July 27, 2009

Enabling Competition
By Jim Knaub
Radiology Today
Vol. 10 No. 14 P. 8

Technology—in this case, teleradiology and IT—is radically changing radiology. Ever-expanding IT capabilities that have transformed numerous industries, from banking to publishing to retail, are increasingly making their presence felt in healthcare. Digital imaging, record keeping, and reporting provide enabling technologies for teleradiology, which many believe will dramatically alter radiology competition. IT’s role in this process was a central theme of the closing general session, “The Flattened World as the New Enterprise: Threats, Opportunities, and the Role of Imaging IT,” at the Society for Imaging Informatics in Medicine annual meeting last month in Charlotte, N.C.

Paul J. Chang, MD, moderated a panel that included Eliot L. Siegel, MD; Richard H. Wiggins, III, MD; William D. Keyes, MD; and J. Raymond Geis, MD, and included questions and comments from the audience. The session’s two main focuses were the threat that technology and teleradiology create new competition among radiologists and what role imaging IT professionals should play in that evolving process.

Chang asked attending radiologists—the audience contained a mix of radiologists, facility IT people, administrators, and vendors—whether they perceived increased competition from radiology organizations outside their immediate geographic area. Few acknowledged that they have felt such pressure yet. Chang told the audience that just because they don’t yet feel the threat doesn’t mean that it isn’t there.

“There is definitely increased pressure toward consolidation, toward monopolizing radiology services,” Chang told the audience, “and movement away from a boutique-type practice model.” Chang then pointed out that in most business scenarios, such a boutique model is difficult to sustain in a world moving toward large, consolidated business.

While still few in number, there have been several prominent examples where radiology companies from outside a hospital system’s service area have come in and replaced or assimilated local radiology groups with different combinations of boots-on-the-ground radiologists supported by teleradiology. The actual reasons behind such changes have been hotly debated and vary by circumstance, but there’s no doubt that digital imaging and IT advancements make them feasible. Technology has eliminated the basically insurmountable advantage that proximity provided the local group in film-based radiology.

“We represent the enabling technology that will allow this process to continue and increase,” Chang said, “and it’s inevitable that it will.”

Whether these changes will prove good for radiology groups, healthcare systems, patients, and society at large remains to be seen—and may have a huge impact on radiology’s future. But a second question Chang raised in the session was what should IT’s role be in this?

Should IT professionals be what he termed “arms vendors” in the future of radiology, providing the technology and letting others sort out how to use it? Or do imaging IT professionals have a role in helping determine “what we want the proper practice of radiology and, by extension healthcare, to be for society and patients.”

To some extent, an IT person’s answer to that question may hinge on whether he or she works for the hospital or the radiology group. If a radiology group is replaced, its IT people may go out with the doctors, while a hospital’s IT staff may be needed to support the imaging network or be given other IT duties in the facility.

Wiggins, of the University of Utah Health Sciences Center, pointed out that the IT people could be shown the same door as the radiology group. If a teleradiology company comes in and replaces some or all of the radiology staff, many of the PACS administrator duties could also be displaced. (In several of the publicized takeovers, the incoming organizations have attempted to hire some or all of the original group’s radiologists as employees.)

“Are they going to keep you on to run things?” Wiggins commented, “or hand you your pink slip and say ‘You have two weeks to redirect all your modalities to the following IP address and thank you very much, good-bye.’”

Only time and individual circumstance will answer that question, but digital imaging technology and the Internet have created—or at least increased—that competitive threat to radiology groups and perhaps imaging IT people.

— Jim Knaub is editor of Radiology Today.