YO U R M E D I C A L I MAG I N G C LO U D

PRED ICT TO P R E P AR E :

5 Radiology Trends to Watch

Executive Insights in Partnership with HIMSS, Stanford
Childrens Health and New England Baptist Hospital
Overview
Theres never been more turbulence and opportunity, within healthcare. Its a perfect
storm of a changing legislative landscape, changing patient behavior, and disruptive new
technologies like cloud computing and articial intelligence.

If youve been wondering what it all means for radiology over the coming year, then weve
prepared this executive brief for you. In partnership with HIMSS and healthcare leaders from
Stanford Childrens Health and New England Baptist Hospital, youll hear ve trends that are
on the horizon, and how healthcare professionals are getting in front of the wave.

On a special webinar event, in partnership with HIMSS, Dr. Safwan Halabi, a pediatric
radiologist and a fetal radiologist, who also runs the informatics portion of imaging at Stanford
Children's Health shared his insights into the trends hes seeing in radiology and healthcare
in general. He was joined by Tyler Martin, the Executive Director of Ambulatory Network
Operations at New England Baptist Hospital, and Morris Panner, CEO, Ambra Health.

EXECUTIVE SUMMARY
The adoption of value-based care continues, with implications for
physicians, patients, payments, and measuring performance.
C O NT R IB U T OR S

An increased focus on patient experience, and increasingly active,

engaged patients is driving initiatives for radiologists to connect Dr. Safwan Halabi
with patients in a whole new way. Medical Director Radiology
Informatics, Stanford
Children's Health
Patient behavior, new technology, and a shift in the industry is
changing the role of radiologists. Theyre no longer only the the
doctors doctor theyre increasingly integrated into the patient Tyler Martin MHA, R.T. (R)(CT)
journey. Executive Director of
Ambulatory Network
With industry consolidation, and an increased need for Operations, New England
Baptist Hospital
interoperability between providers, the move to cloud-based
Vendor Neutral Archive is accelerating. Its revealing multi-faceted
benets, from improved disaster recovery, to easing physician Morris Panner
access to imaging. CEO,
Ambra Health

New technology innovations like articial intelligence and

machine learning, as well as workow automation are both
helping augment physician decision making, and reducing
administrative workload.

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Top of Mind: The Growth of Value-Based Care
Its no secret that healthcare providers are on the move
from a primarily fee-for-service model, to value-based
care, with shifting incentives to change provider behavior.
Reimbursement is changing to focus on quality of care
by reducing unnecessary procedures or redundant
"One of my goals, and especially in the
pediatric setting, is trying to reduce
radiation, by reducing unnecessary tests
and procedures value based care is
the vehicle to do that.

imaging studies. DR. SAFWAN HALABI

As providers look to provide better care without increasing costs, theyre looking to pull in
departments like radiology into the whole care management process.

There are challenges however to implementing value-based care that are both logistical, and
based on the shifting sands of the current legislative environment. In terms of practical
implementation, the panel noted that one of the barriers to adoption is around metrics.

Dr. Halabi, noted that Medicare Access and the CHIP Reauthorization Act (MACRA), and
Merit-Based Incentive Payment System (MIPS) all create the need for better metrics, benchmarking
and performance management. The challenge however, is how to determine what the right
value-based metrics are, what are the milestones to track, and how to compare them with
geographic and outcome based benchmarks.

So, for radiology executives, data collection is key, such as recording the impacts of imaging on
care, and the cost eectiveness of imaging across dierent scenarios and conditions. Also, its
not just about over-utilization. On the ipside radiology executives must also show the risks of
lower utilization. For example, the situations where it may end up costing more in the long run,
due to unnecessary admissions or perhaps an incorrect assessment.

A major driver for value-based care has also been legislative,

90% of healthcare attendees said
with the roll-out of the Aordable Care Act (ACA). However, with
value-based care is here to stay.
legislation in ux, there have been question marks as to whether
EVENT POLL
it will slow down, or stop the adoption of value-based care.

