The Diagnostic Imagination in Radiology

I read an excellent series of articles recently about the Diagnostic Imagination in Radiology by Rodney Sappington, PhD.

Rodney W. Sappington, PhD is a senior clinical data scientist, informatician, author, and healthcare strategist.  He is CEO of Acesio Inc., a disease insights company that leverages medical and non-medical data to better understand early indicators and inequities that lead to global disease incidence. He can be contacted at RodneyS@sappington-associates.com.

Screen Shot 2017-04-18 at 1.58.08 PM

Here is the third article in the series that I believe our followers will find interesting:

Executive Summary

  • The final part in this series addresses the impact of machine learning on jobs and expertise in radiology service.
  • Machine intelligence automation is a complex picture. There are trends moving in opposite directions.  One direction represents job reductions, another direction represents expanding opportunities and new types of jobs.
  • Computerization and machine intelligence together reallocate rather than displace jobs. The skills required to do and carry out diagnostic image interpretation will change rather than be replaced.

Dr. Sappington writes, “This final article in the series on the diagnostic imagination will examine job loss and shifting professional expertise in radiology. As a set of deployments, machine intelligence not only has a technical impact but social and economic implication.

Diagnostic expertise has been taught to radiologists for generations as a decade long right-of-passage based on extensive medical education and residency training. Radiologists have been trained to think of themselves at the center of pathology, anatomical, and functional diagnostic orders.  Their expertise (and cognitive and perceptual pattern recognition) is developed over years.

What’s been called the “The Fourth Industrial Revolution” by the World Economic Forum, challenges these medical training times and approaches.1  This socio-economic shift affects radiology but also the larger global economy.  Machine learning, advanced robotics, and biotech are some of the fields disrupting old lines of employment. In this revolution we’re seeing the time horizon shrink between training and employment and adapting to new skills. As the World Economic Forum states, 65% of our children starting first grade today will end up working in new job types that don’t yet exist.2 This accelerated training-to-employment cycle puts enormous pressure on planning for how jobs will shift, emerge, and disappear not tomorrow but next month, next year.  Between 2015-2020 it’s estimated that there will be a “total loss of 7.1 million jobs – two thirds of which are concentrated in routine white collar office functions, such as office and administrative roles – and a total gain of 2 million jobs, in computer and mathematical and architecture and engineering related fields.” 2  In economic parlance, this global disruptive labor market change and churn between job families and functions has significant import upon radiology.  Such features of radiology make it prone to disruption and job churn due to its fully digitized, networked, uses of Big Data, teleradiology, and under-realized application of real-time image analyses at the point of diagnostic interpretation.  Healthcare will be hit hard across specialties and organizations with automation, in part, due to machine intelligence but also changing demographics, market consolidation, and still unforeseen but volatile public-private reimbursement structures.  Radiology may be hit harder due to the digital maturity of its image archives, image compression, and cloud-based distributed services.

Rodney

As seen in Figure 1, we can begin to place healthcare in this global perspective of labor markets and jobs by industry.

The graph locates healthcare among other industries undergoing rapid change from machine intelligence in two respects: healthcare skills are the most likely to be disrupted among all industries and yet healthcare will retain some skill stability into 2020.

This tension will continue beyond 2020.  The number one barrier to leveraging machine intelligence for optimal clinical benefit and job creation, cites the World Economic Forum report is insufficient understanding of disruptive changes.  That is, healthcare may be particularly resistant to such proactive understanding due to a recalcitrant and complex payment mix, insular hospital competition, and medical science resistant to change.

Machine intelligence automation is a complex picture.  There are trends moving in opposite directions.  One direction represents job reductions, another direction represents expanding opportunities and new types of jobs.  These trends mean different things to different people on the economic spectrum of the “American Dream.”

One of the key features of the American Dream is how we compare our standard of living to our parents.  In economic terms this is measured as absolute income mobility.

Those who are upwardly mobile have fallen sharply over several decades. “Rates of absolute mobility have fallen from approximately 90% for children born in 1940 to 50% for children born in the 1980s.”[1] As digital technologies have advanced and globalization has taken hold across industries the economic pie has become increasingly less distributed.  There are fewer winners in the middle and lower economic areas of the US economy.  People are reaching up, but there are fewer brass rings to latch on to.

If we were to drive up GDP mobility would not change.  Real change lies in “the distribution of growth across income groups.” What this means is that growing GDP by itself does not revive the “American Dream” for subsequent generations, instead economic growth must be “spread more broadly across the income distribution.” In short, to climb up the economic ladder requires a more equitable distribution of wealth not just a wealthier country for the few.  We are placing machine intelligence on top of an American Dream of haves and have-nots.

When we look at radiology we see a microcosm of this larger economic mobility scenario with an annual radiologist income above $300,000 and job growth over 15% over 10 years.3 However, radiologists are experiencing wage fracturing due to the piece working interpretation services.  Radiologists have benefited from flexible work hours and cloud-based digital interpretation systems. However, what was once one job and one income can now be several teleradiology jobs being cobbled together to achieve a similar income.  This can be inefficient, operationally exhausting for an individual radiologist and opens the radiologist to ongoing contract and credentialing administration not to mention diagnostic error.

