Dr. Shrestha is Vice President, Medical Information
Technology, University of Pittsburgh Medical Center, Pittsburgh, PA; and
Medical Director, Interoperability & Imaging Informatics,
Pittsburgh, PA, and Mr. Kalafut is the Director of Operations, NextGeneration Imaging, GE Healthcare, Pittsburgh, PA.
Disclosures: Dr. Shrestha is a Founding Member Executive Advisory
Program at GE Healthcare, is on the Medical AdvisoryBoard of Nuance,
Inc., and Vital Images, Inc., as well as on the Editorial Board of
Applied Radiology, and the Advisory Board of KLAS Research.
Alone we can do so little; together we can do so much.
is a classic Zen kōan that asks: “What is the sound of one hand
clapping?” Often given to students to aid in enlightenment by leading
the mind into a cul-de-sac with no way out but enlightenment, the kōan
is both the object being sought and the relentless seeking itself. Ina
kōan, the self sees the self not directly but under the guise of the
kōan. Enlightened yet?
Think about it. While the classic Zen kōan
has no real answer, it provokes many questions when it comes to the
power of partnerships.One hand cannot clap without the other. Indeed,
clapping is a process that involves 2 hands. What radiology needs is to
aim for these exuberating outcomes that can best be brought about by
alliances in the form of true partnerships. Perhaps what radiology needs
is enlightenment birthed by meaningful partnerships every which way
As radiology professionals from every corner of the
world coalesce in Chicago for yet another grand RSNA annual meeting, the
“power of partnership” is a powerful theme that asks more than it
answers, that inspires as much as it directs. Across science, education
and technology, the opportunities abound more when groups collaborate
and really come together in sharing, doing, dreaming, and achieving.
Gang up on the problem, rather than each other
come in all shapes and sizes. Valuable and meaningful partnerships can
be fostered and should be sought after across a variety of groups. These
could include groups and teams within the health care organization,
smaller groups across disciplines, such as clinical and research, or
across industries in health care and beyond. Partnerships could be with
organizations, vendors or even perhaps competitors(“coopetition”).
Indeed, collaboration and partnerships can take all shapes and forms,
and could be local, regional, or international. In this cut-throat
competitive landscape of survival-at-all-costs, the seemingly natural
norm is an “every-man-for-himself” stance that borders on a
fight-or-flight instinct. However, to truly leverage the power of
partnerships, one has to completely reverse the traditional views of
competitive survival. For some, or perhaps indeed for many, this may be
an ‘unnatural act,’ but one that could reap many benefits. One could
argue that in this age, when we are all tasked with doing more with
less, collaboration and meaningful partnerships are a necessity for survival.
has been said that “the secret is to gang up on the problem, rather
than each other.” When businessman extraordinaire ThomasStallkamp said
this, he clearly formulated this thought on the basis of his years of
expertise leading change across many successful companies and boards.
Fostering partnerships as a strategic imperative can for some mean
committing to a new way of working together. But rather than viewing
this as a ‘quick-fix,’ organizations should see this as an ongoing
process and a business discipline.
Partnership for radiologists as a driver of value-based imaging
There is no doubt that change is coming to the world of imaging; both in the very way we practice the profession, as well as in the way imaging contributes value
back to health care. The spiraling costs of health care in the United
States are nonsustainable, and it has perhaps been rightly stated that
“advanced imaging is the bellwether for the excesses of fee-for-service
medical care.”1 There is a definite need to shift from a volume-based practice of imaging to one that emphasizes value across the care continuum.2
is evident, however, is that radiologists need to do a much better job
of partnering with the ordering physicians, the care team, and patients
in order to tip the value equation to their favor. Radiology as a group
is facing increasing threats of commoditization. The inordinate level of
focus on metrics, such as report turn-around time (TAT) and fee for
service provided, has made the radiologist into an invisible commodity
ready to be traded freely on price. This is directly contradictory,
however, to the notion of value-based imaging and accountable care,
where quality and care coordination are just as important as costs and
where risk sharing models are becoming the new norm. Radiologist
outreach programs need to be put in place, and radiologists should be
incentivized to forge meaningful relationships with referring cohorts.
