The rapid movement toward value-based reimbursement systems is creating new pressures on imaging departments at provider organizations, forcing IT executives to begin radically restructuring how those departments will operate in the future.

“This change is going to happen,” said Kevin McEnery, M.D., a professor in the Department of Diagnostic Radiology at MD Anderson Cancer Center in Houston. “We’re changing to a value-based system, and so the focus of what we will do will change.”

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 to 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 to patients, imaging operations no longer will be viewed as revenue producers, but as cost centers.

“Everything we’ve done involves creating more ‘stuff,’“ McEnery said on May 29 during a presentation at the Society for Imaging Informatics in Medicine conference in Washington. “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.”

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

Also See: HIE Cuts Redundant Imaging by 25 Percent

And, as healthcare organizations consolidate and merge, they’re wrestling with finding the best approach for handling consolidation of imaging operations, said Steven Horii, professor of radiology and clinical director of medical informatics at the University of Pennsylvania Medical Center.  Some consolidating organizations 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.

For instance, as imaging enables studies that provide finer resolution or more images per study, many providers are wrestling with their ability to handle large quantities of data. For example, dual energy CTs can produce 4,000 images, each consuming hundreds of megabytes.

Also, images may reside in multiple locations and may be associated with annotations or reports, further complicating storage problems, as well as potential medico legal concerns about which is the most recent image, and whether the most recent analysis is associated with that image.

Finally, imaging professionals are vexed with the challenges of incorporating non-diagnostic images, such as those from physicians using smart phones to take pictures of patient conditions or treatments. Such images typically don’t meet DICOM standards and are not of diagnostic quality, but are useful for clinicians in recording or conveying information, said Rasu Shrestha, chief innovation officer for the University of Pittsburgh Medical Center.

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