Imaging’s Place in Value-Based Healthcare

SIIM 2015 LogoThe answer to a question asked in a SIIM 2015 Friday morning session was clear–medical imaging needs to make further progress to be in a position to provide value-based care.

This was the focus of Rasu B. Shrestha, MD, MBA, University of Pittsburgh Medical Center, John W. Nance, MD, Johns Hopkins University, and Kevin W. McEnery, MD, University of Texas MD Anderson Cancer Center in the session, “Providing Value-Based Healthcare – Should Imaging Lead, Ride Along, or Get Left Behind?”

Radiology: Data Rich, Information Poor

Dr. Shrestha began the session by focusing on what we mean when we talk about value-based care, how radiology needs to get to where it needs to be, and the opportunities to get there by discussing the barriers that are currently preventing this from happening.

The state of radiology is that the specialty is data rich and information poor. It has commonly had its innovators, and has led the charge in healthcare innovation (film to digital, etc.), but its innovation over the years has also been its downfall, as numerous silos have popped up within healthcare providers. The next stage for radiology is breaking down those silos and extracting the data so we can comb it for information, which according to Dr. Shrestha’s slide, showed that from the information we obtain from data, we can then gain knowledge about the patient(s), and eventually turn that knowledge to wisdom, with increased value provided to the patient along the way.

The main problem with the imaging workflow today is that radiology is image-centric and not patient-centric. The specialty stopped talking to other specialties within the hospital as it drowned in too much data, and not enough intelligence. Moving forward, context will be king–both obtaining context to produce better reports, and providing additional context once the exam has been done and the report created.

Dr. Shrestha’s main point was the importance of data liquidity, which is freeing data from the silos, liquidating the assets because of the immense amount of value it hold. The problem is that radiology has not been able to do this.

The technologies currently being developed will radiology in this direction. The next generation will be patient-centric, predictive protocols, cloud-based VNA, adaptive learning, contextual reports, and value-based imaging.

Radiology can only improve what it can  measure. In a volume-based imaging model, report turnaround time, and number of studies read were the metrics. Moving forward, it will be superior outcomes, patient-centric care, clinical quality metrics, increased transparency, total cost management, and shared savings.

Definition of Value

Following Dr. Shrestha, Dr. Nance of Johns Hopkins University looked at the definition of value, its history in radiology, its current status, and barriers.

He started out with the honest definition of value, which is:

Value = Outcomes/$

Value does not equal quality, efficiency, safety, outcomes, or cost, per se, and he highlighted that there is currently an alphabet soup of organizations (government, nonprofit, associations) currently focused on outcomes, because the current measures are certainly not.

Dr. Nance went through common measures, and how diagnostic imaging is not a big part of them. The Healthcare Effectiveness Data and Information Set (HEDIS), has 81 measures and only three have anything to do with diagnostic imaging. None related to outcomes. Physician Quality Reporting System (PQRS)–254 measures, and only 13 deal with diagnostic imaging. Again, none related to outcomes. National Quality Forum has 636 measures, with 15 having to do with diagnostic imaging, even though imaging account for 14% of healthcare costs.

The fact is that diagnostic imaging lacks outcome measures.

ACR’s Imaging 3.0 is heading in the right direction by seeking to improve the value of radiology. The types of quality measures are focused around structure, process, and outcomes. Structure focused on underlying infrastructure of a system, which has serious limitations. Process measure are most common, contain a lot of value, have some advantages that are actionable, but again, have serious limitations. This is because people gravitate toward measures that are easily extractable, even though they may not be the most relevant.

Why are outcomes so allusive? You need data validity. Stringent national benchmarks, which are often lacking. Large sample sizes and follow up to show differences. There are good examples out there with large, randomized controlled trials, but it is not commonplace yet.

The challenge moving forward for radiology in this area will be diagnostic accuracy, the quality of communication, change in management of the specialty, and the effect on outcomes.

Transitioning from Volume-Based to Value-Based Imaging

Finishing up the session, was Dr. McEnery of University of Texas MD Anderson Cancer Center.

The objectives for his section centered around examining the transition of imaging from volume-based to value-based, and discussing the role of informatics support in demonstrating the value of enterprise imaging in the transition to value-based healthcare.

