Why We Need Pediatric Radiologists

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

There was a recent interview on AuntMinnie Europe with Dr. Gabriele Hahn about the relative importance of pediatric radiology in Germany. In the interview, Dr. Hahn states that the number of practicing pediatric radiologists in Germany is declining and has been for about the past 20 years. She finds the trend troubling because pediatric radiology is a specialty that requires different knowledge than radiologists who solely capture medical images for adults.

Carestream recently published a blog post from Cincinnati Children Hospital’s (CCH) Radiology Department that talks about bringing in child life specialists to help with the imaging process for pediatric patients. The department does this because the specialist has a breadth of knowledge about child behavior that can help keep the patient calm and relaxed so the radiologist can capture the best image as efficiently as possible.

This is the sort of wisdom that applies to pediatric radiologists because they have a keener eye for issues that are relevant to younger patients. Dr. Hahn said in her interview that pediatric imaging practitioners give

Pediatric radiology requires the utmost care and delicacy, as patients' bodies are still developing at the time of imaging exams.

Pediatric radiology requires the utmost care and delicacy, as patients’ bodies are still developing at the time of imaging exams.

greater thought to radiation dose, an important pediatric imaging issue. The specialists’ techniques allow them to capture the best quality image while using the smallest level dose possible for the exam.

A trend we have seen throughout 2013, and will continue to see develop throughout 2014, is the need for interdisciplinary teams, and developing cultures engrained in thorough communication. With a practice as niche as pediatric imaging, practitioners must be consistently kept in the loop and sought for when pediatric patients require imaging exams. The partnership CCH demonstrated between the radiology department and child life specialist is the perfect example of this. If a child behavior expert is not available, then this strengthens the case for having staff solely dedicated to providing medical imaging exams for children.

What has been consistent throughout all discussions related to pediatric radiology is that a great deal of sensitivity and care is needed to effectively capture a high-quality image. Pediatric radiologists possess these characteristics and are sure to be vital for any facility’s that cares for young patients. Dr. Hahn offered this piece of information to further support the need for pediatric radiologists:

“From my lengthy experience as a pediatric radiologist, I can tell that a lot of colleagues, radiologists, and clinicians who have not had appropriate training find it difficult to reach the correct diagnosis or to come up with normal findings.” – Dr. Gabriele Hahn, AuntMinnie Europe, February 17, 2014.

At ECR 2014, pediatric imaging is sure to be a topic of great interest among attendees. Carestream will be demoing several products that address this trend such as our DRX-2530C wireless detector, and our IHE Dose Reporting software that transfers dose information from CR and DR systems directly to a facility’s PACS.

Equipment Solutions for European Medical Imaging Budgets

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

The dynamics of the European economy are quite diverse, and even more so when looking into the healthcare systems across the nations. Back in November, Frost & Sullivan released a report commenting on how Europe was about to experience a large increase in the use of refurbished medical equipment due to limited hospital budgets across the continent, particularly in Southern Europe.

For perspective on how much growth we will see in this area, Frost & Sulllivan found that the market earned revenue of $417.6 million in 2012 and estimates this to reach $582.3 million in 2019. The major goal behind this trend being that hospitals and health systems need to save money on their technologies, but still need to perform a high volume of procedures at a high level of quality. While the growth appears to be inevitable, Frost & Sullivan said that there are challenges present:

“The market, however, presents its challenges. For instance, reimbursement laws across some European regions, such as France, compel reimbursement to be cut by half if the equipment is older than five years. This forces some hospitals to purchase new equipment. Moreover, regulations in certain countries such as Romania and Bulgaria restrict hospitals from purchasing old equipment using state funded loans. Because almost all public hospitals are covered by the state, they opt for new systems over refurbished models.” – Frost & Sullivan, 12 November 2013

The health systems that cannot purchase refurbished equipment have other options to handle the increased demand for volume and quality of procedures. Many are looking at the ability to streamline processes by upgrading pieces of their imaging systems instead of purchasing entirely brand new ones.

The ability to move from analog to computed radiography (CR), or from CR to digital radiography (DR), has become easier and more affordable. This has allowed for radiology departments to improve their imaging processes and also not spend a large portion of their budgets all at once.

