Using the EHR to Improve Imaging Care

The development of the electronic health record (EHR) is coincident and synergistic with other technologies that are revolutionizing the practice of radiology. Radiologists may now enjoy complete access to health information, evolving capabilities in image archiving and analysis, and instant access to the world’s medical literature through the internet and personal electronic devices.

Consequently, the future practice of radiology will entail significant management of information as well as more traditional image interpretation. With new capabilities will come new challenges in workflow, but more importantly, new opportunities in patient care. These will include improved interpretation accuracy, customization of patient care, and a higher profile in patient management. Where traditional radiology has been pattern-based and image-centric, the new radiology will become more knowledge-based and patient-centric.

The EHR is central to this transition. In traditional radiology, the communication of pertinent clinical data is generally unidirectional from clinician to imager. Utilization of clinical data in the new radiology will be interactive, requiring a willingness to mine the EHR and influence medical management. This offers the potential for customized care well beyond that afforded by the traditional radiology approach, and in so doing, will empower our clinical colleagues to provide superior patient care.

To this end, our recent manuscript in Health Affairs estimates the importance the EHR on head CT interpretation accuracy. Future posts will provide insights into how to incorporate knowledge-based, patient-centric strategies into clinical radiology practice.

John L Ulmer, MD, Froedtert Hospital and The Medical College of Wisconsin.

Advocacy Efforts See Results at AMA Meeting

The American Medical Association (AMA) is arguably the most visible name in organized medicine. In the past, the AMA and ACR have been at odds, specifically over self-referral. But the AMA remains an important organization for radiology.

The AMA annual meeting was held in Chicago June 7-11, 2014. Two important resolutions illustrate our need to be involved. The first resolution supported CT lung cancer screening. It was originally referred back to the board by the reference committee. This would have effectively sidestepped the opportunity for the AMA to make a statement and influence CMS policy. Instead, a grassroots effort at the House of Delegates brought the matter to debate. There was overwhelming testimony for the AMA to adopt the resolution. The final successful outcome was the result of hard work and lobbying by the radiology delegation and our AMA friends.

Another resolution recommended reapportionment residency slots along the lines of “critical needs”. This would have transferred slots from specialties to primary care. Due to testimony and lobbying, the resolution was amended to add primary care residency slots as needed, rather than slicing from other specialties.

Advocacy means having a strong presence at multiple levels, including organized medicine. Unfortunately, while we have a strong membership in radiology organizations, we do not do as good a job in the AMA. With new rules, we are at risk of losing additional delegates. Consider joining the AMA today. Designate the ACR as your representative specialty organization. Have radiology represented at your state medical associations. Aim to have a radiologist as part of your state delegation. It does make a difference.

Howard B. Fleishon, MD, MMM, FACR

Advice to the Young Physician

It’s been a bruising process for many of you to get this job and it might seem as if Imaging 3.0 has little to do with what is expected of you as the newest member of the practice, but hear me out.

You might think that all that’s expected of you is to crank through the work list, but please find time to connect with the wider world in which you are practicing. Every abnormal case is an opportunity to talk to a referring physician and every day you are at work is a chance to connect with patients. Might that mean some later evenings than if you took the Imaging 2.0 route? Yes; but when your group is thinking a year from now about what you have added to the practice, I guarantee you that it will mean something if they are hearing from non-radiology colleagues and patients about what a great doctor you are.

Twenty years ago I started what, for me, seemed far from my ideal job. In the Managed Care Panic that shut down hiring in the northeast in the mid-90s my breast imaging fellowship from MGH wasn’t wowing anyone, so my main responsibility was the fluoro schedule. Happy to have a job, I surprised myself with how much I enjoyed interacting with patients and teaching residents. So even if the job you’ve taken is not perfect, try to find something that you can excel at.

Good luck and we’d love to hear your stories. Email us at

Geraldine B. McGinty, MD, MBA, FACR