In a value-based system, Dr. McEnery showed that we must be achieving outcomes at the lowest cost that are patient-centered, focus on the patients’ needs with their outcomes achieved, and focus in the right locations for high-value care.

For high-value, the value-enhancing IT platform accomplishes the following:

  • It is centered on patients
  • It uses common data definition
  • It encompasses all types of patient data
  • The medical record is accessible to all parties involved
  • The system includes templates and expert systems for each medical condition
  • The system architecture makes it easy to extract information

With the change from volume-based to value-based imaging, we will go from being:

  • Transactional to consultative
  • Radiologist-centered to patient-centered
  • Interpretation focused to outcomes focused
  • Commoditized to integral
  • Invisible to accountable

The imaging value patient context that Dr. McEnery showed was:

  • Orders: Appropriate for the patients’ complete presentation
  • Protocols: Optimized to inform the clinical decision process
  • Acquisition: Optimized to inform at safest level, greatest clinical data
  • Interpretation: Focus on findings that are pertinent to patient
  • Reports: Optimized to efficiently show the information, data, and results

Dr. McEnery went on to explain how these changes to value-based care are on the way as health reform continues to take shape. This included the April 1, 2016 deadline of CMS lists qualified decision support providers for ordering professionals, and beginning January 1, 2017, CMS will not reimburse certain claims.

With these changes inevitable, Dr. McEnery ended his session focusing on the clinical decision support (CDS) process and how it will move diagnostic imaging to a value-based process. Essentially, CDS and EMR needs to inform the entire patient process, and significant changes are in process for the delivery and reimbursement of healthcare.

IT systems will need to evolve to allow radiologists to become a part of this evolution. As Dr. McEnery said at the beginning of his session:

“I don’t want to be in the backseat. I want to ride shotgun. I want radiology to ride shotgun in the innovation process.”


PulvinoRich Pulvino is the digital media specialist for Carestream. He is attending SIIM 2015 from May 28-30 at the National Harbor in Maryland, and will be publishing blog posts throughout the event.


The Next Imaging Evolution Will Contain a New PACS

SIIM 2015 KeynoteThe theme of SIIM 2015 is “Creating the Image Enabled Enterprise”—a mission to bring radiology and imaging informatics to the forefront of healthcare enterprises.

This theme came through loud and clear in Donald K. Dennison’s opening keynote, “The Next Imaging Evolution: A World Without PACS (As We Know It).” Dennison was not explaining how PACS would eventually go away, but highlight how the way in which the technology is built, the capabilities it provides, and the way in which it is used will change–moving from a departmental technology to one that is integrated throughout the healthcare provider enterprise and EMR. In fact, that change is happening faster than we may believe.

Dennison kicked off the keynote describing the three main forces that are currently changing the world RIS and PACS:

  1. Payment reform shifting from volume to value-based reimbursement models
  2. EMR adoption
  3. Consolidation of healthcare providers with larger ones buying or affiliating with smaller hospitals, care facilities, or imaging centers

From there, Dennison moved on describe the current state of imaging in the 2010s. The section on departmental vs. enterprise imaging focused on how imaging is managed today, and how it will need to move to the enterprise model moving forward. Departmental imaging isolates radiology, but still contains numerous imaging informatics benefits such as uniting the VNA, enterprise viewer, image archive, PACS, radiology portal, and reporting within the radiology department.

Enterprise imaging will move this information throughout the organization, and will be dependent on the discovery, presentation, storage, and management of the imaging data.

To accomplish this, Dennison highlighted governance as being the key. If IIPs are not sitting down with Document Management and EMR people, this could lead to duplicate work. Governance on where the imaging data is going to be put and how providers will access it is a must. Doing so will result in an informatics that is sensible, indexed, and presented in context when accessed.

Dennison went on to tackle clinical decision support (CDS), interoperability with Web APIs such as HL7 and DICOMweb, multimedia-enhanced radiology reporting, and how there is a plethora of informatics that must be measured if quality is truly to be achieved today.

He arrived at what PACS vendors need to do in order to meet these pressing needs, and it essentially came down to using a PACS in a single-vendor system–encouraging vendors to make a better PACS. One that is engineered to integrate the worklist, image display, report center, and advanced visualization. It must be easier to deliver MERR, there should be one desktop to manage, and should add VNA-like features to the PACS server.

