Radiology is not ruined, it just doesn’t know what it is

Robert Wachter recently published a book exerpt, Has Technology Ruined the Radiology Profession? The basic idea is that technology, first seen as a boon to the profession of radiology, has actually eroded its value, perhaps to the point of replacing radiologists with machines. It’s a cautionary tale, meant to warn the rest of medicine of the risk of the EMR.

I think it’s true. Technology has changed radiology in perhaps foreseeable but unforeseen ways. But it’s no different from many other industries – newspapers, video rental companies, the music industry. Technology changed the nature of the market and the existing companies failed to adapt to those changes.

Blockbuster saw itself as a video rental company. DVD or VHS, it saw itself as a place where people pick up a physical source of entertainment and borrow it for a while, for a fee. Netflix, on the other hand, appears to see itself as a home entertainment company. And that different definition allows it to shift to streaming or content creation. While Blockbuster…well, we all know what happened to that.

The old monopoly of the local radiology department is gone, busted up by technology. So what does your radiology department want to be now? And on what basis should you compete?

Some seem to be competing on speed. Fast turnaround time, perhaps with the added benefit of subspecialty reading – so speed and quality. That’s fine, but there’s an upper limit to how fast the turnaround time can be. It still takes time to view and interpret the exam. And as the interpretations get quicker and quicker, there’s a diminishing value to them. The medical process only moves so quickly, and at some point your customers don’t care if it comes in 20 seconds faster; they can’t consume the product any faster than they already are. So what do you do when you’ve maxed out on speed? Perhaps price then – speed, with a dash of quality, at the lowest price. But there aren’t many winners at the low price game, and you better be able to beat the giant companies with radiologists tethered to their home workstations pounding out studies, or perhaps departments working in countries where they can pay radiologists a fraction of what they would make in the US.

What about quality? Maybe you don’t just have subspecialists, you’re an academic center with the best of the best. You can argue that your interpretations are more accurate and complete than anyone else’s. That can work, but just remember that quality is in the eye of the consumer, not the creator. A report that you are proud of may be seen as useless because it’s hard to understand. Or perhaps you correctly point out the indeterminate nature of the findings, which are then scoffed at because of your “hedge”.  Quality, unlike speed, is hard to quantify. What makes your quality better than that of your competitor, who might be faster, or cheaper? If you are competing on quality, you need to understand how your customers perceive quality, understand what they are willing to pay for, and adjust accordingly.

Me? We’re competing on teamwork. We’re right there with you. We deliver what you need when you need it, but we are also ready to discuss cases with you, meet with you for your tumor boards, work on quality and workflow improvements, and whatever else the team needs. We are leaders in the organization even in areas outside of imaging. Because our product is not our study interpretations, our product is us. You can’t outsource teamwork, and you don’t want to. It remains to be seen if this strategy will work, but it’s what we’ve chosen.

Technology didn’t ruin radiology, it just changed it. How are you going to change to adapt to it?

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