Another threat to radiology jobs is the very thing that radiologists have claimed with pride: their lengthy and intellectually demanding training.  Machine learning and data science is moving much faster in providing guidance to identifying clinical features in CT, MRI, and plain film.  We have already reached beyond human performance in identifying muscular skeletal disorders, early signs of breast cancer, and are making strides in lung cancer.  The phrase “beyond human performance” does not necessarily point to moving beyond the radiologist, but instead to adding value through reduction of radiologic error. One study noted identified, through examples, four strategies for reporting that added value through reduction of radiologic error, helping to mitigate the 12.4% clinically significant error rate found in reinterpretation of outside studies.4  What this means is that training algorithms and training radiologists to be good at pattern recognition are on entirely different time lines.  Radiologists require a decade, but once automated cloud-based machine learning platforms are further perfected (eg, Google’s TensorFlow, Amazon’s AWS, Microsoft’s Azure, IBM Watson) such algorithms will be trained and tested in a day or week, faster than humans can be medically trained. The notion of training to reduce medical error and gain efficiency will increasingly fall upon new sets of skills across data science, machine learning, automating workflows, and clinical judgement.

With daily announcements that AI will be reducing millions of jobs in the near term, we should pay attention to these realities that in some cases predate such technological shifts but also are amplified by the rise of machine intelligence.  The reality is: we live in an economically polarized and cognitively polarized economy. Non-routine jobs are first to be reduced by automation brought on by machine intelligence; however, as noted here, non-routine jobs in diagnostic radiology will undergo shifts in the ways of wage earning, image analysis, and machine-radiologist collaboration.5 The radiologist and radiology department will change, more images and pathology will be identified by more algorithms. Jobs that did not exist today will exist in five to ten years.  Taking cues from other industries is helpful. In other industries from using ATMs in banking to using online shopping via Amazon, bank tellers and storefront retailers have shifted their skills, but such jobs have not disappeared. These shifts happened in less than a decade.  Our timeline is greatly shorter than this.

Machine intelligence also creates new jobs and allows for new types of business models to gain traction.  In a highly cited study, computerization and machine intelligence together reallocate rather than displace jobs. The skills required to do and carry out diagnostic image interpretation will change rather than be replaced.  Dr. Elliot Siegel, Professor Radiology, University of Maryland School of Medicine outlines current tasks that would benefit from machine intelligence automation:6

  • Intelligent screening criteria for mammography, lung cancer, and other cancers including genomic/liquid biopsy data and other lab info
  • Automatic protocoling of studies
  • Assessment of patients at high risk to have positive findings (or low risk)
  • Communication and tracking of findings
  • Multiparametric analysis across multiple modalities
  • Improved departmental efficiency with decreased waiting times
  • Dose optimization

Administrators and Technologists are differently impacted by coming automation. Administrators can prepare by focusing on one of the key linkages in data science: business-data alignments. Radiology business leadership (where most financial and resource-driven decisions are made) and IT (where most computerized data is analyzed and resourced) are often siloed organizational areas of expertise and may not share a common language of setting priorities for radiology service.  One of the revolutions of machine learning has been the expansive online course offerings outside of expensive academic settings. Radiology administrators should leverage these tools, courses, and online accreditation processes.  They arm administrators new appreciation of data science, leveraging data for clinical gain, leveraging data for financial gain, and understanding coding procedures.  Technologists are differently impacted by coming automation due to their hands-on patient contact and patient safety   Although these areas of direct patient care do stand to do well in the come years, technologists are uniquely positioned to expand their radiology service reach to a deeper focus on data flows, imaging workflow and the automation of radiology protocols, and improved pre and post image processing.

Radiology exists within larger socio-economic change.  As a medical specialty it is not special nor will be spared in terms of the impact of machine intelligence. This series has attempted to position radiology (or reposition radiology) into a wider technical-clinical and economic context in which it belongs. Questions remain that underlie AI’s potential to usher in a jobless future and may indicate change often not acknowledged.  What is happening today to the way we represent and manage care when human-centered diagnostic expertise is perceived as temporary, a transition to a greater machine intelligence to come? What kinds of radiology service jobs and expertise are beginning to lose value today, not tomorrow?  How do we plan for and deal with job and wealth polarization within our own field?  What forms of knowledge, data, gender roles and professional adaptation are being considered useful in diagnostic radiology with a horizon of AI before us?

