HIMSS 2014: Proposed Medicare Imaging Rule May Boost Need for Clinical Decision Support Software

Dave Fornell, editor, Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC)

Dave Fornell, editor, Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC)

As an editor for two medical technology magazines, I am always on the lookout for the next big trend in radiology or cardiology. This is especially true when legislation prompts action. This year at the Healthcare Information and Management Systems Society (HIMSS) annual meeting in late February, I will be on the search for new software to help physicians meet appropriate use criteria guidelines in medical imaging.

Stage 2 meaningful use guidelines for electronic medical records (EMRs) suggest use of clinical decision support (CDS) software to help clinicians choose appropriate labs, diagnoses, therapies and imaging exams. A draft policy to replace the sustainable growth rate (SGR) formula being considered by the a joint U.S. Senate Finance and House Committee on Ways and Means Committee might make this suggestion a requirement in the future. The draft policy would deny Medicare payment for the exam if the ordering physician did not consult appropriateness criteria and require prior authorization for outlier providers whose ordering is inconsistent with that of their peers.

The American College of Radiology (ACR) applauded the proposal in early November.  “This landmark step by Congress is a validation of a cornerstone of the College’s Imaging 3.0 initiative that increases quality of imaging care and preserves healthcare resources,” said Paul Ellenbogen, M.D., FACR, chair, ACR Board of Chancellors. “We strongly urge Congress to follow this approach which helps medicine transition from volume-based to quality-based care without interfering in the doctor-patient relationship.”HIMSS14

The policy draft would require the Secretary of the Department of Health and Human Services to specify appropriateness criteria from among those developed/endorsed by national professional medical specialty societies. The secretary must also identify mechanisms, such as clinical decision support (CDS) tools, by which ordering professionals could consult these appropriate use criteria (AUC) CDS systems in Minnesota and at Massachusetts General Hospital have been shown to cut down on duplicate and/or unnecessary scanning and their associated costs.

Studies show that imaging exams reduce unnecessary hospital admissions, shorten length of stay and are directly linked to greater life expectancy.  ACR said Medicare imaging use and imaging costs are down significantly, the same levels as it was in 2003, and that imaging is the slowest growing of all physician services among the privately insured. ACR contends the use of appropriateness criteria can help streamline the ordering of these services.

If this policy is enacted, and it appears to be that it would be a no-brainer decision to help cut the staggering costs of Medicare, I predict it will result in a rapid explosion in and adoption of new CDS systems.

This software is not yet widely offered by PACS, CVIS or EMR vendors because it is difficult to keep up-to-date with the latest data from multiple societies, clinical trials and studies regarding all specialties. To stay current, vendors will have to issue a large number of updates each year, including rapid software revisions each time societies update their AUC. For this reason, AUC/CDS software might be best managed as a Web/cloud-based application, which makes regular software updates much easier.

It will be interesting to see what CDS solutions vendors introduce at HIMSS and other conferences throughout 2014.

Dave Fornell is an editor for Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC).

ACR’s Teleradiology White Paper and What it Means for the Industry

The ACR white paper about best practices in teleradiology that was published in 2013 has been a popular discussion topic over the past several months. David Willcutts, CEO of ONRAD, a radiology services provider based in California that offers flexible, custom radiology service solutions that can include teleradiology, on-site coverage, subspecialty reports and turnkey quality assurance programs, spoke with us about the teleradiology white paper and what he sees as being the most important points.

Willcutts explained that the focus is on important issues related to radiology as a whole, and that these are not exactly unique to teleradiology. A company such as ONRAD has trained radiologists on staff, and it is vital for them to maintain and manage items such as having the right licensure, efficient around time, complying regulations, etc. He stated that as the radiology industry evolves, the two monickers are going to blend and the only way to support clients is to focus on being the best radiologists possible.

In the end, it is all about one core issue – how do radiologists best take care of the patients? The interview with Willcutts can be viewed in its entirety below.

Wireless DR Rooms: Careful Evaluation Will Allow Your Facility to Maximize Productivity and Flexibility

By Fred Hastings, R.T., C.R.A., Director of Operations, Harbin Clinic

Our company is a large multi-specialty physician clinic with 23 separate locations in Northwest Georgia. We recently decided to install fully automated wireless DR rooms at our two busiest locations for routine radiology procedures—our orthopaedic clinic and our main clinic. Even though we had DR systems in these facilities, we chose to upgrade because the latest generation of wireless DR technology offered substantial gains in both image quality and productivity. Automated hardware features and advanced software functionality were also important benefits.