For providers, it is much easier for them to manage all of these capabilities with a single PACS vendor than managing a different vendor for each one.

In his closing remarks, Dennison commented on how imaging informatics professionals have a lot to offer in an era of consolidation, standardization, and integration. Professionals must have a plan in place and they must share it outside their department walls. Every IT investment must have measureable value, and a policy must be developed for imaging record quality—going back to the importance of having governance in place.

Consistency and completeness of records in the age of interoperability and EMR access will be vital, so professionals must be ready to prove their value, because as Dennison said, “Evidence is king.”

PulvinoRich Pulvino is the digital media specialist for Carestream. He is attending SIIM 2015 from May 28-30 at the National Harbor in Maryland, and will be publishing blog posts throughout the event.

10 Sessions We Are Excited to See at SIIM 2015

SIIM 2015 LogoSIIM 2015 takes place this week, and as usual, there is a wide selection of presentations to sift through.  This year’s theme “Creating the Image Enabled Enterprise” speaks to the challenges many SIIM attendees are facing, and how imaging IT can really make an impact across the enterprise.   The meeting will kick off with Donald K Dennison discussing the technical and market forces that are driving change in medical imaging, as well as how facilities can prepare for these changes and take advantage of them.

Listed below are five sessions we identified as “Can’t Miss” at SIIM. Of course there’s many more sessions beyond these, so please be sure to look at the entire program and pick the sessions you find to be the most valuable.

  1. Enabling Capture, Storage, and Enterprise Access of Images from Handheld Devices, Thursday, May 28, 9:45 am – 10:45 am, Annapolis 1 & 2

This session will focus on 1) Understanding today’s pain-points in providing access to images captured from handheld devices; 2) Chart out workflows in various care settings; and, 3) Explore potential solutions through discussion and brainstorming.

  1. Building High-Performance Support Teams, Thursday, May 28, 9:45 am – 10:45 am, Baltimore 3

This roundtable includes Christopher D. Meenan, CIIP, University of Maryland Medical System, Daniel O’Malley, MS, University of Virginia Health System, Charlene M. Tomaselli, RT(R)(M),MBA, CIIP, Johns Hopkins University, and Robert C. Webb, University of Virginia, and will seek to 1) Describe characteristics that make up high-performance imaging support teams; 2) Review organizational structures that foster increased efficiency and collaboration within imaging departments; 3) Discuss the types of software tools that aid in imaging support; and 4) Gain an understanding of common metrics to manage efficiency.

  1. Understanding Enterprise Imaging Use Cases, Friday, May 29, 9:45 am – 10:45 am, Woodrow Wilson A

The objectives for this session will 1) Identify the primary use cases supported by an enterprise imaging strategy; 2) Discuss why enterprise imaging use cases should be incorporated into the planning of an enterprise strategy; and, 3) Explain the importance of enterprise imaging standards and the potential challenges that will be faced by organizations that choose to pursue a vendor neutral archive only solution.

  1. Evolution and Lifecycle of Imaging Clinical Decision Support, Friday May 29, 1:15 pm – 2:45 pm, Woodrow Wilson A

This session will look to help attendees 1) Understand the interplay of imaging CDS with the HER end user; 2) Appreciate the various avenues that CDS can be implemented and displayed; and 3) Identify CDS shortcomings and proposed solutions for decreasing inappropriate and over-utilized examinations

  1. Big Data in Healthcare: Myth, Hype, and Hope – A Point/Counterpoint, Friday, May 29, 4:15 pm – 5:15 pm, Woodrow Wilson D

Objectives for this session include 1) Learning about Big Data, Dumb Data, and Smart Data; 2) Discuss myths, hypes, and hopes that surround Big Data in healthcare; and 3) Learn about the importance of analytics in gaining insight from data and about descriptive, predictive, and prescriptive analytics.

  1. How Are Academic Institutions & Private Practices Integrating Clinical EMRs Into Imaging Workflows, Thursday, May 28, 4:15 pm – 5:15 pm, Annapolis 1 & 2

The White Boarding session, with Cree M. Gaskin, MD, University of Virginia Health System, J. Raymond Geis, MD, Advanced Medical Imaging Consultants, Steven C. Horii, MD, FSIIM, University of Pennsylvania Medical Center, Kevin W. McEnery, MD, UT MD Anderson Cancer Center, Peter B. Sachs, MD, University of Colorado Anschutz Medical Center, and Alexander J. Towbin, MD, Cincinnati Children’s Hospital Medical Center will seek to 1) Explain the types of data available in an EMR, and how to access those data; 2) Discuss the differences among PACS, RIS, and EMR-driven workflow; and 3) Discover ways to maintain or even improve productivity while using the EMR.

