We all know that health care is evolving. The traditional fee-for-service model focused on quantity is being superseded by a value-based model focused on quality, with some sources projecting that more than two thirds of payments will be value contingent in the next five years. To help radiologists thrive in this new paradigm, the American College of Radiology has launched ACR Imaging 3.0 — a road map and corresponding service and technology tool set that radiologists are using to chart the course in this new frontier of medicine.

Imaging 3.0 is the culmination of radiology’s long history. It began in 1895 when German physicist Wilhelm C. Rontgen discovered that under certain conditions, cathode rays could produce a new type of rays, which he dubbed X-rays. We refer to the period from Rontgen’s breakthrough to the introduction of the helical CT in 1990 as Imaging 1.0. Since then, radiology has advanced exponentially with improved modalities and the advent of digital imaging and PACS. But even as the demand for radiology has soared in this Imaging 2.0 era, the industry has faced challenges with rising health care costs, unnecessary radiation exposure, and the threat of obscurity for radiologists, as many have focused on imaging interpretation in back office reading rooms rather than consultation directly with referring physicians and patients.

The Imaging 3.0 initiative resolves those challenges by taking radiologists beyond their reading rooms to maximize their value throughout each episode of imaging care: from the time a referring physician considers imaging to the point that the radiologist delivers actionable clinical recommendations. It outlines the path to high-quality medicine by ensuring appropriate imaging, documenting the value of radiology in patient care, empowering patients through information, and positioning radiologists as leaders in health care reform. In short, Imaging 3.0 is a guide to the future of radiology.

To advance along the Imaging 3.0 path, radiologists will need robust solutions that go beyond the throughput-based strategies used in the Imaging 2.0 world. A workflow platform that emphasizes measurable quality, external integration, and radiologist presence will be critical for success. Within that workflow, radiologists will need tools that ensure imaging appropriateness at the point of order, provide evidence-based guidance throughout interpretation, and integrate their findings and recommendations seamlessly into the patient care process. To that end, the ACR is working with industry professionals to facilitate a new generation of IT solutions — from clinical decision support to actionable reporting — that provide radiologists with the tools they need, precisely when they need them, for integrated patient-centered care.

Next Generation IT Solutions
What do we expect from this next generation of IT solutions? Imaging 2.0 saw incredible advances in technology, including the development of RIS and PACS that helped radiologists meet the exploding demand for imaging. Now, vendors are challenged with evolving these systems further to meet the demands of Imaging 3.0. In doing so, they must pay particular attention to developing imaging life- cycle and care-continuum solutions that emphasize evidence-based decision making, actionable results, integration with non-radiology systems (most notably the EMR), demonstrated accountability through metrics, and active communication and information sharing between radiologists and both referring physicians and patients.

By way of example, we can examine several stages of the imaging life cycle, beginning with the ordering process. Concerns about imaging over-utilization, defensive medicine, and radiation exposure contribute to the need to better manage the ordering process. Since ordering the right test at the right time is essential to improving patient care and decreasing long-run costs, we must look for solutions that optimize this process. At the ACR, we are working with vendors to implement a solution known as ACR Select — a clinical decision support system that uses the ACR Appropriateness Criteria, established evidence-based imaging guidelines, to rank the appropriateness of tests based on given clinical scenarios.

The goal of decision support at the time of order is to eliminate inappropriate imaging and initiate dialog between radiologists and referring physicians about imaging appropriateness. Distributed by National Decision Support Company (NDSC) on the ACR’s behalf, NDSC is integrating the ACR Select solution into EMRs and other point-of-care ordering applications to bring real-time evidence and radiologists’ expertise to a critical point within the care process. Not only does this process ensure evidence-based decision making, but it also aggregates data about the ordering process, which hospitals can use to better understand their ordering metrics and why variations may occur within and across facilities. Additionally, integration with the longitudinal health record has the potential to provide data that health systems can use to gain insights into the impact of diagnostic imaging on patient care.

The need for advanced Imaging 3.0 IT solutions extends beyond ordering to imaging interpretation and reporting. Radiologists need tools that will bring evidence-based information to bear in real time during the interpretive process. Industries ranging from finance to logistics are already benefiting from having access to real-time information. For radiology, natural language processing, advanced search strategies, and other tools will give radiologists access to the latest high-quality evidence when it’s needed most — during imaging interpretation.

Tools for conveying the results of the interpretative process must also evolve so that the information can be consumed by a variety of down-stream systems. Reporting strategies that are structured, actionable, and ultimately integrated into the EMR will be important for driving the subsequent steps in the care process such as alerts and patient scheduling. Integration with the EMR is critical for realizing the value of these data and promoting the necessary collaboration, consultation, and follow-up with referring physicians. It is also essential for communicating with patients, who are increasingly putting a premium on having the ability to easily access their personal medical information, including imaging results, as well as general information about their diagnostic and treatment options

The ACR is engaged in several efforts to help facilitate the flow of information and encourage the evolution of the Imaging 3.0 ecosystem. One such effort, ACRCommon, is a framework of common clinical radiology terms that will improve communication by eliminating the inconsistent language that is currently used at most institutions. In addition to allowing vendors to consume guidelines and recommendations within their applications in context, this standard lexicon will make it easier to track metrics and compare exam results across and among institutions. Another program aimed at improving communication, ACRConnect, will allow vendors to integrate their products — including EHRs, imaging modalities, and PACS — directly with key ACR programs and content repositories (e.g. national registries). This interface will allow radiologists to exchange images and data seamlessly with the ACR for accreditation, research, and other programs that require data aggregation or feedback.

On The Horizon
As with most industries these days, healthcare and radiology must find ways to connect the right people to the right information at the right time. Data must be structured so that both activities and outcomes are measurable. Stakeholders demand it and process improvement depends on it. At the same time, interpersonal communication is at an all-time premium. As we transition to value-based models, demonstrating value in discernible and measurable ways will be critical.

As always, change brings about both challenge and opportunity. As we transition to Imaging 3.0, we are challenged with advancing some of the strategies and tools that have made imaging a successful and critical component of healthcare. At the same time, this presents an exciting opportunity to take technology to the next level to develop tools that will help radiologists, institutions, and patients thrive in the emerging healthcare system. These tools will do more than provide efficiencies and enhance throughput; they will raise the standard of quality, as is necessary to flourish under the value-based model. The ACR is at the forefront of developing and facilitating the solutions that will carry radiologists over the threshold and into the Imaging 3.0 future. Vendors and institutions that integrate the solutions will have an advantage, but ultimately the ones who will benefit most will be those at the center of it all — the patients.

About the author: Mike Tilkin is the chief information officer and executive Vice President for Technology at the American College of Radiology. He has been engaged in leadership roles across the evolving Health IT landscape in areas that range from policy to implementation.