that I see as being important: productivity, profitability, performance and presence. The future of healthcare technology will hinge mostly on performance and presence. [Going forward], quality and relevance can drastically increase," said Dr. Dreyer. "Productivity may take a hit for a while, and if you hinge your profits to productivity, you may see decreases. However, if profits are tied to quality and performance metrics, there will be better outcomes in the long run."
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