Diagnostic Reading #50: Five Must-Read Articles From the Past Week

Carestream LogoA new week means a new Diagnostic Reading. This week we’re looking at digital breast tomosynthesis, patient portals, how hospitals use cloud services, hospital safety, and the future of healthcare.

1. DBT Finds 54% More Cancers than Mammography – AuntMinnie

Digital breast tomosynthesis (DBT) finds 54% more cancers than 2D mammography and reduces recall rates by almost 20%, according to a new study published in Radiology. Even better, the technology identifies lesions in dense breast tissue, which mammography tends to miss.

2. Do Patient Portals Exacerbate Healthcare Disparities? – Healthcare IT News

Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren’t used at all by the very people who may need them most. The report, Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics, was published this month in the Clinical Journal of the American Society of Nephrology. Of 2,803 patients, 1,098 (39 percent) accessed the portal. Of those, more than 87 percent of users reviewed their laboratory results, 85 percent reviewed their medical information, 85 percent reviewed or altered appointments, 77 percent reviewed medications, 65 percent requested medication refills and 31 percent requested medical advice from their renal provider, according to the CJASN study.

3. Hospitals to Triple Use of Cloud Services – Healthcare IT News

Globally, the healthcare organization cloud market could triple in within five years. That would mean skyrocketing from $3.73 billion in 2015 to nearly $9.5 billion by 2020, according to research firm MarketsandMarkets. Adoption of cloud computing in healthcare is likely to increase owing to the rising need to curtail costs and enhance the quality of care, reforms benefiting healthcare IT, proliferation of new payment models, the cost-efficiency of cloud technology, and the implementation of the Patient Protection and Affordable Care Act (PPACA).

4. New Hospital Safety Scores Report Shows Modest Patient Safety Improvements – Healthcare Informatics

The Leapfrog Group released its Fall 2015 Hospital Safety Score report showing consistent top safety performance by 133 “straight A” hospitals, while patient safety improvements across the board were more modest. Of the 2,530 hospitals issued a Hospital Safety Score, 773 earned an A (down from the 782 in spring 2015), 724 earned a B (up from 719), 866 earned a C (up from 859), and 133 earned a D (down from 143). And the latest scores indicate that 34 hospitals earned an F grade, which is up from 20 hospitals from the Spring 2015 Scores.

5. New Survey Forecasts the Future of Healthcare in 2025 – Imaging Technology News

Critical advancements in modern technology will play an integral role in progressing the Future of Healthcare, according to a new survey sponsored by Polycom, Inc.  The study, which polled more than 1,000 healthcare industry professionals from around the world, anticipated that over the next decade, a growing and aging population globally will lead to challenges in quality healthcare, including funding, easy access and a strain on current healthcare infrastructure. However, according to the research, technology developments, such as mobile, the Internet of Things (IoT) and big data, offer a promising opportunity for overcoming healthcare bottlenecks by 2025.

White Paper: 3D Weight-Bearing Imaging Using CBCT

This white paper addresses the benefits of a prototype cone beam computed tomography (CBCT) system dedicated to extremity imaging.

The CBCT system was co-developed by scientists at Carestream Health and Johns Hopkins University. The CBCT system was designed to image both upper and lower extremities, with the lower extremities also capable of being imaged in a weight-bearing configuration.

This unique capability can unveil and better characterize certain pathologies in the knee and ankle joints such as meniscal extrusion, altered tibiofemoral joint space morphology, flatfoot deformity, and distal tibiofibular syndesmosis insufficiency.

As explained in the white paper linked to below, the CBCT system’s images are “excellent” for bone and “good/adequate” for soft tissue visualization tasks. Additionally, the image quality was equivalent/superior to MDCT for bone visualization tasks.

For more details about the CBCT system images, you can read the white paper, “High-Resolution Three-Dimensional Weight-Bearing Imaging of Lower Extremity Using Dedicated Cone Beam Computed Tomography (CBCT).”

Carestream CBCT Weight Bearing Images

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

Diagnostic Reading #49: Five Must-Read Articles From the Past Week

Carestream LogoThis week’s Diagnostic Reading articles look at appropriate ages for breast screening, ICD-10, the cost of cyberattacks, big data, and interoperability.

