January 14, 2016 -- What does the year ahead hold for radiology? From a growing reliance on big data for improved efficiency to the emergence of 3D printing as a clinical tool, medical imaging will continue to experience the constant evolution that is a hallmark of the specialty.
To help guide you through the year, we've come up with a list of nine of the most important trends to watch in 2016. We hope you'll find our selections thought-provoking and useful as you plan for the next 12 months.
Imaging sites will turn to big data for efficiency gains
By Erik L. Ridley
Spurred by the need to operate more efficiently and productively, medical imaging facilities will increasingly turn to data analytics (known colloquially as "big data") for help, and will more aggressively pursue workflow informatics technologies this year.
With the American College of Radiology's Imaging 3.0 initiative and the growing emphasis on value-based healthcare delivery, analytics tools will need to go beyond just tracking operational metrics such as imaging volume, turnaround time, and relative value units (RVUs), said Dr. Woojin Kim, a staff radiologist at the University of Pennsylvania.
"There will be growing interest and demand for analytics solutions that can help medical imaging professionals deliver more value by reducing length of stay, improving compliance, increasing revenue, decreasing medical errors and medicolegal risk, and evaluating outcomes and quality," said Kim, who is also director of innovation at analytics software developer Montage Healthcare Solutions.
By applying big data and data analytics methods to clinical analytics, imaging findings can be correlated with patient outcomes, said Dr. Eliot Siegel of the University of Maryland.
"An early example of this will be in the use of lung nodule databases combined with expert guidelines for specific patients for imaging studies and biopsy and treatment," Siegel said. "Medicine will increasingly go from anecdotal to data-driven using big data and analytics."
Machine-learning methods, which apply artificial intelligence algorithms to learn from data and make predictions, will be a key area of activity.
"We will start to see [machine-learning] applications in both structured and unstructured data mining and analysis," Kim said. "In addition, we will see increasing discussion of use of [machine learning] in analyzing medical images."
A groundbreaking technology that will continue to quietly evolve, machine learning is making strides toward being a defining influence on imaging informatics, said Dr. James Whitfill, chief medical officer for Scottsdale Health Partners and president of consulting firm Lumetis.
Driven by consolidation in healthcare and the need for efficiency, workflow orchestration is another area of imaging informatics that's taking off, said Dr. David Hirschorn of Staten Island University Hospital.
As radiologists increasingly work in larger and larger groups, critical efficiency improvements are needed. Many such benefits can be gleaned from workflow orchestration software that could provide, for example, dynamic balancing of radiologist workload based on the availability and subspecialty of radiologists, the priority of the exam, and the service-level agreements these groups have with hospitals, he said.
"PACS, RIS, and dictation systems are a great step in the right direction; they're necessary but they're not sufficient," Hirschorn said. "You need a brain to drive all of this, and these systems were never really designed to do [workflow orchestration]."
On the corporate side, industry observers should look for concrete results to begin appearing from artificial intelligence initiatives such as IBM's Watson Health project, GE Healthcare's Health Cloud offering, Dell Medical's partnership with Zebra Medical Systems and MphRx, and deep-learning start-up firm Enlitic. Announced with much fanfare in 2015, each of these initiatives was launched with the goal of revolutionizing healthcare -- the question is, will they live up to the promise?
Will value-based payment models finally arrive?
By Kate Madden Yee
A key issue for imaging in 2016 will be whether long-promised value-based payment models will finally begin to develop as alternatives to the fee-for-service system that has dominated U.S. healthcare for decades.
Value-based payments were mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which in addition to permanently eliminating the sustainable growth rate (SGR) set the stage for a shift in Medicare reimbursement from volume to value using merit-based incentive payment systems and alternative payment models.
