How has the COVID-19 pandemic changed priorities in medical imaging?

In light of the sea change in healthcare brought about by the COVID-19 pandemic, PARCA eNews is taking a different approach to its first issue of 2021. Instead of the usual Q&A with a single leader in PACS administration and healthcare IT, we decided to contact a variety of thought leaders from industry, academia and professional organizations to ask a single question – How has the COVID pandemic changed priorities for enterprise imaging and imaging access for radiology departments not just during the pandemic but into the future? Below are quotes obtained by email or excerpts from articles written by the contributors on this topic.

It was clear very early in the pandemic that the systems which had access to data fared better than the ones that did not. Also, during the year, we have seen a remarkable reprioritization of many of the perquisites of digital transformation – like interoperability and increased emphasis on analytics. This is no surprise. Data became more “real-time” as the months wore on and more granular in nature as attempts were being made to manage smaller and smaller geographies to avoid the significant economic effects associated with global country shutdowns. – excerpt from HealthcareIT News article by Dr. Charles Alessi, chief clinical officer at HIMSS

We know that COVID is primarily a respiratory illness with secondary impacts on other organs such as the brain, kidney and liver. Radiology imaging is critical to diagnosis, treatment and post-acute monitoring. This data is accumulating in volumes, and this velocity of data must be readily available for treatment for individual care as well as public health. While data interoperability was previously seen as an existential threat, we now know that the threat of data silos is real and has existed for way too long.

While the smaller community hospitals and provider institutions have been able to get by using the familiar methods such as burning images to a CD, they are now waking up to the fact that these methods are no longer adequate and, more importantly, are detrimental to patient care and infection control. – from email interview Life Image VP of Growth Judy Chong

The few short months at the beginning of 2020 marked a stunning sea change in how Americans used virtual technologies. Early evidence points to high patient satisfaction rates with remote visits, increasing the demand for telehealth and related technologies post-pandemic.

The Department of Health and Human Services reported that within months, nearly half (43.5%) of Medicare primary care visits were being provided by telehealth

, compared to only 1% prior to the pandemic. This rapid growth occurred across the healthcare spectrum. Private insurers saw similar telehealth usage growth, and even acute care patients began using virtual technology to interact with loved ones as hospitals barred most visitors. This incredible shift to virtual modalities coincided with shifting most white-collar work and most schools to online platforms.

Hospitals and other healthcare organizations should prepare for changes to business driven by this shift, recognizing that competition from non-traditional players, such as direct-to-consumer telehealth services, constrains their ability to own and control these new delivery pathways fully. – excerpt from HIMSS article by Robert Havasy, Senior Director, Connected Health and Rod Piechowski, Vice President, Thought Advisory, HIMSS

We do not know yet what the new normal would look like, however I think we do agree on the fact that COVID-19 has not only exposed the vulnerabilities in our healthcare system, its operations and infrastructure set up, but also the need for radical change how we deploy secure and modern platform ecosystems.

I strongly believe that this phase of transitioning out to the “new normal” will provide critical lessons learned in relation to how health systems prepare themselves before returning to business as usual. 

Radiology departments, while they have seen significant decline in certain diagnostic procedures due to the focus on COVID-19 related hospital visits, with the need to work remotely and in self isolation, have also mandated the need for secure and modular industrial scale enterprise imaging platforms.

It was obvious that while COVID-19 was being evaluated from a diagnostic radiology perspective, and capabilities of PACS, COVID-19 related AI initiatives would pop up as well. While there have been few initiatives that are still works in progress, one thing is for sure, the utility of AI within existing PACS will require workflow integration, and that’s where I see the enterprise imaging platform standing out with its secure and modular ecosystem.

Technology providers who have built an enterprise imaging platform for modularity have already demonstrated several successes during this pandemic. At short notice, these providers are fulfilling requests of customers ranging from at home workstation setups, image exchange and real-time collaboration to 100 percent remote supported go-lives.