ACS: Breast Cancer Screening Should Begin at Age 45 – AuntMinnie
Until this guideline revision, published in the Journal of the American Medical Association, ACS had marched in lockstep with groups including the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in advocating that screening start at 40. However, accumulating evidence has suggested that accurately assessing breast cancer risk could be more complicated than simply an age-based calculation — a realization that prompted ACS to review its previous guidelines, most recently issued in 2003.

Preparing ICD-10: Documentation for Fractures – AuntMinnie

A large number of diagnostic imaging exams deal with the assessment of fractures, and the documentation of these exams will require some pieces of information that were not always included in radiology reporting until now. Identification of the episode of care was not usually included in most radiology reporting, but it will now be essential for the correct coding of fractures or other injuries. Providing this information as a part of the patient history will assist your coders in applying the proper ICD-10 code.

Cyberattacks Could Cost Providers $305B – Healthcare IT News

Over the next five years, U.S. health systems stand to lose a total of $305 billion from coordinated cyberattacks, according to Accenture. Even worse, their patients are at big financial risk themselves. The report – The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction – predicts that some 25 million people, one out of every 13 patients, will have sensitive financial data stolen from their healthcare provider’s IT systems over the next half-decade.

Big Data: The Lifeblood of Precision Medicine – Healthcare IT News

Perhaps second only to a learning health system, precision medicine is healthcare’s grandest vision today. The idea is to essentially roll together massive population health data sets with individuals information – including genomics, lifestyle, chronic conditions – then analyze it to more effectively tailor treatments and preventative care plans for patients. At the heart of that, of course, is data. And that is going to require a major shift in terms of both business philosophy and technologies.

An Interoperability Crossroads: As Feds Continue the Push, Health IT Stakeholders Push Back for Faster Results – Healthcare Informatics

When the federal government (CMS) released the final rules for both meaningful use Stage 2 modifications and Stage 3 earlier this month, and at the same time, the final version the Office of the National Coordinator of Health IT (ONC) Roadmap, there were a few loud messages that it was clearly trying to convey: the need for a “person-centered” healthcare and a commitment to interoperability.

Relationship Between Clinical Decision Support Systems (CDSS) & Radiology Must Evolve

Clinical decision support system (CDSS), an early entrant to healthcare IT, can reduce mistakes in medication administration, encourage practice standardization, and reduce duplication or unnecessary performance of diagnostic tests.  When neatly integrated into an electronic health record platform, CDSS can facilitate evidence-based clinical decisions. Built on a backbone of algorithms, rules and alerts, CDSS is a cornerstone of patient safety, healthcare quality, and cost-effective care.

But CDSS has been largely limited to prescriptions, laboratory tests and treatment protocols. This is especially true in the outpatient setting.  Building on this functionality, Congress upped the ante for CDSS with the Protecting Access to Medicare Act (PAMA).  Passed in April 2014, the immediate effect of the law was to forestall implementation of the SGR.  Nevertheless, PAMA is not limited to issues of physician reimbursement. It also details a mandate meant to change physician behavior – specifically regarding the utilization of high-end imaging studies in the outpatient setting.

One of the nearly 40 sections of this law, Section 218, outlines an approach effectively aimed at decreasing utilization by encouraging adherence to specialty-vetted clinical practice guidelines for the ordering of these costly tests.  These practice guidelines, or appropriate use criteria, are meant to drive the development and implementation of radiology decision support tools.  This has become a major challenge to entities that provide radiology services – the mandate to provide CDSS to referring physicians.

Set to take effect Jan. 1, 2017, PAMA is reminiscent of the EHR Incentive Reimbursement Program (Meaningful Use). Since its inception, Meaningful Use has been a puzzle to most who practice radiology. MU’s core objectives comprise the build of a replete centralized patient health record.  But, unlike other disciplines in medicine, EHR design does not conform to radiology workflow and process.  With the passing of this law, PAMA is something of a declaration that RIS and PACS do not go far enough to improve the health of our patients and to decrease healthcare expenditures.

A close reading of the law reveals three parallel strategies:

  1. Ordering physicians must confirm that the appropriate use criteria are consulted when ordering CT, MRI, nuclear and PET studies. Important to note is that adherence will not be required.  However, it will be measured by CMS.
  2. Providers of radiology services will be required to offer CDSS to ordering physicians. The law explicitly states that physicians who provide diagnostic interpretation will be paid only for those claims that confirm a certified CDSS was used.
  3. Those ordering physicians identified as outliers as measured by CMS in 2018-9 will be subject to a prior authorization process beginning Jan 1 2020.

