How a VNA Unifies Clinical Data Throughout an Enterprise

VNA storing and sharing information

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

Mater Health Services in Queensland, Australia, is well known for incorporating technology into its business, which consists of hospitals, health centers, a medical research institute, and a pathology and pharmacy business. It is a Catholic not-for-profit ministry with more than 7,500 staff and volunteers.

Mater first installed Carestream’s Vue PACS, and the organization then got to work implementing a VNA once the PACS  deployment was complete.

The biggest issue for Mater was around electronic images. The organization needed a technology that could encompass all of the imaging modalities. Once installed, Mater realized that more than 60% of the data stored in the VNA was not radiology-specific. As stated by Steven Parrish, CIO and Executive Director, Information and Infrastructure, at Mater Health Services:

“Any image at Mater should be within the CARESTREAM Vue PACS and VNA systems, because that is the single point for clinicians to access and view anything that is image-related to a patient.”

The VNA consolidates disparate imaging systems into one repository using the latest interoperability standards. Combined with CARESTREAM Vue Motion (a universal image viewer), the Vue Archive VNA provides secure, real-time imaging, accessible at an enterprise level and beyond.

Simply put, what was once a siloed process for storing and accessing images has now been broken down and unified with the help of a VNA, meaning that all of the images, photos, and videos are stored and viewable via a centralized location.

For the complete story of Mater Health Services’ deployment of its VNA, you can read the embedded testimonial below, or access it via SlideShare.

Diagnostic Reading #8: Five Must-Read Articles from the Past Week

Happy New YearAs we near the end of 2014, it is a popular time of year to take a look back at the stories and news that had the biggest impact on us throughout the year, as well as look ahead to the trends and issues that will affect us the most in 2015. In this week’s summary, we look at some of the biggest healthcare IT stories of 2014, two studies that look at mobile device use and who orders the most imaging, the top IT technology trends for 2015, as well as the 2015 changes in radiology billing and coding.

1) Top 10 Healthcare IT News Stories of 2014: The list of articles includes such big healthcare IT news such as the delay of ICD-10, big HIPAA breaches, and EHR news related to the future of the business, as well as a few court cases that made news throughout the year.

2) Gartners Top 10 Tech Trends Through 2015. The trends address such popular topics as mobile devices, data centers, and big data, and expand on how these areas are going to be changing in 2015.

3) Who Orders the Most Imaging?: The Advisory Board Group addresses a recent study published in JAMA Internal Medicine by the ACR’s Neiman Health Policy Institute that says that advanced practitioners ordered the most imaging at 2.8% compared to physicians at 1.9%.

4) Radiology Billing and Coding: 2015 Coding Changes: The Radiology Today article states that “as of this writing, the complete authoritative guidance and reimbursement information has not yet been released for the new 2015 procedure codes, but we do have the codes, which provide a good idea of potential questions and concerns.”

5) ASRT: Smart Device Use Leads to Burnout: A study by by the American Society of Radiologic Technologists (ASRT), found that being connected to the workplace through smart devices leads to job burnout. The survey found that about 61% of respondents were connected to their workplace every hour of every day, with about 19% saying that they never ignored workplace communications they received on their smart devices during non-work hours.

Training, Technology & Professionalism: Life as an Athletic Trainer in the NFL

Bills logo

The author of this article, Bud Carpenter, was the Head Certified Athletic Trainer of the Buffalo Bills. In June 2016, he was promoted to Director of Athletic Training Operations.

My non-traditional 29-year career journey—including a SUNY education in Elementary Education and History followed by a stint in the U.S. Air Force as a Russian linguist, to time in training and coaching roles in women’s volleyball, NBA basketball and the legendary Boston Bruins hockey team—has in some crazy way prepared me for the job of a lifetime as Head Certified Athletic Trainer for the Buffalo Bills.

We have a small, tightly knit team of top-notch athletic trainers—all of whom are professionally certified as required by the National Football League. Over the years I have had the privilege to train and mentor about 150 assistants, many of whom now have successful careers in physical therapy, training and sports medicine.

Our job is to provide extensive and highly disciplined care to a large group of elite athletes that present a broad spectrum of needs, challenges and injuries. Our work takes place in a high-intensity world where excellent care is paramount—both to ensure the health of our players and to contribute to the success of the team—and where time is accelerated in ways that are unimaginable to many people. Speed is the key in everything we do and the world of the NFL gives us only 60 minutes per game to get it all right.

