- Email: [email protected]
The Ties that Bind
EDITORIAL
BRUCE J. HILLMAN, MD
The Ties that Bind If there’s one thing I’ve learned over the eons, it’s that you can’t give up on your family, no matter how tempting they make it. —Rick Riorden The article by Michael Franklin in this issue of JACR makes the case for hospital-based radiologists taking on a greater leadership role in their institutions. Mr. Franklin, the CEO of a community hospital in Maryland, speaks with some authority. Among the numerous acronyms that succeed his name is RT. Perhaps because of his background, the author’s tone makes the piece more welcoming than other articles and presentations on this topic I’ve seen. You know, the ones I mean . . . the ones threatening the wholesale replacement of radiology groups that fail to toe the line. The writing is more carrot than stick, which is not to say that the stick does not exist. Mr. Franklin focuses in on several points concerning why hospitals must depend on their radiologists’ good will and cooperation. For example, he notes that radiologists are much more advanced than other specialists in using information systems to standardize practices and improve the quality of care. He cites how decision support systems like computer aided diagnosis and the standardized reporting of mammograms using BI-RADS® have improved the quality of mammography interpretation
by leveling variability and reducing vagaries that lead to inefficiencies in care. Radiologists could help lead the way for other specialists by modeling for others how IT benefits patient care. The urgency of improving care is presented most compellingly in the section of the article headed “Vicarious Liability,” in which the author details the circumstances in which hospitals may share liability for radiologists’ errors and omissions. Because medical imaging is an “inherent function” of a hospital, because emergency room and hospitalized patients have little say in who performs and interprets their imaging examinations, and because the hospital’s board bears the ultimate responsibility for oversight of who provides care in the institution, the culpable acts of radiologists may be visited upon the hospital. Franklin concludes that “this apparent legal relatedness” in the eyes of patients and the community requires that there be joint responsibility in ensuring that all possible precautions are brought to bear to optimize care. Central to the article is that health care and payment reform aside, the more things change, the more they will remain the same. “Radiology is core to the future of hospitals and the healthcare community,” Franklin asserts. The advantage radiology has enjoyed in IT
must be put to good use in leading the way toward verifiable valuebased delivery of care. Consumerism, as it applies to medical imaging, must recognize that both patients and referring physicians are “consumers” and that the pursuit of high-value care must recognize such endpoints as ease of access, timeliness, and clinical utility as part of the construct of “quality.” The author raises a battle cry for cooperation among radiologists, referring physicians, and hospitals to achieve a “patient-centric solution.” In essence, Franklin is saying that radiologists and hospitals are family. We can squabble over how to achieve what must be done, but ultimately our goals need to be aligned if we both are to succeed. His vision for how success can be built around information technology is not novel, but it is compelling. At the heart of the matter is our mutual desire to improve patient care. The path to achieving this objective is both technological and cultural. As Franklin notes toward the end of the article, “Designing new technology around old systems of care will continue to leave holes in the weave. Rather, the capabilities of the technology need to drive processes to be reformatted to strengthen the ties to each other and the patient.” How we get there is fodder for conversation, but in my mind the goal is not debatable.
Bruce J. Hillman, MD, UVA-Radiology Research, Box 801339, Charlottesville, VA 22908; e-mail: [email protected].
230 0091-2182/13/$36.00
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© 2013 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2013.01.003
BRUCE J. HILLMAN, MD
The Ties that Bind If there’s one thing I’ve learned over the eons, it’s that you can’t give up on your family, no matter how tempting they make it. —Rick Riorden The article by Michael Franklin in this issue of JACR makes the case for hospital-based radiologists taking on a greater leadership role in their institutions. Mr. Franklin, the CEO of a community hospital in Maryland, speaks with some authority. Among the numerous acronyms that succeed his name is RT. Perhaps because of his background, the author’s tone makes the piece more welcoming than other articles and presentations on this topic I’ve seen. You know, the ones I mean . . . the ones threatening the wholesale replacement of radiology groups that fail to toe the line. The writing is more carrot than stick, which is not to say that the stick does not exist. Mr. Franklin focuses in on several points concerning why hospitals must depend on their radiologists’ good will and cooperation. For example, he notes that radiologists are much more advanced than other specialists in using information systems to standardize practices and improve the quality of care. He cites how decision support systems like computer aided diagnosis and the standardized reporting of mammograms using BI-RADS® have improved the quality of mammography interpretation
by leveling variability and reducing vagaries that lead to inefficiencies in care. Radiologists could help lead the way for other specialists by modeling for others how IT benefits patient care. The urgency of improving care is presented most compellingly in the section of the article headed “Vicarious Liability,” in which the author details the circumstances in which hospitals may share liability for radiologists’ errors and omissions. Because medical imaging is an “inherent function” of a hospital, because emergency room and hospitalized patients have little say in who performs and interprets their imaging examinations, and because the hospital’s board bears the ultimate responsibility for oversight of who provides care in the institution, the culpable acts of radiologists may be visited upon the hospital. Franklin concludes that “this apparent legal relatedness” in the eyes of patients and the community requires that there be joint responsibility in ensuring that all possible precautions are brought to bear to optimize care. Central to the article is that health care and payment reform aside, the more things change, the more they will remain the same. “Radiology is core to the future of hospitals and the healthcare community,” Franklin asserts. The advantage radiology has enjoyed in IT
must be put to good use in leading the way toward verifiable valuebased delivery of care. Consumerism, as it applies to medical imaging, must recognize that both patients and referring physicians are “consumers” and that the pursuit of high-value care must recognize such endpoints as ease of access, timeliness, and clinical utility as part of the construct of “quality.” The author raises a battle cry for cooperation among radiologists, referring physicians, and hospitals to achieve a “patient-centric solution.” In essence, Franklin is saying that radiologists and hospitals are family. We can squabble over how to achieve what must be done, but ultimately our goals need to be aligned if we both are to succeed. His vision for how success can be built around information technology is not novel, but it is compelling. At the heart of the matter is our mutual desire to improve patient care. The path to achieving this objective is both technological and cultural. As Franklin notes toward the end of the article, “Designing new technology around old systems of care will continue to leave holes in the weave. Rather, the capabilities of the technology need to drive processes to be reformatted to strengthen the ties to each other and the patient.” How we get there is fodder for conversation, but in my mind the goal is not debatable.
Bruce J. Hillman, MD, UVA-Radiology Research, Box 801339, Charlottesville, VA 22908; e-mail: [email protected].
230 0091-2182/13/$36.00
●
© 2013 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2013.01.003