 

References

  1. Schwab K. “The Fourth Industrial Revolution.” Crown Business. 2017.
  2. World Economic Forum. “The Future of Jobs.” January 2016. Available at: http://www3.weforum.org/docs/WEF_FOJ_Executive_Summary_Jobs.pdf. Accessed April 10, 2017.
  3. Pearson D. “Radiologist: One of the best jobs in America.” Health Imaging. January 9, 2017. Available at: http://www.healthimaging.com/topics/healthcare-economics/radiologist-one-best-jobs-america. Accessed April 10, 2017.
  4. http://www.jacr.org/article/S1546-1440(16)30809-2/abstract
  5. Dvorkin “Jobs Involving Routine Tasks Aren’t Growing.” Federal Reserve Bank of St. Louis. January 4, 2016. Available at: https://www.stlouisfed.org/on-the-economy/2016/january/jobs-involving-routine-tasks-arent-growing. Accessed April 10, 2017.
  6. Siegel E. “Peeringinto the Future through the Looking Glass of Artificial” SIIM Annual Meeting June 29-July 1, 2016. Portland, Oregon. Available at: http://c.ymcdn.com/sites/siim.org/resource/resmgr/siim2016/presentation/SIIM16_ClosingGS_Siegel.pdf. Accessed April 10, 2017.

 

Rodney W. Sappington, PhD is a senior clinical data scientist, informatician, author, and healthcare strategist.  He is CEO of Acesio Inc., a disease insights company that leverages medical and non-medical data to better understand early indicators and inequities that lead to global disease incidence. He can be contacted at RodneyS@sappington-associates.com.

[1] Raj Chety David Grusky, Maximillian Hell et al. “The Fading American Dream: Trends in Absolute Income Mobility Since 1940.” The National Bureau of Economic Research. NBER Working Paper No. 22910. December 2016.

 

Join us at the HIMSS17 Career Fair!

Skinner & Associates is excited to announce we will be attending  the HIMSS 2017 Career Fair in Orlando, which will be on Tuesday, February 21st from 10:00am – 5:00pm. Booth #20 – Please also join us afterwards for a reception at 4:00pm!

himss17view

 

CEO Leadership Skills for a Life Science Start-Up

By Tom Miller, Managing Partner, GreyBird Ventures, LLC

So many books and articles have been written about leadership that it is perhaps a vanity to believe that I have anything even incrementally valuable to contribute.  In fact, my first thought in response to Janet’s request that I write this was to simply state that I am not a student of leadership – find someone else.

However, I have somehow successfully navigated a career during which I have had the responsibility for a very large number of CEO’s, both at the divisional level in global multi-national companies and in start-up organizations.  Having hired (and also fired) scores of very senior executives, I have acquired my own set of attributes that I believe are critically important to assess – with one standing out from all the others.  And, having suffered the occasional humiliation of having to fire a CEO or two that I personally thought would be terrific has certainly shaped my interviewing tactics.

Human resources and leader

My interview process has evolved from a simple chat about a person’s career and experience to a fairly structured series of open ended but probing questions.  Prior to the interview, I list and rank both the competencies (domain knowledge) and capabilities (personal attributes) that are important for the specific job.  This is not novel and a quick search will reveal lists and templates for following such a structured process so I won’t go into that here.  Additionally, any mature interviewer will tell you that it is best to ask for stories or specific examples from the candidate’s career to allow an assessment of the attribute being assessed.

However, through it all I am search for a special quality that I have observed in almost all very successful CEO that I have never seen on one of these “how to interview” lists.

Before I begin, one caveat is necessary.  Possessing the magical attribute upon which I will shortly focus is no guarantee of success.  Successful CEO’s come in many personality types and leadership styles and all modes of CEO failure have yet to be discovered.  In the last two years I have personally been involved with two CEO failures in companies in which I was closely involved (in these cases, at least I did not hire them) both of whom were highly intelligent and capable individuals.  And one only has to read the paper to find new boneheaded moves being created weekly with Martin Shkreli and Elizabeth Holmes competing for most creative CEO suicides in the past year or so.  However, I will assert that without the one attribute below, the chances for success are greatly reduced.

The magical quality that I seek might be best summarized in a quote from F. Scott Fitzgerald:

 

“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

 

What I am trying to describe is difficult, so please bear with me.

The successful CEO of a medtech or biotech start-up has a very great deal of simultaneous pressures coming at him/her.  She needs to raise money, while hiring, while staying within budget, while innovating, while keeping an eye on competitors, while adhering to regulatory requirements, while communicating with the board and scientific advisors and investors, potential customers, strategic partners…  all within a domain that has the greatest complexity of any industry on the planet.  There is a reason why the professionals that we serve with our products are trained longer than any other discipline – this is difficult stuff!

In our field, this complexity cannot be simplified.  It must be managed.

Gloss over a critical regulatory issue and your company is toast.  Ignore a one-time strange result in a clinical trial and you may miss that one opportunity to make your product a winner or thrown in the trash.  Our biological world is full of tiny development details on top of biological science that may be poorly understood upon which your entire company is based.  A CEO who does not pay attention to the details, one who does not possess a boundless intellectual curiosity, is certain to miss either the key element of success or the trip-wire of failure.

At the same time, no CEO ever convinced someone to invest in or acquire a company through their mastery of minutia.  He must have the ability to weave all of these details into a coherent and compelling story that appeals to the life-saving humanitarian while presenting us with her plan for a whopping investment return.  We have all seen such CEO’s on stage passionately presenting their company, capturing first the public’s imaginations and emotions before leading every listener to believing in the solid business case at the heart of the enterprise.