The range of injuries we see knows no limit: sprains, cuts, contusions, concussions and fractures…just for starters. Technology—especially modern medical imaging systems—is helping us make better and faster decisions in determining whether a player can safely return to the game. And while speed is critically important to us, it never trumps a player’s health.

Like many areas in life, we’ve moved from technologies we all knew and loved (yes, think X-ray film) to advanced digital diagnostic imaging systems that deliver excellent images in seconds that are easy to access and share. Our training staff serves as the triage point for player injuries and this often leads us to capture X-ray images for evaluation by our team physicians to determine how quickly we need to get a player to a hospital, or whether he can return to the game. Imaging technology helps identify a “degree of injury acuteness” that assists us in making treatment decisions quickly, while also setting a course for longer term tracking and treatment.

Because imaging technology is critically important to us, we are working with Carestream to share information on the specifics of injuries when they occur for use in developing new systems. Carestream has been developing a new CBCT (Cone Beam CT) system for capturing weight-bearing images of extremities (legs, feet, arms and hands) that would be very valuable in the field of sports medicine. Having a compact CBCT imaging system that could be located in the stadium or locker room could further enhance our ability in making treatment decisions.

Having highly trained medical professionals on site with immediate access to the best available technology allows us to provide the best possible medical coverage for our players.  The combination of physicians, athletic trainers and technology is certainly the right formula to treat and safely return our athletes to the playing field.  Facilitating the safe return to play following a serious injury always give athletic trainers a great sense of pride and we are grateful to all who help us achieve that goal.

Carestream OnSight 3D Extremity System received FDA 510(k) clearance in September 2016.

Carpenter_BudBud Carpenter was the Head Certified Athletic Trainer of the Buffalo Bills when he authored this blog. In June 2016, he was promoted to Director of Athletic Training Operations, and Shone Gipson was promoted to Head Athletic Trainer.



Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.


Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.


This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.


Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.


This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.


El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.


This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.


With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.


Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”


In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.


Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Guess the X-ray – December’s Image Challenge

Happy Holidays! Time for a new Guess the X-ray Image Challenge. Last month we had a fluorescent light bulb, which nobody identified correctly. Good luck on this month’s challenge as you enjoy company with family and friends.

This month’s image is below. Please leave your guesses below or on our Facebook page. The challenge will run until January 1, or until the first person correctly names the image. Good luck!

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

December Photo Challenge


Challenges & Opportunities in the Indonesia Radiology Market


Source: Wikipedia

The world’s market for diagnostic imaging is growing fast. Specifically, it is expected to grow at a at a compound annual growth rate (CAGR) of 4.7% from 2013-2018, reaching around $27.1 billion by 2018. In 2013, the US had the largest portion of market share at about 34%, followed by Europe. However, the Asia-Pacific region is poised to grow at about 5.9% from 2013-2018. There is a lot of room for growth in this market as the countries in that region matures and become increasingly ready to acquire new technologies in diagnostic imaging.

The Republic of Indonesia is located in Southeast Asia. It boasts the world’s 4th largest democracy with about 250 million in population by the end of 2013. According to the CIA World Factbook, Indonesia’s economy is growing strong with annual GDP growth of about 5.3%, valued at around $1.285 trillion (purchasing power parity).

The medical supplies market size in Indonesia is valued at around $593 million in 2013, with diagnostic imaging taking up 35%, or about $207 million. This includes CT, MRI, Fluroscopy, X-ray systems (Analog, CR, DR), Films, Mammography, and Ultrasound. Indonesia lacks expertise in the manufacturing of these advanced medical devices, and therefore relies on imports. Indonesia imports 97.2% of all its medical supplies. Based on this research, we have discover a few key challenges and opportunities in Indonesia’s growing diagnostic imaging market:

  1. Budget Constraints: X-ray systems in Indonesia are still often used beyond their average lifespan. Some have been in use for over a decade. It is difficult for premium products to enter the market as most hospitals do not have the budget necessary to make a purchase. This may be a challenge, but it can also an opportunity to focus on value-tier equipment.
  1. Infrastructure: High-speed internet is easily accessible in the US, connecting more people than ever. This enables DR technology to thrive in the country. In many rural parts of Indonesia, internet is a luxury. Many hospitals do not have access to the internet and therefore are not able to adopt DR technology. However, Indonesia is growing. The government will increase spending on infrastructure and in the future, internet will be accessible to most Indonesians, even in rural parts. Therefore it is imperative to invest in CR technology now and upgrade to DR later when they are ready.
  1. Need-driven market: In the US, most radiologists and hospitals purchases of diagnostic imaging equipment are driven by the notion of efficiency to the workflow. They want equipment that delivers efficiency, not just to save money and time, but also to capitalize on opportunity costs. In Indonesia, with a population of over 250 million people, there are only about 1000-1500 radiologists, and less than 2000 hospitals. Moreover, many of the hospitals do not have any imaging equipment. Workflow is not in the mindset of these hospitals yet, because they would first have to first have the technology. This results in low penetration of the PACS system or the DR system in the market. DR systems have a very low market share of less than 10%. For them, CR is efficient enough because they would not have to develop films in the dark room. As Indonesia grows, the number of hospitals and radiologists in the country will follow suit. Soon they will have to adapt to the growing number of patients, and ultimately improve their workflow.

