Diagnostic Reading #29: Five Must Read Articles from the Past Week

It’s Friday, which means it’s time for another Diagnostic Reading! This week’s articles focus on the expanding purposes of VNAs, a study from the Annals of Internal Medicine about breast cancer risk factors, an article about the ICD-10 grace period and updates about presentations from ACR 2015.Carestream Logo

1) Time to Retire the term “VNA”? – Healthcare Informatics

This article addresses the acronym, VNA, and its definition: Vendor Neutral Archive. The growth of health IT products has also expanded their responsibilities. The author claims that a VNA is neither ‘vendor neutral’ nor an ‘archive.’ He goes on to explain, saying that these applications manage data rather than simply archive it.

2) Study: There’s More to Breast Cancer Risk than Density – Aunt Minnie

A study in the Annals of Internal Medicine noted that breast density is not the only factor that should be considered when determining which women should receive supplemental breast screening in addition to mammography. The researchers looked at a variety of factors including age and a consortium of risk factors. The authors writes, “Density information combined with breast cancer risk could be used to prioritize women who could benefit from breast imaging tests with better specificity than digital mammography, such as tomosynthesis.”

3) Number of Female Radiologists, Field Leaders Remains Low – Diagnostic Imaging

According to a presentation this week at ACR 2015, the number of women in radiology has not grown in the last 10 years. This research was done to see if the raised awareness of gender disparity has caused any change in gender representation in radiology. They found that women have consistently made up about 27% of the radiology field since 2004.

4) Newly Introduced Bill Looks to Establish ICD-10 Grace Period – Health Imaging

The US House is moving forward with the ICD-10 bill. The upgrade will take place on October 1. However, some healthcare executives and politicians were concerned that transition to the new coding from ICD-9 would cause confusion. For this reason, a bill was passed that says nobody can be denied Medicare reimbursement solely for using inaccurate codes during the first 18 months of implementation.

5) Medicare Imaging Spending is Down, with Some Variation by State – Radiology Business

At ACR 2015, presenters shared their findings on the trends of Medicare spending when it comes to imaging. They found that overall, national Medicare expenditures for imaging have fallen since 2006. They attribute this to factors based on education about radiation dose and the recession as well as policies instituted by the government. Some states did not follow these trends, read more to find out why.



The Conditions for mHealth Success

There has been no shortage of investment in mobile health (or mHealth) hardware in recent years. Those investments are predicted to continue climbing well into 2016, making up a significant percentage of overall mHealth spending.

mHealth Hardware SpendingAs the chart to right shows, hardware makes up a significant portion of mHealth spending, but IT services and software are continuously capturing share—a trend that expected to continue to grow, with estimated mobile apps for consumers now exceeding thousands. Much of the software that is being used for mobile devices is a reformatting of more general device software, but soon that will change to become more specific application for all the applications that will be used in the enterprise customized for mobile.

When it comes to implementation in the provider settings, the key lies with interoperability. If mHealth systems can connect it to the EHR, then they achieve the ability of improved user interfaces, improved analytics and big data. In addition to interoperability with the EHR, there are four other conditions that must exist for mHealth initiatives to be a success within the enterprise

Strong value case developed for clinicians. Physicians, nurses, and specialists will have to disrupt their practice flow with new procedures to accommodate mHealth capabilities. The first step to encourage adoption is to prove the value proposition: it will save more time and cost less than the expense of learning and implementing it. More importantly, mHealth will drive a better experience for the patient through improved value of care.

Anticipate changes in the way mHealth will be regulated. FDA already has strict guidelines for clinical diagnosis using mobile devices. Carestream’s own Vue Motion for example, was FDA cleared for mobile clinical reading to ensure compliance. Clinicians are now suggesting that mHealth should be part of future Meaningful Use incentives in its own right. Plan for interoperability among these systems.

Manage the ever-growing stream of data. Create techniques to make use of torrents of data arriving in real-time from all sources—medical records, patient data, lab reports, images, clinicians notes, and clinical decision support systems to name only a few.

Anticipate and plan for increased patient engagement in healthcare. This trend will accelerate the adoption of mHealth by clinicians, especially since more and more patients are demanding this from their physicians. Patients are hungry for their own healthcare data, and those that provide them with availability and easy, secure access are the organizations that will be more successful in handling mHealth.

