It’s the Platform, Stupid

“The majority of calls to a reading room do not need to be answered by a radiologist, or at least not immediately,”

University of Iowa Hospitals & Clinics radiologist, Dr. Colin P. Derdeyn, in support of the providers’ decision to hire a reading room coordinator.

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It’s the Platform, Stupid
“So the No. 1 takeaway from the 2019 JP Healthcare Conference is this — for healthcare providers, there is a major shift taking place. They are moving from a traditional strategy of buying and building hospitals and simply providing care into a new and more dynamic strategy that focuses on leveraging the platform they have in place to create more value and growth via new and often more profitable streams of revenue. Simply stated, the healthcare delivery systems of today will increasingly leverage the platform and resources that they have in place to become a hub for both health and healthcare in the future.”

This is from Strata Decision Technology CEO Dan Michelson in Becker’s Healthcare Review, who boiled down the conference’s 25 presentations into the idea that providers are increasingly shifting towards serving as community health and healthcare hubs, and “now is the time (for the other providers) to get started” on their own shifts. Michelson suggesting that many providers have already completed three of the four foundational steps of a platform shift (1. start with a small niche, 2. built an audience, 3. built trust) and are now in the position to add value on top of the platform they’ve created (whether they know they created a platform or not). However, the “adding value” part is really more than just one step, as the providers who’ve successfully executed their platform shifts have done so by: building “digital front doors,” driving patient affordability, tackling social determinants of health, creating partnerships for healthcare innovation, becoming the hub for targeted services and chronic conditions, and leveraging applied analytics. The good news for larger providers is this shift plays to their strengths (big, diverse, etc.), which isn’t always the case with shifts in other industries (often favor new, more nimble companies), and those interested in taking advantage of this platform shift should check out Michelson’s review.

Ultrasound-Guided Diffuse Light Tomography
Washington University researchers are using $2m in NIH funding to understand if ultrasound-guided diffuse light tomography can help radiologists differentiate cancerous from benign breast tumors, thus significantly reducing unnecessary biopsies, healthcare costs, and patient stress. The imaging technique may be able to capture a better image of blood vessels within a suspicious mass by combining a commercial ultrasound transducer (to locate the mass) and near-infrared optical imaging sensors mounted on a hand-held ultrasound probe (to capture total hemoglobin concentration in the mass). The scientists already found that the optical imaging technique would have reduced biopsies by 45% in a 288-patient retrospective study and will next hold a 300-patient clinical trial (comparing vs. mammography) and a second smaller trial (comparing vs. contrast-enhanced mammography) to understand how results differ and whether the new technique will indeed reduce biopsies.

Chair-Level Burnout
Much ink and maybe a few tears have been spilled over radiologist burnout, and new research published in Academic Radiology reveals that this issue goes all the way up to academic radiology department chairs. In a survey of 87 academic chairs, 5% reported having all three high burnout symptoms (emotional exhaustion, depersonalization, or low personal accomplishment), and 38% reported high emotional exhaustion and/or high depersonalization, while only 25% respondents met the criteria for low burnout. That’s pretty bad. The researchers pointed to a lack of institutional support groups for chairs and fewer faculty members in radiology departments as significant burnout factors, although the position’s 62-hour average work week probably doesn’t help. These burnout factors are different than factors impacting other radiology roles, and may not be helped by many of the proposed burnout solutions (e.g. AI-delivered efficiencies, reading room coordinators), but they deserve a similar level of attention.

Three Sides on CT Lung Screening
A study from researchers at the MD Anderson Cancer Center and University of Florida found that clinical practice patients who receive positive CT lung screening exams have over two-times greater complication rates from related invasive diagnostic procedures compared to rates reported in the National Lung Screening Trial (NLST). The study looked at 344,510 clinical practice patients between 55 and 77 years-old who underwent invasive diagnostic procedures between 2008 and 2013, finding that 22.2% of patients between 55 and 64 experienced complications (vs. 9.8% NLST) and 23.8% of patients between 65 and 77 had complications (vs. 8.5% NLST). These clinical patients’ health complications also came with hefty financial costs, with a mean cost of $6,320 for minor complications and $56,845 for major complications. With that evidence, the researchers suggested that complications may be even higher in the “real world” and recommended that physicians advise patients of these greater risks as part of the shared decision-making process. That handles the first two sides. The third side of the CT screening debate came in the article’s comment section, where a surgeon questioned the study’s methodology and high complication rates, suggesting that few in the study group actually originated from screening programs but from a “sicker” population, and called for an end to shared decision-making in lung cancer diagnostics.

A Near Perfect Ultrasound Detector
“We’ve developed a near perfect ultrasound detector, hitting the limits of what the technology is capable of achieving.” That’s from a University of Queensland scientist in support of his team’s breakthrough ultrasound sensor that uses dual optical and mechanical resonance to achieve a previously unrealized level of sensitivity. The new ‘cavity optomechanical ultrasound’ sensing technology “far exceeds” the sensitivity of similar sensors that only use optical resonance and “surpasses previous air-coupled ultrasound sensors by several orders of magnitude,” potentially leading to new applications in biomedical diagnostics, autonomous navigation, and trace gas sensing. This level of visibility is a bit closer than many Imaging Wire readers need, but still amazing, as the sensor could allow scientists to measure the respiration of individual cells and bacteria, potentially changing how scientists understand biology.

The Wire

  • “Watson Health is a very important part” of IBM’s business. That’s IBM CEO Ginni Rometty insisting to frequent Watson Health critic, STAT.com, that IBM remains dedicated to Watson Health after an hour-long talk at CES 2019 where she “spoke little of healthcare.” This isn’t really news (and Rometty probably meant it), but this small quote spread across the internet and contributed to an ongoing storyline about the sustainability of Watson Health after a string of low-ROI acquisitions, high-profile layoffs, and executive departures.

  • Hitachi Healthcare announced plans to launch its new Trillium Oval Cattleya 3T MRI in Japan this May, suggesting that the new system will likely launch in Western regions sometime in mid-2019. The new system will inherit most of the features found in previous Trillium Oval models, including a 74cm bore and 4 channel/port RF irradiation design, while updating its operating software and adding a new QSM function used to measure concentrations of iron, calcium, and other substances in tissues based on changes in local susceptibility.

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