Radiology-Plus with Mina Makary, M.D.

Radiologists juggle multiple tasks every day. From reading stack of studies, to communicating with colleagues and referring physicians, to monitoring the most current information affecting the specialty, radiologists try to fulfill many responsibilities daily while providing the highest level of patient care.

This is why Mina Makary, M.D., assistant professor of radiology at The Ohio State University Wexner Medical Center, decided to take a step outside the reading room and explore his life-long desire to be an entrepreneur. By following that interest and dream, he designed an informatics solution, called RadApp, a by-radiologist, for-radiologist tool that brings combines resources radiologists need at their fingertips to manage their workflow and, potentially, side-step burnout.

In this first installment of Radiology-Plus, Makary discusses with Diagnostic Imaging how his long-term goal of making an impact on others’ lives came to fruition in an informatics tool.

DI: When did you first recognize that you have an entrepreneurial spirit, and when did you first start to explore that interest?

Makary: I’ve always had an interest in being an entrepreneur, but I never knew how to do it. I’ve always been creative, coming up with new projects, new research, new quality improvement ideas. When I’ve looked at successful entrepreneurs, I’m always impressed by how they can figure out a need and develop an innovative solution to fulfill it.

If you do something at a smaller level, you only affect your own life or a few others’. But, if you’re able to turn your idea into a broader market solution, then you can have a greater impact and create a tool or provide a service that helps many more. So, for me, that was the whole point. I started by looking at my own workflow, and I recognized different needs. The No.1 concern was how can we be more efficient because there’s a lot of demand on radiologists in terms of throughput and being able to work quickly through a larger volume of studies while maintaining quality. Radiologists must also be able to communicate critical findings with the care team in an efficient way to help deliver good patient outcomes. I recognized that if I could develop a solution that helped me with my own workflow, it could be valuable to others in my shoes.

DI: How did you start down the path to create RadApp – was there something in particular that led you to develop it?

Makary: We’re in the 21st Century, and everything is moving by leaps and bounds. That speed pushed me to look at the different parts of my job and analyze them. In radiology, it can sometimes take 15 minutes or more to reach someone to report a finding, discuss a patient, or get in touch with other healthcare team members. If you do that all day long, you’re not going to get any work done. If you’re spending time on email or the internet or other sources, trying to look up information, it eats up time. Networking in a large institution with multiple people who are often spread out can also be very difficult. These problems aren’t specific to any one institution, and I didn’t find any solution that addressed all these issues. Based on my experience, I knew I had a unique opportunity to do something about it.

DI: What features of the app are designed to assist in daily workflow?

Makary: I realized there were several gaps in the workflow of my life as a radiologist. One problem was communication – as radiologists, we communicate differently with different groups of healthcare providers. For example, in our emergency department, providers carry Cisco phones, so we frequently have to find the proper phone number to reach the correct provider. Floor teams carry pagers, and outside referring physicians can be reached through yet another completely different system.

This is the way life works in any big institution, as well as many smaller community hospitals if broad coverage is provided by a radiology group. I developed a tool that provides an improved means of communication for all these groups with their systems, whether the radiologist is in the hospital or covering from off-site or at home, and regardless of whether they have internet connectivity or if there is a system downtime.

Point-of-care education was also important. For example, typically when you need to characterize incidental findings or infrequent findings outside your subspecialty, but you don’t know the latest guidelines or evidence, you must go online or reference society guidelines or white papers. It all takes time when you have a stack of studies that you need to go through quickly while providing the best level of reads. To alleviate this problem, I integrated recommendations from different radiological societies for different items, as well as local institutional guidelines and policies. So, if you find yourself in an unfamiliar situation, such as someone calls you about a new device for MRI clearance or a unique foreign body from the operating room, you don’t have to be the top expert. This tool has a reference guide. It can improve patient safety and improve your performance as a radiologist by giving you the best evidence-based or newest guidelines quickly for on-the-job use.

The tool also allows for easier scheduling. Most institutions maintain several calendars, and keeping up with it all is hard. We included a way to access the schedules of who’s covering what site, resident lectures, conferences, vacations, and moonlighting shifts. Another part of the software helps residents, fellows, and attendings in academic medical centers meet ACGME requirements by letting them record work hours and complete evaluations on their phones as they work around the hospital.

Networking is also difficult because radiologists often work in silos and are often covering multiple sites. Everyone is frequenty so focused on their work and their reading room that it’s hard to find time to connect. I created an area for our social media, including Twitter and Facebook. I also have a radiology newsfeed and common forum where users can read radiology news from across the internet in one spot. I’m trying to create an opportunity where all you need is in one place – online or offline – to make your life easy, efficient, and safe.

DI: Once you got into the process, what challenges did you encounter with creating RadApp?

Makary: The process wasn’t easy. I didn’t initially set out to start a company. My goal was to come up with something that worked for me. Every day, my partner and I worked on coding and design. Getting to where we are now took about a year-and-a-half because it was challenging make the software functional on all large platforms (Android and iPhone), as well as varying devices (phones and tablets). Most importantly, we had to be sure it’s security compliant because some features of the tool connect with the hospital network. It had to be usable and user-friendly, and the user-interface had to be pleasing. That gave me the opportunity to explore my passion for art. I like to draw and design, and I used my artistic skills for the graphic design of the user interface.

There’s one thing about the solution that makes it unique among medical software. The other tools we use as physicians most often aren’t developed by doctors. They’re designed by engineers or others who doesn’t directly do what we do, so we end up with often difficult-to-navigate software packages that require maintenance, upgrades with frequent changes, and training modules to understand them. The biggest example is the electronic medical record – people complain about it all the time. I wanted to design something, as a radiology end-user and practicing radiologist, that would work for me and my colleague for on-the-job practical use. After we finished, it was rewarding that the entire department wanted it. At that point, the institution was impressed by this solution and its potential, and encouraged us to launch a start-up company.

DI: Where are you now with your company?

Makary: The company, CoreAccess, has been established. We picked the name CoreAccess because our focus from day one has been centered around the core needs of physicians and improving access into one area to make their lives easier. The software is ready, and we’re talking with different customers.

DI: You developed this solution for radiologists. Is there a connection between your being a radiologist and becoming an entrepreneur?

Makary: As radiologists, we are pioneers. We’re visual learners who use the art and science of medicine. We look at images of anatomy, and we integrate clinical information before going a step beyond for diagnosis. There’s no specialty as broad or as flexible – one morning I’m reading a chest radiograph and talking to a cardiothoracic surgeon, and later I’m looking at a lower extremity runoff, examining a brain tumor, or performing a biopsy. Radiologists work with everyone. We must have a broad understanding of how medicine works – not just medical diagnosis, but how we must communicate with others, what information is pertinent for us and for other specialties. Being a radiologist has enabled me to create something beyond an app. This is an informatics solution to workflow, efficiency, communication, education, networking, and patient safety. And, being grounded in radiology is the key to our success.

DI: On the flip side, has being an entrepreneur enhanced your work as a radiologist?

Makary: I think it did. I have a greater appreciation for not just my area or my actual job, but an appreciation for workflow dynamics, market forces, and the business of medicine. It’s helped me become a better innovator, a better radiologist, and a better leader. The impact of entrepreneurship and radiology definitely goes both ways.

Mina S. Makary, M.D., as an assistant professor of radiology with The Ohio State University Wexner Medical Center. He can be reached via Twitter at @MinaMakaryMD.