The threat of prior authorization is a real, however soft, incentive to change one’s behavior.  Financially speaking, a greater burden must be borne by radiology services given the mandate to offer CDSS to referring providers.

In order to be able to execute on these changes to practice, PAMA defines a relatively tight timeline.  CMS is required to finalize the terms of the appropriate use criteria no later than November 15, 2015.  Once published, CMS will have until April 1, 2016 to approve clinical decision support systems for deployment.  And on January 1, 2017, all ordering providers will be expected to consult a CDSS and radiology services will be required to confirm availability, use, and level of adherence to the appropriate use criteria.  This attestation will be required on all Medicare claims for reimbursement.

My conversations with colleagues locally and across the country make me think that planning for this change is barely nascent in most communities.  I expect this topic is going to heat up soon, especially given the cost and complexities involved.  Time will tell.

Neil Kudler, MDNeil R. Kudler, MD, is the Chief Medical Information Officer and an Internist at Baystate Health in Springfield, Massachusetts. He is also the Chief Information Officer of Pioneer Valley Accountable Care, an ACO with 1,200 physicians and 150,000 lives in risk contracts. He is a Member of the American Medical Informatics Association (AMIA), the Association of Medical Directors of Information Systems (AMDIS),  the Massachusetts Health Information Exchange Provider Engagement and Adoption Subcommittee, and is co-chair of the Premier PACT HITIC Committee. Dr. Kudler is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.

Diagnostic Reading #48: Five Must-Read Articles From the Past Week

Carestream LogoIn this week’s Diagnostic Reading we look at a new breast screening study, response time for stat mobile x-ray, consumers and healthcare technology, EMR adoption, and gamma imaging dense breast tissue.

BMJ: Dutch Data Show Breast Cancer Screening Works – AuntMinnie

According to the authors of a new study published in BMJ, the Dutch example of breast cancer screening works, and mammography screening is a clear way of detecting cancer early, along with increased breast cancer awareness. Women have a greater chance of five-year survival if breast cancer is detected early while tumors are small, fewer in number, and early-stage, noted the authors from Erasmus University Medical Center in Rotterdam.

Hospital Slashes Response Time for Stat Mobile X-ray – AuntMinnie

According to an article in the Journal of the American College of Radiology, A Texas hospital was able to cut radiologic technologist response time to 10 minutes for orders for stat mobile x-ray exams from the facility’s medical intensive care unit (ICU). Implementing a series of improvements that included workflow changes, an equipment upgrade, and — perhaps most importantly — changes in ordering patterns by ICU physicians enabled the radiology department at Memorial Hermann-Texas Medical Center in Houston to reduce technologist response times from over 45 minutes to 10 minutes.

Deloitte: Consumers Using More Healthcare Technology – Healthcare IT News

Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles, according to a new report from The Deloitte Center for Health Solutions. The report, “Health Care Consumer Engagement: No One-Size-Fits-All Approach,” found that 22 percent of respondents used technology to access, store and transmit health records in the last year, up from 13 percent in 2013. Use was higher for those with major chronic conditions: 32 percent compared to 19 percent in 2013.

Study: Full EMR Adoption Can Help Hospitals Overcome “Weekend Effect” – Healthcare Informatics

The weekend effect refers to patients who undergo surgeries on weekends, leading patients to experience longer hospital stays, and hospitals to face higher mortality rates and readmissions. The study, published in the Annals of Surgery, identified five resources that can help hospitals overcome this effect: increased nurse-to bed ratio; full adoption of EMRs; inpatient physical rehabilitation; a home-health program; and a pain management program.\

Gamma Imaging and Dense Breasts: Clinicians Evaluate its Role Along with MRI and Ultrasound – Radiology Today

Looking for the best adjunct imaging to complement mammography for women with dense breasts can be as challenging as reading the mammograms themselves. Comparing the functional imaging that comes with nuclear gamma imaging modalities such as molecular breast imaging (MBI) and breast specific gamma imaging to anatomical imaging of ultrasound and MRI results in debates over the pros and cons of these options. The need for images to drive diagnosis and treatment decisions is continually weighed against the chance of false-positives and the potential long-term effects of radiation exposure.