These alternative payment models will be influenced not only by clinical quality metrics, but also by patients, who will continue to weigh in on how satisfactory they find the imaging services they receive, whether through social media or through vehicles such as the U.S. Centers for Medicare and Medicaid Services' (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
"While actual payment adjustments won't occur this year, radiology practices should start thinking now about how they will adjust to these new payment models," Dr. Andrew Rosenkrantz of NYU Langone Medical Center told AuntMinnie.com.
Also in 2016, watch for further developments from CMS regarding implementation of appropriate use criteria for advanced imaging studies such as diagnostic MRI, CT, and nuclear medicine, developments mandated by 2014's Protecting Access to Medicare Act (PAMA). In November, CMS postponed the January 1, 2017, deadline for physicians to start ordering advanced imaging studies with clinical decision-support software based on appropriate use criteria; the question remains whether the agency will push this deadline back even further in 2016.
Another important theme this year will be how radiologists can continue to "put a face on imaging" -- namely, by actively participating in patients' ongoing education about imaging itself, radiation risk, and which exams are appropriate and when they should be used.
Finally, expect fierce discussion about screening for various cancers, including breast (when to start and how often to screen; using tomosynthesis for screening) colorectal (Medicare still does not cover virtual colonoscopy), and lung (how to establish effective screening programs).
Breast screening debate will continue to rage
By Kate Madden Yee
In 2016, expect more heated debate on breast cancer screening: when women should begin and how often they should be screened.
In fact, the year is already off to an interesting start. On January 12, the U.S. Preventive Services Task Force (USPSTF) published its final guidelines for breast cancer screening in the Annals of Internal Medicine, sticking to its draft recommendations from last April and also its 2009 guidance, which declined to recommend screening for women in their 40s and advised biennial screening for those 50 to 74.
Fortunately for breast screening proponents, the guidelines won't affect Medicare reimbursement for younger women, which was at risk due to a provision in the Affordable Care Act (ACA) that only requires private payors to reimburse for medical services that receive "A" or "B" ratings from USPSTF (breast screening for younger women got a "C" grade). Instead, the U.S. Congress delayed implementation of that ACA provision for two years as the issue is studied further.
As 2016 progresses, each side will present research supporting its own positions, with mammography skeptics hammering away at the "harms" of screening, such as patient anxiety, false positives, and downstream tests, while proponents tout their own research supporting an expansion of screening to new populations -- with neither side landing a deciding blow.
An effort later this month by the American College of Obstetricians and Gynecologists (ACOG) to develop a single set of uniform guidelines for breast screening is intriguing, but it's hard to imagine consensus developing between groups with such hardened positions. Farther in the future, some resolution could come with the development of screening guidelines that are more tailored to an individual's cancer risk rather than age, but many mammography proponents see "tailored screening" simply as a euphemism for "reduced screening."
As the screening debate rages, women's imaging will continue to evolve in 2016. There will be increased emphasis on the importance of radiologists coming out of the reading room and interacting with patients, specifically around breast cancer screening education, according to Dr. Rachel Brem, professor and vice chair of radiology at George Washington University.
"As radiologists, we need to do everything we can to educate patients on the importance of screening mammography," she told AuntMinnie.com. "We can be one of the most important physicians patients interact with in this particular arena."
On the technology side, watch for more research on adjunctive screening technologies, such as abbreviated breast MRI protocols; further development of breast CT and contrast-enhanced dual-energy mammography; and increased focus on molecular breast imaging -- which offers a physiological approach for screening and diagnosis.
And, of course, tomosynthesis will likely continue to permeate throughout women's imaging. Look for studies that investigate how the technology performs with interval cancers, as well as how to fine-tune tomo's performance vis-à-vis patient-level data such as breast density and age. Also keep an eye out for further developments in Dr. Etta Pisano's Tomosynthesis Mammographic Imaging Screening Trial (TMIST), which will compare tomosynthesis with full-field digital mammography.
Finally, don't expect the issue of breast density -- how to measure it and how best to screen women with dense tissue -- to fall off the radar any time soon. Clinical studies will tackle interreader variability and the efficacy of automated density measurement tools.