Article – Insurers will have to change to survive

I have been very interested in the changes to how Radiology revenues will be affected during the shift from volume to value based reimbursement, along with changes to healthcare business models in general. I blogged about it here.

I have also been interested in how Radiology will have to change their behaviors in this new environment of transparency and empowered consumers. I blogged about that here.

In this article, a healthcare investment firm details how insurers will have to change in order to compete for mind share among consumers (with choice).

Another very interesting point they make is about wearables. I agree that they are only used by so called Innovators (from the Innovation Adoption Lifecycle model) today.

But what if insurance companies start offering incentives in the form of reduced policy premiums for people that use them (and share the data with the insurer perhaps). This is much like having a security system on your home lowers the cost of your theft insurance, or smoke detectors lowers your fire insurance premiums. This would create a boom in the mHealth sector, and would likely improve outcomes through early detection and correcting unhealthy behaviors.

I wonder: Will providers and insurers compete for who knows the patient best?

Providers have the EMR data (for encounters with their facility), and perhaps from an HIE (if they are part of one). Insurers have info from payment transactions spanning hospitals, clinics, pharmacies and others.

Where will the data from wearables go? If the insurers are buying (by lowering premiums), I will bet that they get it more often that the provider.

Will wearables and mHealth device vendors be savvy enough to provide it to both? Will consumer-controlled PHR vendors (or information aggregation and brokering tools) have an optimized method for getting data from all a patient’s devices and apps into EMR systems? Will the provider’s EMR or HIE be open enough to receive and store the wearable’s data without manual data entry (or copy-paste)?

Will patient’s be willing to share this personal info with providers and insurers? I will bet: yes.

If I thought the data would help my outcome, and I trusted my provider, I would share it.

If it was certain to lower my premiums, I would share the info with my insurer. If the insurer reserved the right to increase premiums based on info that my wearable provided (i.e. if I sit on the couch too long, my payment goes up), I might reconsider.

Will providers supply no cost (or subsidized) wearable and mHealth devices (or apps) to patients? Will insurers and providers share this cost?

So, how can wearables help in Radiology? Other than sending out reminders on where and when to show up for the exam, and what to do (e.g. eating, etc.) prior to the procedure.

Enterprise Imaging – New HIMSS-SIIM Workgroup

The discussion of so called Enterprise Imaging is a hot topic. So I was very excited to read about the newly announced joint workgroup between HIMSS and SIIM. I believe it holds a lot of promise.

In my experience, there is no lack of technical solutions for capturing, managing, discovering, accessing and viewing enterprise images and related information. The challenge is discovering and sharing the knowledge on best practices of how to put it all together and how to operate the systems that manage this information.

Like diagnostic imaging exams, enterprise images are part of the patient’s medical record, so understanding how they should best be incorporated into the EMR is very important. And this is not just a technical discussion, there are lots of issues around policies and governance of the data that organizations—not their vendors—have to get a handle on.

This is why this workgroup is so important. HIMSS knows all about EMR solutions, and SIIM knows imaging informatics. A perfect marriage.

Creating Practical Value in Practice (of Radiology)

There is a lot written these days about the shift from volume-based to value-based in Radiology (and other medical specialties).

The thing is: volume is real easy to measure. And what gets measured, gets managed.

So, how do we measure value?

One can measure the time it takes to complete the report, sign it, and make it available to physicians and other members of the care team. Radiology practitioners call this Turnaround Time (or TAT). This is pretty easy to do.

We could try to measure whether the report is correct. In other words, is what the Radiologist concludes actually what is wrong (or not wrong) with the patient? This can be harder to measure, as it may take a lot of work to correlate many different data points, or a lengthy period of time for proof to be found.

There are a couple of activities that Radiologists, and other people working in the department, can do to improve the perceived value of Radiology.

In this article, a number of suggestions are made as to how to increase the visibility of Radiologists, as well as improve relationships and trust among other physicians and even patients.

And this WSJ article focuses on simply improving the clarity of the report by improving the language and writing skills of Radiologist. Seems obvious as to the value this would provide, when you read it, but how many Radiologists routinely attend training on how to communicate better?

While improving how Radiologists interact with the outside world—whether through better interactions or better writing—will help the Radiologist’s career, one would hope that it would also improve care. Better communication certainly couldn’t hurt.

Article – SIIM: Experiment in web technologies points to future of health IT

Here is an article summarizing the way Cleveland Clinic is using REST-based APIs to solve real problems in their institution. Taken from a talk given by Mat Coolidge at the SIIM 2014 Annual Meeting.

My First Year as a Consultant – What I have Learned

It has now been over a year since I became a consultant. I have learned many, many things and met some amazing people. I thought I would share some of the things that I have learned.

What was the hardest part of becoming a Consultant?

In past roles, I had direct reports and responsibilities of deliverables and operations. I had authority to make decisions, within my defined scope of control. So, I would make decisions, and instruct people to act. As a consultant, you provide recommendations. You use words like “I have observed…” and “According to my evaluation…” and “It is my recommendation…”. It was not really all that hard to make the shift, but changing any habit takes work.

