Managing Extra-Radiology Data within a PACS-like Framework

Saskia Van Den Dool

Saskia Van Den Dool, Wordwide Marketing Manager, Healthcare Information Solutions, Carestream

Dr. Marco Foracchia, Medical IT Systems Manager, Santa Maria Nuova Hospital, Reggio Emilia, Italy, gave an online presentation as part of HIMSS Europe’s participation at ECR 2015 earlier in March. The presentation focused on residual radiology IT needs and how facilities should go about managing this low quantity, yet highly-specialized data.

Most of the residual data is media in the form of images, video, traces, etc. These media are emerging now because of three reasons:

  1. Clinical pathways providing access to all evidence for all professionals involved
  2. Regulatory legislation requires all data to be readily available in case of patient request
  3. Research requires evidence-based medicine

The clinical pathway is key and includes the following:

  • Referral from periphery to competency center
  • Collective evaluation of all available evidence
  • Comparison of evidence from previous events/different patients

Dr. Foracchia and his organization partnered with Carestream to sponsor and perform a one-year survey of all potential data (media) sources in the hospital—managed, improperly managed, and currently managed.

The remainder of his presentation at ECR went through this study and explained the findings. Dr. Foracchia touched on how radiology may be the solution to managing this residual data since radiologists have been managing data (images) for the last 20 years. The positives and negatives of having radiology lead this change were both be presented, and will leave it up to you, the viewer, to decide on what the right decision is for your organisation.

Dr. Foracchia ended by saying that Reggio Emilia is currently going through a number of projects that will force the organization to address its present and future challenges. This includes gradually extending the number of data sources connected to the central vendor neutral archive, immediately connecting all DICOM sources, and gradually connecting all other non-DICOM sources. The plan is to connect all DICOM sources by end of 2015, and connect all non-DICOM sources by the end of 2016.

The entire presentation has been embedded below for viewing.

Diagnostic Reading #21: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday, which means it is time for a new Diagnostic Reading. This weeks edition includes cybersecurity, ethics in radiology, patient safety, Meaningful Use and EHRs and tips on reading ultrasounds.

1) 6 Steps Healthcare Groups Must Take in Response to a Security Hack– Fierce Health

This article discusses the importance of security when it comes to big data. The author gives tips on how to handle a security breach if it does happen. The steps are to establish a response team, investigate the event, stop the harm, know if it’s a breach, notify those impacted and go back to risk analysis.

2) The Ethical Radiologist– Diagnostic Imaging

In the evolving field of radiology, ethical practice is becoming a higher priority. The author of this article talks about the importance of ethics and how to implement ethical behavior in your practice, touching on establishing a code of ethics, what to do when facing challenges, and how ethics are policed in radiology.

3) Patients Want Information About Radiation Risk– Aunt Minnie

A study conducted by Radiology indicated that patients would like information on the health risks of radiation. The study found that these patients would rather hear this information from physicians than radiologists. This article talks about the importance of communicating with physicians about these risks in order to insure better patient care.

4) Stage 3 Proposal Embraces Open API Movement– Healthcare Informatics

This article touches on the new standards of Meaningful Use Stage 3. In the proposal, the CMS stated that application programming interfaces (API) would be an effective gateway to interoperability. These APIs can be third party applications and may be seen as more accessible than typical patient portals.

5) Ultrasound Exams Present Interpretation Challenges– Aunt Minnie

Sonography is rapidly growing due to its versatility and real-time imaging. With the growth of the ultrasound field, it is important to accurately read images, as well as learn how to read difficult images.

How Can IT Manage the Flood of Healthcare Data?

Access ti healthcare via mobile devicesIt is no surprise that the volume of healthcare data is expanding so rapidly. The research firm IDC said the healthcare data existed in 153 exabytes in 2013, and is projected to grow exponentially to 2,314 exabytes by 2020. That number is unfathomable, but that does not exclude from having to manage and mine the data we are tasked with storing.

While EHRs are the talk of the town, medical images are responsible for taking up a hefty piece of that data pie. In the U.S. alone, it is estimated that by 2018, medical images will account for about 1,400 petabytes (1.4 exabytes) of space. Being that is only in the U.S., and it is not the only nation facing these storage and management issues.