The adoption of mobile devices in the healthcare organization has been inevitable. Delaying adoption can have negative effects on the organization, as well as the patient, because as their perceived value of care decreases, so can the hospital’s reputation. For these reasons, it is becoming imperative that hospitals begin implementation of mHealth technologies and use them to improve patient care and the patient experience within their facilities.

For more details on the necessary conditions for mHealth success, read and download the fourth chapter in our CIO eBook series, “The Healthcare March to Mobility.”

Ben Wilson_IntelBen Wilson is the Director of Mobile Health at Intel Corporation. He is responsible for development and execution of mobile health strategies and programs at Intel. Ben is also Co-Chair of the Accountable Care Community of Practice, a consortium of healthcare IT leaders committed to collaboration in the development of Accountable Care healthcare organizations. A Stanford graduate, Ben’s MBA and MPH in Health Management were earned at UC Berkeley.

Climbing to Peak Performance with the DRX-Ascend

The DRX-Ascend has been a popular piece of equipment for Carestream since it was first introduced. The high-end DR system has allowed imaging centers, orthopedic facilities, urgent care clinics and hospital radiology departments to provide high-quality, efficient imaging to patients, while having reduced installation costs.

As the video shows, departments are able to take advantage of the performance, quality, and value that the system offers.

Diagnostic Reading #28: Five Must-Read Articles from the Past Week

Carestream LogoIt is the end of the week, which means it is time for a new Diagnostic Reading to highlight some of the must-read articles you may have missed through the week. This week’s focus is on healthcare IT security, with three of the five articles focusing on the topic. This is a topic that will be of importance for some time, as the safety and security of patient data cannot be understated. Patients must be kept safe and facilities must be compliant if they are to avoid the potential hefty fines and high costs of a security breach.

1. CISO: Security Must Work Within Workflow – Healthcare IT News

Connie Barrera, director information assurance and CISO of Miami-based Jackson Health System, highlighted how her job at the organization is to ensure security, while also balancing functionality and consumption. She comments how that in addition to streamlining operations, healthcare organizations must also streamline clinical workflow – which is critical if clinicians are going to adopt new policies and technologies.

2. Employees Top Causes of Security Mishaps – Healthcare IT News

The report, conducted by the BakerHostetler privacy and data protection team, is based on more than 200 security incidents the firm advised clients on during 2014. It found that a majority of security incidents were caused not by cyberattacks or lost unencrypted devices but by human error. BakerHostetler found employee negligence topped the list of five biggest causes of security lapses, accounting for 37 percent of them. Device theft from people outside the organization was #2 on the list at 22 percent, followed by employee theft at 16 percent; malware at 14 percent and phishing at 11 percent.

3. 5 Ways to Close Common Medical Device Vulnerabilities – FierceHealthIT

The U.S. Department of Veterans Affairs CIO Stephen Warren highlighted the five ways to close the vulnerabilities. These include 1) making sure devices are not connecting to Windows XP; 2) combat the irreplaceability of devices running on XP by highlighting how it can be cheaper to pay for new devices than deal with a security breach; 3) Make sure devices have anti-virus and anti-spy software; 4) ensure software is updated regularly when available, and 5) Giving people dedicated locations and computers to check personal emails instead of using networked computers.

4. Next-Generation Health IT Requires Primary Care Input – FierceHealthIT

According to a recent article in Journal of the American Board of Family Medicine, practicing clinicians have the clearest understanding of what they need from health IT and should be shaping the national HIT research agenda. Researchers and clinicians need to team up to fully describe the workflow, information needs and communication processes required for health IT to effectively support clinicians’ needs. This partnership should extend to the practice-level tasks of using data to optimize the care of whole panels of patients in order to redesign care to support population needs.

5. MPPR on the Chopping Block – Health Imaging

After U.S. legislators killed the SGR, the editor of Health Imaging asks if Multiple Procedure Payment Reduction (MPPR) could be the next controversial policy to be ended. The Diagnostic Imaging Services Access Protection Act (HR 2043) was introduced in the U.S. House by Pete Olson (R-TX), Peter Roskam (R-IL) and Betty McCollum (D-MN). It mirrors the newly introduced U.S. Senate bill S.1020 and would prospectively repeal the 25 percent MPPR applied to Medicare reimbursement of imaging interpretations for scans performed on the same patient, in the same session, on the same day.