Probably every one in the field has met the stellar but one-dimensional CEO that is a micro-management detail freak whose employees quit and whose company cannot raise the next round of financing.  More frequent is the brilliant visionary who never delivers.  The challenge is in the fact that these two attributes are, if one thinks about it carefully, often mutually incompatible.

Delivering the compelling and visionary story while keeping in mind all of the myriad risks and uncertainties of daily execution is difficult.  This often leads the detailed-focused CEO to not be able to communicate and sustain his or her clear and steady mission resulting in cloudy messaging to all stakeholders with too many zigs, zags, back-alleys, and distractions.  The impression left is that the hand at the wheel is anything but steady.

On the other hand, the visionary CEO may simply ignore the little problems that may be the first signs that attaining the oft-presented vision might be more difficult than originally expected.  In fact, the better they are at defining their compelling goal, the more in danger they will be of not hearing (or worse, creating a culture that they don’t want to hear) any distraction from their lofty path to success.

And yet the best CEO’s manage this conflict quite well and smoothly glide between a focused steady vision and the agility of finding solutions to all of the inevitable daily problems that threaten the enterprise.

Leadership with education

I have to confess that I have yet to invent a systematic way of teasing out this desirable professional schizophrenia in an interview.  So I poke and prod my way around it asking first for a two sentence summary of business strategy and then plummeting deep into the weeds of a subject to see how far the candidate can dive.  I ask how they communicated the inevitable deviations to plan and when and how these deviations were first discovered.  It is often illustrative to ask about the area in which the CEO states that they are particularly expert and asking for what is unknown or still to be explored in that field.  And, as I have found that all of the best CEO’s have a capacity and even a need for introspection and self-reflection, I always ask what they would do in a particular situation if they had to re-live the experience be it success or failure.

All of this is designed to accomplish one thing during the interview – I attempt to force the candidate to rapidly switch between vision and detail.  I want to find myself convinced by the former and impressed by the latter.  Therefore, it is this intellectual agility, the ability to hold these two opposing attributes in mind and still retain the ability to function, that ultimately guides my decision.

 

Send comments and questions to: tmiller@greybirdventures.com


 

After receiving a degree in Nuclear Engineering from the University of Massachusetts at Lowell, Tom studied Medical Physics at the Harvard/MIT Health Sciences and Technology joint program graduating with a Masters degree in 1982.  During his academic career he worked at Los Alamos, the Swiss Institute for Nuclear Research (now the Paul Scherer Institute), Brookhaven National Laboratory, and the Massachusetts Gene4732328.jpgral Hospital as a research associate in radiation biophysics.

Tom then joined Siemens Medical Systems where, after 9 years, he became the first non-German CEO of a German factory and global business unit.  He left Siemens after 15 years to become CEO of the global medical operations of Carl Zeiss as well as CEO of Carl Zeiss USA.  Completing a successful turnaround of operating losses, he joined Analogic Corporation as CEO.  After three years and a doubling of the stock price, Tom left to become CEO of LightLab Imaging, a start-up that he helped to establish.  Following the profitable sale of LightLab, Tom re-joined Siemens eventually serving as a member of the operating board of Siemens Healthcare and the CEO of Customer Solutions Division, responsible for 26,000 employees in over 130 countries.  In 2013, Tom co-founded GreyBird Ventures, LLC, a venture firm focused on early stage investments in precision medicine diagnostics.  

 

 

boston

Interested and qualified? Email resumes to Kimberly House at Kimberly@skinnerandassociates.com

Executive Options (Part 2): Benefits of Interim Management in Healthcare

by Kim O’Leesky, VP of Business Development at Skinner & Associates Executive Search

Interim Management: What was Old is New Again

Due to many factors including cost, time, ROI, skill or culture match, interim management had fallen out of favor as an approach to tide the course.  Yet, the very reasons it was successful in the past are still very much relevant in the circumstances of the current environment, which merits it to be one of the top “life preserving” action steps. In fact, many organizations have learned that inviting and investing in routine, random, “outside ranks” organizational diagnostic checks is vital to recognizing unforseen or unanticipated issues, allowing organizations to nimbly course correct before significant damage occurs.

Lifebuoy and Businessman

An experienced interim can often input objective, qualified advice during a indeterminate period; allocate ample time to logically and carefully assess the current state and respective needs; and formulate a thoughtful set of options, plans, or selections.  In this way, an interim can maintain and/or foster forward momentum, calm and stabilize staff, and, if needed, clear decks, which will support the attraction of and ultimate success of strong candidates.  Often an interim can be an effective change agent to remove obstacles, fill skill voids, or provide education or alternative messaging to advance appropriate agendas that were stalled or met with resistance under current leadership. They can provide validation and/or preserve current relationships that are necessary for ongoing management by acting as a necessary but short term disrupter.