Comparing the diagnostic imaging market in the US and Indonesia is difficult as the US is a mature market compared to the emerging market of Indonesia. However, Indonesia displays promising growth as the nation matures itself towards better, more advanced, and more reliable healthcare technologies. Despite the challenges the young nation might have, as shown, there are numerous opportunities available that we expect to see come to light in the future.

Nick SumarkhoNicholas Sumarkho is member of the worldwide marketing team for Carestream’s Digital Medical Solutions business and is well-versed on the healthcare and diagnostic imaging markets in Indonesia.


Moving Scotland to a Digital Medical Information Environment

NHS Scotland Health Boards

Map of the NHS Health Boards in Scotland. Source: NHS Scotland Wikipedia page

In 2007 NHS Scotland took the brave step to move into the PACS environment. A consortium approach was adopted so most Health Boards in Scotland would be involved, and a team was quickly put together consisting of radiologists, clinical physicists, radiographers, managers and a few well-intentioned others. The objective was to ultimately purchase a PACS for Scotland’s National Health Service in one procurement process, and implement new systems and software to facilitate efficient management of patient images and data, expansion of information sharing and improved workflow for the benefit of patient care.

In Scotland there are 14 Territorial Health Boards and most have acute hospitals, with some hospitals situated in the Highlands and Islands region, and others either in rural or urban areas. The population of Scotland is 5.3 million and the concentration of the population is mainly in the central belt.

The specification document and business case to move to PACS were written and approved. Thereafter lots of presentations were given across the country to galvanise key stakeholders into agreeing to fund the project, the ongoing maintenance costs and a National programme manager. Despite the IT and Imaging fraternity’s firm belief this was the way forward, we were required  to consider the many multiple strands of  financial demand on the government. However, it is fair to state we were tentatively optimistic.

Soon we had agreement on the need to move Scotland to a digital medical information environment and now needed to make quick progress.

But could we? The multiple Health Boards had a variety of Hospital Information Systems (HIS), some had no Radiology Information Systems (RIS) and in the absence of a coding system how would the clinical governance requirements be satisfied?

In addition to the above hindering factors, the clinical need and the diagnostic imaging requirements from NHS facilities across the country were growing at an unprecedented rate, yet the size of the radiology workforce had not kept pace with demand and activity, and patient wait times were growing.

Because we followed our business plan carefully and thoroughly, the PACS architecture we have established in Scotland is entirely consistent with the architecture set out in the proposals and we have successfully enabled delivery of patient medical images across Scotland. In fact, the business case for PACS was predicated on the potential that it offered greater sharing of the radiology workload (specifically in smaller Boards with recruitment difficulties and where specific expertise may be lacking).

The success of our NHS PACS project across the country has streamlined care, and enabled faster diagnosis and treatment for patients. The journey was not without its challenges but the outcome was exactly what we had planned for.We are now in the process of moving to the V11 upgrade across the country, this project is going well.

Aileen MacLennanAileen MacLennan, Director of Diagnostics, National Health Service (NHS) for Scotland – Greater Glasgow and Clyde. She is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.


Diagnostic Reading #6: Five Must-Read Articles from the Past Week

Crystal Ball

We begin to look at key trends to expect in 2015 as 2014 nears its end.

It’s been a week since RSNA has finished, but the conversations surrounding the show, the technologies, and the trends have not ended. In this weeks post, we look at AuntMinnie’s top trends from RSNA, along with predictions about what we can expect in the healthcare IT world in 2015. Other articles will look at how radiology reporting is evolving, how patients want more out of their EHRs, and how radiologists and referring physicians work best when they work together.