Medical images and records are only going to take up more space as they become more advanced. 3D images take up more space than 2D, and the more video and rich media is depended upon in the healthcare, the higher our volume of data will climb.

Case in point is digital breast tomosynthesis. It has been reported that for DBT slices, the necessary storage space is 100 times more than what is required for a full-field digital mammography exam. DBT was listed by Time Magazine’s as one of the most remarkable health advances in 2014. With this type of coverage, and more studies being released that provide evidence supporting DBT’s benefits, its popularity is only going to increase, meaning the amount data we store for these exams will increase as well.

Storing Data is Relatively Easy – It’s What we Do with this Data that Matters

A solution like Vendor Neutral Archive (VNA) is a great foundation for data storage.  The ability to store clinical content from various clinical settings such as images, videos, and reports can complete the EMR. Breaking down data silos has been proven to make data storage more efficient. Having direct access to relevant priors can also reduce the need for duplicate exams, which reduces costs on the system, time and resources.

Storing data into a VNA is relatively easy, especially when using standards-based protocols. It is ensuring the integrity and quality of the data that will ultimately aid decision support and analytics. Consider these scenarios:

  1. The Endoscopy department has large amount of videos. Beyond storing the clinical notes into the EMR. The clinical content, i.e. the video itself often is stored within the department. Inaccessible by other clinicians.
    • If you are to consolidate the storage, how do you ensure the video is properly tagged with the right patient demographics or exam information if that was not part of the acquisition device itself? This tagging is critical to ensure the data can be retrieved by the right users as part of their clinical workflow.
  2. In physiotherapy, the treatments are recorded and documentations are made during the consultation. This includes videos and x-rays. Now, the patient is ready to come back for surgery. Physiotherapy services is not part your network, consulting doctor has no way of viewing the videos or radiology data.
    • Importing data via a CD is manual – only if that patient brought the CD to your facility. How does the patient easily make that data available? How do you ensure the external patient ID is properly consolidated and matched to the clinical content?

There are many more workflow challenges when it comes to acquisition and distribution of data once stored. Carestream  recently launched our Clinical Collaboration Platform (CCP) at RSNA 2014, which addresses these issues when it comes to clinical data management. The modules include Data Ingestion; Acquisition Management, Repository; and Distribution. All of which can be deployed as individual services depending on the health system’s needs. Acquisition Management leverages standards based workflow such as IHE-XDS-I to ensure the integrity of the data. Distribution includes universal viewer and MyVue patient viewer that enables the patients to access manage and share their own clinical content..

What do you think about data storage and access in today’s healthcare environment? What are the needs that IT departments are addressing in order to handle the immense growth of data that must be managed? 

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing director for Carestream’s Healthcare Information Solutions (HCIS) business.




Repetitive Stress Injuries in the Sonography Profession

aiumSiteLogoAs a newcomer to the American Institute of Ultrasound in Medicine (AIUM) conference it was challenging to hone in on the many compelling educational sessions I could select to advance my understanding of the field of sonography. But after only a few minutes of listening to J. Oscar Barahona, BS, RDMS of Greenwich Ultrasound Associates (CT) moderate a discussion on “Associated Injuries in the Sonography Profession” it was clear I made a solid choice.

Repetitive stress injuries plague people everywhere. From office workers to pipe fitters, to professional athletes and weekend warriors, and affecting landscapers to trauma surgeons—few are spared the pain, injury and damage that often results from repetitive tasks performed over long periods of time.

But I was stunned to learn that healthcare workers have one of the highest rates of work-related musculoskeletal disorders (WRMSD) and that up to 90% of ultrasound professionals report injuries at some point in their careers. His colleague on the panel, Kevin D. Evans, PhD, RT(R) (M) (BD), RDMS, RVS, FSDMS, College of Medicine, The Ohio State University, cited a survey of sonographers who self-reported that 59% were working in pain at least 50% of their shift.

The list of causes of WRMSD to sonographers was linked to a range of issues including:

  • Number of cases per day and duration of exams
  • Size of patient, type of exam and intensity of the exam
  • Number of years in the profession
  • Poor posture, positioning and transducer gripping
  • Older equipment or equipment lacking in smart ergonomic design
  • The absence of updated training to provide better education on how to avoid injuries
  • Increased workloads to drive productivity as a response to decreasing reimbursements

As I absorbed slide after slide of information detailing a long list health problems that beset sonographers, this did not seem like a profession that would lead to anything but a painful, injury plagued retirement for those who can—or who are able—to go the distance.