These elements completely align with the mandates for health transformation and innovations necessary to change workflows in a maturing, networked electronic world.  In addition, if these successes are celebrated from the fresh perspective garnered from interim management, audit diagnostics will continue to reap the future benefits of thought invigoration and growth of staff skillset.

Why Go Outside?

In precarious times many organizations opt for instant gratification via terminations or other abrupt actions; in essence, adopting a “throw the baby out with the bathwater” mentality.  For obvious reasons, rarely are these rash efforts productive in either the short or long term.  Alternatively, some will appoint an interim from within hoping to minimize disruption and promote confidence.  There are times when this might work, however, with the storm swells ahead on so many fronts there are distinct limitations with this approach. Often there will be a team assigned to provide leadership for an interim period, but this action dilutes accountability, as there is no one individual who is responsible, and hospital committees are infamously both inefficient and ineffective.

There are a myriad of accounts in which this approach is littered with pink slips related to failed EHR implementations. While board members have the best interest of the organization as their fiduciary responsibility, they seldom fully appreciate the core root causes, as usually they have limited experience or knowledge to lead a complex hospital.  The tug to promote from within (often especially relying on organizational familiarity and anticipated shorter runway to action) fails to recognize the role disparities of a CEO and other executives.  In short, precarious times require clarity of focus. As such, it is not best navigated by someone thrust into a role who is essentially doing on-the-job training, as well as concurrently responsible for their other full-time job.   Turnarounds need an interim to tackle the politically charged decisions and deal with the unhealthy organizational behaviors. Internal individuals may not have the objectivity, skill set, nor the political capital to effect change.  Along these same lines, an internal candidate may directly or indirectly handicap an effective search and the ultimate success of the successor.  This can be more costly to the organization than the original situation.

What can an organization expect from a professional Interim?

Employing a professional interim addresses a number of conventional concerns.  First, fresh perspective and additional experiential skill sets are invaluable.  These aptitudes can help validate and provide assurance that the organization’s vision and infrastructure are on track.  They can help to provide organizational stability as it adjusts to change.  By completing an objective organizational assessment, they can create (either independently or collaboratively) based on need and expectations a move-forward plan and make necessary fine-tuning of course trajectory, including difficult considerations and actions.  They can assist with mentoring and on-boarding as needed.  If the interim is set up for ongoing diagnostic audits, they can corroborate alignment, foster and fortify direction, and provide peripheral vision and insight.  It is key to remember that, like any hire, not all “interims” are the same nor are they a “jack of all trades”.   It is imperative to have someone who is experienced, seasoned, and has the skill sets aligned with the organization’s needs.

How should an organization implement an Interim program as part of its ongoing path to success?

There are many routes an organization can choose from to fill voids in their teams. Like most things, the first step is recognizing there is a need and appreciating where it makes sense to “rent” in order to supplement efforts or where it makes sense to outsource versus “build” or “own”. The traditional paths include promoting from within, organizational HR searches, engaging a consulting firm, word of mouth, etc.  As with most considerations, there are pros and cons, and most organizations see the highest ROI from objective and principled methods.

Business people assembling puzzle

In the healthcare IT space in particular, it is exceptionally hard to find these key resources.  Many forward thinking organizations have found it necessary to change their historical approach of using internal HR for these specialized circumstances and are now partnering in new ways with a focused executive search firm.  This is not to be confused with just providing a search for candidates but rather structuring a new business symbiotic relationship.  These firms are nimble and have their pulse on the advancing trends, along with access to the industry leaders.  With their diverse efforts in the vendor, academic, as well as provider spaces, they are best able to identify opportunities, share expertise, and beyond to address the unique challenges and complexities of the healthcare industry.  In short, they can often be an invaluable organizational leadership sounding board and focus group.

The Interim Management world is a new “space” for some search and consulting firms and some use this approach as a nugget to get their foot in the door, like a “bait and switch”.  It is important to implement due diligence to get the right partner.  Key elements to look for include one that recognizes that “interim” is just that: interim and not a permanent position. Interim has a finite, defined period.  They should have access to currently employed, as well as career interim candidates with verifiable track records.


 

Kim O’Leesky is the Vice President of Business Development with Skinner & Associates Executive Search, Inc. As a highly regarded, published, and sought out industry leader, Kim has been 099a2dainstrumental in creating, advancing, and optimizing methodologies concerning technology-enabled Healthcare Transformation, Informatics, Governance and Compliance with community, urban, academic, not-for-profit and for-profit healthcare entities nationally and globally.

 

 

Executive Options (Part 1): Shifting Sands Call for a Staffing Evolution

by Kim O’Leesky, VP of Business Development at Skinner & Associates Executive Search

The healthcare operational environment continues to be in a state of flux with tide shifts on a seemingly unpredictable schedule.  With the pending presidential elections on the horizon, the uncertainty has only escalated as healthcare leaders struggle to anticipate the fate of legislation including Obamacare, Meaningful Use, as well as local market shifts.  Some folks are doing their best to steady the course to maintain their current position, while others are more aggressively attempting to grow. Either strategy may or may not align with board or investor expectations which are fueling unrest and action.  These turbulent seas compound the normal day to day operational and strategic complexities, resulting in confidence considerations, moral instability, and ultimately, leadership and staff skill set mismatches and changes.