  1. Use Cases for Medical Images in Clinical Informatics: A Whole New World of Imaging Informatics, Saturday, May 30, 8:00 am – 9:30 am, Woodrow Wilson BC

The objective of this educational session held by J. Raymond Geis, MD, Advanced Medical Imaging Consultants, PC Kenneth R. Persons, MSEE, Mayo Clinic, and Christopher J. Roth, MD, Duke University Health System, will be to help attendees 1) Become familiar with the wide diversity of image use cases and file types now being used in health care; 2) Understand the issues associated with archiving, viewing, and sharing these images; and 3) Discover different workflows associated with acquiring, archiving, and viewing these images.

  1. Analytics In Imaging – How Can You Use Data Effectively to Run Your Department?, Saturday, May 30, 9:45 am – 10:45 am, Annapolis 1 & 2

Gorkem Sevinc, MSE, CIIP, Johns Hopkins University, will show attendees how to 1) Gain a robust understanding of analytics needs of a department (business-level to operational); and, 2) Develop the knowledge to gather requirements of analytical reports for various levels of business owners.

  1. Digital Breast Tomosynthesis: Ready for PACS Prime Time?, Saturday, May 30, 12:00 pm – 1:00 pm, Exhibit Hall CD

We may a little bias about this session as one of our own thought leaders, Ron Muscosky, MSEE, will be participating, but regardless, it is still a session not to be missed as DBT continues to gain more traction in women’s health imaging. The session will 1) Discuss infrastructure, integration, and standardization challenges posed by DBT; 2) Learn about the requirement and solutions that are defined in the IHE DBT Profile; and 3) Discover commercial options that are currently available from vendors to meet the challenges.

  1. The 2015 Dwyer Lecture – An IT Blueprint for the Value Based Imaging Era, Saturday May 30, 3:00 pm – 4:30 pm, Woodrow Wilson A

Paul G. Nagy, PhD, CIIP, FSIIM, Johns Hopkins University, will give the closing lecture that will 1) Discuss Michael Porter’s model for transforming healthcare delivery; 2) Identify new IT requirements needed to enable this delivery model; and, 3) Illustrate current demonstration projects.

SIIM 2015 is sure to be an excellent and educational event, as these 10 sessions already prove. Also be sure to check out the SIIM 2015 Hackathon that seeks to build upon what was started in 2014.

See you at the Gaylord National in Washington, DC/National Harbor. Stop by the Carestream booth, #425 and tell us how SIIM is going for you. Have a great time at SIIM 2015!

Julia, Weidman, Marketing Manager,  Healthcare Information Solutions, CarestreamJulia Weidman is the Healthcare Information Solutions Marketing Manager for the US and Canada at Carestream. She will be attending SIIM, and will be in the Carestream booth, #425.


Diagnostic Reading #29: Five Must Read Articles from the Past Week

It’s Friday, which means it’s time for another Diagnostic Reading! This week’s articles focus on the expanding purposes of VNAs, a study from the Annals of Internal Medicine about breast cancer risk factors, an article about the ICD-10 grace period and updates about presentations from ACR 2015.Carestream Logo

1) Time to Retire the term “VNA”? – Healthcare Informatics

This article addresses the acronym, VNA, and its definition: Vendor Neutral Archive. The growth of health IT products has also expanded their responsibilities. The author claims that a VNA is neither ‘vendor neutral’ nor an ‘archive.’ He goes on to explain, saying that these applications manage data rather than simply archive it.

2) Study: There’s More to Breast Cancer Risk than Density – Aunt Minnie

A study in the Annals of Internal Medicine noted that breast density is not the only factor that should be considered when determining which women should receive supplemental breast screening in addition to mammography. The researchers looked at a variety of factors including age and a consortium of risk factors. The authors writes, “Density information combined with breast cancer risk could be used to prioritize women who could benefit from breast imaging tests with better specificity than digital mammography, such as tomosynthesis.”