When Ambra polled event attendees however, 90 percent indicated that its here to stay, while
indicating that the rigorous legislation surrounding it may perhaps be moderated a little.

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 WILL VALUE-BASED CARE LIVE ON IF THE ACA GETS REPEALED?

No, it will no longer

be a main priority
10%
Yes, it will become a
fundamental aspect
28%

Yes, elements of
it may remain
62%

An Increased Focus on Patient Experience

Noted by our panelists, elevating patient experience is a
signicant area of focus, as patients get increasingly
engaged in healthcare decisions.
An overriding key to patient experience is to provide the
patient with an integrated experience, from the point
they rst register, to when they are discharged.
Interoperability being able to easily
move imaging about a patient from one
healthcare provider to another can be a
powerful inuencer for patient experi-
ence and satisfaction.
TYLER MARTIN

For the patient, it means how physicians, administrative sta, and assistants work together must
look like a seamless process ideally, across facilities and throughout the network.

The panel shared several initiatives around patient satisfaction,

We make it easily accessible for a
patient to upload their outside
imaging from anywhere, as long as
they have internet access
TYLER MARTIN
much of which involved integrating the patient experience.
One area of focus for referral centers is improving image
sharing and interoperability between providers so that
everything is keyed up by the time the patient is seen, and the
physician has already had an opportunity to review the imaging
that was performed elsewhere.

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At New England Baptist Hospital, Tyler sees patient empowerment as a major opportunity, and
theyre making it easy for patients to upload their outside imaging from CDs, whether at home
or oce directly to NEBHs website minimizing repeated imaging studies, and reducing the
chance that patients arrive at the hospital without their imaging.

The Rise of Patient-Centered Radiology

Patient-centered radiology is a hot topic, with a gradual
move towards delivery of reports directly to patients. One
area where the gap is closing in the patient journey is the
communication between dierent providers in the health
system, referring physicians and clinicians.
40 percent said using patient-portals
to eliminate CDs was key to adopting
a patient centered approach it was
the biggest single focus area.
EVENT POLL

For radiologists, who have typically worked almost solely with doctors, a shift to a more
patient-centered approach can be seen as a challenge, or even feared. But the move to more
patient engagement is inevitable, with patients increasingly expecting to be able to access their
medical information and reports on a patient portal. But it can be a real opportunity for radiologists
too, especially with increasingly more engaged, active patients.

HOW HAS YOUR FACILITY WORKED TO OFFER PATIENT-CENTERED RADIOLOGY?

All of the above

28%
Using patient portals
and eliminating CDs
40%

Implemented easy to
understand guidelines to Increased the role of the
share with patients radiologist in patient care
19% 13%

With the growth of patient access to reports, the panelists noted that curation is becoming key
to make them more patient-friendly, and easier to understand, a concern thats also often
raised by patient panels.

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At New England Baptist Hospital, Tyler sees patient
We're focused on being custom-
empowerment as a major opportunity, and theyre making
er-centered overall; not only the
it easy for patients to upload their outside imaging from patient, but treating our physicians
CDs, whether at home or oce directly to NEBHs website as customers too.
minimizing repeated imaging studies, and reducing the
TYLER MARTIN
chance that patients arrive at the hospital without their
imaging.

Adoption of Cloud Vendor Neutral Archives

Unlike a PACS, which is typically designed to serve one department, a VNA is designed to be a
long-term archive, a central repository for housing images from a variety of systems. A Cloud
VNA takes the capabilities of a traditional Vendor Neutral Archive further by providing a exible
framework over the internet in which images can be transferred, viewed, and patient imaging
and data can be joined together, enabling a holistic patient health record by unifying reporting
and imaging.

It's clear that with MACRA and other
large initiatives that require a lot of
overhead to eectively implement
just the record-keeping of it all, that
consolidation is inevitable. Interop-
erability is critical.
MORRIS PANNER
At a macro level, industry regulation, and industry
consolidation is creating a greater need for interoperability,
integration, and exchange of data, from patient records, to
imaging, across private practices, health systems, imaging
centers and more. Siloed systems are no longer good enough.
Its why cloud VNA has moved to the fore.