1) Top 5 trends from RSNA 2014 in Chicago

The key trends include RSNA celebrating its centennial, the popularity of sessions focused on CT lung screening now that the U.S. Centers for Medicare and Medicaid Services will reimburse for scans in high-risk smokers, enterprise focus driving imaging informatics, digital breast tomosynthesis and dense breast tissue dominating the breast imaging topic, and radiology recognizing the need for change.

2) Big Data Underpins Five Health IT Predictions for 2015

2015 trends to pay attention to include physicians beginning to embrace rather than abhor EMRs, a rise in the democratization of health information, pharma taking more of a care provider or services role in healthcare, a massive data breach forcing real action around health data privacy, and quality rising as the future king of the industry.

3) Reinventing Radiology Reporting: Adding Value by Leveraging Emerging Technology

While this also ran here, we want to share the Harvey L. Neiman Health Policy Institute’s publishing of the post. Richard Duszak, MD, is Chief Medical Officer, Harvey L. Neiman Health Policy Institute, and Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, shares the results of a RSNA digital poster focused on how multimedia enhanced radiology reporting can increase the value of radiology.

4) Patients Want More from Their EHRs

More patients are looking for enhanced features and functionality with their EHRs. The article focuses on the results of the study, “Engaging Patients and Families: How Consumers Value and Use Health IT,” which is a follow-up to a similar 2011 report that assessed consumer views toward EHRs.

5) Radiologists, Referring Physicians Work Better Together

As reported in the article, radiologists are more often inserting clinical expertise, even if it puts referring physicians on the defensive. The article shares the opinions of physicians and how they are accepting of the information radiologists provide. Technology is having an increasing influence on this relationship, resulting in referring physicians seeking input from radiologists.

Reinventing Radiology Reporting: Adding Value by Leveraging Emerging Technology

This post was also published on the Harvey L. Neiman Health Policy Institute’s website.

Over the last decade, the way we consume information has changed radically. Sure, reading the Sunday newspaper by the fireplace on a cold winter morning remains a rare treat. But curated content through Twitter or pushed content to my inbox that links me to constantly updated media outlet websites is now my main channel for information. Those sites are increasingly interactive, and like many readers I frequently view hyperlinked images, figures and charts to supplement my reading experience.

So why hasn’t radiology kept up with the times? For decades, radiology reporting has remained pretty much the same: free-form findings and text in a report. I believe referring physicians want more. A radiologist’s most valuable product is not laser toner on paper—it’s meaningful and actionable information. And the way we choose to consume our news should provide guidance on how to deliver diagnostic findings.

What if we could embed interactive hyperlinks to critical images—as well as quantitative analysis in the form of tables for vessel analysis or lesion management—into our reports? Referring physicians could navigate to these bookmarks in seconds directly from our reports, and so could our patients.

Technological enablers now exist to permit radiologists to offer this higher level of reporting. With this technology now coming to market, I was part of a team that compared referring physician satisfaction with multi-media enhanced reporting (MMER) to standard reporting. In an electronic poster entitled: “Traditional Text-Only vs. Multimedia Enhanced Radiology Reporting (MERR): Referring Physicians’ Perceptions of Value,” colleagues from Emory University, Carestream Health, and I presented our results from a survey of 200 U.S. medical oncologists, radiation oncologists, neurosurgeons and pulmonologists last week at RSNA.

About 80% of respondents said multi-media enhanced reports “improved understanding of radiology findings by correlating images to text reports” and delivered “easier access to images while monitoring progression of a disease/condition.” That was no surprise.

The real wow for me, though, was that just as many physicians indicated that such enhanced reporting would “increase the likelihood of referring patients to facilities that offer multi-media reporting.” That’s a pretty powerful message to radiologists and radiology administrators: give your customers what they want or they’ll take their business elsewhere.

The decision to deliver meaningful and actionable information—or not—will likely have a profound effect on imaging referral habits as this reporting technology enters the marketplace. Early adopters are likely to gain a referral advantage and secondary adopters will then be relegated to playing catch up for years to come.

While we should all be striving to add value to our work for value’s sake—just because it benefits our patients—the marketplace in which we practice is not so altruistic. Winning hospitals and practices will be the ones that provide stakeholders what they want. Based on our survey, referring physicians want more than just old-fashioned, text-based reporting.

The only way to fight off commoditization is by providing value. Delivering meaningful and actionable information is a powerful way to do just that.

Dr. Rich DuszakRichard Duszak, MD, is Chief Medical Officer, Harvey L. Neiman Health Policy Institute, and Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine. The scientific paper documenting this research was presented at the RSNA conference from 12:15-12:45 pm on Wednesday, Dec. 3.