At Carestream, the phrase “Right for Today, Ready for Tomorrow,” is a mantra for us when it comes to X-ray solutions. Not only does it keep us focused on providing customers with the technologies needed to handle high volumes and provide top-notch image quality, but it also prepares them for any future upgrades needed without having to overhaul entire systems.

For example, a health system is working with CR equipment and is looking to make the move to DR, but can’t afford a brand new system. Instead of buying a complete DR system, the radiology department can purchase DR retrofit kits that are meant to convert CR systems to digital with the simple conversion to new software and wireless DR detectors. It is a quick, easy, and affordable for the facilities that are constrained by budgets, but must still provide the top level of quality and care to patients.

Carestream will be featuring and demoing its DR equipment at ECR 2014, which you can read more about on our event page. The video below provide additional background about making the switch to DR.


[Webinar] Does Image Quality Matter?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

You would think that the answer to this question would be an easy “yes,” but it is not as clear-cut as you would believe. The reality is that many factors influence actual and perceived image quality. A so-called “poor” image detector can still produce good-quality images, while a “good” detector can easily produce poor-quality images. The bridge between the detector and its images involves exposure techniques (e.g., kV, mAs, filtration, anode, dose, etc.), image processing (e.g., optimization, compression), and the characteristics of the display system itself. Finally, the observer at the end of the imaging chain also plays a critical role..

On March 4, I am going to be conducting a webinar for members of the Carestream VIBE user group that will seek to answer the question, “Does Image Quality Matter?” The definition of image quality often differs from person to person, depending on whether the focus is on objective evaluation, subjective perception or task performance.  This makes the subject of image quality both interesting and complex.

The webinar will attempt to reduce this complexity by focusing on three basic questions about image quality:

  • What is it?
  • Where is it?
  • Who should care, and why?VIBE_Graphic_1_2

To answer these questions, we’ll look at the contributions to image quality from detector performance (e.g., contrast, spatial resolution, noise), from image processing (preprocessing, display optimization), and from display performance (e.g., perceptual linearization, calibration). At the end, we’ll also examine the role of observer performance (e.g., human visual system characteristics) in the final determination of image quality.

At the end of the webinar, attendees will have a clear understanding of what we/they mean when we/they say “image quality” and how it may differ across its three main categories—objective, subjective, and performance-based.   Attendees will also understand the important role that the observer plays in determining the success or failure of an imaging chain. By the last slide, attendees will be able to answer with greater confidence the question “Does image quality matter?” and be able to explain the complex balance of factors in the imaging chain that makes this simple question significantly deeper than might first appear.

You must be a Carestream customer to join the VIBE user group. If you are a customer and would like to join, you can click here.

If you would like to register for this webinar, please click here.

Preparation and Support is Key to Safe Imaging with Pediatric Patients

Alexander Towbin, MD, Neil D. Johnson Chair of Radiology Informatics, Cincinnati Children's Hospital (left), and Catherine Leopard, Child Life Specialist, Cincinnati Children's Hospital (right)

Alexander Towbin, MD, Neil D. Johnson Chair of Radiology Informatics, Cincinnati Children’s Hospital (left), and Catherine Leopard, Child Life Specialist, Cincinnati Children’s Hospital (right)

Patient comfort has always been an important component of the medical imaging process. However, when a child is the patient, comfort becomes vital. There are many components of medical imaging that can intimidate children, or be downright scary for them. Like many other pediatric radiology departments, the Radiology Department at Cincinnati Children’s Hospital employs child life specialists to help support our patients and their families before, during, and after their radiology appointment.

Child life specialists are trained professionals who work with our patients and their families to assess and understand each individual’s specific psychosocial needs. They then work collaboratively with the radiologist and technologist to ensure that the procedure goes smoothly and that high-quality, diagnostic images are produced.

Successful pediatric imaging is dependent on proper preparation before the procedure.

There are many things that can be done to help pediatric patients and families prepare for a radiology procedure. In our department, child life specialists often first contact a patient’s family by phone before the appointment to discuss developmental information, stressors related specifically to the radiology examination or other important information the family believes might impact their child’s ability to cope positively during the procedure. Obtaining this information ahead of time allows us to adequately prepare for our patients so that we can provide them the best experience possible.

