Who is responsible for clinical data storage in hospitals today?

We want to hear your opinion!

It sounds like a simple question. But at many provider organizations, it’s anything but simple.

Determining what group has oversight and responsibility for this important area—and satisfying the many stakeholders who may have a role in storage strategy, implementation, use and management—can be tricky and contentious business at many facilities.

Add the reigning confusion of murky rules on EMR funding and government incentives, the varying regulations for archiving film and digital records and the arrival of new modalities requiring different viewing and storage protocols, and you have a complex recipe for handling one of your most important assets: your clinical data.

We’re asking you to provide your perspective on this important issue!

If you’d like to be a part of the discussion—and receive a copy of the report we’ll produce from the answers you provide—please complete the survey (be sure to provide your email address at the end so we can send you the report—your name/answers will not be shared and are held confidential), and watch this space for an update with results and analysis.

Thank you for your input!

Clinical data archiving survey link—click here to participate!

Remember this image? No one actually guessed it—the answer is below

Nobody guessed right!

You may recall last month’s Image Challenge contest, in which the adjacent image was posed to Everything Rad readers to test your X-ray mettle.

We had lots of clever guesses, but no winner. But because we’re so happy that we had lots of entries, we’re sending Everything Rad mugs to all entries anyway. We’ll be in touch shortly to make sure we have snail mail addresses for all of you (you know who you are). Meanwhile, watch for our next “What is it?” image contest coming soon. This next one is even tougher!

It’s not an alarm clock!
It’s not a night safe!
It’s not an engine!
It’s not a projector!
It’s not an incubator!
It’s not a radio!

It is a (Kodak) film camera!

Is security cloud computing’s Achilles heel?

Cloud computing is a subject of great interest to healthcare CIOs. Using this model, their facilities can share data and workflow between sites, minimize on-site equipment investment and the need for skilled IT specialists to manage applications and data.

Is the sky clear for healthcare CIOs to embrace cloud computing with eyes wide shut? Not so fast!

Healthcare data has specific requirements that are not fully ensured by general-purpose cloud offerings, the primary one being security. Since security has many levels, we as an industry need to be more specific about healthcare data. Here are a few areas that need to be closely managed…

Long term preservation – Healthcare data needs to be preserved and accessible for tens of years. This means that the issue is not only integrity, but making sure the data is retrievable up to 15 years from now (standards play is a key role here).

Confidentiality – As a crucial parameter for healthcare data, this requirement has many technical and architectural consequences. It’s necessary to prevent any unauthorized access, trace and report on any access to data and make sure users are correctly and strongly authenticated. Cloud infrastructure administrators must also be identified by name and it must be ensured they do not have access to healthcare data (encryption technology is a must).

Hosting location – It can be difficult to implement a “virtual cloud” without a thorough understanding of where the data resides. Data can be located in different sites, but these must be clearly identified and the associated local security clearly evaluated. For example, you cannot send U.S. patient data to a cloud—not knowing if it will be stored in India, New York, China or Switzerland—or with what security measures.

Data responsibility Health information is subject to strong security requirements from the legal authorities in the different countries. It means that the healthcare institutions that are entrusting the personal medical data to a third party must clearly be able to state and control that data are handled according to specific healthcare legal requirements—making the contractual link between the entities critical.

We’ve been working on these requirements for several years, building an eHealth cloud that uses cloud computing technologies and concepts—but with the addition of healthcare-specific security measures and architecture—making it suitable for the rigorous healthcare environment and associated legal constraints.

Are you ready to move the cloud era and enjoy the benefits? Do you see other constraints?

Patrick Koch, Carestream Health

How do you turbo-charge multi-site reading and reporting workflow?

Create a global patient worklist across mulitple reading sites/locations

Challenge: Diagnostic Imaging Group, a multi-site U.S. imaging group, needed the ability to send medical exams from any imaging location to remote radiologists at any workstation, including their homes or group offices. It sought to eliminate manual processes involved in sharing patient information and imaging exams across multiple locations, enabling the efficient flow of information in a multi-site radiology workflow

Solution: Establish an enterprise-wide reading workflow that can improve radiologist productivity and enhance the accuracy and speed of reporting to referring physicians.

Hear directly from the CIO… Diagnostic Imaging Group CIO Lyle Backenroth will be presenting details of his organization’s multi-site implementation in an upcoming webinar hosted by Health Data Management, to be held June 22 at 2:00 p.m. Eastern / 11:00 a.m. Pacific.

Register now to learn details and ask questions about how his group…

  • Implemented a solution that works with the group’s RIS/PACS to generate a global patient work list accessed by radiologists working from homes or offices—with a common user interface and advanced reading capabilities to radiologists wherever they are
  • Assigns an exam to a radiologist based on their specialty, such as neuroradiology, mammography or muscular-skeletal
  • Designed new processes to boost efficiency for all users: staff, radiologists and referring physicians

– Jo Linder, Carestream Health

Editor’s Note: This webinar is sponsored by Carestream Health.

Radiology Vitals: Life as a Radiology Administrator

Rick Perez, Radiology Administrator, Winthrop University Hospital (Mineola, NY), he is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends, discusses life as a radiology administrator and anticipated challenges imposed on radiology departments due to expected decreases in reimbursement rates.

[youtube=http://www.youtube.com/watch?v=UhRbvojok2U]

How concerned are you about new reimbursement rates? What’s your biggest challenge?

Imaging dense breasts: Where to go from here?

