Daily Bulletin 2016

Radiology Offers Lessons to Entire Medical Industry for Digital Transformation

Monday, Nov. 28, 2016

Because it experienced a digital transformation early, radiology serves as the "canary in the coal mine" for the rest of the medical industry, according to Robert M. Wachter, MD, who delivered an opening session lecture Sunday in Arie Crown Theater.

"Radiology tends to be first in these areas, so it has many lessons for the rest of us," said Dr. Wachter, during his presentation, "Hope, Hype, and Harm as Medicine Enters the Digital Age: Lessons From (and For) Radiology."

Robert M. Wachter, MD

Robert M. Wachter, MD

"You (radiologists) really have taught us a tremendous number of lessons. We're all going to live this as technology runs through the rest of our fields," he added.

Dr. Wachter, professor and interim chair of the Department of Medicine at the University of California, San Francisco, where he also directs the division of hospital medicine, examined this topic in his New York Times bestselling book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age. He notes in the book that the demise of radiology rounds in hospitals has become an unintended consequence of digitalization of images and PACS.

"When I was a medical student, there was no question the central hub of the hospital was the radiology reading room," said Dr. Wachter, who was ranked the most influential physician-executive in the U.S. by Modern Healthcare magazine in 2015.

"Within a year or two, PACS eliminated the radiology rounds. Nobody said they should end, nobody speculated that they would. It just happened because physicians no longer needed to look at film," he added.

Dr. Wachter took away several lessons from that experience: digitization of the "thing" (in this case radiology reports) creates the opportunity for infinite distribution; social relationships and communication patterns that previously depended on gathering around the old technology will wither; and power relationships mediated by who controls the new technology will be renegotiated.

Dr. Wachter says he sees this pattern happening at his institution, estimating internists now spend half their time on computers. This results in physicians spending less time in hospital wards.

"There are no more doctors in the wards because they are no longer tethered there by paper charts, and therefore we left," he said. The downside of this is that doctors become less visible, which can limit interaction with patients, families and nurses.

He said two things went wrong. First, technology was treated as technical change rather than adaptive change. Adaptive change requires users themselves to change. Second, the industry is still in the early stages of adapting to healthcare information technology, which he broke into four stages.

So far, only the first stage, digitalization of the medical record, has been reached. The remaining three stages are still to come: creating ubiquitous connectivity from the various digitalized parts from individual institutions, gleaning meaningful insights from the data, and finally converting those insights into action that improves value.

"The fourth part is the hardest – it involves changing the workflow, the training, the skills," Dr. Wachter said.

He added that because digital reports eliminated radiology's monopoly on that information, the specialty is at risk of commoditization or replacement by cheaper alternatives. He said radiologists need to demonstrate their value to practicing physicians and patients.

"It's not just that you get the reading correct, it's that that reading leads to better, safer, cheaper care for patients," he said. "That will be your savior."

But while the risk of digital replacement is real, Dr. Wachter said he doesn't see that happening anytime soon. Instead he said hybrid models where technology augments the work of people will be the norm for the foreseeable future.

Question of the Day:

What correction factors do I need to convert CTDIvol to dose?

Tip of the day:

Just because a device is MRI compatible does not mean it will remain so, if it is altered. For example, a neurostimulator may be MRI conditional, but if the base unit is removed (but leads remain in the patent) that patient is not necessarily safe to scan anymore.

The RSNA 2016 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.