3) Number of Female Radiologists, Field Leaders Remains Low – Diagnostic Imaging

According to a presentation this week at ACR 2015, the number of women in radiology has not grown in the last 10 years. This research was done to see if the raised awareness of gender disparity has caused any change in gender representation in radiology. They found that women have consistently made up about 27% of the radiology field since 2004.

4) Newly Introduced Bill Looks to Establish ICD-10 Grace Period – Health Imaging

The US House is moving forward with the ICD-10 bill. The upgrade will take place on October 1. However, some healthcare executives and politicians were concerned that transition to the new coding from ICD-9 would cause confusion. For this reason, a bill was passed that says nobody can be denied Medicare reimbursement solely for using inaccurate codes during the first 18 months of implementation.

5) Medicare Imaging Spending is Down, with Some Variation by State – Radiology Business

At ACR 2015, presenters shared their findings on the trends of Medicare spending when it comes to imaging. They found that overall, national Medicare expenditures for imaging have fallen since 2006. They attribute this to factors based on education about radiation dose and the recession as well as policies instituted by the government. Some states did not follow these trends, read more to find out why.



The Conditions for mHealth Success

There has been no shortage of investment in mobile health (or mHealth) hardware in recent years. Those investments are predicted to continue climbing well into 2016, making up a significant percentage of overall mHealth spending.

mHealth Hardware SpendingAs the chart to right shows, hardware makes up a significant portion of mHealth spending, but IT services and software are continuously capturing share—a trend that expected to continue to grow, with estimated mobile apps for consumers now exceeding thousands. Much of the software that is being used for mobile devices is a reformatting of more general device software, but soon that will change to become more specific application for all the applications that will be used in the enterprise customized for mobile.

When it comes to implementation in the provider settings, the key lies with interoperability. If mHealth systems can connect it to the EHR, then they achieve the ability of improved user interfaces, improved analytics and big data. In addition to interoperability with the EHR, there are four other conditions that must exist for mHealth initiatives to be a success within the enterprise.

Strong value case developed for clinicians. Physicians, nurses, and specialists will have to disrupt their practice flow with new procedures to accommodate mHealth capabilities. The first step to encourage adoption is to prove the value proposition: it will save more time and cost less than the expense of learning and implementing it. More importantly, mHealth will drive a better experience for the patient through improved value of care.

Anticipate changes in the way mHealth will be regulated. FDA already has strict guidelines for clinical diagnosis using mobile devices. Carestream’s own Vue Motion for example, was FDA cleared for mobile clinical reading to ensure compliance. Clinicians are now suggesting that mHealth should be part of future Meaningful Use incentives in its own right. Plan for interoperability among these systems.

Manage the ever-growing stream of data. Create techniques to make use of torrents of data arriving in real-time from all sources—medical records, patient data, lab reports, images, clinicians notes, and clinical decision support systems to name only a few.

Anticipate and plan for increased patient engagement in healthcare. This trend will accelerate the adoption of mHealth by clinicians, especially since more and more patients are demanding this from their physicians. Patients are hungry for their own healthcare data, and those that provide them with availability and easy, secure access are the organizations that will be more successful in handling mHealth.

The adoption of mobile devices in the healthcare organization has been inevitable. Delaying adoption can have negative effects on the organization, as well as the patient, because as their perceived value of care decreases, so can the hospital’s reputation. For these reasons, it is becoming imperative that hospitals begin implementation of mHealth technologies and use them to improve patient care and the patient experience within their facilities.

For more details on the necessary conditions for mHealth success, read and download the fourth chapter in our CIO eBook series, “The Healthcare March to Mobility.”

Ben Wilson_IntelBen Wilson is the Director of Mobile Health at Intel Corporation. He is responsible for development and execution of mobile health strategies and programs at Intel. Ben is also Co-Chair of the Accountable Care Community of Practice, a consortium of healthcare IT leaders committed to collaboration in the development of Accountable Care healthcare organizations. A Stanford graduate, Ben’s MBA and MPH in Health Management were earned at UC Berkeley.

Climbing to Peak Performance with the DRX-Ascend

The DRX-Ascend has been a popular piece of equipment for Carestream since it was first introduced. The high-end DR system has allowed imaging centers, orthopedic facilities, urgent care clinics and hospital radiology departments to provide high-quality, efficient imaging to patients, while having reduced installation costs.