We believe that it is important to provide our patients’ and their family information about the radiology procedure in a manner that they can understand. In order to do this, child life specialists first assess a child’s developmental level as well as his or her current mood and anxiety level. Once this assessment is made, child life specialists use appropriate pictures, videos, medical dolls, sample medical equipment and/or models to help prepare the patient for what he or she will see, hear, feel and experience during the radiology examination.

2530C DRX

Pediatric imaging always requires the utmost care and preparation to ensure the image is properly captured and the patient remains comfortable.

The education process can begin either before the examination is scheduled or after a patient has arrived. For example, children who are scheduled to have a MRI at Cincinnati Children’s can come to the Radiology Department beforehand to tour and “practice” the scan. They can see the MRI room, lay in the scanner, and hear the sounds the MRI scanner makes. All of this preparation helps to answer questions, build the patient’s confidence, and ultimately leads to the successful completion of the MRI.

We have found that when children are appropriately prepared for an examination they are able to more successfully cope with the experience. While it is important to produce high quality images in order to accurately diagnose disorders, we believe that it is just as important to perform the examination in a way that is supportive of the patient and family. These two goals can only occur when members of the radiology department work together as a team. We use these principles every day to make the imaging experience as stress-free as possible for children and their parents.

When playtime leads to a lesson: a case study.

An example that illustrates this point occurred recently in fluoroscopy. A 4-year-old boy arrived in our department for an upper GI examination. After assessing the boy, the child life specialist discovered that the large and confining space of the fluoroscopy camera was scary for him. In order to help calm the boy’s fears, the child life specialist played with him, using the camera to play hide-and-seek. This helped the child to become more familiar with the equipment and feel less overwhelmed. The child life specialist then spoke with the technologist and radiologist discussing the patients fears and offering suggestions (such as slowly moving the tower and keeping it a little higher than normal) to lessen his stress and anxiety.

During the study, the child life specialist engaged the patient in play and directed that play in specific ways to help the patient achieve the necessary positioning and cooperation for the imaging. This attention to the boy’s fears helped him to easily get through the examination. This kind of supportive experience has a lasting effect on our patients and allows them to gain confidence as they undergo repeat examinations.

Collaboration between child life specialists and parents can keep children at ease.

We encourage parents to be involved in their child’s care throughout the Radiology appointment. Parents can help prepare for an examination and soothe their child during the procedure. Parents can use the Cincinnati Children’s Radiology website to learn accurate information about their procedures. They can also view pictures of CT and MRI equipment with kid friendly explanations so that children can become familiar with the process before their appointment. As part of the preparation process, a parent can demonstrate what the child will need to do. Children look to their parents for clues on how to handle new experiences, so when the parent practices first, it helps the child to think, “If Mom or Dad did it, so can I.”

When a child is scared, we know that a parent can make him or her feel better. We encourage parents to stay close to their child during most examinations and encourage them to hold hands, sing, or play throughout the procedure. Literature supports that when parents are given good information on what to expect during the procedure and are given an active role to play, their stress is lessened, which ultimately lessens the stress of their child.

Child life specialists have a central role in the Radiology Department at Cincinnati Children’s Hospital helping us to better care for our patients. We see their impact every day in the smiles of children and their parents.

Patients and Physicians are Getting Engaged

Jeff Fleming, Vice President Healthcare IT Americas, Carestream

Jeff Fleming, Vice President Healthcare IT Americas, Carestream

Radiology patient portals contribute to savings in time and money by helping to reduce CD production, but what about patient engagement?

A radiology patient portal is a great way to transmit images and reports to referring physicians, but what about patients? Do they care about access to their images? Would they use a patient portal if they had the option? Is it too complex or unnatural for them to look directly at their own imaging information?

The answer is a resounding, “We love our images!” Carestream studied more than two thousand patients at Houston Medical Imaging over a three-month period. 56% actually activated their patient portal to access their images or transmit them to a referring physician. This level of engagement, considerably higher than the level that would satisfy the Meaningful Use engagement criterion, was consistent across the entire study period. To validate the results, Carestream commissioned an in-depth quantitative study by IDR Medical titled, “Patient Attitudes Regarding Use And Utility Of A New Patient Portal Platform.” The following facts emerged:

76.5% of patients interviewed stated they would be more likely to recommend an imaging center to a friend or colleague if they were offered an online imaging portal solution.