Radiology’s Role in Medicine’s Mobile Revolution

Patient Portal

“Radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care.” – Jim Knaub, editor, Radiology Today

My dermatologist walked into the exam room, peering through his half-glasses at the smallish tablet computer in his left hand. He promptly looked up, greeted me, and shook my hand with his right.

“Last time you were here, we froze a couple spots on your scalp, one on your left hand and one your right lower leg,” he said, while dragging his finger across the touch screen and showing me the figure that represents me and my various lesions. “Have you noticed anything else you want me to have a look at?”

With that, he then slipped the tablet, which had one of those heavy-duty protective cases on it, into the flat pocket of his lab coat and started with my quarterly skin check. (That’s what happens when you’re a 54-year-old, sun-baked ginger.)

My adventures in aggressive skin cancer defense are not the point of this blog entry, but my dermatologist provides a good example of mobile medical imaging making its way into a clinician’s routine practice. Not long ago, that skin check visit would have started with the same greeting, followed by my doctor making his way to the laptop computer an assistant had placed on the counter next to the exam table. He would review my medical record on his EHR and then start the examination. The portability and ease of use of the tablet has upped his patient engagement game. I have seen doctors express concern about how working with a laptop EMR interferes with paying attention to the patient, but using a tablet, my dermatologist has worked it out.

Imaging did not come into play on my most recent visit because my dermatologist does not photograph the suspected precancerous lesions he freezes with his cryo-blister gun (not the technical term).  He has photographs of the melanoma he’s cut off me, the basal cell carcinoma he burned off, and the squamous cell he froze. Dermatology does not provide a good example of how radiology images are used by clinicians because the only modality is a digital camera that costs a few hundred bucks and almost all of a dermatology practice’s images are generated in house. The doctor takes the pictures and hands the camera to the assistant who then uploads the images to the EHR.

That said, my dermatologist’s use of his tablet beautifully illustrates how clinicians want their images available to them when treating their patients. And for specialties that you routinely provide images for, I believe radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care. As clinicians figure out how they will integrate tablets, images, and EHRs into efficient day-to-day care, they will increasingly expect their imaging providers to deliver patient images to their EMR, or at least in a way that the referrer can easily upload them to the EMR so they can be readily used in a clinical setting.

Radiologists will always do most of their reads at their workstations, with a small percentage of off-hour or emergency cases read on a laptop, tablet, or phone in various outlier situations. The greater mobile revolution will be among your referral customers—which any forward-thinking organization wants to serve better—and imagers will be asked to enable that by being able to deliver images readily usable at the point of care, or at least easily uploaded to where the referrer can easily make that happen.

JimKnaub_headshotJim Knaub is the editor of Radiology Today.



The Last Hope for Interoperability

In Biblical times, Moses parted the red sea; in World War II, the allies landed on D-day; and in Star Wars, the legendary ObiWan Kenobi trained the young Jedi to destroy the dark star and save the day.

But today, who or what great event will force health care’s hand so that all health care systems become interoperable and work together seamlessly?

“We have been waiting for EHR interoperability since the dawn of EHRs in the 1960s,1”exclaims Donald Voltz, MD, in a recent article on solutions to making EHRs interoperable.  Dr. Voltz is clearly frustrated and with reason. He points out that the average hospital operates competing EHR’s that do not share information, causing confusion and leading to medical errors. There’s really no excuse, he points out. The medical industry has had many opportunities to bring about interoperability with the Health Information Technology for Economic and Clinical Health Act (HITECH) and the Meaningful Use EHR Incentive Program requirements are designed to standardize basic EHR functions. What’s the point of having EHRs if they can’t exchange data from one hospital to the next? Can you imagine if your AT&T phone couldn’t call someone using Sprint or Verizon?

So why aren’t these EHRs interoperable yet? Perhaps it’s by design? If so, who’s the man the behind the curtain? The competing hospital networks; the competing vendors; or can we chalk it up to government mismanagement? Or is it simply that their incentives are not aligned?

Getting to the point:  Who’s going to save the day?

Maybe it will be the early adopters and self-proclaimed IT innovators in health care—aka, the radiologists. Historically, they have pushed the envelope on embracing new technology, motivated by the need for speed and efficiency when it comes to reading radiology studies.  More recently, radiology has made a dramatic shift toward centralizing data as PACS drops the ‘a’ in archiving and morphs into RIS/EHR’s. Others, like David Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center and principal investigator for RSNA’s Image Share project, have taken the initiative to develop patient portals.