As the video shows, departments are able to take advantage of the performance, quality, and value that the system offers.

Diagnostic Reading #28: Five Must-Read Articles from the Past Week

Carestream LogoIt is the end of the week, which means it is time for a new Diagnostic Reading to highlight some of the must-read articles you may have missed through the week. This week’s focus is on healthcare IT security, with three of the five articles focusing on the topic. This is a topic that will be of importance for some time, as the safety and security of patient data cannot be understated. Patients must be kept safe and facilities must be compliant if they are to avoid the potential hefty fines and high costs of a security breach.

1. CISO: Security Must Work Within Workflow – Healthcare IT News

Connie Barrera, director information assurance and CISO of Miami-based Jackson Health System, highlighted how her job at the organization is to ensure security, while also balancing functionality and consumption. She comments how that in addition to streamlining operations, healthcare organizations must also streamline clinical workflow – which is critical if clinicians are going to adopt new policies and technologies.

2. Employees Top Causes of Security Mishaps – Healthcare IT News

The report, conducted by the BakerHostetler privacy and data protection team, is based on more than 200 security incidents the firm advised clients on during 2014. It found that a majority of security incidents were caused not by cyberattacks or lost unencrypted devices but by human error. BakerHostetler found employee negligence topped the list of five biggest causes of security lapses, accounting for 37 percent of them. Device theft from people outside the organization was #2 on the list at 22 percent, followed by employee theft at 16 percent; malware at 14 percent and phishing at 11 percent.

3. 5 Ways to Close Common Medical Device Vulnerabilities – FierceHealthIT

The U.S. Department of Veterans Affairs CIO Stephen Warren highlighted the five ways to close the vulnerabilities. These include 1) making sure devices are not connecting to Windows XP; 2) combat the irreplaceability of devices running on XP by highlighting how it can be cheaper to pay for new devices than deal with a security breach; 3) Make sure devices have anti-virus and anti-spy software; 4) ensure software is updated regularly when available, and 5) Giving people dedicated locations and computers to check personal emails instead of using networked computers.

4. Next-Generation Health IT Requires Primary Care Input – FierceHealthIT

According to a recent article in Journal of the American Board of Family Medicine, practicing clinicians have the clearest understanding of what they need from health IT and should be shaping the national HIT research agenda. Researchers and clinicians need to team up to fully describe the workflow, information needs and communication processes required for health IT to effectively support clinicians’ needs. This partnership should extend to the practice-level tasks of using data to optimize the care of whole panels of patients in order to redesign care to support population needs.

5. MPPR on the Chopping Block – Health Imaging

After U.S. legislators killed the SGR, the editor of Health Imaging asks if Multiple Procedure Payment Reduction (MPPR) could be the next controversial policy to be ended. The Diagnostic Imaging Services Access Protection Act (HR 2043) was introduced in the U.S. House by Pete Olson (R-TX), Peter Roskam (R-IL) and Betty McCollum (D-MN). It mirrors the newly introduced U.S. Senate bill S.1020 and would prospectively repeal the 25 percent MPPR applied to Medicare reimbursement of imaging interpretations for scans performed on the same patient, in the same session, on the same day.

Radiology’s Role in Medicine’s Mobile Revolution

Patient Portal

“Radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care.” – Jim Knaub, editor, Radiology Today

My dermatologist walked into the exam room, peering through his half-glasses at the smallish tablet computer in his left hand. He promptly looked up, greeted me, and shook my hand with his right.

“Last time you were here, we froze a couple spots on your scalp, one on your left hand and one your right lower leg,” he said, while dragging his finger across the touch screen and showing me the figure that represents me and my various lesions. “Have you noticed anything else you want me to have a look at?”

With that, he then slipped the tablet, which had one of those heavy-duty protective cases on it, into the flat pocket of his lab coat and started with my quarterly skin check. (That’s what happens when you’re a 54-year-old, sun-baked ginger.)

My adventures in aggressive skin cancer defense are not the point of this blog entry, but my dermatologist provides a good example of mobile medical imaging making its way into a clinician’s routine practice. Not long ago, that skin check visit would have started with the same greeting, followed by my doctor making his way to the laptop computer an assistant had placed on the counter next to the exam table. He would review my medical record on his EHR and then start the examination. The portability and ease of use of the tablet has upped his patient engagement game. I have seen doctors express concern about how working with a laptop EMR interferes with paying attention to the patient, but using a tablet, my dermatologist has worked it out.