Change Simple Word in Sand Horizontal Handwritten Outdoors
This isn’t complete doom-and-gloom or meant to inspire one to batten down the hatches.  Rather, while C-level leadership and essential staff exit creating disruptive or traumatic vacancies and creating instability, if anticipated or managed correctly this can present both great risk… and great opportunity! These changes present the perfect opportunity to conduct an experienced, objective audit and assessment of the health system organization. This anchoring should result in a plan which can be implemented to improve finances, quality, satisfaction, employee relations, and governance. However, mitigation steps are necessary to avoid potential situational risks, such as forward momentum loss, unrealized goals, negotiation failures, key staff defection, and competitor intrusions.

The big question is: How do we fill this void?

…To be continued…

 

Stay tuned for the second part of this Executive Options blog series titled “What is Old is New Again: Interim Management in the Healthcare System”

 


099a2da

Kim O’Leesky is the Vice President of Business Development with Skinner & Associates Executive Search, Inc. As a highly regarded, published, and sought out industry leader, Kim has been instrumental in creating, advancing, and optimizing methodologies concerning technology-enabled Healthcare Transformation, Informatics, Governance and Compliance with community, urban, academic, not-for-profit and for-profit healthcare entities nationally and globally.

Patient Engagement? Should we really be working on Person(al) Health Engagement?

By Sandra Lillie – Founder, Meade Advisory

We hear a lot about patient engagement strategies and innovations as a result of Meaningful Use measures; however, innovation appears to remain focused on sick care and  the 2-10% of the patient population that currently drive 80% of the cost of healthcare.  What are we doing to engage the people who have opted out of the healthcare delivery system unless they require acute or urgent care?  These will become the future 2-10% driving 80% of costs if we do not address this now.   Most have no primary care physician; and do not know their health status, may have underlying hidden conditions, and do not know the steps to take to lead a healthier life.  We each know people (perhaps even ourselves) who use Google as their health care provider.

Sixty (60) million Americans lack adequate access to primary care.   Fifty-four percent (54%) of Americans that have scheduled a doctor visit, admit they have postponed or cancelled it.

Add to this equation the prevalence of high deductible health plans becoming the coverage of choice, and the growing number of Millennials in the workforce (75% by 2020); we are on the brink of the obsolescence of healthcare delivery as we know it today.

It is time to invent something new.

What Millennials seek gives us a lot of clues to what we can accomplish for the non-participating person in healthcare delivery.  Millennials want:

  • To maintain a healthy life and avoid healthcare
  • Access to Health anywhere and anytime:
    • Digital first and throughout their healthy lifetime with active utilization of personally accessible technology
    • Avoid areas of sick care – physician practice waiting rooms.
  • Strong social interaction that support a need to help others while helping self.

The time is now for healthcare delivery systems to transform to health engagement systems.  This requires a new approach, organized to focus on the health of the person at whatever stage, and to engage proactively -and virtually on an ongoing basis- to support steps toward healthy lifestyle.  It means meeting the person in community rather than waiting for the urgent condition to bring them into the system.

It means, with the shortage of primary care providers, that a new team approach will emerge; one that is led by nurse practitioners and other members of the team that can comprehensively and cost effectively engage with the person to assess, guide, coach and virtually connect the person to healthier living….and when necessary to warmly refer the individual to treatment facilities when more specialized services are needed.  This team must remain maniacally focused on the delivery of health services without being pulled into sick care services. To be even more specific, Health Services needs to be redefined.

What do I mean about health services?

  • Annual wellness physicals…but WITH the missing “follow-up and engagement” that the typical primary care providers just do not have the time to deliver
  • Lifestyle assessments and coaching
  • Weight loss and weight management services with focus on health for the long run
  • Sustained community engagement through social networking, wearables, virtual groups that support positive reinforcement of healthy living
  • In-person and group education

shutterstock_414576661And by the way, while it is outlined above as proactively engaging the person not participating in the current healthcare delivery system, it appears that this new team and approach can provide care coordination management needed to help those with chronic conditions remain in control of their condition.

None of this is new news, as they say.  The concept just does not broadly exist today…despite much experimentation.

Efforts by large health (and academic) systems will fail to make a significant impact to health improvement across the population. Why?

  1. They blur urgent care with wellness population management, thus creating the environment that patients are avoiding for interactions other than treatment
  2. Do not appear to be crafted to appeal to Millennials (a growing percentage of population as Boomers die off)
  3. Expensive capital infrastructures prevent scaling to multiple locations, especially non-urban
  4. Appear to lack the social network & wearables integration to forge effective virtual support to health improvement initiatives
  5. Rely on local reputation and institutional presence difficult to expand to a national market

Healthcare delivery organizations are actively seeking ways to improve outcomes but have to prioritize sick care- which is the historical foundation upon which they have built their operations.  Retail clinics provide urgent care, episodic health interaction, and the sale of health related goods; but lack the sustained engagement with the person and naturally, are reluctant to trade retail shelf space for lifestyle coaching.

