The radiologist in a digitised globalised world: thrive or wither?
Department of Biomedical Imaging, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
Question: What is the truest definition of Globalisation?
Answer: Princess Diana's death.
Question: How come?
Answer: An English princess with an Egyptian boyfriend
crashes in a French tunnel, driving a German car with a Dutch engine, driven by
a Belgian who was drunk on Scottish whisky, followed closely by Italian
Paparazzi, on Japanese motorcycles; treated by an American doctor, using
Brazilian medicines .
Change, although constant, does not always announce its
arrival in the way and form we are all comfortable or happy with, let alone
recognise it is happening. The introduction of some new technique or modality
is usually clearly visible, but the impact of that change on practice is
usually more subtle and gradual until one day we may find ourselves being
washed away by a giant Tsunami while we ask what is happening! Globalisation is
similar in that the increasing interdependence and interaction among people,
companies, and governments of different nations, driven by international trade
and made possible by innovations in information technology will also sweep the
Good health for all is an accepted international goal 
with broad gains in life expectancy over the past century. However, despite
these gains, health inequalities between the rich and the poor persist. The
prospects for future health increasingly depend on the relatively complicated
process of globalisation  where health is not only a benefit of development,
but is also indispensable to development . Illness leads to "medical
poverty traps" , creating a vicious circle of poor nutrition, forgone
education, and still more illness, undermining the economic growth that is
necessary, although not sufficient, for widespread improvements in health
The economic aspects of globalisation of health care have
been the driving force behind the overall process of globalisation over the
last two decades . The accrued benefits of globalisation vary between the
developed and less developed nations with the general view that the more
developed nations have benefited more from the current form of globalisation.
Consequently, for the less developed nations the globalisation of health care
raises contentious issues like:
How can countries deal with globalisation in the context of their
existing cultures, beliefs, resources and system?
How do we deal with the impact of globalisation on the health care
delivery systems of the various jurisdictions? 
How does a nation claim a share of the economic activity that the health
industries and service sectors represent, which incidentally is the largest
global industry on a global scale? 
How can the developing nations protect the indigenous treatments from being
patented in the industrialised nations?
How can the serious brain drain of the limited health care personnel
from the less developed nations to the industrialised West be moderated to
ensure the needy in these countries have access to this invaluable resource?
What mechanisms should be in place to ensure universal access to
essential medication and basic imaging facilities?
Is the promise of technology that is vital for the competitiveness of
the developed nations applicable to less developed nations? Or should they
choose a more appropriate level of entry considering their limited financial,
human and technical resources?
Globally, health care costs have been escalating, more so
in the industrialised Western nations with attempts to control spending. In the
US, the biggest challenge to their budget is mandatory spending for programmes
such as Medicare and Medicaid, and Social Security. If entitlement spending
were not brought under control, it has been projected that these programmes
would consume 60 percent of the entire federal budget by 2030 . It is
estimated that over 80 cents out of every premium dollar goes directly towards
paying for medical services, 10 cents of which cover costs of medical liability
and defensive medicine . Even though imaging will face the brunt of the
cost-cutting, it has also been shown that while imaging costs are rising at
approximately the same rate as other hospital costs, it provides benefits such
as shorter hospital stays, which actually reduce costs .
For organizations or practices to remain competitive in
this global environment, they must recognise the new health care marketplace
and its effects on their practices. These changes encompass health consumerism,
marketing, providership, recruiting  and the networks.
The consumer of the 21st century is increasingly critical
of quality and service, but more importantly they want the consultation,
diagnosis and treatment, and if possible, cure right now! In addition, these
consumers have educated themselves on their medical condition and are prepared
to question their health care provider on the choices available to them .
They even come with stacks of printed copies of information downloaded from the
Internet for confirmation and clarification. The increased presence of the
personal health record , centered on consumer, is empowering them with
control of their health care. It is not unthinkable for them to insist that
their health information is updated into their records for second opinions and
safe keeping. They will become their own gatekeepers.
In medicine, irrespective of the state of development,
globalisation has resulted in almost immediate dissemination about new
treatments, technologies and strategies for health promotion, or the
opportunities for enhanced political participation and social inclusion that
are offered by new, potentially widely accessible forms of electronic
communication. This has been made possible through increased access to
Internet, satellite television, publications as well as the greater ease and
cost of travel. Enquiries about some new breakthrough that was just announced
half way round the world only a few days ago or why are we not offering a
particular treatment even though it is reportedly giving excellent results in
publications, are not uncommon.
While consumers search the Internet to gain better
knowledge about their health and medical conditions, they are also seeking out
the most attractive health care provider both locally, regionally and
internationally . They look at comments by third-party providers and by the
patients themselves on blogs or testimonials.
Health care providers must now make their services more
readily accessible than was ever physically possible previously and at an
amazingly reduced cost. Already, this inevitability has reached the individual
clinician where doctors/institutions/service providers recognise that Web-based
technologies will inevitably become more central to their work . Health
tourism is another consequence of this trend where we will see greater
collaboration between services and centres across oceans providing complex care
e.g. health insurance companies providing services for their clients in other
nations. The rationale being increased speed of care at lower cost with a
sea-side holiday thrown in for recovery.