Imaging did not come into play on my most recent visit because my dermatologist does not photograph the suspected precancerous lesions he freezes with his cryo-blister gun (not the technical term).  He has photographs of the melanoma he’s cut off me, the basal cell carcinoma he burned off, and the squamous cell he froze. Dermatology does not provide a good example of how radiology images are used by clinicians because the only modality is a digital camera that costs a few hundred bucks and almost all of a dermatology practice’s images are generated in house. The doctor takes the pictures and hands the camera to the assistant who then uploads the images to the EHR.

That said, my dermatologist’s use of his tablet beautifully illustrates how clinicians want their images available to them when treating their patients. And for specialties that you routinely provide images for, I believe radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care. As clinicians figure out how they will integrate tablets, images, and EHRs into efficient day-to-day care, they will increasingly expect their imaging providers to deliver patient images to their EMR, or at least in a way that the referrer can easily upload them to the EMR so they can be readily used in a clinical setting.

Radiologists will always do most of their reads at their workstations, with a small percentage of off-hour or emergency cases read on a laptop, tablet, or phone in various outlier situations. The greater mobile revolution will be among your referral customers—which any forward-thinking organization wants to serve better—and imagers will be asked to enable that by being able to deliver images readily usable at the point of care, or at least easily uploaded to where the referrer can easily make that happen.

JimKnaub_headshotJim Knaub is the editor of Radiology Today.



The Last Hope for Interoperability

Cristen Bolan, American Organization of Nurse Executives (AONE)

In Biblical times, Moses parted the red sea; in World War II, the allies landed on D-day; and in Star Wars, the legendary ObiWan Kenobi trained the young Jedi to destroy the dark star and save the day.

But today, who or what great event will force health care’s hand so that all health care systems become interoperable and work together seamlessly?

“We have been waiting for EHR interoperability since the dawn of EHRs in the 1960s,1”exclaims Donald Voltz, MD, in a recent article on solutions to making EHRs interoperable.  Dr. Voltz is clearly frustrated and with reason. He points out that the average hospital operates competing EHR’s that do not share information, causing confusion and leading to medical errors. There’s really no excuse, he points out. The medical industry has had many opportunities to bring about interoperability with the Health Information Technology for Economic and Clinical Health Act (HITECH) and the Meaningful Use EHR Incentive Program requirements are designed to standardize basic EHR functions. What’s the point of having EHRs if they can’t exchange data from one hospital to the next? Can you imagine if your AT&T phone couldn’t call someone using Sprint or Verizon?

So why aren’t these EHRs interoperable yet? Perhaps it’s by design? If so, who’s the man the behind the curtain? The competing hospital networks; the competing vendors; or can we chalk it up to government mismanagement? Or is it simply that their incentives are not aligned?

Getting to the point:  Who’s going to save the day?

Maybe it will be the early adopters and self-proclaimed IT innovators in health care—aka, the radiologists. Historically, they have pushed the envelope on embracing new technology, motivated by the need for speed and efficiency when it comes to reading radiology studies.  More recently, radiology has made a dramatic shift toward centralizing data as PACS drops the ‘a’ in archiving and morphs into RIS/EHR’s. Others, like David Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center and principal investigator for RSNA’s Image Share project, have taken the initiative to develop patient portals.

Could personal health records (PHR) play a role in driving EHR interoperability?

PHR’s can do many great things, according to With patient portals your organization can enhance patient-provider communication, empower patients, support care between visits, and, most importantly, improve patient outcomes. Truly transformational?  Not there yet.

An independent study, 3 led by Giampaolo Greco, PhD, MPH, assistant professor in the Department of Population Health Science and Policy at the Mount Sinai School of Medicine in New York City, surveyed 2,552 patients, who underwent radiology exams in four academic centers and established online PHR accounts using the RSNA Image Share network. The results showed that 96% responded positively to having direct access to their medical images, and 78% viewed their images independently.

Call it the clinical selfie—who doesn’t want to know what they look like on the inside? The radiologists are certainly on to something when it comes to luring patient into using EHR’s. But are pictures enough to keep them coming back? Even the biggest social media junkies get tired of Instagram. They had to come up with Snapchat—now you see it, now you don’t.