What new careers does this create?

Implementing a model for person(al) health engagement offers the opportunity to create new careers across this new care team.  First is the potential to grow and retain nurse practitioners who seek team care involvement, will provide wellness physicals and have the opportunity to collaborate with the extended team on a plan for ongoing health improvement for life.  In addition, nurses can expand their skills through mastering health and lifestyle coaching.  This represents a strong alternative to the current nursing environment and returns nurses to nurturing engagement with the person.

Next, innovation around a person(al) health engagement model as illustrated above relies heavily on technology savvy professionals who are knowledgeable about social network systems, the dynamic array of wearables and virtual collaboration technologies.

A vital job requirement will be creative invention and problem solving to change the status quo.

It is time for healthcare delivery to become health person engagement.  By engaging with the person as an individual, as part of a family, and as a member of a community, HEALTH organizations can improve the overall health of our population.  It’s time to partner to accomplish this.

 

_JAH6307-EditSandra Lillie is a client and former candidate of Skinner & Associates. Sandra is the founder of Mead Advisory services providing advanced strategy, and consulting expertise, to enable clients to leverage their organization to improve market alignment, collaboration, support and better results.    She is a partner with David Joiner, Founder, of USA CareStore. 


Thinking about stratifying your imaging technology? Think about your people. Part 2:

by Skinner & Associates’ Guest Contributor: David Whitney, CTO of Medical Diagnostic Imaging Group (MDIG)

As healthcare organizations consider stratifying their imaging technology, the process of augmenting their technical skill-sets to sustain a newly adopted platform can be easily overlooked. Part 1 provided a high level overview of what stratified technology is, and what skills and roles are required to plan for an environment. Part 2 assumes an organization has already analyzed requirements and gaps within their existing environment, and is focused on fulfilling those needs.

How can an organization address resource challenges?

While this may seem like an age-old human resource challenge, building or sustaining a business may conflict with an organization’s strategy to grow a business. Growth cannot be impacted by a behind-the-scenes reallocation of resources. Metaphorically, addressing these challenges is similar to changing the tires on a racecar while it circles the track. Typically, pit stops are designated along straightaways of a track and designed for addressing maintenance at a point of lesser course disruption and influence from track participants. As with racing, timing is essential to performing maintenance at points which are least disruptive to day-to-day operations or disruptive to growth strategies. Organizations must be free to address the challenges of a twisty road ahead, while establishing predetermined maintenance points to address the car. Timing is essential; expedient execution is critical. Many solutions exist to address the timing and execution of an organization’s resources.

shutterstock_376463377

Continuing Education Programs:

An excellent option for organizations maintaining a clearly defined and long straightaway approach to future state development. Education and training programs provide an excellent long term strategy, but may not provide the immediate needs for an organization. While these programs provide career path engagement and an excellent employee retention benefit, they must make sense for the bigger picture of an organization’s transformation. It is essential to invest in your talent pool but cost, duration, staff capacity, and criticality should be mutually considered when approaching resource gaps. Regardless, an organization must still understand its future state roadmap and one solution may not fit all technical initiatives.

Permanent Placement:

An excellent option for organizations maintaining a clearly defined and long straightaway approach to future state development. Long-term recruiting may require minimal upfront investment, but candidates must be fully vetted to understand what value and impact they will have within an organization’s current and future state. Although permanent placement is a short term investment, long term expenses to maintain employee skill-sets offset upfront savings and critical to maintain value and employee satisfaction needed for retention. An organization must also closely track employee satisfaction to ensure these investments are protected over the longer term, and return on investment is realistic. Social media, job boards, and word-of-mouth provide cost effective avenues for sourcing talent, but an organization must maintain a strong understanding of resources available in today’s market. Now that an organization understands which gaps exist, it must ensure each candidate is vetted by a stakeholder who understands what to “specifically” look for within the pool of candidates. By considering a quality recruiter with deep industry relationships, an organization can offset much of this job-to-candidate matching and achieve a high-success rate of employee adoption.

Staff augmentation:

An excellent option for organizations attempting a challenging or short to mid-length straightaway approach to future state development. As a short to mid-term solution, staff augmentation will handle a here-and-now solution, but expense may be higher as compared to permanent placement over the duration of an initiative. A major advantage to augmentation is the ability for staffing in accordance with the scope of an initiative. Cost can be contained and long-term expense is limited if the objective and duration is precisely defined. However, an organization must always examine their future state roadmap and consider any likelihood of the role as permanent placement.  In such event, identifying a temp-to-perm placement is always possible during initial negotiation and selection. Once again, utilizing a quality recruiter or consultant to assist with augmentation can provide a high-success rate of employee adoption.

