At Mayo Clinic, Drs. Bradley Erickson (Director of Radiology Informatics) and Bernard King (Chair of Radiology) exemplify how collaborative leadership can make all the difference in the transition to a more data-driven clinical culture.

1. Smarter Planet
Leadership Series
Mayo Clinic:
Streamlining the imaging workflow to improve
the efficiency and quality of patient care
From the time Dr. Bradley Erickson was old enough to think Leadership
about his career choices, professional sports never really crossed
his mind. Though if you look at what he’s doing today at Mayo
Spotlight
At Mayo Clinic, Drs. Bradley
Clinic, you’ll see he brings a “double threat” to a different kind of Erickson (Director of Radiology
game – medical imaging informatics. As a practicing neuroradio- Informatics) and Bernard King
logist, Erickson relies on imaging technologies like computed (Chair of Radiology) exemplify
Dr. Bradley Erickson, how collaborative leadership
Director of Radiology tomography (CT) and magnetic resonance imaging (MRI) to pin- can make all the difference in the
Informatics, point, define and better understand abnormalities of the nervous transition to a more data-driven
clinical culture.
Mayo Clinic system. It’s a role that affords Erickson the opportunity to touch
the lives of many patients. But that’s just half his job. How Mayo Clinic
got smarter
The ability to look at medical
As Director of Radiology Informatics, Erickson has also played perhaps the most imaging from two perspectives –
prominent role in Mayo Clinic’s ongoing efforts to transform medical imaging the informatics angle and the
clinical angle – can help uncover
practices through the integration of intelligence and analytics into day-to-day opportunities for change. Drawing
processes. Having earned a Ph.D. in Biomedical Imaging before his medical on this advantage, Dr. Erickson
training, Erickson’s connection to informatics may be an even deeper part of his recognized that Mayo Clinic could
leverage business rules and
educational DNA. At the very least, it’s evident from talking to him that Erickson’s algorithms to orchestrate its
Dr. Bernard King, medical imaging workflow, and
dual backgrounds give him a unique perspective on the challenges facing Mayo
Chair of Radiology, thereby improve the efficiency
Mayo Clinic Clinic and the rest of the healthcare industry. and quality of patient care – its
overarching priority. By integrating
clinical intelligence and automating
processes, Mayo Clinic is moving
closer to optimizing its medical
imaging processes – from ensur-
ing the proper ordering and
execution of tests, to their inter-
pretation, diagnosis and resulting
course of treatment. Dr. King’s
endorsement and leadership were
essential to paving the way toward
a new culture built on smarter
imaging practices.
Let’s Build a Smarter Planet

2. A vision for smarter imaging The benefits of Mayo
If you draw a line between Mayo Clinic’s current imaging initiatives and its decision to begin implement- Clinic’s intelligent imaging
workflow solution
ing digital image processing in the 1990s, its 2004 decision to collaborate with IBM on a broad set of • Estimated 25 percentage point
initiatives marked a key inflection point. From there, both the tempo and range of Mayo Clinic’s overall increase in diagnostic sensitiv-
informatics activity increased. Within them, medical imaging emerged as an early focal point of process ity for brain aneurysms through
intelligent flagging of high-risk
improvement efforts, due in large part to the growing awareness of medical imaging testing practices areas
as a disproportionate driver of healthcare spending. Through a series of small-scale pilot projects,
• Improved patient outcomes
Erickson came to recognize not only the promise of injecting added intelligence into the imaging work- through improved diagnostic
flow to optimize it, but also the factors that stood in the way. Now – with a strong mandate from the top capabilities
and broader access to technology resources – Erickson was poised to put that vision into action. • Improved radiologist productivity
and effectiveness through the
integration of detection testing
A useful way to illustrate Erickson’s plan is to envision medical imaging as a sort of journey, spanning into workflow
from the physician’s decision to order a test to the point of interpretation and diagnosis. At any point
along the way, myriad actors in the process – primary care physicians, radiologists, technologists
and specialists – are making decisions that can have cascading impacts downstream in the process.
Indeed, from the outset, the very act of ordering a test procedure brings several decision parameters
into play, from the type of test and equipment, to the position of the patient and the level of image con-
trast. Each of these decision points affects what comes after them in the journey.
Once a medical image has been acquired, much of the remaining journey is focused on enhancing its
diagnostic value by placing it within the broader clinical context of the patient’s previous tests, textual
reports, treatment history and other background information. The endpoint, as it were, is for the order-
ing physician to have all the information he needs – connected and presented in the proper context – to
enable the most accurate interpretation and diagnosis.

