Dr. Marc Kohli

Q&A with SIIM chair-elect Dr. Marc Kohli

June 23, 2020
by Sean Ruck, Contributing Editor
HealthCare Business News connected with Dr. Marc Kohli, medical director of Imaging Informatics at UCSF Health just a few days before national social distancing orders were implemented to help flatten the curve of coronavirus infections. SIIM has made the decision to hold their annual meeting in an entirely virtual format, which makes sense for an organization at the forefront of technology and innovation.

In this interview we learn more about Dr. Kohli’s background and the initiatives underway with SIIM.

HCB News: What inspired you to get into healthcare and more specifically, into imaging informatics?
Dr. Marc Kohli: I’ve been a computer geek since I was a little kid. My dad had an Atari computer that hooked up to the television and ran basic programs. I had a book of computer games that were basic programs and I typed them out line by line. I didn’t have any idea what the content really meant, except I knew that something fun would happen I typed at the end. I was lucky to grow up with technology in my household.

I studied computer science in high school and a little in college. When I got to the end of college, I was thinking about going to medical school and I thought I had to make a binary choice between medicine or computer science. I decided that computer science was a better hobby than medicine — most people frown on medicine as a hobby — so I decided to go to medical school. Once I was in medical school, I realized that decision was really a false choice because computers were really important to medicine and especially in radiology. I was lucky to get introduced to radiology early on in medical school as part of my first-year anatomy course. There was a hilarious radiologist Bob Tarver, who would come in on Fridays and teach the course. So, I approached him one day and told him I was looking for a job for the summer. He invited me to come do research in radiology. The rest is essentially history.

HCB News: How long have you been a member of SIIM?
MK: My first meeting was in 2006 in Austin. That’s kind of fun for me to be going back to Austin for the 40th anniversary during my time coming in as chair. I was a radiology resident at the time and attended as a representative of the Association of Academic Radiology Chief Residents. I didn’t go annually while I was a resident, but starting in 2009 I haven’t missed a meeting.

HCB News: What have been the benefits of your membership?
MK: I think the first thing is the relationships and people. A lot of people, when you ask about what SIIM means to them, say SIIM is their home. It’s where they speak with like-minded people and chat with people who just get them. That has certainly been my experience as well.

SIIM is a place where I’ve been able to hone my presentation skills and my communications skills. I’ve had a lot of opportunities to work on publications through SIIM. And importantly, I’ve made new relationships that definitely benefit my day-to-day life. For instance, we’re setting up a DICOM router at UCSF and because of SIIM, I know other people who have the same DICOM router. So when we have problems, I can reach out and send an email and connect our teams and troubleshoot. We also actually chose our router based on conversations I had at SIIM. So the interconnectivity and relationships have been unique and valuable for my day-to-day work.

HCB News: Who should consider joining the society?
MK: We have a couple of different groups of members within SIIM. Folks we call imaging informatics professionals — those are people who work with systems like PACS and radiology information systems in order to deliver care for our patients. Those folks generally come from an information technology background, or are also radiologic technologists looking to learn more about the IT side. We have a good number of M.D. and Ph.D. imaging informaticists who are interested in operations and novel science. We also have a rapidly growing group of trainees. The society recently made memberships free for trainees a year to a year and a half ago. Another thing that makes SIIM unique is that our vendor partners are members in the society, which creates uniquely beneficial dynamics.

HCB News: Are there other societies SIIM works with?
MK: Absolutely. We have strong partnerships with RSNA, ACR, and AAPM (American Association of Physicists in Medicine).

We recently signed an MOU with EUSOMII (European Society of Medical Imaging Informatics), which is SIIM’s counterpart in Europe. We also have a new relationship with DPA (Digital Pathology Association) that we’re excited about. One of SIIM’s goals is to be more inclusive beyond radiology, so we’re quite excited about this opportunity.

HCB News: Does SIIM do any lobbying?
MK: Not officially. But we work closely with MITA and the ACR. We do respond to requests for public comments, but don’t actively lobby.

HCB News: What are some big developments in imaging informatics over the last year?
MK: I’d say the continued push behind machine learning and artificial intelligence are probably the biggest hot topics. I think another thing is that many institutions are going through what I call the third-wave of PACS replacement. Those are the two big themes.

I think that integrating AI tools into our workflow is at the top of many lists. That means things like DICOM routers are becoming more important. When we think about having a suite of artificial intelligence applications, [while] some only care about a particular type of study data, thinking how you’re going to implement and route images is going to be important in the future.

HCB News: Are imaging informatics professionals more integrated into the mainstream day-to-day of healthcare organizations than they have been in the past?
MK: I’d say yes. The trend in general is that those informatics professionals were initially hired by the radiology department, but have increasingly become part of the central IT organizations throughout the country. I think that is both good and bad. It’s allowed a lot of people to specialize and be more focused on their applications. But with it, also comes more overhead from a change management perspective. More standardization and less overall flexibility, which helps us deliver service more reliably, also increases overhead. It has been a trend, but I think we’re close to a plateau on that one.

HCB News: COVID-19 is dominating the news cycle now and likely for the next few months at the least. Is there any part imaging informatics plays in combatting the disease?
MK: Radiology has always been a leader when it comes to telemedicine. There are many advantages to telemedicine for responding to things like a pandemic. I know the number one issue for us at UCSF is trying to spin up our home work stations and trying to redistribute the work. Because of the complexity and specific applications we use, it’s not just as easy as giving someone a laptop and telling them to go work. We have display requirements to be mindful of, software limitations and hardware requirements, privacy and security concerns. I think we’re well-positioned to handle the work, but there’s a lot to do.

There’s definitely a lot of buzz around the informatics community trying to streamline operations. Imaging informatics professionals are going to be involved in things like how to reduce elective procedure volumes, reduce elective scans, but do it in a way that you don’t forget about your patients, don’t compromise their care.

Finally, after telemedicine and operational support, the third piece is innovation. Imaging informatics has a strong history of innovation. Some people are asking if there’s some way machine learning could help in the response to COVID. I think there are a lot of different ways, with one being a workflow standpoint, maybe early alerting, and things like that.

HCB News: How do you predict imaging informatics will change over the next five years?
MK: I think the big changes facing imaging informatics are going to be related to the push for interoperability and expanded patient access to data. I also know CMS is starting to change its reporting requirements for things like MIPS and MACRA and I think we’re going to see imaging informatics professionals submit to more registries.