79.3% of patients said they would be more likely to return to the facility for future scans.

Both the report on the Houston Medical Imaging clinical trial of the MyVue radiology patient portal and the independent study of patient attitudes toward patient portals are available here. You can also view a summary of the study in the infographic below.

ACR on the CNBSS Mammography Study: “Deeply Flawed and Widely Discredited”

Clinical Development Manager, Women’s Healthcare, Carestream

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

A disturbing study about the effectiveness of mammography was released to the public on February 11 in the British Journal of Medicine. The New York Times wrote about the study, providing such summaries as:

“… the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.” – New York Times, February 12, 2014

The goal behind this study was for researchers to determine if there is any advantage to discover breast cancers that were too small to feel. The study claimed that there is no advantage, but the American College of Radiology (ACR) came to the rescue to debunk this claim.

The ACR came right out to call the study “deeply flawed and widely discredited” and backed up its words. Citing reviews from experts, the ACR learned that the trial used second-hand mammography machines, which were not the most up-to-date at the time the study was conducted. The ACR went on to say:

“The images were compromised by ‘scatter’ which makes the images cloudy and cancers harder to see since they did not employ grids for much of the trial. Grids remove the scatter and make it easier to see cancers. Also, technologists were not taught proper positioning. As such, many women were not properly positioned in the machines, resulting in missed cancers. And the CNBSS radiologists had no specific training in mammographic interpretation.” – American College of Radiology, February 12, 2014

Additionally, the ACR brought about claims that the CNBSS violated the rules of conducting a randomized, controlled trial (RCT). This was because each woman who participated in the study had a clinical breast examination by a trained nurse so that they knew which women had lumps and which women indications of more advanced cancer. For a RCT to be valid, the women assigned to the screening group or the control group must be random, and this was certainly not the case.

One issue with the wording in the news articles that covered the CNBSS study is that they are including mammography exams into the same category as treatment. But these are two different areas. Mammography and the advancements made in the field are leading to earlier detection of breast cancer. Patients are then referred to their physicians who then determine the diagnosis best course for treatment.

Along with the ACR, the mammography medical community made sure its voice was heard after large news outlets began picking up the story. On the radiology trade publication site AuntMinnie, Dr. László Tabár and Tony Hsiu-Hsi Chen, DDS, PhD, wrote an op-ed about the CNBSS study and how the medical field has been dismissing it for years, citing it as being “a failure from the beginning.”

They go on to say that even the World Health Organization’s International Agency for Research on Cancer (IARC) workshop excluded the study in 2002 because the study was not population based and “the Canadian trials could not evaluate the independent impact of mammography because of the confounding effect of physical examination.” At the end of their letter, Drs. Tabár and Chen quote Dr. Norman Boyd, who had this to say about the CNBSS study 21 years ago in Radiology (1993, Vol. 189:3, pp. 661-663):

“Taken at face value, the results of the [CNBSS] argue for abandoning mammographic screening as a population-based means of controlling death rates from breast cancer. We believe such a conclusion to be unjustified and unsupported by the findings of the [CNBSS] … [and] the results of these trials should not be used to change the prevailing scientific view of the potential benefits of screening with mammography.”

Those of us that have been involved in mammography since the 70s have seen enormous advances in the understanding of what is needed to ensure early detection and the effectiveness of mammography. The industry has helped to improve the image quality since the Canadian study with advances in analog film, improvements in x-ray units and of course the introduction of digital mammography and digital breast tomosynthesis.  There have also been great advancements in the training of technologist that perform and the radiologists that interpret mammography.

Early detection remains a must if we wish to continue to improve the survival rate of breast cancer. To dismiss the value of mammograms is to turn a blind eye toward a disease that is predicted to be diagnosed in 232,670 new cases in 2014 in the United States alone (source: American Cancer Society). It is the second leading cause of cancer death in women and dismissing exams that can lead to earlier detection is putting more women at risk.

In the video below, Dr. Tabár provides more details about the flaws behind the the CNBSS study.