Patient portals are still struggling to engage patients. A recent study, Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record, examined successful portal implementation strategies used by small and medium-sized practices, as well as factors that influenced patients’ use. The results were mixed. The portal, MyPreventiveCare, tried to promote and explain preventive and chronic care to patients. Of the total of 112,893 patients, ranging in age from 18 to 75, nearly 26 percent created an IPHR account; users increased at a rate of about 1 percent per month throughout the entire study period; and patients logged in to the site an average of 3.7 times during the course of the study and spent seven minutes per session. Total patient portal uptake by practice ranged from 22.1 percent to 27.9 percent. The researchers concluded that indeed patients increasingly want to get online and have better access to their doctor—but clinicians need to help them with that.

The next step—better personalize the content. Getting close, but not there yet.

But for patients to truly adopt the portal, they need to own it; not only receive data, but respond to, interact with, and create it themselves. Yes, patients create data by communicating with their health care providers.

The online world is not a monologue; it’s simply another vehicle for everyday dialogue. Patient interaction can close the EHR interoperability gap. Once patients embrace health care IT for themselves, the walls of inoperability will come crumbling down. So, can you guess now the hero is?  

  1. Voltz D. Why I Hope to Help End EHR’s Lack of Interoperability. OpenHealth News. Posted March 23, 2015.
  2. What is a patient portal? Posted March 20, 2014.
  3. Greco G, Patel AS, Lewis S, et al. Patients Take Control of Their Medical Exam Records. Study presented at the annual meeting of the Radiological Society of North America (RSNA). Released December 2, 2014.
  4. Krist A, Woolf S, Bello G, et al. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record. 1370/afm.1691Ann Fam Med September/October 2014 vol. 12 no. 5 418-426.

Cristen Bolan, Senior Marketing Specialist, American Organization of Nurse Executives (AONE) – Subsidiary of the American Hospital AssociationCristen Bolan, Senior Marketing Specialist, American Organization of Nurse Executives (AONE) – Subsidiary of the American Hospital Association

Diagnostic Reading #27: Five Must Read Articles from the Past Week

Carestream LogoIt’s almost time for the weekend, but first make sure you catch up on some of this week’s most important articles. The topics include big data and customized healthcare, data security, advice from a recognized health system for reducing readmissions, a possible halt in ICD-10 implementation, and radiology’s role in precision medicine. Enjoy!

1) How Big Data Will Customize Our Health Care– Wall Street Journal

This article discusses the growth in data use in healthcare. The author says that though health systems have been adopting technologies that can collect, consolidate and share data about patients, they haven’t fully learned what to do next. Furthermore, he notes that electronic health systems will collect data, but there may be challenges when it comes to figuring out how to use it.

2) Healthcare Security: Adapt or Die– Healthcare IT News

In this article, the author talks about the growing concern for data security in healthcare. Medical records sell for nearly three times as much on the black market as credit card information. In 2013, 40 million people had personal information stolen. Having said this, the article goes on to discuss new security priorities. Disgruntled employees and hackers pose a security threat, if health systems do not adapt, they could be at risk for data breaches.

3) No One-Size-Fits-All Strategy for Readmission Reduction– FierceHealth

Ascension Health, the nation’s largest non-profit health system, has been working to reduce readmissions by individualizing care to specific patients. The organization seeks to meet the needs of an individual before they need hospitalization. The system promotes education and looks at factors that each person may face such as socioeconomic status, family support and community resources.

4) House Bill Proposes Halt to ICD-10 Implementation– Healthcare Informatics

With the ICD-10 deadline for implementation coming in October, a new bill has been introduced. If passed, this bill would prevent the Department of Health and Human Services from replacing ICD-10 with ICD-9. The dispute comes due to issues with the new coding in the bill. The bill has not yet made it to the House floor for a vote.

5) Radiology’s Role in Precision Medicine– Diagnostic Imaging

Government initiatives have emphasized precision medicine. Precision medicine can lead to more effective treatment of patients. This article discusses how radiology can be used to phenotype by following tracers to determine the presence of cancer cells after chemotherapy. With medicine shifting from a one-size-fits-all model, using imaging to personalize medicine can be used to diagnose and prevent in different ways.