Consultants:

An excellent choice for organizations addressing a very challenging, undefined, or extremely short straightaway to future state development. Although the highest short term expense, a quality consultant can provide the most flexible solution for initiative driven objectives. Instead of focusing on individual talents, an organization can focus on initiatives while exploiting a consultant’s tool-box of skill-sets. However, choosing the right consultant or group requires an investment in diligence. The chosen consultant must be able to deliver on-time, at cost, and provide the value as defined by an organization’s needs. With the correct choice, an organization can accurately forecast and control bottom line costs. Keep in mind that expense overrun can become a costly mistake with these precious commodities when an organization loses sight of its short-term initiatives and milestones.

In conclusion, creating a stratified imaging platform will provide a flexible and cost effective solution for an organization. However, the sustainability and success of a stratified environment is dependent on the people that support it. By sourcing personnel according to the results of resource analysis, an organization can effectively realign its people with the processes and technology.

 

Dave Whitney is a former candidate and client of Skinner & Associates. UnknownDave is the Chief Technology Officer at Medical Diagnostic Imaging Group (MDIG) based in Phoenix, AZ and a frequent contributor to the subject of Health Information Technology.

Taking Control of your Medical Imaging Data

Is your organization struggling to get control of its imaging information during this time of healthcare delivery transformation? You are not alone.  

By Sandra Lillie – Founder, Meade Advisory

How many times have we heard that hospitals are in transition from procedure-centric healthcare to patient-centered health delivery?  Daily, do you say?

The shift to value and focus on outcomes demands greater reliance on patient-centered information across care settings and time versus procedure-based information across events.  For organizations to adapt, they need good visibility to the breadth of clinical content associated with their patients as individuals and as populations.

Strategic reasons to get control of your organization’s imaging systems and content:

  • Some of the richest content resides in a hospital’s imaging and specialty departments, whether radiology, cardiology, orthopedics, dermatology or surgical imaging. The list is long and the content is often held in proprietary system silos.
  • Enterprise image and content management is a priority for many healthcare delivery organizations (HDOs) as they work to make patient information more interoperable, liquid and available to physicians and enterprise systems, like the EHR.
  • Unlocking silos of rich clinical information, both discrete and unstructured, into an accessible foundation enables easier, more efficient consumption for a multitude of purposes.

shutterstock_145545664With enterprise imaging, the medical imaging informatics community is maturing and evolving its definition of the set of capabilities to capture, index, manage, store and provide access to exchange, as well as provide business analytics for, all clinical imaging content across the healthcare enterprise.

You CAN get greater control over your medical imaging information. How do we approach unlocking this clinically-rich content and gain control for our organizations?

Enterprise imaging, or de-coupling PACS, unlocks your organization from proprietary imaging solutions or PACS. This is not only technically feasible but cost-effective today where it would have been viewed as emerging just five years ago. In fact, it is far costlier to fail to gain increasingly independent control of your imaging data.

Steps to gaining control:

→  Step one: Inventory imaging and specialty department imaging content and solutions. Identify your timelines for refreshing imaging information technology (i.e., PACS) currently in place.

→  Step two: Identify important imaging management, view and workflow tools your clinicians utilize today.

→  Step three:  Assess your options in the market to get independence and control at each layer of enterprise imaging:

  1. Image visualization (enterprise image viewer)
  2. Image workflow/worklist capabilities
  3. Image storage and management (vendor neutral archive)

 

Questions to ask your organization and your vendors:

  • What are the benefits to implement some or all of enterprise imaging (de-coupled PACS) during an imaging solution or PACS replacement?
  • What is your organization’s expectation for technology providers as you work to bring “disconnected” patient content together for better results and cost savings?
  • What are the key considerations and roadblocks to achieving an IT architecture to support control of your organization’s image data?
  • What analytics, reports and visualization technology are needed most at this time to speed insight and operational effectiveness?

 

What does it mean to your personnel?

As with any enterprise strategy, the commitment to take control of your medical imaging data requires strong governance and operating controls.  Skillfully moving the organization forward to information independence from the Vendor Lock of proprietary PACS rewards the adaptive innovators willing to advance their organization.

Organizations recruit Enterprise Imaging Directors and staff charged with the responsibility to break down image silos to make this important clinical information more fluid across the organization’s stakeholders.

Directors of Enterprise Imaging must have a demonstrated knowledge of the clinical imaging content produced in specialty departments outside of radiology and cardiology; and productive strategies to manage them toward access across the organization in a patient-centric manner. Leaders in enterprise imaging need to be experienced in the imaging technologies currently implemented and informed on the innovations taking place in the market; with a focus on interoperability, image management strategies,
breath of visualization technologies, and workflow solutions that can be adeptly applied to their organization; and with an exceptional level of communication and organizational skills to achieve results.

_JAH6307-Edit
Sandra Lillie

 

Sandra Lillie is a client and former candidate of Skinner & Associates.  Sandra is the founder of Mead Advisory services providing advanced strategy, and consulting expertise, to enable clients to leverage their organization to improve market alignment, collaboration, support and better results.  

 

%d bloggers like this: