The rapid movement toward value-based reimbursement systems is creating new pressures for imaging departments at provider organizations-and that will have a downstream effect as these organizations choose and use imaging-related information technology in the next few years.

The move to value-based reimbursement will render obsolete past approaches that maximized revenue through an emphasis on volume. This will force IT executives to begin radically restructuring how imaging departments will operate in the future.

"We're changing to a value-based system, and so the focus of what we will do will change," said Kevin McEnery, MD, director of innovation in imaging informatics in the department of diagnostic radiology in the division of diagnostic imaging at The University of Texas MD Anderson Cancer Center, Houston.

Imaging departments and radiologists have brought revenue into provider organizations by doing radiological studies and interpreting them as quickly as possible-more exams and reports translated into more revenue. In addition, as departments brought in new technologies or improved capabilities of existing modalities, they increased revenues for providers.

As organizations now expect to be reimbursed for the value of the care provided, imaging operations won't be viewed as revenue producers, but as cost centers.

"Everything we've done involves creating more 'stuff,'" said McEnery. "Our systems have to change because the game is changing. We're going to be asked to achieve outcomes at the lowest cost. Healthcare will be patient-centered; we will be asked where we can add value to patient care."

Imaging departments are responsible for more technology and integration of their work into electronic health records, said James Whitfill, chief medical officer for Scottsdale (Ariz.) Health Partners. With new cost constraints, purchasing of new IT will have to be done more carefully.

"We developed all of this imaging technology, kind of like NASA going to the moon," he said. "You give us money because we're bringing in a ton of money to the hospital. Now it's going to be different."

The move to value-based reimbursement will put a premium on the ability to share images from previously conducted studies, rather than repeating imaging procedures and expecting additional reimbursement.

"If my organization is the one writing a check for $1,000 for that next CT, maybe I want that copy from across town, because that only costs me $50 or $100," he said.

Consolidation of healthcare organizations also is likely to affect the use of IT and future purchases, said David Marichal, chief technology officer for Radiology and Imaging Specialists of Lakeland, Fla., which works with a variety of hospitals and providers in the area.

Many have "gotten into that [accountable care organization] mode," he said. "Their CIO had been very siloed about their approach to imaging. Now, it's like she's saying, 'We need to be able to share between ambulatory and other settings. That challenge is very real to her because she's got clinicians coming to her saying, 'I want to be able to see a patient's record and their imaging from here, here and here.'"

A variety of technologies will grow in importance as organizations try to quickly and seamlessly share images. Vendor-neutral archives and other enterprise-wide approaches will likely gain favor with burgeoning healthcare systems.

As healthcare organizations increasingly use EHRs, imaging systems will need to integrate diagnostic imaging and specialist reports into organizations' patient records systems, according to speakers at the SIIM meeting. This will present large technology challenges for providers, which currently find it difficult to include images in EHRs, or easily and quickly locate images and results in other departmental systems.

As healthcare organizations consolidate and merge, they're struggling to find the best approach to consolidation of imaging operations, said Steven Horii, professor of radiology and clinical director of medical informatics at the University of Pennsylvania Medical Center. Some have used a federated approach, allowing providers with existing imaging systems to continue using them, but using middleware to enable entities to communicate with each other.

Other organizations are adopting enterprise imaging systems, which hold all images from a network and centralize storage. Both the federated and enterprise approach pose problems for organizations, Horii said.

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