3. Insights from experience Leadership is…
Leveraging trust
Dr. Bernard King, Mayo Clinic’s
As a physician, Erickson recognized the day-to-day realities of this flow firsthand, including its radiology chair, wasn’t afraid to
vulnerabilities and weak links. But it was his instincts as an imaging informatics expert that led him to lead his staff “out of the trenches”
and encourage them to embrace
think about how it could be improved by connecting it together in an intelligent workflow that auto-
a series of new imaging practices.
mated and simplified many of the supporting tasks along the way. As Erickson explains, the benefit of But he also recognized the risks
such an approach is that it both promotes and requires a level of process standardization, which in to credibility that went along with
that role. “[Leadership] means
turn enhances the quality and efficiency of care. “An important part of quality is consistently doing the giving your people clear guidance
same thing for the same reason,” says Erickson. “A lot of errors result from people thinking they can on what they’re supposed to be
doing, while at the same time mak-
make exceptions [to the standard] for no good reason. Workflows help address this by encoding and ing sure you take them in the right
enforcing agreed-upon best practices, which mitigate the impact of whims or personal judgments direction.”
where they’re not appropriate.” – Dr. Bernard King, Chair,
Radiology Department,
Mayo Clinic
Erickson’s vision was realized in an imaging workflow environment known as the Advanced Medical
Imaging Solution (AMIS). Developed and implemented by Mayo Clinic and IBM, its defining attribute is
a reliance on underlying rules that orchestrate the movement of medical images throughout the cycle.
Based on the type of imaging test ordered, AMIS determines which analytical algorithms are appropri-
ate to apply to aid in interpretation, how the imaging data should be presented, and where in Mayo
Clinic enterprise it needs to be routed. If, for example, a head scan for brain tumors is ordered, AMIS
automatically queries the patient’s record for previous scans, and if found, runs an image-comparison Lessons learned
Know when to defer
algorithm that highlights changes in the patient that can signal progression or regression of a tumor.
Listening and a sense of humil-
ity can go a long way. Though a
radiologist himself, Dr. Erickson the
informatics expert knows when
Bridges to cross to listen – and act on – the insights
and feedback of the radiology
“workhorses” at Mayo Clinic. “I’m
While the AMIS project represented the successful bridging of informatics and radiology, Erickson sensitive to the fact that there are
recognized that its broad-based adoption within Mayo Clinic’s radiology department also required him better, more experienced radi-
ologists. So I’m very cautious to
to cross a cultural bridge. His basic challenge was to convince a group of professionals with a deeply
make sure that we don’t introduce
entrenched sense of autonomy – a group long accustomed to lots of decision-making latitude – to allow changes that I think are better, but
for more standardization in the way they do things. He knew he needed a leader on the clinical side make it worse for other people.”
with the credibility and the clout to get the message across, and he didn’t have to look far. – Dr. Bradley Erickson,
Director of Radiology Informatics,
Mayo Clinic
Long before Dr. Bernard King became Chair of Mayo Clinic’s Radiology Department, his superiors saw
in him a rare combination of clinical excellence and the ability to bring people together as a team to
accomplish things – in a word, leadership. When the chair at the time sought someone to work with the
new informatics team, then in the early stage of Mayo Clinic’s digital imaging program, he saw King as
the ideal person for the job, thus inaugurating a working relationship between King and Erickson that
continues to this day.
AMIS determines which analytical algorithms
are appropriate to apply to aid in interpretation.