Video: Accomplish Your Mission with the Touch Prime Ultrasound System

With the new dynamics of healthcare the stakes for sonographers have never been higher. It is a group known best for having mastered the art of turning sound waves into diagnostic imagery. One false move and department productivity and patient satisfaction can plummet.

The time has come to give these special agents an ultrasound system they can personalize to propel their efficiency. Replace the one-sized fits all control panel littered with buttons and knobs for a sleek, smooth surface with a revolutionary combination of touch and sound. A swipe of the badge gives sonographers secure access to their individual preferences and controls that push the limits of productivity and position each sonographer to embark on their missions faster, with enhanced intelligence.

The new tool of choice is the CARESTREAM Touch Prime Ultrasound System. A system that can consistently deliver pristine images and offers an extraordinary personalized, intuitive user experience never before seen by sonographers.

Mission ready. Personalized for every sonographer.

Your mission today, should you choose to accept it, is to watch this demonstration of the ultrasound system sonographers helped to design and share with your favorite special agent of patient care.

Diagnostic Reading #47: Five Must-Read Articles From the Past Week

Carestream LogoA new week means a new Diagnostic Reading, This week we are looking at health record security, meaningful use, a CT use study, ICD-10, and patient engagement in hospitals.

Report: 45 % of Americans Have Had Records Compromised – Clinical Innovation + Technology

According to a white paper from iSheriff, a provider of cloud-based enterprise device security, almost 45 percent of Americans have had their sensitive health information compromised via a cyberattack. The New Healthcare Crisis: Cybercrime, Data Breaches and the Risks to Patient Records highlights the largest breaches and points out that the five-year total is more than 143 million compromised patient records which is more than one-third of the 319 million Americans.

U.S. Government Finalizes Meaningful Use Regulations – AuntMinnie

The announcement by the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) and the U.S. Centers for Medicare and Medicaid Services (CMS) featured the final rule for stage 3 in addition to modifications to current stages of the MU program. The reporting period for providers to attest to meaningful use of IT in 2015 has been dropped from 365 days to 90 days. New participants in the MU program can take advantage of a 90-day reporting period in 2016 and 2017.

6 Glaring and Disruptive ICD-10 Glitches – Healthcare IT News

Linda Girgis, MD, Family Physician, South River, NJ, shares her experiencing using ICD-10 in its first week. The glitches she experienced are outline in her article and include: the CMS grace period, clearninghouses, referrals, eligibility checks, wait times and personnel.

Study: Skip CT in Most Blunt Emergency Trauma Cases – AuntMinnie

According to a study of more than 11,000 patients that was published October 6 in PLOS Medicine, doctors can safely forego CT imaging in more than one-third of emergency blunt trauma cases by using clinical criteria to assess patients rather than automatically sending them to imaging. The researchers hypothesized that two validated clinical tools could be used to avoid unnecessary radiation-bearing exams and also save money. They showed that nearly all injuries can be found using the two sets of clinical criteria, which they called “decision instruments,” comprising either six or seven elements. Both deliver at most a small fraction of the radiation dose of CT, the group reported.

ONC: Patient Engagement Capabilities Increasing in Hospitals – Healthcare Informatics

According to ONC data, which includes data from the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey, this is a significant increase from 2013, where 1 out of 10 (10 percent) hospitals provided the capability. Further, most hospitals allowed patients to transmit (66 percent) and download (82 percent) health information; however nearly all hospitals (91 percent) allowed patients to view their health information electronically.

VIBE: Carestream’s Next Generation Vue User Group

Carestream VIBE User Group CommunityOver the past year Carestream’s Very Important Board of End-Users (VIBE) User Group has grown rapidly and actively based on user input and collaboration. As we collected extensive customer input and feedback, we found the need for an enhanced platform. The result was an optimized resource that is tailored to the needs and wants of our current users, the VIBE Community.

The new platform contains a comprehensive content library containing a mixture of documents, videos, and covering topics such as Healthcare IT and market trends, ROI and productivity, and exclusive Carestream information. Extensive service documentation is also available in the group for easy access such as release notes and manuals. Members of the VIBE community also receive exclusive invitations to online webinars.

The community contains interactive discussion groups for RIS and PACS for peer-to-peer collaboration.  Users are able to ask questions and easily share documents, videos, links and images within the group. Additionally, we have a dedicated team of Carestream subject matter experts at service and active within the VIBE Community.

