The Double-Edged Sword of Technology: “Disruptive Technologies” Concern Radiologic Profession
Radiologists concerned about sagging reimbursements and offshored jobs now have a new worry: the influx of cheap, “good-enough” scanning technologies that may enable competitors to infiltrate the world of radiology, compete on unequal terms, and redefine the standards of practice. One expert, looking 10 years ahead, gives an ominous prediction: “These disruptive technologies,” he says, “are going to rock our world.”
But industry analyst Frank J. Lexa, M.D., M.B.A. also sees an encouraging flipside: If radiology can rally its ranks and raise public awareness, we might succeed in blunting the sharper edges — possibly significantly — of this impending revolution. Lexa’s credentials are impressive. Educated at Harvard, Stanford, and the Wharton School, he is a clinical associate professor of radiology (Neuroradiology Division) at The University of Pennsylvania Medical Center and adjunct professor of international marketing at The Wharton School, University of Pennsylvania. He has authored more than 75 articles, book chapters, and key presentations, and frequently speaks on issues at the intersection of finance and medicine.
What is disruptive technology? Using the definition coined by Harvard economist Clayton Christensen, Lexa identifies it as relatively cheap, sub-optimal technology that topples the status quo. Among his world-at-large examples are semiconductors versus vacuum tubes, and digital audio players versus compact disc players versus cassette tapes versus vinyl records.
Just as technology has revolutionized radiology, Lexa says new disruptive technologies threaten to throw the discipline into disarray and compromise patient care. Radiology today is in the early stages of this paradigm shift. The biggest threats likely will be seen in ultrasound, CT and MRI. The situation will find radiologists and non-radiologists increasingly working at cross purposes. While radiologists continue to push scientific frontiers by way of faster, better, more costly technologies, competing physicians will carve out huge territorial niches using cheaper, lower-quality tools.
Lexa’s case in point: MR scanners. Once supersized beyond the scope of most facilities, today’s scaled-down units are “much cheaper to acquire and operate, easier to use, and about one-tenth the weight and one-tenth the size of systems a generation ago,” Lexa observes. Throw in attractive financing and leasing terms, and another barrier falls to outsiders. The same sub-optimal MR technology that wouldn’t earn a radiologist’s second look, Lexa says, “may be good enough for an orthopedic surgeon, neck surgeon or urologist who wants to answer a small number of questions rather than provide full service and do highly detailed examinations.” But it’s also attractive to medical people not currently working in diagnostic imaging, who say: “’Why not do some scanning myself?’” Lexa says.
As barriers fall and scanners go small and cheap, Lexa foresees entrepreneurs with freestanding MR units setting their sights on shopping malls, urgent-care doctor offices, even super-drugstores. Shortly thereafter, as MR scanners become transportable by van, he foresees another trend. Executives once too busy “to drive downtown and wait an hour” will become receptive to paying a premium for a lunch-hour scan on their office parking lot. At least initially, this “personal-trainer” model won’t be widely affordable, Lexa says, but will carve yet another chunk out of radiology’s shrinking territory.
The tight supply of skilled technologists has traditionally been a threshold to disruptive technologies, but Lexa sees a corresponding market offset: pushbutton technology. “If systems become close to pushbutton simple, the nurse at the urologist’s office can push the button,” he observes. The convergence of yet another innovation – telepresence – could eventually allow scanning to be done without on-site radiologists or technologists. “One can imagine the equivalent of centralized call centers for technologists,” Lexa says. “The scanning itself could be done by a technologist across the state — or across the world.”
Skeptics may scoff, Lexa concedes, but so too did skeptics 25 years ago, when they prophesied the offshoring of jobs to the developing world. Lexa’s vision thus is one of radiology teetering on a tightrope that is buffeted by the vacuum of supply and the winds of demand. Disruptive technologies, to press the analogy, will emerge as a sudden dip in a jet stream. Lexa says he talks to radiologists residents who are heartened about the relative scarcity and high earnings in their profession, but they do not fully grasp that the market eventually overcomes all barriers — sometimes violently.
In some areas, the leading edge of disruptive technologies are already being felt. In 2006, ACR President Harvey Neiman, M.D., FACR, underscored the threat when he spoke at a Society of Radiologists in Ultrasound meeting in San Francisco. “The clinical market’s drive for handheld ultrasound scanners … could severely undermine the continuous development and improvement of high-end ultrasound technology," he said.
Mitigating the Effects of Disruption
While radiologists cannot stop the march of disruptive technologies, they can soften its impact, Lexa says. The ultimate threat to radiology, he says, is that disruptive technologies threaten to commoditize the profession, and turn its faithful practitioners into interchangeable cogs who cede medical authority to less-qualified individuals.
“One of our key sources of service and quality as radiologists is our interaction with patients and referring docs,” Lexa observes. “If you only see yourself as creating images, or putting words to images, then you're missing a lot of what you should be doing to decommoditize yourself.”
Disruptive technologies may lower standards of care, but Lexa says radiology cannot abandon its 100-year commitment to quality. “We need to push back by using our advantages in experience, service and quality,” he says. “If people are doing substandard imaging because it is cheaper, then we need to make this known to patients, referring docs, insurance companies and other major players. We need to turn things around by saying, ’We are professionals and we are taking responsibility for people in a very critical event in their lives.’ This goes far beyond a commodity view of what we do as professionals.”
Being vigilant and market savvy is paramount. “You can't be surprised by the orthopedic surgeon down the street who buys a machine that you've never heard of,” Lexa says.
But radiologists also need to be more consumer oriented. This might entail offering convenient evening or weekend hours. Similarly, making patients cool their heels in reception areas is a losing strategy, Lexa says. “People have become remarkably intolerable of waiting. There are data that suggest that if Americans were to grade physician performance, most would drop you a full letter grade for every seven minutes spent waiting to be seen.” Lexa’s argument is compelling: “You can't make patients wait for a half an hour unless doctors are willing to receive lots of failing grades.” Ultimately, he says, radiology must help solve consumer problems, rather than ignoring them or letting other professionals fill the need.
Lexa also sees the need for radiologists to “take the lead in trying to capture certain innovative technologies.” If mobile technology proves workable, he says, radiology groups should be doing it before everybody else — “before somebody else is smart enough to do it.”