Achieving a streamlined process is extremely important because the orthopaedic site requires that patients first meet with their physician, have an imaging study if needed, and then go back for a consultation. At the main clinic, patients may be imaged and sent on their way or the patient may be required to return to the referring office with the results DRX-Evolutionof their exam. Rapid delivery of high-quality imaging studies is essential to keeping physicians on schedule and reducing patient wait times. A smooth workflow greatly impacts both physician and patient satisfaction.

After conducting an evaluation of several wireless DR systems, Harbin clinic managers and technologists unanimously selected a new DR room that is configured with a motorized overhead tube, motorized wall stand and an automated table for convenient, efficient patient positioning. The system’s software can automatically capture and stitch long-length images in the upright and supine position—which is a key benefit for orthopaedic studies.

For healthcare providers who are evaluating new DR rooms, I would make several suggestions based on our experience:

  • Wireless DR technology should offer both wireless transmission and removable detectors. Some DR systems we initially considered used a wireless network but the detector was wired into the wall Bucky. We wanted the flexibility of using the same detector for wall stand, Bucky and tabletop exams.
  • A detector that can move between multiple DR systems further boosts productivity and helps lower costs, while also offering redundancy.
  • An easy-to-use operator interface can maximize productivity. As technologists rotate between different sites, having the same type of DR equipment with a highly intuitive interface at all sites significantly enhances technologist efficiency.

Digital radiography has been around awhile, but the newest generation of wireless DR systems delivers significant advantages that make it worth evaluating for a variety of imaging environments.

Why User Groups Are Necessary for Technology End-Users

By Jim Travitz, Senior Imaging Analyst, Trinity Health, Holy Cross Hospital, and President, Carestream VIBE User Group. He is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.

When becoming an end-user of a particular piece of technology, one way to ensure you are able to get the most out of that technology is to join a user group, if the company has set one up. By joining a user group, customers are essentially creating a line of communication between not only themselves and the company, but with like-minded customers like themselves as well—and that is where some of the most important benefits exist.

Collaboration is the name of the game when it comes to user groups. The ultimate goal is for customers to discuss issues and solutions among each other, allowing the company to chime in when necessary. As an example, I am currently the president of Carestream’s VIBE User Group for its HCIS products, and am currently corralling more Carestream customers to join the group because of the benefits it offers. In addition to learning about the latest PACS, RIS, and other HCIS updates, there are several other initiatives in the works for VIBE:

How-to guides for users: We want users to have knowledge and informational materials available at their fingertips when joining the group. This is made possible by creating channels for users to reach out to one another, as well as Carestream delivering on providing the information we need to learn about its technologies.

Bring clarity to the user group:  As a group, we have the ability to decide what are the most important ideas/issues that need to be addressed. Collaborating to decide this is able to give Carestream a better idea on how to develop its products so it can meet our needs. Being from diverse organizations, we are going to have different needs we want addressed, so it becomes up to the group to deliberate on what the most universal needs are that can be focused on.

Sharing content: The best source of content in a user group tends to be the users themselves. Coming across an article or research, and then sharing it with the group is one of the best resources available. The best user groups are those that are the most educated and participate often, so by sharing content, users are contributing to improving the education of the group.

Education from Carestream about new features: If users are to experience the benefits from Carestream’s technologies, then education will be needed on its part to educate users about new features. Be it in the form of webinars, demo videos, or downloadable guides, education about these features is a must, and one the company is looking forward to providing.

Regarding the future of VIBE, I am currently working to fill a couple positions in the user group. I am looking for a PACS Knowledge Manager and a RIS Knowledge Manager. These two positions will be tasked with organizing all of the content that is shared among the PACS and RIS sections of the group, and ensuring that this information is accessible for all members.

Additionally, I recently attended RSNA in December and was able to talk with other members of VIBE about what they are looking from joining the group. The two biggest needs users are looking for from the group are consistent user collaboration and webinars from current VIBE members. With these features being put into place, it is our plan than as VIBE evolves, so will the members of the group. That will be the most beneficial end-game for all of those involved.

If you are a Carestream HCIS user and are interested in joining the VIBE user group, you can click the link to sign up.

Below is an interview I conducted at RSNA about VIBE, what changes are currently taking place in the user group, and what improvements users can expect in the future.

Why Multi-Media Reporting is a Necessity in Today’s Medical Imaging Industry

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

When we say “multi-media reporting,” we are talking about the inclusion of information beyond words and numbers—images and even videos that can better tell the full story of a patient’s medical imaging history. As stated before, reporting and data is now a necessity in the radiology world, and this data is needed not only by the radiologist, but also referring physicians and patients too.