Could personal health records (PHR) play a role in driving EHR interoperability?

PHR’s can do many great things, according to HealthIT.gov. With patient portals your organization can enhance patient-provider communication, empower patients, support care between visits, and, most importantly, improve patient outcomes. Truly transformational?  Not there yet.

An independent study, 3 led by Giampaolo Greco, PhD, MPH, assistant professor in the Department of Population Health Science and Policy at the Mount Sinai School of Medicine in New York City, surveyed 2,552 patients, who underwent radiology exams in four academic centers and established online PHR accounts using the RSNA Image Share network. The results showed that 96% responded positively to having direct access to their medical images, and 78% viewed their images independently.

Call it the clinical selfie—who doesn’t want to know what they look like on the inside? The radiologists are certainly on to something when it comes to luring patient into using EHR’s. But are pictures enough to keep them coming back? Even the biggest social media junkies get tired of Instagram. They had to come up with Snapchat—now you see it, now you don’t.

Patient portals are still struggling to engage patients. A recent study, Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record, examined successful portal implementation strategies used by small and medium-sized practices, as well as factors that influenced patients’ use. The results were mixed. The portal, MyPreventiveCare, tried to promote and explain preventive and chronic care to patients. Of the total of 112,893 patients, ranging in age from 18 to 75, nearly 26 percent created an IPHR account; users increased at a rate of about 1 percent per month throughout the entire study period; and patients logged in to the site an average of 3.7 times during the course of the study and spent seven minutes per session. Total patient portal uptake by practice ranged from 22.1 percent to 27.9 percent. The researchers concluded that indeed patients increasingly want to get online and have better access to their doctor—but clinicians need to help them with that.

The next step—better personalize the content. Getting close, but not there yet.

But for patients to truly adopt the portal, they need to own it; not only receive data, but respond to, interact with, and create it themselves. Yes, patients create data by communicating with their health care providers.

The online world is not a monologue; it’s simply another vehicle for everyday dialogue. Patient interaction can close the EHR interoperability gap. Once patients embrace health care IT for themselves, the walls of inoperability will come crumbling down. So, can you guess now the hero is?  

  1. Voltz D. Why I Hope to Help End EHR’s Lack of Interoperability. OpenHealth News. http://www.openhealthnews.com/hotnews/why-i-hope-help-end-ehr%E2%80%99s-lack-interoperability. Posted March 23, 2015.
  2. What is a patient portal? HealthIT.gov. http://www.healthit.gov/providers-professionals/faqs/what-patient-portal. Posted March 20, 2014.
  3. Greco G, Patel AS, Lewis S, et al. Patients Take Control of Their Medical Exam Records. Study presented at the annual meeting of the Radiological Society of North America (RSNA). http://www2.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=784. Released December 2, 2014.
  4. Krist A, Woolf S, Bello G, et al. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record. 1370/afm.1691Ann Fam Med September/October 2014 vol. 12 no. 5 418-426.

Cristen Bolan, Senior Marketing Specialist, American Organization of Nurse Executives (AONE) – Subsidiary of the American Hospital AssociationCristen Bolan, Senior Marketing Specialist, American Organization of Nurse Executives (AONE) – Subsidiary of the American Hospital Association

Diagnostic Reading #27: Five Must Read Articles from the Past Week

Carestream LogoIt’s almost time for the weekend, but first make sure you catch up on some of this week’s most important articles. The topics include big data and customized healthcare, data security, advice from a recognized health system for reducing readmissions, a possible halt in ICD-10 implementation, and radiology’s role in precision medicine. Enjoy!

1) How Big Data Will Customize Our Health Care– Wall Street Journal

This article discusses the growth in data use in healthcare. The author says that though health systems have been adopting technologies that can collect, consolidate and share data about patients, they haven’t fully learned what to do next. Furthermore, he notes that electronic health systems will collect data, but there may be challenges when it comes to figuring out how to use it.

2) Healthcare Security: Adapt or Die– Healthcare IT News

In this article, the author talks about the growing concern for data security in healthcare. Medical records sell for nearly three times as much on the black market as credit card information. In 2013, 40 million people had personal information stolen. Having said this, the article goes on to discuss new security priorities. Disgruntled employees and hackers pose a security threat, if health systems do not adapt, they could be at risk for data breaches.