There are about 200 pieces of informational content on the site contributed by Carestream employees across the organization as well as customers. The most popular content on the site includes information and documentation on new releases of PACS and RIS, as well as several customer led questions and discussions.

If you are not already a member of the new VIBE Community, don’t miss out on the conversation! All Carestream customers who are current users of our healthcare information solutions are eligible to register.

You can get connected now by visiting VIBE Community page and registering for an account.

Once you are signed up, there is a three-step process for getting started:

Complete your User Profile

Upload an avatar and pictures: Show us who you are.

Add your Skills and Expertise: Tell us what you’re an expert at. This is important so if a user has a question or idea on a specific topic, they will know who to talk to.

Understand Resource Spaces and Discussion Groups and Follow What You’re Interested in

What is a resource space? Our Resource Spaces serve as content libraries consisting of webinars, videos, customer testimonials, service documentation and more.

What is a discussion group? Our Discussion Groups are where the conversation happens. Ask a question, share a best practice, discuss an idea  or at the very least view what your peers have to say.

Start Connecting!

Don’t be afraid to post your questions or ideas: A good place to get started is to tell us a little about yourself in our intro thread.

Additional questions? Feel free to ask other users or Carestream subject matter experts, or browse through our other documents in the Help/Getting Started space.

Adina SchoenemanAdina Schoeneman is the global marketing specialist for the healthcare information solutions business, and is also the community manager for VIBE.


Guess the X-ray – October’s Image Challenge

It’s a new month so that means it is time for a new “Guess the X-ray” Image Challenge. September’s Image Challenge, a ball in a baseball mitt, was never guessed correctly (although there were some good guesses), so let’s see if we can make things a little more difficult this month..

The x-ray image for October is below. The challenge will run until the end of the month or until the first person guesses correctly.

To participate this month, leave your guess in the comments below or on our Facebook page. Good luck!

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

October Image Challenge

Diagnostic Reading #46: Five Must-Read Articles From the Past Week

Carestream LogoThis week in Diagnostic Reading, we are looking at ICD-10, as yesterday marked the deadline for the code implementation. We also look at the effects of patient consultations, breast computer-aided detection, and the security of medical imaging technology.

1. ICD-10: Inside the War Rooms – Healthcare IT News

A closer look at how consultants, hospitals, and IT vendors are working on ICD-10, the new-to-us 20-year old classification system that U.S. healthcare payers and providers must start using as of October 1, 2015.

2. Health IT Leaders Call ICD-10 Transition “A Step Forward” – Healthcare Informatics

Yesterday marked the deadline for ICD-10 code implementation and many health IT leaders have applauded the nationwide transition as a necessary step to build more robust medical records. In a statement, the Coalition for ICD-10, a broad-based healthcare industry advocacy group, said the transition to ICD-10 “is a historic moment for U.S. healthcare and a major milestone in the evolving transformation of our 21st century healthcare delivery system.”

3. Patient Consultations Boost Pediatric US Experience – AuntMinne

According to a study published in the American Journal of Roentgenology, when it comes to the parents of children receiving ultrasound studies patients really want to get imaging findings directly from radiologists. Researchers from Stanford University School of Medicine implemented radiologist-patient consultations after routine outpatient pediatric ultrasound studies at Lucile Packard Children’s Hospital. They found that more than 90% of parents indicated they would prefer to meet directly with the radiologist at every visit going forward.

4. Study Raises New Doubts About Value of Breast CAD – AuntMinnie

According to a new study published online Monday in JAMA Internal Medicine, radiologists who used computer-aided detection (CAD) software to read screening mammography exams had no better accuracy than those who didn’t.

5. Are Your Secure? PACS, MRIs and Other Medical Devices at Risk of Being Hacked, Says Security Experts – Radiology Business

According to a presentation made by two security researchers at DerbyCon 5.0 in Louisville, Ky., many healthcare provider computer systems and medical devices in the U.S. are vulnerable to hackers. Using the search engine Shodan, which finds computers based on software, operating software or other specific details, the researchers found access to tens of thousands of hospital computer systems and medical devices. This included a “very large U.S. healthcare system” with more than 12,000 employees and more than 3,000 physicians. The system included 97 MRI systems, 323 PACS Systems, and hundreds of other devices.