Commercial or Commodity? Which paradigm will position your health system for sustained leadership in radiology?

Successful commercial enterprises are led by individuals who challenge conventional thinking. They address short-term needs while dynamically positioning their organizations for future growth. The healthcare environment, including radiology,is in the midst of an era of unprecedented change as we transition from volume to value. As a result, health systems are taking many cues from commercial enterprise. Hospital and radiology department executives are now concerned about patient satisfaction and they are following customer service examples from commercial enterprises. Hospitals and imaging providers alike are also looking to dynamically expand services by creating stronger relationships with referring physicians, adding new service lines and even partnering with competitors. The climate of change will invariably result in the identification of numerous organizations that will be positioned for sustainable leadership in their communities and those that will not be positioned for growth.

In the short term, radiology executives in particular must focus on reducing costs and increasing process efficiency (eg, standardization) — all while improving outcomes. These objectives can lead to a commoditization approach, especially when it comes to diagnostic imaging. The conventional thinking would dictate that total cost of ownership should be the sole determining factor for new technology purchases. Our belief is that imaging technology can serve as a crucial link between diagnostic outcomes and economic success. With the right diagnostic imaging tools, radiology department executives can help their organization:

• improve outcomes with access to better information;
• reduce costs and provide opportunities for greater standardization; and
• cost-effectively extend services so your health system plays an integral part in the well-being of its population.

Computed tomography (CT) is a nearly ubiquitous tool that helps healthcare organizations diagnose conditions quickly and more accurately; CT can also be staffed at all hours. For years CT has been the reference standard to answer some of the most urgent clinical questions: Is it a hot appendix? Why is the patient experiencing shortness of breath? Is the stroke resulting from ischemia or from a hemorrhage? These are the types of questions that have significant impact on key performance measures, such as the quality of inpatient admissions, improved diagnostic outcomes, and less likelihood for readmissions.

New CT scanners with fast acquisition speeds make exams easier for those patients who are unable to perform a breath hold. Siemens also provides automated tools to help technologists confidently adjust scan parameters to perform low-dose imaging. This leads to less intra-technologist, intra-shift variation, which allows for workflow consistency across the organization and can help reduce overall radiation dose.

New technology benchmark

This year, radiation dose continued to be an important topic as we saw the establishment of the NEMA XR-29 Smart Dose Standard (XR-29). The standard affects CT scanners being used to image Medicare patients. To summarize what is required, these scanners must include pediatric protocols, DICOM structured reporting, Dose Check and automated exposure control. These tools help ensure a safer procedure. Starting in 2016, there will be a 5% reduction of Medicare reimbursements for imaging procedures using non-compliant technology. In 2017 and beyond, the penalty will increase to 15%.

Across the industry there are significant numbers of scanners in use today that were purchased in 2007 or earlier, and some of these systems simply cannot be upgraded. Siemens is doing everything possible to help customers comply with XR-29. We have announced that 90% of our non-end-of-support installed base can be upgraded at no charge.

Moving to XR-29 compliant technology should be about more than protecting Medicare reimbursement. We view this as an opportunity to move to CT technology that brings advanced diagnostic functionality and that positions the organization to become a leader in population health initiatives.

Dual energy is ready for prime time

Chief among the benefits of new CT technology is the ability to derive even more diagnostic value thanks to greater clinical utilization of dual-energy imaging. Siemens Healthcare pioneered the concept in 2005 when we released the first CT scanner with two X-ray tubes and two detectors. Dual-energy means that a CT technologist acquires images using two different X-ray energy settings, making it possible to observe different tissue characteristics.

In 2005, the approach was exciting but used sparingly in academic and research settings. Today, there is more widespread adoption because the technique can be replicated on single-source scanners, which comprise the majority of CT scanners sold today. The Siemens approach to dual-energy focuses on true dose neutrality. We believe that whether using the reference-benchmark, dual-source dual energy, or single-source dual energy, the additional diagnostic information should not be delivered with a dose penalty to the patient.

Dual-source dual energy has significant clinical potential. For example, using the Liver Virtual Non Contrast application, it is possible to generate an unenhanced liver image, from an enhanced dual energy image, without additional scans. The resulting image helps healthcare providers better characterize liver lesions.

Or take the case of a stroke work up, a patient might receive a cranial CT study to rule out hemorrhage. Using Dual-source dual energy Brain Hemorrhage, a virtual non-contrast image can be generated from a contrast-enhanced dual energy scan — saving time and helping healthcare providers better differentiate old and new intracranial bleeds.

When assessing any CT scanner for its dual energy capabilities, these three criteria tend to be most important:

1. crisp images with the option for even sharper contrast and significant metal artifact reduction;
2. no extra dose in either single-source or dual-source dual energy scans; and
3. broad applicability to address the widest range of clinical questions and patients.

Focusing on your patients

Siemens Healthcare has new CT solutions that can be installed in settings that would not have been considered in the past.

Consider the intensive care unit, which is usually situated on the top floor of the hospital. Transporting patients from the ICU to the imaging department is a challenging, time-consuming task. Siemens has solutions that can bring imaging services directly into the ICU, which alleviates the need for patient transport, improving workflow, clinical decision making and patient safety.

Many hospitals are also looking to expand services with freestanding emergency rooms. This approach aims to offer similar quality to the hospital emergency room in a less crowded, more patient-focused setting. These entities can help expand the hospital’s footprint and they are required to include imaging modalities like CT, X-ray and ultrasound. Siemens can also install a CT scanner onto a mobile RV-sized vehicle which will enable CT imaging services to go where patients need them most, such as underserved rural areas. With siting in an RV-sized vehicle, the complexity and cost of delivering mobile imaging is reduced because a CDL driver’s license is not required. Such a solution can have an especially significant population health impact through improved access to earlier detection for diseases such as lung cancer which is playing an increased role in reducing overall mortality associated with the disease.

In trauma settings Siemens can install CT technology that slides into the trauma bay. Oftentimes trauma patients cannot be imaged because there is not enough time to transport them to radiology. Siemens can bring imaging to the patient so trauma surgeons are no longer flying blind. How much more effective can trauma surgeons be with immediate access to image guidance?

Conclusion

Healthcare organizations are already adopting commercial approaches to drive how they interact with patients. Customer service is key. Adopting new imaging technology should be viewed as a similar customer service initiative. With the combination of an ideal total cost of ownership, and the opportunity to bring imaging services to some of the most challenging patients — while improving diagnostic confidence and outcomes — Siemens is your technology partner. We deliver sustainable healthcare technology that will help your organization stand out as a leader in the community.