I enjoy my spinning class. At one moment, I am climbing up a hill with maximal resistance, the flywheel is hardly turning, and the instructor is calling out “Do you feel the burn”? Then she yells out, “Let out four gears,” and the next moment I am coasting down the hill with the flywheel turning rapidly ( Figure 1 ). Similar to the flywheel spinning up and down hills, I have started reminiscing about the speed of my year as president of ASE. It is not over yet as I write this page, but I realize it has gone at breakneck speed. It has been an awesome year with a lot of important ASE activities, meeting new people, and international travel. Since it is only one year, you really start the job early as President-Elect in January 2016 as you organize all the committee and taskforce assignments and then run the February board retreat. The theme of my year was emphasizing leadership through engagement and teamwork as presented in the book “Boys in the Boat” which was changed to “Boys and Girls” in the Boat. Another theme was to focus on social media to get ASE’s message out, as I wanted to be known as the “tweeting” president. This President’s Message will give my personal perspective of the year and key accomplishments with regards to our strategic plan.
First of all, it has been my honor and privilege to serve as President of ASE. The Society is in excellent hands with its current executive leadership slate of Drs. Rigolin, Lindner, and Swaminathan. My tasks were made much easier by working with the excellent senior staff leadership of Robin Wiegerink, Hilary Lamb, Rhonda Price, Debbie Meyer, Andrea Van Hoever, and Mary Alice Dilday as well as the other outstanding ASE staff members. I especially enjoyed visiting ASE headquarters in Raleigh and interacting with the enthusiastic staff ( Figure 2 ). I have also enjoyed composing the monthly president’s messages with current themes of healthcare reform, governance changes, diastology and pericardiology guidelines, and our new, in-progress ImageGuideEcho Registry. The November 2016 retreat was very important, having a deep dive into the value of echo in the changing healthcare environment with an invited lecture by Dr. Kevin Schulman from Duke University. This was especially relevant as we see changes in the Affordable Care Act which could definitely impact the field of cardiovascular ultrasound.
What was actually accomplished in relation to our strategic goals? There was a major emphasis on attracting all users of ultrasound (Goal 1). Our international presence grew through the expansion of our alliance partners and the dissemination and translation of our guidelines. I am proud to say that we are up to 21 international alliance partners, including most recently Cuba, Australia and New Zealand, Saudi Arabia, and the College of Anesthesiology of Singapore. The multinational study, the “World Alliance Societies of Echocardiography” (WASE) Normal Values Study, is going full blast. Its goal is to determine normal chamber quantification values in a large variety of geographical regions worldwide. This should provide crucial data on EF, diastology, and strain values in a diverse ethnic population around the world. Our global presence was enhanced by ASE sessions at the annual meetings of our alliance partners in India, Europe, Japan, and Canada. We made a major impact in expanding into the structural heart disease (SHD) space with the development of a structural disease task force and arranging not one but two very successful SHD unique forums with device and echo companies as well as ASE leadership. In my president’s message, I called this “Interventional Echocardiography Meets Structural Heart Disease: Speed Dating in DC.” New education in this area is now available with a new SHD DVD. A multi-authored state-of-the-art focus issue on SHD, as well as a guideline entitled “Residual Valvular Regurgitation after Percutaneous Valve Repair or Replacement,” is also in progress for JASE and should be published in the next six months.
We have been also active in promoting the value of healthcare to all stakeholders (Goal 2). The ASE website, including the ASEUniversity.org site, is being redesigned in order to make it more user-friendly, and a Heart Month campaign was started to build patient awareness through social media. We developed crucial information for TEE operators with the new billing requirements for the TEE code when performed with moderate sedation. We were very active in preventing significant cuts to reimbursement for contrast echo as well as preserving echo-related TTE and stress echo-codes through the RUC as well as encouraging the use of strain and myocardial perfusion codes. ASE lobbied and avoided the passage of an echo-specific site neutrality policy. We also worked on a strategy against bundled payments and episodes of care with letters to CMS and Secretary Price. At the Scientific Sessions in Baltimore, there was a novel payer summit and Hill day to address Congress.
I was proud of the ongoing development of ASE’s ImageGuideEcho Registry module (Goal 3) which will be an echo-specific qualified clinical data registry (QCDR) and will be important in future years for meeting the quality metrics in the changing healthcare environment. This will be the “next big thing” for echo as we will finally have national echo data showing the value of echo related to outcomes. Echovation Challenge 2017 at the Scientific Sessions was very exciting as it highlighted practices and processes that have the potential to enhance the diagnostic process in cardiovascular ultrasound while maintaining excellence in patient care.
I was amazed by how the governance of ASE (Goal 4) changed before my eyes as we streamlined and made ASE more efficient with the help of Neil Weissman who led the governance task force. The board will eventually shrink from 27 members to 21 members and become more engaged, with board members having 2-year terms. Also, there was improved training of Committees and Councils chairs to increase communication to work as a team (the “Boys in the Boat” theme) with the board and executive committees. We also standardized how the leadership will be chosen for the different council steering committees. We hope to have new councils in the future (i.e., Critical Care, etc.) and to develop a leadership track with a learning academy to attract rising stars and our leaders of tomorrow. We appointed an international representative (Bonita Anderson from Australia) who will be starting on the board in June 2017.
The Scientific Sessions in Baltimore, whose theme was to investigate, innovate, and incorporate, was an exciting venue with a Unique Value of Echo Summit, hands-on Point of Care and Vascular Sessions, and the ASE Foundation 8 th Annual Research Award Gala. Also, the ASE foundation was very active over the last year with mission trips to the Philippines, Africa, and China in 2016 as well as to Cuba, Vietnam, and China in 2017. With over 2,900 active donors, the Foundation funds were used for research grants, 20 travel grants, the top 25 researchers, and completion of a $200,000 multi-year grant in 2014/2015 to a research team from the University of Chicago for an Echo-fusion project.
On a personal level, I was fortunate to travel around the world representing ASE, working with international leaders, and spreading the message of excellence in cardiovascular ultrasound ( Figure 3 ). During my tenure, the CASE journal was launched on Feb. 27, 2017 with Dr. L. Leonardo Rodriguez and Karen Zimmerman as Editors-in-Chief. This is an exciting, peer reviewed, open access, cardiovascular imaging case report journal featuring interesting cases from around the world. I was also proud to announce that JASE will have a new Editor (Dr. Michael Picard) who will be stepping in for Dr. Pearlman as he finishes his 10 years as Editor. I should mention that our guidelines are going strong with recent publications in the clinical use of stress echo in non-ischemic heart disease, three-dimensional echo in congenital heart disease, aortic valve stenosis, as well as the non-invasive evaluation of native valvular regurgitation which will have a huge impact on clinical practice.