A Partly Pictorial Overly Long Review of 2019

It seemed fitting to reflect on a year which started out in such a terrible manner professionally and personally but as a direct consequence the two incidents were a springboard and catalyst to events spanning ten cities, over 46500 km of (work  related) flights and major changes to professional outlook and practice.

Some of you might recall that in one part of England there has been a regional Enterprise Imaging Procurement that had seemingly gone on forever. The previous year ended with this being put out of its misery (to use a veterinary or farming colloquialism) and nigh-on five years of hard work and effort terminated. Great – not.


Things were only to get worse in the month of two faces with the arrival of the dreaded brown envelope of doom from HM Pensions Service. I would challenge anyone to identify a decision that has had a more profound detrimental effect on the NHS than financial policy that destroyed - perhaps irrevocably - the goodwill and extra-contractual efforts that have
underpinned safe and timely provision of care to NHS patients. It beggars belief that NHS consultants and senior managers would be penalised more by this device than they wouldreturn to senderearn for offering to eschew private practice in favour of addressing deficiencies in timely care.
But here it was in its five figure glory. And in many ways my on-going career path was to be defined for me. No more 13 session weeks, no more applying for clinical excellence awards, no more looking at burgeoning reporting lists and looking to sacrifice even more family time to address them…well okay I’m getting ahead of myself….at some point I mean. Safe transitions of a hitherto lifetime mindset of service takes time to implement.

Not without good cause, however, is Janus appropriately named the god of gateways, transition and new beginnings. From this nadir stemmed the desire and purpose to right both wrongs and thus fuelled the events and journeys (figuratively and literally) for the rest of the year.

A new Board was convened in said region of England and a rapid exercise was mooted to arrive at a meaningful and swift conclusion. Fires were fuelled, loins were girded and resolve was stoked. The result was a gruelling timeline and perhaps all the more satisfying for it.

During this somewhat turbulent period I also decided to start penning my views on HealthIt matters for broader consideration. The outcomes were a special feature scientific article in Radmagazine entitled PACS: What Radiologists need to consider as well as a white paper I co-wrote about one of my main hobby-horses: the inefficiency of the current MDT structures from a Radiology perspective: Reclaiming time and space from the MDT Black Hole

At the same time I decided to take my flirtation with the idea of undertaking consultancy work alongside my NHS practice more seriously and went hunting for a suitable engagement ring –first stop Orlando and HIMMS!

Having been to RSNA previously which rightly claims the mantle for the largest medical conference in the world, the size and scale of the largest Health IT congress was staggering. Over the course of the next five days many (many!) miles were walked in that Orange County Convention Centre and many hands were
shaken. The vibe was certainty interesting from aclinician’s point of view. But perhaps the most substantive aspect of that trip was travelling 6800km to connect with a wonderful group of individuals – UK CIOs! The camaraderie and
kinship of this group is glorious and it is a privilege to have be accepted (perhaps too strong a word – tolerated?) amongst their ranks (ie the whatsapp group  ).

Back to Blightly. And a whirlwind of OBS scoring and clinical validation events. The metaphor of the serenely swimming swan with the hidden furious paddling under the surface is apt.

From here we neatly segway into the procurement site visits in the merry month of May. What a stark contrast to a horde of people from all the region’s Trusts making their own way at different times to different hotels in the various locations to instead have a small crack team having the absolute privilege of visiting the company headquarters and R&D bases of the three suppliers in Sweden, Israel and Canada. All three visits were fascinating in different ways. Two are also meritous of comment for entirely unrelated reasons:



The visits took place during Ramadhan. It was quite humbling to fly into a cold rainy Swedish town on a Sunday night and be presented with a table laden with seafood as the suppliers were aware I was part of the attendee party and didn’t know if I had been fasting and had chance to break said fast – and were mindful that arrivals times were after shops and restaurants would have closed. To say I was touched by the thoughtfulness is an understatement.


Another rather overwhelming moment washaving the honour of being able to carve out some time to visit Jerusalem - the City of God. A beautiful place and it was humbling to reflect that an NHS procurement afforded me/us this opportunity. Old Jerusalem is an incredible place and we felt privileged to revel in the atmosphere.

It was also pretty cool being able to visit the headquarters of one of the most well-recognised AI companies in the world and speak to their senior team.

The wheels had barely touched the tarmac in Ringway before I was off again at the start ofJune. This time at the kind invitation of KLAS to their DHIS event in Barcelona. A fantastic concept bringing together suppliers, clinicians and investors to a series of round table discussions. Wonderful.


