Enterprise Imaging: Transforming radiology with the power of partnership

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Alone we can do so little; together we can do so much.

—Helen Keller

There 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 possible.

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

Partnerships 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.

It 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

What 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 improved outcomes.2

A partnership is not a purchase order

At 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.”


  1. Iglehart JK. Health insurers and medical-imaging policy—a work in progress. N Engl J Med. 2009;360:1030–1037.
  2. Shrestha RB. Accountable care and value-based images: Challenges and opportunities. Appl Radiol. 2013;4:19-22.
  3. 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.
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Enterprise Imaging: Transforming radiology with the power of partnership.  Appl Radiol. 

About the Author

Rasu B. Shrestha, MD, MBA, and John F. Kalafut, PhD

Rasu B. Shrestha, MD, MBA, and John F. Kalafut, PhD

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.

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