Then Daniel A. Merton, BS, RDMS, FSDMS, FAIUM of the ECRI Institute rounded out the discussion by highlighting the importance of intelligent ergonomic design in the development of ultrasound systems and how this must significantly influence purchasing decisions. Referring to a body of information available from the Society for Digital Medical Sonography, he cited advances in technology that offer relief in the form of adjustable high-resolution monitors with appropriate brightness and contract levels; improved interface and control panels that optimize layout; and lightweight, balanced transducers operated in the company of ergonomically designed exams tables and chairs.

As I walked away from this session and toured the AIUM exhibit area, I observed how manufacturers are working tirelessly to improve the many design aspects of ultrasound equipment to enhance not only the level of care provided to the patient, but to improve the life of the medical professional who delivers that care as well. And I liked what I saw.

Robert_Salmon-Carestream-Health_headshotRobert Salmon is the director of corporate communications at Carestream and is currently attending AIUM’s annual meeting in Orlando, FL.



Diagnostic Reading #20: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday, which means it’s time for a new edition of Diagnostic Reading! This week’s reading includes the benefits of big data, the effectiveness of early imaging, pediatric radiology, an update on healthcare legislation, and an article about the importance of mammography technicians to women’s health. Have a great weekend!

1) The Benefits of Data-Driven Healthcare– Hospital Impact
This article addresses the issue of data analysis. The author makes a point to say that though data is important, simply collecting the data is useless. Evidence-based reports are noted as the most effective way to improve healthcare. If data can be used to determine which departments are underperforming, then the issue can be repaired.

2) JAMA: Early Imaging Questionable for Older Adults with Back Pain– Aunt Minnie
Researchers from the University of Washington found that early imaging for back pain in adults older than 65 years old has no significant clinical value. This study, which was recorded in the Journal of the American Medical Association, emphasized that though there are no benefits for patients, early imaging procedures add to healthcare costs. Also read: Adults at Low Risk of Heart Disease Shouldn’t Get Screening

3) Building Trust in Pediatric Imaging– Diagnostic Imaging
When working with pediatricians, it is important for radiologists to gain rapport. This trust comes from more than just accurate readings. Radiologists also need to exhibit interest in the patient and commitment to reducing radiation dose. This article looks more deeply into the relationships between radiologists and pediatricians and gives insight on how to build trust.

4) Washington Debrief: Interoperability Bill Would Penalize Non-Compliant Vendors– Healthcare Informatics
This article discusses new pieces of healthcare legislation that have been introduced. First, EHR providers and vendors will be required to be interoperable by 2018. Second, this article talks about data security. Legislators are making progress towards securing patient records and notifying patients in the event of a data breach. Lastly, lawmakers have been working to fix the current Medicare system in order to improve the physician reimbursement.

5) NCoBC: Mammography Techs Play Crucial Role in Women’s Health– Aunt Minnie
Mammography is one of the most rapidly growing segments of health imaging. This article discusses the importance of the technologist. Patient-technologist interactions have become more intensive and the technologist has taken on greater responsibility when it comes to education. The author lays out guidelines for mammography technologists to thrive in the new scene.

How a Hospital Improved Image Storage & Access with SaaS

ASZ Hospital in Aalst, Belgium is the first hospital in the country to use the Vue for Cloud-Based Services software-as-a-service (SaaS) model. The 600-bed hospital operates across three sites, and manages about 320,000 studies annually.

ASZ signed a seven-year contract for CARESTREAM Vue Cloud-Based Services, with four years of onsite storage at two of the hospital’s sites, and the rest managed in the cloud by Carestream in its own data center.

In the video below, you can listen to ASZ’s experience using Carestream’s cloud offering and the benefits it has experienced. This includes the fee-for-service model, in which Carestream provides a price for each examination allowing for ease of prospective budgeting (no surprises), easier access to images and studies via Vue Motion, and easier reporting to measure how many examinations are occurring and being stored for each modality.

