Greater Innovation through the Delivery of Elegant Radiology

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Dr. Phillip A. Triantos, board certifed radiologist at Shades Mountain Imaging, reviews how diagnostic imaging finds itself integral to the competitive and financial dynamics faced by healthcare providers in trying to keep patients in their local community. Progressive organizations like Advanced Radiology Services, Foundation Radiology Group, Inland Imaging in addition to many smaller localized groups are delivering on that goal today.

Dr. Phillip A. Triantos

Community providers shouldn’t have to surrender patients to larger, distant institutions. They should be able to keep their patients close to home where they want and need to be. The Elegant Radiology model provides a basis for this to occur.

A couple prominent published articles over the last year have emphasized how the shifting landscape of diagnostic imaging prompts the need for greater innovation. Dr. Philip A. Triantos notes that in the March 2011 Journal of the American College of Radiology, John A. Patti, MD cited in the article “Radiology-Centric Medicine and the Need for Practice Transformation” that “Strategies must be identified to develop higher levels of service to our patients, medical colleagues, coworkers, hospitals and communities. Adding value beyond interpretation is a core element of service enhancement.” More recently in the article “View from Above” in the February 2012 issue of Radiology, Hedvig Hricak, MD attributes imaging’s success on its ability to innovate and subspecialize to meet the needs of the community.

There is no question – hospitals and health care systems face unparalleled change at an alarming speed and the imaging industry must scale, innovate and adapt at an equal or greater pace. According to the Annals of Internal Medicine, the average hospital must coordinate care among 229 physicians across 117 practices for its Medicare beneficiary population alone, not to mention Medicaid and private pay. The situation continues to become more complex – and at an accelerated rate – due to aging baby boomers and conditions resulting in a generally overweight population. The number of individuals with 4+ chronic diseases at time of admission is expected to more than double in 2012, beyond what it was just ten years ago. Increasingly, hospitals see declines in inpatient volumes offset by growth in the outpatient settings. This trend is exacerbated by the favorable mix that tends to accompany those served in an outpatient environment.

Imaging Impact:
Imaging procedures are rapidly increasing to support this change while simultaneously becoming more integrated throughout every episode of care, delivering more diagnostic capability and becoming more complex and multi-dimensional in function.

Diagnostic imaging finds itself integral to the competitive and financial dynamics faced by hospitals in critical service lines, attracting and keeping the right patients, attracting and keeping the right physicians and in the setting of expensive asset purchases.

Radiology Transition:
Radiology itself has gone through a needed clinical specialization transition to keep up with demand. Sub-specialization – along with niche modality and special procedure expertise – has gone from a luxury available only in the university and teaching hospital settings, to a necessity for even the smallest of community hospitals and imaging centers. Many institutions and other physician specialties have turned to employment as a partial answer.

For diagnostic imaging this is an impossible scenario. Hospitals simply can’t afford to employ the level of sub-specialty expertise necessary today, much less in the not too distant future. Community hospitals, even regional IDNs, shouldn’t have to surrender patients, credibility and opportunity to larger, distant institutions. They should be able to keep their patients close to home where they want and need to be.

Inadequate Answers:
This is all against a backdrop of decreasing availability and inadequate coverage from many radiology groups and the challenges that can be faced with finding the right virtual radiology, off-shoring, and teleradiology “hybrid” company to deliver the appropriate care. This model serves up convoluted and disconnected offerings, making matters more complex, and exposing numerous potential points of failure. Cost pressures are literally everywhere. Hospital administrators and their medical staff need a far better answer to this challenge that is local in nature, yet possesses deep, innovative leverage to drastically reduce costs. Clearly, a new era of radiology service delivery is necessary – one that offers a very different yet simple, elegant solution.

Elegant Radiology Requirements - Get Out of the Basement:
First, radiology must move out of the traditional “basement” role and emerge quickly into the boardroom where its unique knowledge base and understanding can be utilized in real-time. Radiology groups must become strategically aligned and far more interactive to support service line initiatives, large capital expenditures, enterprise projects, competitive differentiation and overall performance improvement. Radiology groups will need a broad base of knowledge on which to draw in order to properly fulfill this new role.

Automated High-Value Exchange:
Traditional, more passive involvement with “report and forget” mentalities must be replaced with proactive, high-value interchange with referring physicians. Automated software and processes that help radiologists with the quality of this necessary interaction will have to be developed and adopted. New software and new staffing assistance/extenders for service, support, pre-reads, prioritization, routing, and managing multiple legal entities must be implemented – similar to how PACS replaced film hanging protocols and prior study availability. Radiologists will need to be more efficient, and eliminate a great deal of wasted time and unused capacity in order to find critical clinical exchange time.

New Methods, Configurations and Software:
In order to provide the depth of expertise necessary to quickly turn around final results – new philosophies, processes, software, and staffing configurations must be developed. Centralized and virtualized expertise, availability and “criticality” of a team of radiologists must be spread across multiple sites for the economics to work. Radiology groups will have to become larger, smarter and far more automated. Clinical and workflow tools will have to be more advanced. Staffing, however, cannot simply be placed off-site.

Ideal blended configurations, automation, clinical tools and referring physician interaction software will be employed – making the location of a radiologist far less relevant than clinical expertise and availability. Reporting and service levels for monitoring and measuring success will exist. Quality systems will not be a separate function but will take on all the characteristics of a service delivered like that seen in other industries.

A simple, yet powerful and elegant model of automated leverage, strategic capability and precise clinical knowledge is the answer. The delivery of an elegant radiology model may seem like a distant promise; however, there are some progressive organizations like Advanced Radiology Services(Grand Rapids, MI),Inland Imaging(Spokane, WA), and Foundation Radiology Group(Pittsburgh, PA) delivering on that promise to meet the needs of the community today.

About Dr. Triantos:
Dr. Phillip A. Triantos is board certified by the American Board of Radiology. Dr. Triantos graduated from The University of Alabama at Birmingham as well as The University of Alabama at Birmingham School of Medicine. He completed his radiology residency training at Baptist Health Systems in Birmingham, Alabama.

Dr. Triantos currently practices at Shades Mountain Imaging which is a state-of-the-art, medical diagnostic facility located in Vestavia, Alabama. The center's philosophy is to provide topnotch medical imaging while at the same time delivering convenience, comfort and accessibility.


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Phillip A. Triantos, MD