The radiology report is the working tool for the referring physician. That is why this vital tool is critical for imaging and for overall patient care. A more robust reporting platform can lead to two important factors:

  1. More information for physicians to make better decisions
  2. Easier to understand information so patients can be more involved in their own healthcare

These ideas are not exactly anything new, but they have yet to be put into widespread practice throughout the medical imaging industry. The ultimate goal is to reduce errors and improve productivity of the radiologist. This can be accomplished by automatically including the measurements and data from various modalities. One example of this would be with a lesion management application. The radiologist uses the app to measure a lesion, and instead of just including the measurements in the VueReporting report, now the images with the specific measurements can be included so physicians have access to the entire story behind the patient. In addition to the quantitative measurements, graphs can also be included in the report, providing an easier to read method of showing either the increase or decrease in size of the lesion.

Context will also play a key role in reporting. With so much information present, radiologists and physicians may need to see additional information than what is presented. A feature such as contextually aware bookmarks—such as clicking on a graph and seeing the data, images, and annotations behind the graph—allows for easier, more efficient navigation throughout the report. In the end, multi-media content has the ability to aid clinicians in treatment planning because it enhances the data present in the report.

To demonstrate this, Carestream is sponsoring a Clinical Innovation + Technology webinar on Thursday, February 13th, at 2pm EST titled, “A Better Way to Follow Oncology Patients:  Optimizing IT to Link Physicians and Facilitate Care Decisions at NIH.” The webinar will demonstrate how leading radiologists and oncologists at the National Institutes of Health (NIH) are using technology such as semi-automated cancer lesion management and multi-media reporting software to reliably, consistently and quickly distribute reports in oncology follow up and treatment planning. This is leading to more effective communication, clinical insight and confidence among physicians in longitudinally tracking lesions with more quantitative and structured reports—and better communication with patients as well.

Five Ideas the Medical Imaging World Will Be Implementing in 2014

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream

A new year means it is time to turn a new leaf. However, in the medical imaging world, this leaf may not be as new as we think. In 2013, many trends, topics, and ideas became part of the industry’s vernacular: multidisciplinary teams, big data, tomosynthesis, etc. While these trends gained traction through highly publicized research, 2014 will be the year of implementation.

Last year marked the time when certain trends were shown to have benefits, and this year will be the time when these ideas are put into practice among a larger portion of the industry. The following five trends are what we expect to see implemented widely throughout 2014, and we will be looking forward to measured results, analyses, successes throughout the year and into 2015.

Multidisciplinary Teams: This has proven to be a major benefit for healthcare organizations across the world, and a necessity for those working in radiology who want to emerge from the darkness. In a post from 2013, Dr. Marc Zins, Department of Radiology, Hôpital Saint-Joseph, explained the numerous benefits his multidisciplinary team provided: The quality of the communication throughout the department improved immensely, the department became better organized and have implemented new processes and protocols that have improved efficiency, it has become easier to sustain quality time, and better communicate metrics to members across the team. If radiologists want a more prominent role within their organizations, then forming and joining multidisciplinary teams is a must.

Tomosynthesis: This was a popular topic at RSNA 2013. There was a great deal of research presented that demonstrated the benefits of tomosynthesis and how it can improve diagnoses. We conducted a study in collaboration with the University of North Carolina School of Medicine that showed the feasibility of a stationary chest tomosynthesis system, and how it had the ability to improve image quality and enhance detection of small lung nodules and other chest pathology. Additional research presented at RSNA 2013 showed that the degree of visibility vastly improved using tomosythnesis, a higher percentage of the cancers were more definitively characterized as masses compared to asymmetries when using tomosynthesis for diagnosis, and when compared to conventional radiology, tomosynthesis allowed for increased cancer detectability upon screening. This was because of its improved visibility and the precise morphology of cancers allow for a better lesion diagnostics in initial imaging. It’s being proven over and over how beneficial 3D imaging can be, and look for more healthcare facilities to put this technology in place in 2014.

Reporting/Data: The idea about providing better reporting and data collection for radiologists is that it leads to better decision making and improves the patient’s understanding of their images. The implementation of better reporting tools would influence much of the decision making being done by radiology departments today. Data is becoming more and more valuable, and when it is brought into the decision-making process, it results in clearer, more appropriate actions being made that benefit the patient, department, and healthcare organization as a whole. Reporting software has the ability to reduce errors, improve productivity with automatic inclusion of data from modalities, embed clinically rich insight such as key images and multi-media content, quantitative analysis, or lesion management graphs into the final report. With these capabilities, the radiologist has access to a wealth of vital information that can be used for improved diagnoses.

Article courtesy of The Wall Street Journal: http://on.wsj.com/1gAT5oy

Article courtesy of The Wall Street Journal: http://on.wsj.com/1gAT5oy

Image Storage & Access: According to Frost & Sullivan, the amount of storage volume needed to house medical images has more than tripled since 2005, and it is projected to double in the next five years. A statistic like this is quite daunting. Data is everywhere. It is being created and consumed at exponential rates, and it is the job of healthcare facilities to properly store the images, and simultaneously ensure that they are accessible for the appropriate people. Security of these images is a necessity because of HIPPA regulations.  The ease of access is becoming even more of a necessity as not only medical professionals need these images and data, but more often patients are demanding access to their images too.