Connecticut recently passed a law mandating that women undergoing mammography screening be informed of their breast tissue density. Much discussion has followed as to whether this is a good idea for patients, and what the ramifications might be for mammography centers and women’s health providers should this legislation spread to other states.

Like many health-related bills, a compelling patient story served as its driving force… Connecticut breast cancer patient Nancy Cappello, Ph.D., received an advanced-stage breast cancer diagnosis in 2004, despite a recent “normal” mammogram that showed no signs of pathology. Her cancer was not discovered by annual mammography screening because she had dense breast tissue, which lessens the sensitivity and effectiveness of mammography screening. Underlying Capello’s personal story is known scientific fact…

  • Women with dense breasts, defined as either heterogeneously dense or homogeneously dense, have four to five times higher risk of developing breast cancer*
  • Many women have dense breasts: more than half of women younger than 50 and at least one-third of those older than 50*
  • Dense breasts present challenges for mammographic imaging, since noncalcified breast cancers are often obscured, reducing sensitivity

Opponents of the Conn. law argue that it is not purely based on science and will cause more harm than good—through increased fear and confusion among women and an increased number of unwarranted, and costly, imaging exams. While this remains to be seen, the law does pose a logical question…

What exactly should women, and their consulting physicians, do with this information?

Answering this question is complicated by the fact that radiology professionals are not always consistent in classifying breast density. Breast composition, mainly determined by the amount of breast density seen in mammograms, is typically evaluated visually. I’ve personally seen different radiologists assess the same woman with a different tissue density classification. This could be problematic!

Our research teams are developing a better method to automate the assessment of breast density using CAD technology. It’s our hope that this method will provide a more consistent and accurate measure of breast density, arming clinicians with consistent tissue density results based on precise measurement and industry standards. We’re also working on dense-tissue-based image normalization for more consistent appearance of mammographic images—to help radiologists compare prior and current mammograms more effectively and to better detect subtle changes over time. This is in addition to our continuous work to improve our mammographic image processing technology, so pathology stands out more when imaging and analyzing dense breasts.

Armed with accurate and consistent tissue density information, patients and their physicians can formulate a screening plan that is right for them.

Of course, we’re only scratching the surface here. What do think should be done to address this complex issue? Where do we go from here?

– Anne Richards, Clinical Development Manager, Women’s Health

* Berg, W.A. et al, Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA, 299 (18), 2151-2163.

Get your PACS out of the cloud

Cloud computing meets PACS

Cloud computing is a hot topic at SIIM 2010, and with good reason. It enables greater flexibility in delivering, storing and accessing information throughout an enterprise. Radiology directors, PACS administrators and IT managers are all likely to be involved in designing and purchasing cloud computing components and services for radiology applications.

While a cloud-based PACS can be designed and supported by a healthcare provider, it can also be offered as part of a remotely hosted service. At SIIM, we are launching a cloud-based, fee-for-use PACS service that combines all of the functionality of a leading-edge PACS solution with the lower costs associated with reducing investment in capital equipment, security technology and management personnel. Our new eHealth PACS Services…

  • Equip healthcare providers to connect to secure, remote data centers where patient information can be shared with authorized physicians over a simple Internet connection
  • Enable convenient remote reading for a primary diagnosis, as well as the ability to obtain a second opinion from another radiologist or specialist
  • Synchronize patient data and exam information so identical information is available to all users, regardless of location
  • Allow the sharing of information among disparate systems via a vendor-neutral infrastructure (an optional feature allows users to access advanced reading tools such as native 3D features and automatic registration of volumetric exams)
  • Employ the latest encryption and security measures to meet HIPAA rules as well as rigorous patient privacy regulations used in other countries

The first healthcare provider to sign up for this service is a Netherlands-based group that will use the service to deliver an enterprise-wide PACS solution for their three hospitals and to provide secure image access to remote clinicians.

Is outsourcing the responsibility for maintaining, updating and ensuring security for PACS attractive? Or are there reasons you want to keep PACS in-house?

– Patrick Koch, Carestream Health

What are you looking for in a PACS?

What's in your next PACS?

Interoperability with existing systems? Ease of use? Built-in advanced features?  Yes, yes and yes according to many healthcare providers that we speak with.

Interoperability is a critical issue because a PACS is always placed in a heterogeneous environment—typically including HIS and/or RIS, voice dictation systems and EMR. A smooth integration ensures rapid communication of information and a streamlined workflow. As you evaluate PACS, ask vendors to provide reference sites where they have performed similar integrations.

Ease-of-use always translates to greater productivity and user convenience. At SIIM, we’re introducing a new user interface that allows you to adapt specific interfaces based on the user roles (e.g., radiologists and other types of physicians). So we allow users to match the interface to the level of complexity they need.

User functionality has always been important, but an additional emphasis is on built-in advanced features such as 3D, vessel analysis and more advanced application functionality. In addition, the ability to perform automatic volume comparison streamlines workflow by allowing radiologists to read all exams and priors from a single PACS workstation quickly. Did we mention it’s also more cost effective?

What top three features are you looking for in PACS?

– Eran Galil, Carestream Health

Editor’s Note: To read about our latest CARESTREAM PACS release, click here.

SIIM 2010 Preview, Part II, with SIIM Fellow Eliot Siegel, MD (Podcast)

In part II of our interview, Dr. Siegel discusses concerns about the U.S. Government’s criteria for the “Meaningful Use” of health IT and expected collaboration between radiology and IT teams. Click on the link below to activate the audio stream, or you may choose to save the mp3 file to your computer/device. Dr. Siegel is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends

Carestream_CAST_Eliot-Siegel_PartII