Customized imaging improves diagnoses, empowers patients, and enhances radiology's value-added reputation.
Personalized medicine - it's a term heard around nearly every hospital corner and in virtually all private practices. What began as a vague concept has grown, through healthcare reform, into the widespread use of tools to give patients the most individualized care possible.
But providing this type of customized service often requires genetic information to make informed healthcare decisions - data that isn't often used in radiology services. So, is there such a thing as personalized radiology?
The answer, it turns out, is yes for both the patient and the provider.
"Personalized radiology is tailored specifically to support the needs of each patient and their families as individuals," said Mary Saltz, MD, chief integration officer of community affairs at Stonybrook University. "It takes into account their level of illness severity, language needs, cultural background, age, and any other special things that make them different from other patients."
And, so far, according to Roger Eng, MD, president of San Francisco-based Golden Gate Radiology Medical Group, this personalized approach to radiology is catching on. In many ways, it echoes the tenets behind the American College of Radiology's Imaging 3.0 initiative - it's switching provider mentality from volume-based to value-based.
"Personalized radiology is synonymous with the whole idea of being more specific and engaging with patients," he said. "When we engage them, they're more than just a film. We get more elements of who they are from their personal history to their clinical one. It's a way to find out things that aren't in the electronic health record."
Personalizing the Approach
Many industry experts contend personalized medicine cannot succeed without being closely integrated with personalized radiology. In a 2011 study published by the European Society of Radiology, the authors wrote that genomic information, imaging-based information, and previous clinical information will be required for optimal future care. As a result, radiologists will be called upon to take on bigger roles in research, as well as to proactively dig into a patient's clinical history to help inform their diagnoses.
Reaching this goal isn't necessarily easy, however. It requires the clinical environment as a whole to shift focus, Saltz said. Instead of ensuring the comfort and ease of workflow for staff and providers, the No. 1 priority is now developing a system robust enough to support patients both during and after their scans.
Providers and practice managers must now consider whether patients have difficulty navigating imaging equipment, what accommodations families need during wait times, and how radiologists can expand the role they play in the rest of a patient’s care, such as serving as consultants to referring physicians. When feasible, Saltz suggested practices and departments build their offices from the ground up, soliciting and incorporating patient opinions and needs throughout the process.
Giving patients a truly individualized experience goes beyond tending to physical comforts, Eng said. It requires radiologists to pull in all relevant labs results, histories, diagnostic studies, and physical exams before rendering a diagnosis. For example, he said, providers should routinely review colonoscopy results when evaluating an abdominal CT scan. He acknowledged, however, that it could be more difficult for larger departments or organizations to make this type of workflow change.
Even with these shifts in focus and work behavior, tailor-made radiology experiences will only truly flourish when patients have open access to their scans, particularly in electronic formats, Saltz said. Letting patients inside the imaging vaults and opening the door to questions is unchartered territory for many radiologists, though.
"As a profession, we still feel uncomfortable about sharing reports with patients, but this is a huge area in radiology that will explode," Saltz said. "This all brings to bear the need for patient portals."
And there will likely come a time, she said, when radiologists can customize their reports for multiple audiences, including the patient, general internist, and the sub-specialist.
While personalized radiology will initially require some hand-holding for patients, it's the radiologists who are likely to have the most trouble adapting to and understanding this new clinical approach, Saltz said.
"Discussing studies with patients and answering their questions isn't necessarily a good fit for the way we're accustomed to practicing," she said. "Radiologists will need training in outreach. This will definitely be an area where the radiologists will need help to understand what personalized radiology is and why we have to do it - and why we'll be sorry if we don't."
Failure to embrace personalized radiology could undermine the specialty's efforts to prove its importance and relevance in healthcare, as well as safeguard its reimbursement payments.
In addition to modifying patient and provider behaviors, integrating and streamlining the ever-growing amount of technological resources needed to monitor patient information could prove difficult and expensive, Eng said.
"Changes at the radiologist and staff levels in incorporating systems process and technologies will vary in terms of purchasing costs," he said. "We can try, through electronic systems, to bring together lab results, referring clinician and specialist consultations, and exam findings. But some technologies are still not fully developed yet, so there is still great difficulty within many organizations in doing so."
As personalized radiology continues to gain ground, though, partnerships between radiologists and all other healthcare providers will only grow in importance, he said.
The Impact of Personalized Radiology
It might take time to realize the benefits of a personalized radiology approach to practice, Eng said, but the effort is worth it. For the past several years, his practice has slowly adopted this approach, and they are now reaping the rewards.
"My facility began working on a personalized radiology approach since we first went electronic. It's been a long process, but we've seen a major payoff. We can now tap into 75 doctors within our community," he said. "We decided to get an enterprise-wide electronic health record so we can see into other PACS to review complicated cases. There have been times when I've been able to consult with three other providers for the same patient who has multiple problems before making a diagnosis."
Having this additional access not only improves the care patients receive, but it also enhances the relationship between radiologists and referring physicians. The personalized radiology approach gives radiologists more opportunities to serve as imaging consultants, highlighting their skill set and increasing the value of their clinical contributions, he said.
This pivot toward personalized radiology will also go far in rehabilitating the industry's weathered image, Saltz said.
"By becoming more prevalent in the public eye, we will regain our position as respected physicians - not just a technical person working in the background," she said. "We will be seen by referring physicians, patients, and the larger community as extremely important linchpins in the delivery of patient care."
Demonstrating this type of value falls in line with the healthcare industry's overall push away from volume-based care, and it could help radiologists hold on to more reimbursement dollars in the face of Medicare payment cuts.
Ultimately, personalized radiology as a concept fits neatly within current healthcare reform measures. It fosters cooperation among various providers, Eng said, in much the same way as Patient-Centered Medical Homes and multi-specialty groups or networks.
And the industry's desire to enhance the role imaging plays in patient-centric care continues to grow, he said.
"We are being tasked to show where we can provide value for healthcare dollars that come our way for imaging," he said. "Personalized radiology can help us show that we do make an impact and improve care in a cost-effective way."