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Why 'Do No Harm' Isn't Good Enough for Radiology and Radiology IT


Are systemic changes in product innovation needed to address suboptimal workflows in radiology?

Radiologists are among the most technologically savvy of all physicians. For decades, they have been at the very forefront of medical innovation, adopting technologies that completely revolutionized patient care. Radiologist and radiology IT companies have a well-earned sense of professional pride in how they’ve leveraged technology to advance medicine.

However, IT developments of the past 20 years have also resulted in the siloed components and piecemeal software solutions that comprise the current suboptimal workflow in radiology, compromising patient outcomes and putting their lives at risk.

“Do no harm” is the core principle of the Hippocratic Oath taken by all physicians, including radiologists. The risk of action must not outweigh the risk of inaction. This oath is meant to ensure that all physicians, given their ability to impact matters of life and death, take their responsibilities seriously and prescribe treatments accordingly. However, the oath can also create a bias towards maintaining the status quo, meaning new technologies and techniques are most often built as incremental improvements to the existing standard of care, and those that don’t are viewed with disproportionate skepticism and resistance.

Traditional IT companies also champion the “do no harm” principle with the old proverb “If it ain’t broke, don’t fix it.” Each company favors staying within the limited scope of its existing workflow footprint over addressing the broader systemic issues of radiology IT’s underlying architecture. This has created a classic “innovators dilemma” in the IT marketplace. The current piecemeal architecture is broken. New products would benefit from a better architecture, but the profits of these companies would likely take a hit.

Let’s be clear and fair. To provide the tools to enable radiologists to work faster and smarter, companies would have to fundamentally reengineer their technology and entirely rebuild their technical teams and company processes. They simply aren’t positioned to do that. They are in a highly competitive industry with a business model designed around their existing technologies. They are not incentivized to do wholesale reinventions of their platforms to solve systemic issues. They have years of work left to deliver on features they promised years ago. They are stuck in the system they created as are the physicians they serve.

As a result, companies have become unwittingly complicit in a system that is failing to keep pace with modern demands. Radiology IT was once a bastion of medical innovation. Now the whole IT industry is struggling just to “do no harm,” and that simply isn’t good enough. Not for radiologists and not for their patients.

Solving these systemic problems requires a major overhaul of the architecture of radiology IT. What hangs in the balance is nothing short of the future of the profession: radiology must find new ways to provide value, and software companies must give them the modern tools to do so.

As the specialty solely responsible for processing 80 percent of all health-care data by volume, and as the only specialty in health care practiced entirely through software, today’s radiologists are in a unique position to lead a software revolution that will move medicine forward.

Reestablishing Radiologists as Med-Tech Trailblazers

Radiologists have a history as med-tech trailblazers. In the 1970s and 1980s, the adoption of advanced imaging modalities (MRI and CT) allowed for the diagnosis and treatment of pathologies previously unknown to medicine. These advances obviated the need for exploratory surgery ahead of interventional surgery. In the 1990s, radiologists spearheaded the digitization of medicine by replacing imaging film with digital images.

Yet, radiology has one of the last unconsolidated workflows in medicine. This is because radiology IT architecture was built at a time when the individual pieces — such as data storage, speech recognition, and image rendering — were challenging and expensive to develop. No one company could do it all. Each company designed and delivered separate components that were non-interoperable. This siloing persists today and creates technical problems that detrimentally affect patient care.

For example, the artificial siloing of radiology reporting and image database software (PACS) prevents either system from having the full patient context and requires the radiologists to keep them in sync manually. Instead of just saying “lung” and having the right images displayed in the viewer and the right section of the report queued up, radiologists must manually find the right section of the report, scroll through multiple image slices, and adjust the window levels accordingly. 

Another major problem area is the report itself: a one-dimensional, plain text-only document that doesn’t support any markup or the automatic incorporation of measurements from the image. This outdated format makes it harder for the radiologist to bring specific findings and follow-up recommendations to the attention of referring physicians who can then easily miss them. Indeed, radiologist-recommended followups happen less than 40 percent of the time, resulting in thousands of preventable deaths each year.

Let’s Do Better than ‘No Harm’

For the last decade, the technological issues arising from radiology IT’s interpretation of “do no harm” has arguably done more harm than good. The risk of inaction has become too high. Radiology IT is bleeding out and it is high time for proactive steps to ensure patients get the best possible care radiologists can deliver.

Patients have suffered the most, of course, but it’s the radiologist, not other stakeholders, who feels the greatest pressure. Payors aren’t going to pay more, companies aren’t going to charge less, and patients aren’t going to stop seeking care. If anything, the advent and proliferation of low-cost imaging hardware will only serve to multiply the demand for radiology over the coming decade.

For these reasons, radiologists must demand the systemic changes they want to see by calling on technology companies to provide the tools radiologists need to do their best work. 

Radiologists were the first medical professionals to make the leap to digitization two decades ago. They can and must be first again, this time to drive the next wave of IT innovation that will filter throughout the entire medical community for the benefit of patients.

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