Portals Provide Benefits to Physicians and Patients, With Few Barriers to Access

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Clinical applications continue to be a vital part of our ever-evolving health care system as Meaningful Use Stage 2 increases in adoption and patient engagement receivers a higher participation rate. Not only is engagement occurring between patients and physicians in regards to accessing their EHRs, but patients are increasingly asking for access to their medical images so that they have their entire medical history at their fingertips. As proof of this, we have seen the value of providing patients with access to medical imaging portals, and the long-term benefits it has for both them and physicians, according to a study conducted by IDR Medical GmbH [full disclosure: the study was commissioned by Carestream].

From the study, it became clear that physicians need to be offering patients access to these portals because the patients are demanding it. Among the 1,000 people surveyed, the results found that 83% of the patients see value in being able to access their medical images via a patient portal. The financial advantage for providing patients with access is that patient satisfaction increases, according to the study. Respondents said (76.5% of them) they would recommend such a portal, and a physician who provides access to the portal, to family and friends.

Patient satisfaction allows healthcare providers to engage their patients in a way that both improves the overall care for the patient and allows for providers to retain and attract more patients. The study showed that 79.3% of respondents would return for future scans based on having access to their medical images via a portal. With Meaningful Use Stage 2, healthcare providers must have patient engagement capabilities in place with at least 5% of their patients. The reason being that engaged patients are more educated about their healthcare and because of this knowledge, they will want to be more invested in their care.

It is common for healthcare providers to claim that not only do patients not want the access to portals (which the study says is not true), but that there are barriers that would prevent patients from adopting the new technologies.

  • Age: Older populations take more medical images and receive medical care more often than younger patients. The study sought to answer whether age would be a detriment to portal deployment and adoption, and it turns out that age is not a barrier. On a scale of 1 to 7, with 1 being “extremely unlikely” and 7 being “extremely likely,” all seven age-segmented groups rated their likelihood of using this tool greater than 4.75. Most importantly, while patients age 71 and above scored the lowest at 4.76, the age group 51-60 scored the highest at 6.08. A score of 4.76 still shows a more likely interest in portals, with the overall results being high.
  • Technology: On the same 1 to 7 scale, respondents who characterize themselves as having very basic, moderate and advanced levels of IT competence scored 5.44, 5.79 and 6.09, respectively, for the likelihood of using an imaging portal. Similar to age, level of knowledge about technology will not prove to be a barrier to patient portal adoption among patients.
  • Image retakes: A hypothesis about image retakes hindering the use of an imaging portal was proven incorrect in the study. On the 1 to 7 scale, those who have not had to undergo an image retake scored 5.8, compared to those who have needed to have their image retaken at 6.0. Respondents’ overall scores ranked from 5.75 to 6.02 across X-ray, ultrasound and mammogram testing. Like age and technology, having images retaken proves not to be barrier with interest remaining high across all segments.

Patient portals are now in a phase where they are a “must-have” for healthcare providers. Aside from Meaningful Use mandates and incentives, the benefits of deploying a patient portal are proving that these technologies are benefitting both the healthcare providers and the patients. A more educated and knowledgeable population of patients is not only inevitable, but is already here. Mobile and wearable technologies are keeping people more in tune with their bodies, and now patient portals are keeping them in tune with their medical visits and exams.

HIMSS 2014: Enterprise Data Management—An Executive Perspective

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Enterprise data management has always been a daunting task. Best practices and case studies are often shared because telling these war stories is how facilities can best learn from one another. It is a way to cope with the challenging and vital task at hand.

Since enterprise data management encompasses so many components, it is best to break down the different components that are maintained throughout the enterprise—capture, analysis, storage, access, sharing, etc.

The essence is the exchange of information—from the patient to the physician, to the departmental system, to the storage of the data—and the exchange needs to remain fluid to allow optimal care for the patient.

At HIMSS14, in partnership with the HIMSS organization, Carestream will be sponsoring a panel titled, “Executive Perspective: How to Achieve Efficient Enterprise Data Management.” Jennifer Horowitz, Senior Director of Research for HIMSS Analytics, will moderate the session that consists of four executives who can each provide different perspectives and best practices in designing and maintaining an efficient data management system.

Panelists include:

Among the variety of technologies present at HIMSS, data management is certainly the trend that is holding some of the most attention. This is because it affects the physician, healthcare facility, and, most importantly, the patient.