4. So when it comes to adopting informatics-driven imaging processes, which constituencies need to be Mayo Clinic: The
involved and bought in? In King’s view, it’s everyone. “Broad buy-in – among radiologists, technologists, parameters of smarter
medical imaging
nurses, physicians and surgeons, as well as the institution as a whole – is essential to fully capture the
Instrumented
benefits of imaging informatics,” says King. “The essence of the leadership challenge is to convince AMIS collects data directly from
someone to go somewhere when they don’t really know where they’re going, based on the idea a wide variety of imaging devices,
that you’ve been right before and they trust you going forward. That means giving your people clear such as CT and MR scanners,
and routes them for analytics or
guidance on what they’re supposed to be doing, while at the same time making sure you go in the viewing as desired.
right direction. Take the wrong direction and your credibility takes a major hit.”
Interconnected
AMIS receives any of the numer-
Mayo Clinic’s approach to governance is also seen as an effective framework for promoting adoption ous image types and stores them
on the clinical side. If Mayo Clinic’s acid test for any initiative is the impact on the well-being of its in an industry standard format
to enable easy accessibility and
patients, the way it gets there as an organization is through consensus, not dictum. In principle, Mayo interconnectivity with third-party
Clinic’s governance model reflects this by giving the clinical side the preeminent role in defining its applications.
needs, and the IT side the role of enabler and facilitator. But when the two sides get together to map Intelligent
out the future – sessions that frequently involve IBM – the true spirit that prevails is one of problem- Flexible business rules and algo-
solving, with creativity, collaboration, and give-and-take all coming into play. “As we clinicians become rithms control the ordering, routing,
processing and analysis of medical
aware of capabilities and technologies we didn’t know about before, our “wish lists” change and images, thus optimizing efficiency
new ideas bubble up,” explains King. “Our ability to learn and try new things is what makes it organic and diagnostic accuracy.
and exciting.”
“Our ability to
learn and try
new things is
what makes
it organic
and exciting.”

5. Continuous learning
As the body of clinical experience grows, best practices are continually being refined and new clinical
insights are challenging established ways of thinking. From the outset of the project, ensuring the ability
to adapt to this dynamism was central to Erickson’s vision. Because AMIS was designed on a founda-
tion of flexible algorithms and rules, Mayo Clinic now has a standardized framework for continually
improving all aspects of its medical imaging workflow. Put simply, Mayo Clinic is constantly enhancing
its ability to perform the right tests, to execute them the right way, and to interpret their results with
maximum accuracy.
At Mayo Clinic, systemic change has brought about systemic benefits. Because more automated
processes enable radiologists and technologists to be more productive and efficient, they’re better
able to focus on the clinical side of their job, with a more direct impact on the well-being of patients. Mayo Clinic’s AMIS solution is …
Improvements in testing techniques and new analytics capabilities have also led to improved diag- Software
nostic accuracy. For instance, by using analytics to flag high-risk areas in test results, Mayo Clinic IBM DB2® 9 for Linux® UNIX®
has achieved an estimated 25 percentage point increase in diagnostic sensitivity for detection of and Windows,® IBM WebSphere®
Process Server
brain aneurysms.
Servers
To King, though, the nature of Mayo Clinic’s collaboration with IBM may well go down paths that have IBM System x,® IBM BladeCenter®
HS20, IBM System Storage®
yet to be conceived. “I see the model we’re following – of getting creative people together to share DS8100
ideas and solve problems – resulting in achievements we never anticipated,” says King. “It’s a great
fit with our own culture and it’s helping Mayo Clinic to be a leader.” Services
IBM Systems and
Technology Group
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