Cloud VNA is being embraced by providers in several dierent areas, from ease of image access
and sharing, to improving business continuity, and disaster recovery.

Adoption is often taking a hybrid approach, with Tyler noting

that they use a traditional PACS solution within the At some point, everyone is probably
department at New England Baptist, but rely on cloud-based going to end up with some sort of
to get imaging out to the rest of the world. It's easier to cloud-based VNA system.
manage, and it costs a lot less to provide access, without TYLER MARTIN

the need for complex desktops and VPN connections.

Tyler even sees opportunities to bypass the PACS system completely in some cases, where
modalities can all send to the cloud VNA, so the radiologist can at least still give preliminary reads,
or a full read if they need to, while waiting for the traditional PACS system to become available.

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Opportunities to Apply Machine Learning and Articial Intelligence

Healthcare providers have been incentivized by a series

With PAMA, health systems and groups
of government legislation from the American Reinvestment
will be judged based on 2017-2018
and Recovery Act (ARRA), to the Health Information performance, and that will aect how
Technology for Economic and Clinical Health Act (HITEC), they get paid and reimbursed in 2019.
and now the Protecting Access to Medicare Act (PAMA), DR. SAFWAN HALABI
to deploy Clinical Decision Support (CDS) systems.

In our poll, 78 percent of attendees saw multiple opportunities to apply intelligence to healthcare,
including improving workows, monitoring patient follow-up, and linking radiology & pathology
reporting.

HOW DO YOU THINK ARTIFICIAL INTELLIGENCE COULD TRANSFORM RADIOLOGY IN 2017?

Monitoring physician
follow-up
6%

Link radiology &

pathology reporting
All of the above 3%
78%

Automating workows
like patient matching
13%

There's this fear that machine learning
and articial intelligence will replace
physicians, but I really think it'll augment
what they do.
TYLER MARTIN
The panel noted that new technology such as machine
learning and AI may be used to augment decision making.
Dr. Halabi sees opportunities for aiding in detection of
disease, either with imaging, or even prior to imaging, by
predicting which patients really do need to be seen rst.

For example, who needs a mammogram, or at what age should they get it. Its a future he notes,
where we can predict where patients need to be, or who they need to see, what interventions
need to be done, or what screening they need to have.

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Tyler sees other ways to apply the latest technology, to use
intelligence and automation to improve workows. By
streamlining image routing at NEBH, getting images in,
routing them instantly to the right departments and people,
theyve improved both administrative and physician
eciency.
Workow automation has helped us
reduce manpower on the administrative
side. And its drastically helped get
patients through the imaging depart-
ments a lot quicker for studies.
TYLER MARTIN

Conclusion
Its an exciting time for radiology. New technology, more
Technology innovations like cloud engaged patients, and a shift to being more integrated
medical image management, or into the overall patient journey as a whole are changing
articial intelligence can help us the role of radiologists.
move from what is fundamentally a
fee-for-service world to a world that Its clear that technology opens up new opportunities for
no longer just rewards volume.
radiologists to make the move to being more connected
MORRIS PANNER to patient care. Its better for patients, providers, and
ultimately for radiologists too.
Patient portals provide a powerful bi-directional way to engage with patients, from patients
uploading their studies, to radiologists providing curated reads directly to them. Cloud-based
VNAs open up new avenues for receiving, viewing, and sharing imaging. And workow
automation and machine learning promise to lighten the administrative burden, and augment
some aspects of decision making.

ABOUT AMBRA HEALTH

Ambra Health is a healthcare cloud company dedicated to making digital medical image
management accessible to all, from anywhere. Our powerful cloud-based suite streamlines the
medical image exchange process and connects patients, care providers, and facilities worldwide.
We work with some of the largest hospitals and health systems such as Stanford Children's
Health, Weill Cornell Medicine and Memorial Hermann as well as private practices, imaging
centers, clinical research organizations, and health information exchanges. Discover what the
power of the cloud can do for your healthcare enterprise at ambrahealth.com.