3) No One-Size-Fits-All Strategy for Readmission Reduction– FierceHealth

Ascension Health, the nation’s largest non-profit health system, has been working to reduce readmissions by individualizing care to specific patients. The organization seeks to meet the needs of an individual before they need hospitalization. The system promotes education and looks at factors that each person may face such as socioeconomic status, family support and community resources.

4) House Bill Proposes Halt to ICD-10 Implementation– Healthcare Informatics

With the ICD-10 deadline for implementation coming in October, a new bill has been introduced. If passed, this bill would prevent the Department of Health and Human Services from replacing ICD-10 with ICD-9. The dispute comes due to issues with the new coding in the bill. The bill has not yet made it to the House floor for a vote.

5) Radiology’s Role in Precision Medicine– Diagnostic Imaging

Government initiatives have emphasized precision medicine. Precision medicine can lead to more effective treatment of patients. This article discusses how radiology can be used to phenotype by following tracers to determine the presence of cancer cells after chemotherapy. With medicine shifting from a one-size-fits-all model, using imaging to personalize medicine can be used to diagnose and prevent in different ways.

Video: Animated Demo of the DRX-Evolution Plus

The DRX-Evolution has gone through a number of updates and enhancements over the years. So much so that the new round of enhancements has led us to release a new version–the DRX-Evolution Plus.

These updates to the system include a new look with high-tech LED lighting for function and aesthetics, capability of installing advanced apps when they become available, a higher weight capacity table for patients up to 705 lbs. (320 kg.), and extended tube and column range for sites with high ceilings.

The animated demo below walks you through these various features and enhancements.

Guess the X-ray – May’s Image Challenge

Spring is in full swing! It’s a new month so that means it is time for a new “Guess the X-ray” Image Challenge. Let’s see if we can fool you with this month’s image challenge. Last month we had toothpaste, which must have been too easy because it was identified pretty quickly. Hopefully, this month’s challenge is a little more difficult.

To participate this month, leave your guess in the comments below or on our Facebook page.

The May image is below, the challenge will run until the end of the month or until the first person guesses correctly. Good luck!

Sorry… Carestream employees and their agencies are prohibited from entering.

May 2015 Image Challenge

Diagnostic Reading #26: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, it’s almost the weekend, and that means it’s also time for a new Diagnostic Reading. This week’s articles include an article about technology and connectivity written by a Carestream’s director of IT, more questions about the USPSTF breast screening recommendations, tips to improve healthcare quality, the new CMS quality-based standards and how patient portals might cause disparities.

1) Is Technology Still the Main Road to the CustomerCIO Review

The growth of new media has been obvious in recent history. David G. Sherburne, Director of IT for Carestream, provides his insight on the growth of media when it comes to “C-Level executives.” Sherburne makes the initial observation that technology has created connectivity and ease of access across several levels. He notes that for this reason, he states that executives should abandon the old-fashioned silo system and work more closely with their “C-Level” peers.

2) Should women over 75 be screened for breast cancer?AuntMinnie

Many questions have been raised about the recent update by the USPSTF concerning recommendations for breast imaging. One of the disputed topics is about the recommendation for women over 75 years-old. This article explores the importance of continuing breast screening when women are older, highlighting how other organizations such as the American Cancer Society and the American College of Radiology have recommended that women should have annual screenings starting at age 40, and as long as they are in good health.

3) 15 ‘Vital Signs’ to Improve HealthcareFierce Healthcare

Quality healthcare is a point of emphasis at just about any facility. This article lists 15 metrics, as determined by the Institute of Medicine (IOM) that can affect the overall health of Americans and lead to better health care provision. These factors include patient safety, care access, community health, addictive behavior, preventative services, etc.

4) CMS Releases Strategic Vision for Physician Quality Reporting Programs – Healthcare Informatics

The Centers for Medicare and Medicaid Services have released standards for quality care reporting programs. This initiative moves the payment system away from the fee-for-service model and begins the shift toward reward incentives for providing quality care. Quality reporting and patient feedback are emphasized by the new plan.

5) Study: Patient Portals Could Widen Health Disparities – Healthcare Informatics

A recent study at Northwestern Medical has found that patient portals might widen disparities by race, education and health literacy. The study concluded that people who are not health literate are 3.5 times less likely to register for patient portals than their counterparts.