Diagnostic Reading #19: Five Must Read Articles from the Past Week

Carestream logoIt’s the end of the week, which means it’s time for five more articles in the newest Diagnostic Reading. This weeks articles include an update from CMS, preparation for Meaningful Use Statge 2 attestation, the benefits of following up, insurance and the affordable care act, and a study about the perspective of patients on the benefits and harms of medical testing.

1) CMS Announces ‘Next Generation’ Accountable Care Organization Model – FierceHealthcare

The Centers for Medicaid and Medicare have announced a new ACO model that will encourage healthcare providers to take more financial risks. This new system will offer more predictable financial targets as well. The goal of the ‘next generation’ model is to offer strong financial incentives by focusing on quality rather than quantity of care.

2) A Health IT Auditor on the Two Big Obstacles in MU Stage 2 – Healthcare Informatics

This article discusses the difficulty that healthcare organizations have when it comes to deciding if they are ready to attest for Meaningful Use Stage 2. There are two main issues: 1) Providing a summary of care documents electronically, and 2) effectively implementing patient portals.

3) Early Follow-Up Reduces Readmissions of High-Risk Patients – FierceHealthcare

A study conducted by the Annals of Family Medicine found that following up with patients reduces the rates of readmission. The study found that follow up is particularly important for patients with a high-risk of readmission. If followed up with within a week, the rate of readmission for these patients dropped by a significant margin.

4) Exchange Enrollment Sees Limited Progress with Youth, Minorities – Modern Healthcare

Over 11 million people have enrolled in state-based or federal insurance programs. However, this year, the number of enrollees under the age of 35 has only increased one percentage point. Likewise, minority groups did not see improvement in percentage. While the Asian and Latino populations remained at the same percentage, the percentage of African American enrollees dropped 3%.

5) Patients Overestimate Benefits, Underestimate Harms of Medical Testing – Radiology Business

Researchers at Bond University in Brisbane, Australia, conducted a study that found patients overestimate the benefits of medical testing by a substantial amount. In the same manner, the study found that about 50% of patients underestimate the potential harm of medical testing. This is said to be important because these phenomena cause over diagnoses, unnecessary testing, and reduce the true value of radiology or other medical procedures.


Multimedia-Enhanced Radiology Reporting in Action

We have been talking about multimedia-enhanced radiology reporting (MERR) for some time now, dating back to before RSNA 2014. Just the other day, we presented an infographic that explained the results of a study in which physicians stated that MERR is an improvement over text-only reporting, and that they would refer patients to imaging facilities that use the technology.

Now, with the help of Carestream’s Michael Hornback, RIS/PACS Specialist, see Carestream’s MERR offering, Vue Reporting for Radiology, in action with capabilities such as embedding of images and charts in the report, voice annotation, and hyperlinking to bookmarked slices.

Editors note: A study by the National Institutes of Health published in 2017 demonstrated that Multimedia radiology reports enhance tumor tracking.


Infographic: The Value of Multimedia-Enhanced Radiology Reports (MERR)

Cristine Kao, Healthcare IT, Carestream

Cristine Kao, Global Marketing Director, Healthcare Information Solutions, Carestream

The evolution of radiology reports is a trend that we have been following for a long time. As we moved beyond text-only reports, it is imperative that we not only embrace the multimedia capabilities in today’s report, but also understand how these reports can improve radiology’s value within the healthcare continuum.

The infographic below contains key findings from a study published in the Journal of American College of Radiology (JACR) titled, “Traditional Text-Only Versus Multimedia-Enhanced Radiology Reporting: Referring Physicians’ Perceptions of Value.” We partnered with Dr. Richard Duszak and Dr. Gelareh Sadigh at Emory University School of Medicine and the healthcare market research firm IDR Medical to conduct the study and the findings are encouraging for radiology.

As you will see below, not only do physicians find multimedia-enhanced radiology reports as an improvement over text-only reports, but that these new features provide more value to radiology and improve patient education as the information within becomes easier to follow and understand.

Multimedia-Enhanced Radiology Reporting Infographic

Guess the X-ray: March’s Image Challenge

A new month means a new image challenge. Last month’s image was a bottle of cologne and it was correctly identified. This month’s image might be more challenging.

The March image is below. Please leave your guesses in the comments or on our Facebook page. The challenge will run until the end of the month, or until the first person correctly names the image. Good luck!