"Pictures at an Exhibition" Courtesy TzviErez
I'm back from a rather brief trip to Chicago and RSNA. I had two days to see stuff and get some edumacation, as we say down here in the South, and I tried to make the most of it.
Educationally, I used my limited time to concentrate on PET and thyroid/parathyroid imaging. I come out reassured that we are doing things correctly. I'm still a little confused as to the best application of SPECT/CT to parathyroid imaging, so I'll probably be doing some experimentation when we finally get the darn thing sometime early next year. One presentation claimed better accuracy with good old pin-hole/planar imaging than with SPECT/CT. We'll see.
I began my 48-hour RSNA marathon early Monday at the Siemens Press Conference. Somehow, Siemens still thinks I'm some sort of journalist, which speaks more toward my friendship with people who decide such things than their better judgement. Not to worry, though, the room was filled with real reporters from real publications, who will properly convey the things correspondents are supposed to write. But you might want to question their judgement: some of them said they were readers of this blog, or at least familiar with me, and if I were them I probably wouldn't admit it. One VERY wise lady from a VERY respected publication did note the iconoclastic tone I generally manifest, proving that she really does read this. Thanks, Ms. C.P.!! I'm going to tattle, though. Some of the reporters were on their laptops doing things other than paying attention to the presentations, and one reporter who used to work for Siemens asked some very long and barely comprehensible questions at the end. Which were answered quite throughly.
Having been a regular attendee at the Siemens event, I was surprised this year to see new faces. In years past, Dr. Hermann Requardt, (PhD in Physics!) CEO of Siemens Healthcare, presided over the meeting, with Dr. Gregory Sorensen, (Neuroradiologist) CEO of Siemens Healthcare North America, in the supporting role. They are no longer with us, at least no longer visible, having been replaced respectively by Dr. Bernd Montag, also a physicist, and David Pacitti, recently of Abbott Labs. Requardt is now on the board of Bruker, Inc., and is the new Chairman of the Board of SuperSonic Imagine; Sorenson was removed just in October. HMMMMMM.... Perhaps their vision didn't match the current trends, but I can't say I heard anything much different than last year in that regard. Back in February, Siemens announced the change of CEO's. Joe Kaeser, President and CEO of Siemens AG, said: “Mr. Requardt and the managers and employees of Healthcare can be quite proud of their highly successful work together over the past years. I have the greatest respect for Mr. Requardt’s decision to make way for a generation change. We are now setting up Healthcare as a separately managed business within Siemens in order to pave the way for an equally successful future in a highly dynamic market and innovation- driven environment. This is now the task of Bernd Montag, Michael Reitermann and Michael Sen. They will have the full support of the Managing Board and their direct partner, Board member Siegfried Russwurm, who worked in the company’s former Medical Engineering and Medical Solutions units for ten years.”
I could report chapter and verse of what was said, but I'll leave that to the real reporters. What I will convey is my impression as the only physician in the room. (At last year's event, I was one of two along with Dr. Sorensen.)
Technologically, there was a smattering of this new or upgraded scanner or that, the standard stuff. Dr. Montag announced 510K approval of Siemens CT scanners for lung screening programs, and the new "teamplay" software for data transparency and availability (acknowledging the ubiquity of tablets in the healthcare environment). The new HELX touch-control ultrasound scanners should reduce operator variance thorough streamlined user interface. It's supposed to be easy for inter operative use by surgeons. Thanks, Siemens. We also note the advanced robotic and even 3D capability of the new MultiTom Rax X-ray room. Good incremental improvements, all. No mention of PACS, advanced visualization, etc.
The main message I got from the hour-long session is that Siemens understands the changes in healthcare, both here and pending, and wants to help physicians navigate them successfully, "Enabling Healthcare Providers Worldwide" in their words. The flip-side is that Siemens is invested in these changes, assumes they will come, and is resigned to the fact that they ARE coming. The transformation process to the new reality has three components:
- Consolidation of Providers
- Industrialization--Dr. Montag: "Medicine is not an art anymore. It must be managed like a company in a controlled fashion." How sad.
- Managing Health--i.e., the transition from fee-for-service to value models
The process supposedly is inexorable, like the Law of Gravity.
Diagnostics, particularly imaging are pillars of healthcare, and have been almost from the beginning. In fact, Roentgen himself was an early Siemens customer, and the company archives contain a letter of complaint from the man himself, noting the rather high equipment costs. Some things never change. Indeed, Siemens has been in on quite a few innovations in medical imaging, PET, PET/CT, PET/MRI, dual-source CT, etc.
Dr. Montag tells us that "90% of medical decisions are based on technologies in the Siemens portfolio." This, I think, is a little misleading. We could say that 95% of the world is lit by technology in the GE portfolio, the remaining 5% still using fire, but that really doesn't get us anywhere. I might have phrased it differently, but we get it.
Further examples were given of how Siemens can and will holistically improve health care, radiation therapy guidance, laboratory productivity, and triaging patients. Siemens will help us with standardization, consulting, and a world-wide network geared to mastering the digital transformation, leading to better outcomes at lower costs.
In the end, 10% of the costs of healthcare relate to diagnosis, and our value thus depends on early diagnosis which could reduce the price of the remaining 90%. That's a better definition of value than I've heard to this point.
Still, I'm personally not as convinced as the good folks at Siemens that this value thing is permanent. Much will depend on the upcoming elections among other things. But I do understand the need to conform to the environment in which they wish to sell their wares. No doubt if fee-for-service comes back, Siemens will exercise its flexibility once again, and pivot back to whatever worked in the old days. Like selling scanners to doctors' offices. Just like GE. Still, if your going to scan, you might as well have the best scanner.