Patient Engagement: This topic has been a hot item for the past couple of years due to the prominence of EHRs, but now radiology is becoming invested in this arena. Medical images are becoming a more important component of the EHR, and the portals are serving as the access point for patients to view and share these images. In a study we conducted with IDR Medical in 2013,we found that 79% of patients would be more likely to return to a facility that offers online image portal and 76% indicated they would recommend the facility to others. In the end, 83% of those surveyed said that they would use a patient portal to access and share their medical images—a sign that this is a need that healthcare organizations should be providing.

These are not the only trends that will be popular in 2014, but are certainly among the most prominent. This year is going to be a year of action. We have passed the testing phase and now must move into implementation if the benefits of newer technologies are to be realized. It is going to be another exciting year for healthcare and medical imaging.

Top 10 Everything Rad Posts of 2013

10.  Patient Engagement – A Healthcare Reform Topic Everyone Can Agree On

This post discusses the path to patient engagement and health impact in radiology with the use of patient portals. These portals not only allow patients easy and secure access to their X-ray exams and diagnosis on the radiology report, but it gives them the freedom to share the information freely with other physicians or specialists and become proactive in managing their healthcare treatments.

9. Rebooting Radiology at SIIM 2013 June 6-9: Five Things to Look for in Dallas

SIIM 2013 addressed the many issues and technology tools required by 21st century radiologists and their colleagues. This post discussed the multiple themes of the program and broke down specific sessions that were held throughout the annual meeting.

8. Getting the Most out of RSNA By Using the RSNA 2013 Mobile App

This post breaks down the RSNA mobile app and all the helpful features available on it. You have all the access you need at your fingertips, which makes navigating the show a breeze.

7. ECR 2013: Q&A with Dr. Les Folio, Radiologist at the National Institutes of Health Clinical Center

Dr. Les Folio presented his work on “Automated Registration, Segmentation, and Measurement of Metastatic Melanoma Tumors in Serial CT Scans” at ECR 2013. We caught up with him before the event to learn more about his research and his thoughts on radiologists being more quantitative in reports.

6. Detailed and Precise Measurement with Lesion Management

Lesion Management is an embedded application tool in our Vue PACS that provides native oncology follow-up capabilities. Larry Ray, one of the creators of the application, discusses the features and benefits of the tool for both the patient and healthcare provider.

5. What Features Should You Analyze When Shopping for a Mobile X-ray System?

This post outlines the key features radiology departments should look into when analyzing mobile X-ray systems. Those features include: visibility and ease of transportation, image processing speed and preview, and reliability and flawless implementation process.

4. The Invisible Gorilla Study and Inattentional Blindness: Are Radiologists at Risk?

The Invisible Gorilla Study explains inattentional blindness, which happens when a person’s attention narrows and blocks out certain things. A similar study was conducted with radiologists and 83% missed the gorilla in the image due to the fact that they were focused on finding lesions, tumors, etc., not a gorilla. This post further discusses inattentional blindness and what radiologists can do to combat it.

3. [INFOGRAPHIC] HIMSS 2013: The Need for Patient Access and Patient Portal Adoption

Patients are gaining more access to their medical records and therefore taking a more invested interest in their own health. Health facilities that implement patient engagement technologies are seeing benefits on both patient satisfaction and financial fronts. This infographic breaks down patient engagement through the use of patient portals and the results of our MyVue portal from two trials we conducted with Houston Medical Imaging and Ferrara Hospital in Italy.

2. [INFOGRAPHIC] Portals, Access, and Engagement –Patients Are Demanding It

To understand patient’s perceptions and needs, we partnered with IDR Medical to conduct a direct survey, which asked what patients are looking for in terms of medical images, patient portals, and online access to those images. The infographic provides an overview of the key insights from the study.

1. Section 179 Tax Deduction: The Hidden Benefit of Capital Equipment Purchases

This post breaks down U.S. tax benefits for small business owners through this year’s Section 179 deduction and is equipped with a table to easily highlight the potential deductions.

Guess the X-ray—January’s Image Challenge

Happy New Year! Hopefully everyone had a safe and exciting holiday break. Congratulations to the few people who guessed December’s X-ray image– they were Michael Kors eyeglasses. Below is the original image.

Let’s get into the first image challenge of 2014! Please leave your guess in the comment section below. The challenge will run until January 31, or until the first person correctly names the item in the image. Good luck and happy guessing!

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