This rather dizzying period of time also affordedme the luxury of (re)discovering my writingmojo and I had the pleasure of publishing a few articles including an extended piece about my views regarding Artificial Intelligence’s role in Radiology beyond what was currently being offered which I called:

The rAIdiologist will see you now I also wrote a guest blog about patient data
silos The Real Impact of Inaccessible Patient Data in Radiology and was invited to
participate in a podcast: A 360-Degree Patient History: Realistic Or Pipedream?

June also saw the journey to the home of the SIX time European Champions for the UKIO Congress in Liverpool. As well as a raft of stimulating HealthIT sessions, there was also a glimpse into the intended vision of increased collaboration with Industry via the Demo Zone presentations.

But sadly if “Seafood in Sweden” could be deemed a good representation of cordial professional courtesy, “Diet Coke Gate” (as it came to be known) was the antithesis. A salutatory lesson that words travel faster than humans, that years of carefully curated persona can potentially be undone by inappropriate language and behaviour. The unsavoury incident had ramifications clearly on the person at the heart of the incident but also the multinational company he represented. The ensuing investigation extended to several months before all parties concerned were able to move on (figuratively in some cases, literally in the case of the protagonist).


The previously mentioned article outlining my vision of artificial intelligence had been received and was exemplified by the invitation to curate and lead a session at the European chapter of AI-Med. This event took place in Shoreditch in September and was a great opportunity to demonstrate practical implementations of AI in Radiology in the NHS and beyond.

Around this time I also had the privilege of being interviewed by Highland Marketing to solicit my views on the importance of engagement and
codevelopment for meaningful AI.




Late autumn also brought with it, finally, the biggest change to my
professional life and working practice since I became a Consultant
Radiologist, with the transition from 13 years 13-session week full time
NHS Radiologist, to a part time NHS Radiologist now pursuing a long-held desire to engage in more consultancy and medical advisory work. From the bitterness of that brown envelope back in January, let’s hope for some sweet succour in 2020 and beyond!


You are welcome and invited to learn more via my website: SMRadiology

There were two further notable events in November. The first was my initial formal consultancy engagement – this was particularly pleasing as it had been solicited soon after my intentions to this role has been advertised, and was almost immediately after I changed my working practice to accommodate such work and thus it felt like validation of my plans. The pre-dawn flight felt strangely liberating!

Shortly after this I was invited to host a podcast with Zebra Medical’s Chief Medical Officer regarding AI in Radiology – indeed in Imaging more broadly including its impact on workflows. You are welcome to listen to it here:



And there was STILL time in the year for an additional flight to the US. Not been for five years and now twice in the same year! Perhaps fittingly, from humid HIMMS in January to chilly Chicago in December for RSNA. It was an interesting experience to say the least. There was (not surprisingly) a strong AI focus again but none of the razzmatazz from previous events. It all felt a little underwhelming to be honest – which gave ample justification for me to arrange a “Brits chAI” social networking event for Brits at RSNA – unconsciously mirroring Orlando again where I had met British HealthIT folk across the pond.

And indeed coming full circle, the end of the year has also brought with it positive and welcome news about finalisation of a Preferred PACS supplier for our region.


Over to you 2020 and here’s hoping for an equally exciting, hopefully rewarding year packed full of collaboration, engagement with personal, professional and regional growth. Passports have been renewed, foreign conference flights booked – see you in Dubai in January for Arab Health Week!

I can’t wAIt for 2020 🙂

Dr Rizwan Malik

Dr Rizwan Malik. MBBS MA(Cantab) FRCR Dr Malik is a consultant radiologist at Royal Bolton NHS Foundation Trust, where he is Divisional Medical Director and Associate CCIO. Prior to this he was the Trust PACS and Imaging Lead, Divisional Clinical Governance Lead, as well as Clinical Lead for Radiology. He is also the Clinical Lead for the Greater Manchester Collaborative Imaging Procurement Project. Dr Rizwan Malik Dr Rizwan Malik Recognised as a leading Digital Health thinker in the NHS, his agenda setting blog posts on LinkedIn are closely followed by both Industry and NHS colleagues. He is an invited International Speaker at conferences about PACS and around the role of AI in Imaging in particular. Curator for UKIO informatics workstream 2018 & 2019 where he aimed to diversify the range of presentations and engage the supplier community in shared learning activities, he is now the Vice President (Industry Liaison) for UKIO. He provides mentorship and strategic steer to a number of Health IT companies. He is Clinical Advisor for InHealth reporting, and has previously worked in the role of Medical Advisor for Wellbeing Software. After completing his medical training at the University of Cambridge; United Medical and Dental Schools of Guy’s & St Thomas’ in London; and Manchester’s Radiology Training Scheme Dr Mallik took up his post at Bolton in 2006 as a general radiologist with subspecialty interests in chest, nuclear medical radiology, developing a particular interest in healthcare informatics. In addition he has experience in medico-legal reporting and a history of working closely with primary care colleagues to establish community radiology services.


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