The four executives on this panel are sure to shine a bright light on the successes and struggles they have experienced and the lessons that all attendees can take away: how to achieve higher revenue and lower costs while enhancing productivity for IT staffs and radiology departments. Effective and efficient enterprise data management is not impossible, but it is difficult. This panel assures attendees that they are not alone in their quest, and provides insights on how to stay on the right path.


ECR 2014: How Vendor-Neutral Data Storage Can Break Down Department Silos

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Be it imaging or healthcare information systems, the ultimate goal is of the physicians is to provide the highest quality of care to the patient. Reducing medical errors and duplicative care for patients is a must if providers are to make their treatments efficient and effective. However, within information systems, data is often being kept within silos and this is impeding on facilities to provide the most efficient care.

Today, the combination of diagnostic image and data management is a complex challenge. Facilities need to manage their costs without compromising productivity, workflow, or quality of care. Understanding the facility’s needs is, first and foremost, the initial step in the quest for properly implementing an appropriate solution—and these needs will vary among organizations. Common needs include:

  • Department silos archives replaced by unique archive
  • Cross-site secured data sharing
  • Benefits to the overall enterprise rather than one specific department.
  • Consolidate patient-centric data repository

One answer to these needs is a consolidated archive –where all data from all departments is combined in a single repository but that means the high cost of a larger archive or additional storage capacity for the current one. It also means a major disruption to established departmental workflow. Also, while this data may be archived, that’s all it is –there’s no efficient way to access it, display it or distribute it.

The archive preserves information in a vendor-neutral format, and is available across the enterprise for access.

The archive preserves information in a vendor-neutral format, and is available across the enterprise for access.

The answer to these needs is becoming clearer that a comprehensive, vendor-neutral, patient-centric solution that can accommodate multiple departments, multiple modalities, and multiple data types, while allowing each department to maintain autonomy will be fulfilling in financial, workflow, and quality of care aspects.

To get the most out of a VNA, there should be a number of features to look for. These include:

  • Patient centric repository for storing all data, which can save an organization on money and resources due to to all data being stored and access from a single location
  • Enterprise workflow portal that has an interface to manage siloed storage and data sources without changing the departmental workflow
  • Advanced reporting and clinical viewers to distribute data, which allows sharing and clinical collaboration by giving clinicians across the enterprise access to the patient’s longitudinal record and contextually aware data
  • Intelligent administration, which would involve a dashboard with real-time analytics to provide clinicians to the most up-to-date results, leading to more efficient care for the patients.

There are also a number of requirements a facility must be aware of when implementing a VNA. These core requirements, such as interoperability, flexibility, scalability, and disaster recovery capabilities, should be achievable thanks to the features of the VNA. As data usage increase—and it will continue to increase for the foreseeable future—facilities must be prepared to handle this influx of data. Storage capacity and easy accessibility for all necessary departments is a must, and anything less will be unsuitable for organizations.

At ECR 2014, Carestream will be demoing and showing off its latest solution for enterprise data management. Join us in booth #210 to see a live demo and learn how we can manage various data formats for your organization.

HIMSS 2014: Personal Health Technologies Help to Answer the $4.6 Trillion Dollar Question

Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group

Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group, Intel Corporation

Below is a guest blog post from Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group. If you will be at HIMSS14, be sure to attend his educational session (#74) on Tuesday, Feb. 25, at 10 a.m. in Room #320. During his talk, Eric will share his own experience battling cancer and the lessons he learned about the importance of a customized care treatment plan. You will also hear about the future of genomics and personalized medicine. Find out more information and read the latest blog posts on health IT in the Intel Health and Life Sciences Community.


In the currently raging debates about healthcare, there’s little attention to population aging and the cost of care — two critical trends that I call the $4.6 trillion question.

By 2020, there will be 55 million Americans over age 65, reflecting a global population aging trend that could be as important to our future as global climate change.  Also by 2020, according to federal government projections, the nation’s healthcare costs will be $4.6 trillion, close to doubling in a decade.