As the silos of data and diagnostic imaging PACS systems are being collapsed and secured, the modular enterprise imaging platform approach is gaining significance, as it offers systemness (sic) and security. – excerpt from ITN news article by Dr. Anjum Ahmed Chief Medical officer and Global Director of Innovation, Agfa HealthCare

The pandemic has quickly increased the adoption of new technologies and will change the way radiology departments work also in the long term. It has produced growth in a few areas, including the greater use of distributed workflows. However, radiologists are facing increasing workplace pressures that can lead to decreased job satisfaction and burnout.

The increasing complexity and volumes of cases and increasing numbers of noninterpretive tasks, compounded by decreasing reimbursements and visibility in this digital age, have created a critical need to develop innovations that optimize workflow, increase radiologist engagement, and enhance patient care.

With the ongoing demand for imaging, evolving patients and physician expectations and multiple challenges from the pandemic, opportunities to build efficiencies in imaging workflow is paramount. Service to patients and providers and reducing patient wait times should be at the front and center of imaging operations. For example, clustered scheduling, self-scheduling, and shorter scanning protocols can empower patients and minimize patients time in the facility while improving access to high value imaging test.

Standardize imaging operation at each site to mitigate quality and safety concerns. Along with expanding imaging service hours, we must consider investing in mobile solutions for screening mammograms, ultrasound and based on the needs and geography, also for CT and MRI modalities.

Workload balancing with site-specific exam scheduling such as screening exams and elective less complex imaging at the ambulatory sites can maximize efficiency. Minimizing patient no-shows, same-day cancellations and leakage to outside facility can exacerbate the challenges for imaging operation and handing demand.

Similarly, its wiser to continuously monitor performance and success through certain key performance indicators (KPI) and deliverables. Telehealth has rapidly expanded during the pandemic.

We envision a scaled down remote radiology reading capabilities to be deployed post pandemic as it affords needed flexibility to the faculty to support their professional and family needs. Similarly, teleconferencing technology to teach residents, provide consultation, support multidisciplinary conferences, to participate in the faculty meetings and other events will continue to grow.

To mitigate long term risks, it is also crucial to explore investments in the advanced information technology solutions and automations. In addition, build partnerships with other interdependent departments to build some contractual obligations. – from email interview Dushyant Sahani MD. Professor and Chair of Radiology, University of Washington

I don’t think patients or providers are going to tolerate spending hours in traffic to accomplish in person what we know can readily be achieved remotely even after the pandemic is over.

The pandemic caused our telemedicine visits to skyrocket nearly overnight. With that came a more urgent need for patients and other facilities to be able to share imaging performed elsewhere with orthopedists, cardiologists, and neurologists who depend on imaging to make their clinical decisions. Despite the efforts of the leading image exchange vendors and partially because EMRs or regions haven’t invested in imaging interoperability, image exchange is far from an automated process. 

 In our system, the pandemic forced us to align systems, procedures, and resources to enable to facilitate incoming imaging directly from patients and other facilities as the number of telemedicine visits grew rapidly. We are still working on optimizing these workflows. Telemedicine and the needs for efficient imaging exchange are not going away any time soon. We anticipate prioritizing image exchange at the enterprise level for some time to come.

As we socially distanced reading room, our reliance on remote reading capabilities with robust collaboration software increased. More of our radiologists and reading room coordinators were working remotely than ever before. We redoubled our efforts to make sure more radiologists had robust equipment at home and that the entire team – including reading room coordinators, radiologists, administrators, and technologists were well connected through a common collaboration platform. 

Even with a fraction of radiologists on site in reading rooms, we have been able to keep up with volumes, which are now at pre-pandemic levels. We anticipate remote reading will continue to be a part of our strategy even after we have dealt with the pandemic. – from email interview Nabile M. Safdar, MD, MPH, Professor and Vice-Chair of Informatics, Dept. of Radiology and Imaging Sciences, Emory University