The traditional borders of the imaging department are
fading: Multi site operations, off-site readings and especially teleradiology
are changing the way radiology is performed. The jury on off-shoring is still
out, since major challenges occur when one looks at issues of cross border
transfer of digital image information, whether for purposes of reading or use
for management. This is in part due to the highly regulatory environment and
national compliance requirements.
The promotion of cost reduction and savings for using
off-shore services in health care should not by themselves be solid business
grounds for off-shoring. It is essential that organisations consider the use
off-shore services as a strategic tool, which must be integrated with their
business model e.g. would these off-shore services support and improve the
organisation's overall ability to deliver quality services? Would patient
safety or care delivery efficiencies and service levels get better?
Closer to home, medical imaging may not be the only
productivity driver as digital imaging and information technology (IT) allow
providers to better manage vast volumes of data at a lower cost. Only two
elements exist in a connected world; the customer and the information and the
key to the former lies in managing the latter. Implementation of health care IT
will provide hospital administrators and physicians a competitive advantage in
helping them manage their practices akin to that of a business. The better use
of technology and inter-operable electronic networks should accelerate
integration, standardisation and knowledge transfer of the administrative and
clinical information, and especially in the context of the globalisation of
health care and efforts in many countries to create a sustainable health
system. Ultimately, it is hoped that such use of data-mining would result in
better outcomes, more cost-effective processes and overall improved health
IT would allow organisations to track a wide array of
variable affecting practice e.g. revenues by exams vs. charges; planned vs.
actual scheduling; referring physician trends � where are referrals coming
from?; referral market trends � measure referrals by zip codes and
demographics; staff efficiency � average and individual, track
productivity � volume trends; incomplete exam work � unfinished exams
affect your bottomline and efficiency; accounts receivables � average
payment periods; total patient time � both patient and facility and
referring physician report time � how long does it take to get the report
to the referring physician?
On the provider side of imaging services, challenges arise
when images are accessible to any physician as they are to radiologists.
Consequently, referring specialists are increasingly reading imaging exams
especially when the images provided are so exquisitely detailed and/or are of
textbook quality. This threatens to make radiology, as we know it and as it is
being practised, obsolete for certain specialties . The future of radiology
will hinge upon building value in the role of the radiologists as a synthesizer
of patient information, including images, history, pathology and molecular
diagnostics, in an effective bidirectional communication. This must be done in
the most cost-effective manner that helps control health care costs. In
addition, there are also issues with relation to workstation and what must be
done to enhance productivity. What are the characteristics of the ideal
workstation of the future to ensure maximization of the potential of digital
Quite simply, the future of radiology is strongly
dependent upon the ability of radiologists to add new value to the service they
provide, especially as perceived by referring physicians and other specialties.
If radiologists don�t change their current work flow and provide the
value-added diagnostic information in a timely manner to their referring
physicians, they will continue to lose control over additional imaging
There increasingly much broader and more severe worldwide
shortage of health care workers than the periodic shortages over the past four
decades. This shortage reflects growing demand, shifting demographics, a change
in career expectations and attitudes about work, and worker dissatisfaction
within health care  as well as greater mobility and international
recognition. To meet this demand, providers will be forced to recruit staff
worldwide taking into consideration the heterogeneous needs of workers from
various cultures .
Global networks in medicine have allowed individuals,
organisational and business linkages in both international health and global
medicine. These networks have promoted cooperative relationships in areas such
as standards and formulation of practice guidelines, research in multi-centre
and multinational trials (the European Institute for Biomedical Imaging
Research [EIBIR] ), health education e.g. biij online recordings ,
ECR�s Digital Preview System [EDIPS] ), visitor exchange, humanitarian
service as well as medicine and supply donation. Radiology like most other
specialties must take further advantage of these networks to promote and enhance
the understanding of important issues e.g. control of molecular imaging
including cross-training techs in preparation for the continued emergence of
Globalisation has impacted every other industry, and
health care has not been exempt. Globalisation, unfortunately, is not something
to react to. A practical approach for leaders would be to look at globalisation
not if it can be applied today, but rather, what are the forces moving health
care in this direction, and how can leaders prepare their organisations to
respond? Practically speaking, there are so many urgent issues currently facing
leaders that it seems difficult to find time for things, which are arguably
more futuristic. Nevertheless, it will be important for leaders to keep abreast
of future issues today and incorporate imminent concepts as a significant part
of the future of health care.
Even though it is impossible to predict exactly where new
technologies, and social and economic changes will take us, we must
nevertheless think about the new order of things in relation to where and what
we are now and what we wish to become in the new order of things. Leaders must
not react to the future; rather, they must prepare for it. We must prepare
organisations for change in the possible futures. And build organisations that
can thrive in a shifting environment where �what� changes get done along with
�how� they get done and even �where� and by �whom� and �for� how much. Health
care leaders must learn to control their destiny or someone else will.
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|Received 7 April 2008; accepted 10 April 2008
Correspondence: Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel.: +603-79492069; Fax: +603-79581973; E-mail: firstname.lastname@example.org (Basri J.J. Abdullah).
Please cite as: Abdullah BJJ, Ng KH,
The radiologist in a digitised globalised world: thrive or wither?, Biomed Imaging Interv J 2007; 3(4):e59