The key to bringing value back to radiology is to foster these
partnerships, and seek improved intradepartmental and cross-specialty
collaborations that firmly enhance the value that radiologists rightly
bring to the care continuum. In creating these valuable partnerships,
radiologists have an opportunity to be fully engaged with emergency
physicians, hospitalists, and primary care physicians (PCPs) as part of a
collaborative solution towards appropriate image utilization and
A partnership is not a purchase order
a more macro level, many success stories in the world of business can
actually be attributed to successful partnerships. Even in the imaging
industry, we have seen successful models of industry partnering with
health care organizations and universities to not just capture new
technical knowledge and validate assumptions, but also to truly innovate
and connect with care settings and improve patient-health outcomes. It
is often in these rich partnerships that products are not just built,
but perfected through iterative processes. The more invested the
university or health care organization is into the partnership, the more
the chances of success. The same is true for the industry partner. The
successful transformation of an alliance to actual results often takes
discipline and is best done in environments that foster creativity,
teamwork, and cyclical-development amidst a framework that interweaves
specific discipline to create value from ideas generated and validated
in these partnerships. For these endeavors to thrive, both parties must
trust each other.
Every sales quarter, we see an overuse of cheesy
phrases, such as ‘strategic partners.’ Cutting a purchase order is
clearly “strategic” for the vendor as a means to an end for the sale of
their products or services. And while a signed purchase order may create
a vendor-customer relationship that may even end up with a positive
return on investment (ROI), this should not be confused with true strategic
partnerships.Not every vendor-customer relationship is ripe for a
strategic partnership, since this type of partnership often calls for a
framework that is the opposite of executing against a predefined
contract. Often aided with a set of core goals and incentives that are
meaningful to both sides of the partnership, the most successful of
these alliances actually foster flexibility, agility, open
communication, and joint decision-making.
Is the dog wagging yet?
Morgan, Mates, and Chang published an editorial in the June 2006 issue of Journal of Digital Imaging addressing
the incentive misalignments between health care providers and imaging
vendors. To date, there have not been too many incentives for vendors to
dedicate scant R&D resources toward quality applications and
technologies that cannot directly factor into an immediate ROI in a
fee-for-service paradigm. However, in 2013, the landscape is arguably
much different. Morgan et al suggest close interaction and collaboration
between vendors and the user community as a path to ensure the right
product is being built to address the right market and patient needs and
to “put the wag back in the dog.”
In recent years, many
progressive vendors in health care IT have adopted “agile” development
methodologies perfected by the broader software development industry. To
develop imaging IT products in an agile fashion, it is critical that
radiologists, technologists, PACS administrators, and other users
continuously remain engaged and provide candid feedback and live
testing. Cycle time can be substantially reduced and work that does not
add value can be eliminated. This can only happen, though, if the users
are open-minded and willing to truly partner in the development process.
There is no magic formula for devising
the right types of partnerships, but there is also no doubt that
meaningful and well-aligned partnerships could transform the face of
radiology as we know it today. With a positive, persuasive, and
collaborative approach, synergistic partnerships based on mutual respect
can be incentivized for success. Crafted correctly, these partnerships
enable organizations to be nimble. Decisions can be made faster, can be
of higher quality and can be customer driven. As Henry Ford rightly
said: “Coming together is a beginning, staying together is progress, and
working together is success.”
- Iglehart JK. Health insurers and medical-imaging policy—a work in progress. N Engl J Med. 2009;360:1030–1037.
- Shrestha RB. Accountable care and value-based images: Challenges and opportunities. Appl Radiol. 2013;4:19-22.
- Morgan M, Mates J, Chang P. Towards a user-driven approach to radiology software solutions: Putting the wag back in the dog. J Digit Imaging. 2006;19(3):197-201.