To be honest, becoming a consultant was never a dream of mine. What attracted me to it was the variety of interactions and the opportunity to work on interesting projects. And getting to choose who I worked with. I have been really lucky to work with some great people at my clients, so I am enjoying it quite a bit.

Why Hire a Consultant?

I have found three main reasons people engage a consultant.


They lack some important skill set in their organization for some short term project. An example is preparing and managing an effective RFP process.


Staff is too busy with the day-to-day operations to take on the work of an additional project.


There is a perception of bias among some stakeholders and they need an independent analysis and recommendation.

My Advice

Clients come to me with a wide variety of problems, but my overarching advice is usually the same. You need 3 things: To know (honestly and accurately) where you are; To know where you want/need to be, and; The right amount of talent to get there.

The first item can often be the hardest as our perceptions can skew our reality. The second requires some vision and input and collaboration from lots of viewpoints. The last sounds hard, but it is actually the easiest of the three. You just need the will to seek the talent and to commit the resources to getting it. If the first two steps are done right, the necessity of investing the resources is usually pretty obvious.

The first step to change is admitting that you can’t stay where you are.

Imaging Informatics Knowledge

I have found that there are a number of people that are skilled in HL7 integration (though still not enough to complete all the interfaces needed fast enough), but the level of knowledge in DICOM and IHE is less than I expected. A lot of problems can be solved if one understands the purpose of the information models and transactions that DICOM and IHE have built. The importance of ongoing learning in this area, such as by being a SIIM member and getting involved in that community, is more important than ever.

What is the best PACS (or VNA, or Enterprise Viewer, or other product)?

I get asked this all the time. The answer is always “it depends”. And, I am not trying to use consultant-speak, but it really depends on what you are try to achieve. If there was a one “best” vehicle for everyone, we would all be driving (or flying) it. Different products have their strengths and weaknesses. If you know your business goals, you can define requirements, and then assess the product (and vendor) as to the fit to your needs. Coming up with methods to verify vendor claims, and validate that the value claimed will be realized in your environment, is another important step in the process. The key is designing the right level of “test” (which will have a cost) for the level of risk that the capability represents.

In Closing

I actually learned a lot more than what I listed here, and am happy to share everything I ever learn …with my clients. 🙂 I will post a similar summary after Year Two and see what wisdom another year brings.

Article – Communities vs. Networks

I highly recommend that you read this very well-written article on the differences between Communities and Networks.

Upon reading, I immediately identified the networks in my life, and the true communities.

I have lamented the erosion of communities to make room for networks in my own life. And I (try to) make genuine efforts to keep my true communities together, but it is not always easy and too often people fail to see the purpose or value.

SIIM 2014 Reflections

Another SIIM Annual Meeting is in the books. As usual, it was a great event with tons of great information, discussions and networking.

Some observations…

  • There are some very bright folks working in clinical informatics that us imaging informatics folks should be collaborating with. They have cool stuff, we have cool stuff. We need to build bridges and keep each other informed.
  • Enterprise Imaging is slowly catching on. We need more details documented, such as exactly what values we should be putting into which attributes/fields for specific image types, but the overall message of the need for clear and consistent metadata along with the images is finally taking hold.
  • The vendors I spoke to were happy (happier than usual). It is no secret that SIIM is more about education, learning, networking and relationship building than high volume lead generation. It attracts thought leaders and people tasked with knowing how to get things done. Its members are loyal and have long careers in imaging informatics. Still, vendors that I visited seemed happy with the attendees that came through their booths. One emerging vendor closed a new customer on the exhibit hall floor (a first for them).
  • Hackathons are fun and a great way to learn about new technology. The SIIM Hackathon was a ton of work to pull off, but worth every minute. When you give smart creative people effective new tools, they can do amazing things in a short period of time. Seeing the applications and intgrations that the Hackathon participants completed in a few days (hours, in some cases) was great.
  • Twitter is not only a fun to interact with friends during the meeting, but also a great way to get key points of learning (in near real-time) for sessions that you could not attend. Twitter and climbing the SIIM Twitter Leaderboard ladder is also at the level of an addiction for some (you know who you are).
  • Long Beach is a great little place for a meeting.
  • SIIM meetings are very well run. The sessions rarely experience any technical issues. Speakers are well prepared. The agenda is clear and finding the rooms are easy. Sometimes we only notice when things go wrong, but fail to notice when they go right. SIIM staff has this ‘running a meeting’ thing down to a science.

That’s it for now. Already looking forward to SIIM 2015 in Washington D.C.

Going back to Cali (Long Beach, that is)

About to board a jetplane to the SIIM 2014 Annual Meeting in Long Beach California. Very much looking forward to seeing friends and colleagues, as well as learning lots and recharging with some great new ideas. A lot has changed in our industry since last year, so it will be an exciting meeting.

And I hope to get some sun while I am there. 🙂

Article – Corporate Acquisitions of Startups: Why Do They Fail?

This is a great article. With the rampant acquisition of smaller companies by larger ones that is common in the healthcare IT industry, and the inevitable slowing or death of product innovation and organizational momentum when they merge (read as: are absorbed), it is very useful to know why this happens.

On a related note, if you are interested in start-ups vs. established corporate vendors, check out my article on Where to Build It?.