One of the ways we must respond to these trends is to use technologies that enable a model I call “care anywhere.” Thanks to a range of personal health technologies available now—mobile health (mHealth) capabilities for smart phones and tablets, telehealth technologies for remote patient monitoring and virtual visits, intelligent software assistants for prompting and coaching, and social technologies for connecting patients, families, and providers in powerful new ways—we have the opportunity to move away from costly, institution-centric care delivery for the majority of needs.

The core necessity is this: care must occur at home as the default model, not in a hospital or a clinic. We need this to curb escalating costs, increase access and improve patient experience and outcomes.

Policy makers are paying attention.  Last month, committees in both the House and Senate passed Medicare reform through Sustained Growth Rate (SGR) bills with bipartisan support, encouraging greater interoperability and data exchange for electronic health records (EHRs). And a discussion of telehealth measures led to an agreement between the Congressional Budget Office director and Senate to work together on how to estimate savings, an issue that has plagued telehealth and mHealth for years.

But even with all of the excitement, reforms and investment activity around mHealth, the promise of care anywhere – made possible by mobile technologies, data analytics and real-time connectivity – is far from being realized.

I think about the importance of care anywhere from three perspectives:

  1. As a patient who tried to force in-home, mobile and virtual care models for myself while undergoing cancer and chronic kidney disease treatment for 24 years, my fight was not just against cancer but against a flawed healthcare system.
  2. As a social scientist who has studied the cultures of healthcare innovation, I have seen the many challenges we must overcome to redefine the roles of patient, caregiver and provider.
  3. And as a business executive responsible for health innovation opportunities globally, I have learned a lot from other parts of the world that are deploying social, political and technical infrastructure for care anywhere.

A new Intel study found that more and more people are feeling empowered through new technology tools to become fuller participants in their own care. More than half of the respondents globally believe the traditional hospital will become obsolete in the future.HIMSS14

Today, technology is reducing unnecessary emergency room trips using real-time video collaboration between patients, EMTs and doctors and reducing doctor office visits with innovations such as in-home blood pressure, ultrasound and eye tests that instantly send information from your smartphone to your doctor.

In Indianapolis, where cardiac patients were treated using remote care technology, St. Vincent’s Hospital saw a 75 percent decrease in hospital re-admissions, proving that care anywhere can take costs out of the system and better support patient recovery.

In the future, doctors will be able to track patients’ health instantaneously through ingestible tracking devices in their bodies. More than 70 percent of respondents in our research are even receptive to using tools like toilet sensors, prescription bottle sensors and swallowed monitors.

But no amount of technology innovation investment alone can help us mainstream mHealth. We need a shared roadmap and strategy to create a movement around these care models. Remote care will never gain momentum without laws that allow doctors to be reimbursed for effective patient care no matter how it is delivered.

Medicare reform through the SGR includes telehealth as a method for physicians to transition to alternate payment models. Reform should provide incentives to use advanced technology innovation, when appropriate. As Congress makes needed changes in payment, let’s take this opportunity to make bold changes in the way people access care. By expanding telehealth reimbursement for all chronically ill patients in their homes, not only will patients benefit, but the United States will see a reduction in Medicare costs.

The Wyden-Isakson-Paulsen-Welch Better Care, Lower Cost Act of 2014, introduced last week, offers a targeted approach for providers to focus on chronic care management by offering preventive services through new technologies such as telehealth.  This bipartisan, bicameral legislation would encourage providers to coordinate care and reward them for achieving healthy outcomes rather than for the number of services they provide. It’s about time we change the formula for smart care and payment in the United States

Our nation is aging and traditional healthcare costs are unsustainable. Technology advancement has outpaced our laws. Patients have told us that they are ready to embrace care anywhere. It is time for policy makers to help patients, their families and a broader range of health workers innovate answers to the $4.6 trillion dollar question.


Eric Dishman
Intel Fellow and General Manager of the Health & Life Sciences Group, Intel Corporation

Eric Dishman is an Intel Fellow and General Manager of the Health & Life Sciences Group, responsible for driving Intel’s strategy, R&D, new product and policy initiatives for health and life science solutions.

He is known for pioneering techniques that incorporate anthropology, ethnography, and other social science methods into the design and development of new technologies. Eric’s organization focuses on growth opportunities for Intel in health IT, genomics & personalized medicine, consumer wellness, and care coordination technologies.