The sum of its parts…

My discussion for this entry is in two segments.  In the first segment I will discuss changes in radiology and the separate components of modern radiology practices that need to be integrated to create a more healthy practice, department and hospital.  In the second segment I will discuss the 6 specific enhancements that can be seen when groups synergize the way they practice.

Segment 1.

“The whole is greater than the sum of its parts.” Aristotle

Today what we was referred to as “Radiology” is now “Diagnostic Imaging,” a metamorphosis brought about by the confluence of two changes within the field over the last 15-20 years. First, there has been a significant increase in technology. Initially, there was radiography, fluoroscopy and special procedures. Now we’ve added CT, nuclear medicine, ultrasound, MRI, mammography and teleradiology. Second, radiology was once practiced by a group of general radiologists who had to be good at everything. Now most progressive radiology groups practice as an integrated group of subspecialty radiologists.

In addition to these fundamental changes in radiology, most conventional radiology practices also have a partnership with a teleradiology practice. Finally, additional needs and requirements for improving our interaction with clinical colleagues and patients has put an increased emphasis on our capabilities and responsibilities as consultants.

Current departments of diagnostic imaging are comprised of four distinct components and activities. These are (1) subspecialized diagnostic imaging interpretations; (2) interventional procedures; (3) consultation; and (4) teleradiology.

Subspecialization.

Subspecialization within radiology has significantly improved patient care. Subspecialty radiologists typically have a deeper working knowledge of the specialty they serve.  This improves their ability to participate more effectively with the clinician in the care of the patient. Subspecialization also helps guard against encroachment into imaging by other specialties.  

If subspecialty expertise is not immediately available within the imaging department, this must be sought elsewhere. Teleradiology partners play an important role with many smaller and midsize groups in encouraging subspecialization and providing subspecialty interpretations that are not otherwise available from the group.

Interventional Procedures.

Minimally-invasive procedures have been and will continue to be a backbone of patient care as patients who were once sent to open surgical procedures are now being treated endoscopically. Ceding this segment to other specialties only invites more aggressive activities in diagnostic imaging interpretation.  Supporting interventional practices can be difficult however, particularly with small to midsize groups that don’t have the time and money required to make this practice successful and financially viable.

Teleradiology partners assist the practice and the interventionist by providing additional “hands” to get the imaging work done. This allows the interventional radiologist to pursue and grow a professionally satisfying, thriving and profitable interventional section.

Consultation.

As we move into a new era of healthcare, radiologists are being required to step up and provide additional consultation services, not only to our physician colleagues, but to a host of allied health professionals.   As consultants we have an opportunity to participate where we can have an impact on what I call “grass roots” patient care. Providing additional consultative support to these practitioners improves patient care and keeps cost down by preventing unnecessary escalation to urgent care centers, emergency rooms and eventually hospital inpatient admission.

This addition to our responsibilities needs to take on a focus of its own.  Radiologists need to move from being imaging-centric to becoming patient-centric.  Teleradiology practices, by being available 24/7, can be a partner as conventional practices provide increased consultative services to all healthcare providers.

Teleradiology.

Teleradiology practices provide support to many groups in addition to the traditional on-call and weekend coverage. Today 24/7 assistance is available in traditionally difficult-to-cover subspecialty areas  (MRI of small joins, complicated pediatric cases, postoperative spine or brain cases, complicated MSK MRI cases and virtual colonoscopy, to name a few).

Additionally, by providing IT expertise teleradiology practices can assist with organizing practices that cover multiple facilities. One of the main concerns encountered by these practices is the issue of load leveling between radiologists. This process is at the heart of the teleradiology practice. Being able to easily move cases between radiologists at different facilities improves efficiency, decreases turnaround time, takes advantage of subspecialization within the group and improves patient care.

Stay tuned for segment 2 of this series which will address the added value of a synergistic approach.

-Dr. Timothy Myers

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