Brett Starr, MD, Chair, Department of Cardiovascular Sciences & Chief of Cardiovascular and Thoracic Surgery, Frye Regional Medical Center
Run the numbers on almost any imaging program and a familiar pattern surfaces: a large share of scans flag a finding that then goes nowhere, with no follow-up scheduled.
As a physician, that's a daunting reality with potential for morbidity and mortality; as a health system leader, it's a missed strategic opportunity.
While it's easy to treat a finding as a statistic, every one of those findings belongs to a patient, and one who is already in your facility, scanned, and plugged into your care delivery system. Left untracked, that patient either falls out of care entirely or ends up finishing the workup at a competing system down the road.
In rural service lines, the gap is driven often by two distinct issues: distance and socioeconomics.
Eighty-six percent of rural counties have no practicing cardiologist, and specialized cardiac surgical care is unavailable in nearly all of them, so a finding that needs a specialist often needs a referral out of the community entirely. In addition, lower income rural communities often have patients who are less able to travel to receive the care that isn’t available locally.
In urban and suburban systems, there are different challenges: fragmentation and overspecialization.
Specialists are everywhere, spread across departments that each assume someone else is tracking the patient. An aortic aneurysm found on an ER scan can pass through radiology, primary care, cardiology, and vascular surgery before anyone sets a plan. While four providers may have had access to those findings, if none of them owns that handoff, the finding drifts to the wayside, especially if incidental.
The underlying cause is different by geography but the service line growth, revenue opportunities, and patient outcomes impact are not.
Longitudinal tracking does something for primary care physicians that's easy to overlook: it protects the trust they've spent years earning.
In small towns, physicians see their patients at church, at the grocery store, at a school function. These are friends, family and neighbors and a missed finding is a conversation they'll have to have in person.
In cities, primary care physicians are juggling referral networks too large to navigate by memory, and a dropped handoff looks like a system failure even when it happened three departments away from them.
A standardized surveillance system gives radiology a backstop against inconsistent report language, and it gives referring physicians confidence that a finding they send forward won't disappear until it’s too late.
Fewer patients slip through the cracks, bolstering relationships that took years to build, and the service lines keep the trust that drives future referrals along with it.
While patient health statistics focus on outcomes, service line health statistics are driven also by economics.
From the service line perspective, every finding that gets tracked properly, navigated, and referred ultimately generates a patient that remains in-network for downstream visits, diagnostics, and eventually even definitive care.
At any point of failure from capture, to tracking, to navigating, that same patient falls out of follow-up, at best gets picked up by a system that did track it, and at worst returns only once those findings have significantly progressed.
Either way, the service line has lost dependability and market share. Roughly one in four scans across your total imaging volume carries a finding at risk of exactly that outcome.
Incidental findings aren't simply a compliance or medicolegal risk to mitigate. They're patients who have entered your pipeline sitting untouched inside your own imaging archive.
Systems that build reliable, guideline-driven surveillance into their cardiovascular and oncology programs not only protect morbidity and mortality outcomes, they are vital to grow service lines and capture market share and procedural volume that would otherwise leak out or become unrecognized.
This is where the infrastructure ROI is clearly in the black for service line volume, revenue, and growth.
The infrastructure gap here isn't a system or clinician failing to do their job one patient at a time, it's the absence of a system built to reliably catch ALL findings in a system where gaps are inherent.
Close that gap, and the same imaging volume you're already running starts converting to completed, in-network care instead of quietly leaking out the back door.
Learn more about Eon’s Cardiovascular solutions.
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Common Questions
Every incidental finding belongs to patients already engaged in your system. Capture, track, and navigate those findings and that patient stays in-network for visits, diagnostics, invasive and non-invasive procedures, and hopefully for definitive care. Otherwise, they may fall out of care or find their way to competitive systems that capture that patient and build reputation on those findings.
Tracking a finding for months or years through repeat imaging until intervention happens appropriately, and if it doesn’t, coordinating outreach to patients to get them back on track. The goal is to surface patients at the right time for the right conversation instead of relying on them to follow up on their own.
No. Physicians still make every clinical decision on diagnosis, timing, and intervention. Surveillance keeps patients visible to the care team but doesn’t replace physician judgement.
Most importantly, it closes the vulnerable gap between radiology studies and documentation of findings and further management of those findings. Critical communication with alerts to the ordering physician or primary care physician is facilitated, and then subsequent navigation for follow-up care. Fewer dropped handoffs means fewer conversations where someone has to explain to a patient why nothing happened. This is the medical equivalent of preventing the fumble on the 1 yard line.
No. While rural health systems are often vulnerable due to specialty access and distance to full-service facilities, urban and suburban systems lose patients to fragmentation and silos across subspecialized departments. Despite the reason, both patterns show up as lost follow-ups, lost volume, lost reputation, and worse patient outcomes.
