Radiology and Macro Healthcare Trends Part III: Quality Care

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

Part II of this series explored how radiology can impact cost effectiveness at healthcare facilities.  In this final post, we will look at delivering quality care in our new healthcare environment.

New regulations, controlled costs for facilities and patients, and technological innovations have given healthcare providers the ability to more easily provide patients a high-quality level of care. Particularly in radiology, we see significant advances in the products and software that support the capture and delivery of images.

Patients expect that the care they receive will be of the highest quality.  To contribute to this, radiologists should think about the following:

  • Streamlining Communication
    • Making sure that getting to images and results is easy for technologists, doctors and patients. One way to do this is leverage new technology that provides a platform from which this is possible.  Doctor and patient portals are becoming more and more popular – and standard functionality – across many types of healthcare facilities.
  • Playing a Role in Patient Communication
    • Instead of seeing radiology outside of the healthcare continuum, facilities and radiology professionals can work to see how imaging has a direct impact on the quality of patient care. This understanding must be facility-wide so that radiologists have the support they need to become part of the continuum and to be educated on how to communicate with patients.

Technological advances such as reporting platforms that offer native voice recognition, RIS or PACS integration, and advanced reporting, support internal and patient communication.  Having a strong, integrated reporting system contributes to reducing delays in processing and produces better, more contextual reporting.

One area in which streamlining communication and patient communication is having a greater impact is in the area of telemedicine.

Telemedicine, and to be more specific, teleradiology, has not entirely come to fruition because of laws and payment systems that are more encouraging for face-to-face doctor-patient visits. In the U.S., doctors are licensed by states, but the rules follow where the patients live, so doctors must also be registered in their patients’ states too. In the European Union, doctors are licensed by country and have the free reign to practice throughout the union, no matter where their patient lives.

While the U.S. may seem more conservative with telemedicine laws, telemedicine practiced within a state has its advantages. It can be difficult for those living in rural areas to have access to quality care. With a broadband connection, telemedicine can provide rural populations with high-quality care that many in more populous areas have access to. This is certainly the case in China, where it is spending billions on healthcare reform with an emphasis on teleradiology.

What do you think? Are you seeing radiology become an integrated, vital component of quality healthcare? Are there other trends to keep an eye on? 

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare is being published in three parts. Part I was posted in September and Part II was published in October.


Diagnostic Reading #3: Five Must-Read Articles from the Past Week


On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

This week’s Diagnostic Readings include updates on meaningful use, analysis of telemedicine growth, tips about dose management and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.

1) Survey Indicates Telemedicine Adoption Growth among Healthcare Executives

This post presents the results of a survey taken by 57 healthcare executives. The findings explore the extent to which health care systems are adopting telemedicine and electronic health records (EHR). The author explores the the channels of telemedicine that are the most popular among this sample group.

2) Enterprise Imaging—Walking the tightrope: Optimizing radiation dose management 

Since the 1980s, the annual per-capita radiation dose from medical exposure has risen from 0.53 mSv to 3.1 mSv. This article from the November edition of Applied Radiology explores the challenges and solutions of moderating dose. The author discusses how the balance of radiation dose management can be optimized.

3) AMA Urges CMS to Drop Meaningful Use Penalties

This article addresses the existing meaningful use criteria and the difficulties that some medical centers may encounter. This piece discusses that reasons outside of a physician’s control may be the reason for their lack of interoperability. Due to these difficulties, the American Medical Association has asked the Centers for Medicare & Medicaid Services to “suspend all penalties to physicians and healthcare facilities for failure to meet meaningful use criteria.”

4)  It’s Time for Radiology to Take Peer Review Seriously

This post discusses the importance of knowing your diagnostic accuracy rate in radiography. The author writes about comparing accuracy rates to bench marks and national standards. These ideas could lead to more accurate readings and more industry-wide credibility.

5) To Improve Mammography Reading Accuracy, Follow Through with Workups

This article discusses the correlation between reading high volumes of mammography readings and accuracy rates. The study conducted at the Group Health Research Institute in Seattle found that radiologists with higher numbers of annual workups had higher screening sensitivity and cancer-detection.

Webinar: The Future on Displays


Click the image to go to the sign-up page for the webinar, “The Future on Displays.”

On Tuesday, November 18, I will be presenting a webinar titled, “The Future of Displays.” The goal of this presentation is to provide attendees with an idea of what they can expect to see in the evolution of medical-grade monitors they work with on a routine basis, and how they differ from conventional displays.

Multi-modality hybrid diagnostic displays are essentially the future of image viewing in radiology. The image quality and versatility these monitors offer for facilities have been able to improve efficiency and allow for remote access to images from a central point, which also allows the execution of remote calibration and performance monitoring.

After the webinar, it is my goal that attendees can take away the following information:

1) Why medical monitors are needed over conventional monitors. This is especially true for telemedicine. We must ensure that radiologists conducting the readings have the same set up and same calibration as the technologies at the physical imaging center, so that they are both viewing the same image.

2) Screen elements that have an impact on image quality. Luminance, sharpness, brightness, contrast, gamma, uniformity, grayscale, and panel technology are elements that will be discussed. These image technologies, in addition to panel size customization, are what contribute to high-quality images on a medical monitor.

3) Quality control is vital for medical-grade monitors and certain standards must be followed. Standards define the condition, how monitor should be checked and controlled, and that this should be done every quarter. There are many countries that buy medical equipment and do not understand why one image looks different between two different screens. I will cover the different quality control standards facilities need to adhere to in order to ensure high image quality, as well as how these standards change among different regions and modalities.

4) Thorough understanding of the required type of display. Everyone understands the workflow, but when it comes to the image quality for different modalities—ultrasound, mammography, MRI, CT—how should the colors/greyscale be displayed? What happens when the monitor is not calibrated?

You can click the following link to the sign up for the webinar, “The Future on Displays.” It will be taking place on Tuesday, November 18, at 10 AM EST.

Juergen HeckelIng. Juergen Heckel currently serves as EIZO’s worldwide VP of Medical Business Sales and Marketing. With over 13 years in the medical industry, he has worked with a large network of key hospital decision- makers and radiologists – making him an authority on market trends and needs regarding display solutions.

Diagnostic Reading #2: Five Must-Read Articles from the Past Week

RSNA 2014 imageThis week’s Diagnostic Readings include a preview of the 2014 RSNA conference, the impact of politics on the field of radiology, advice to improve patient engagement and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.

1)RSNA 2014: A Century in the Making

This article talks about what to expect at this year’s RSNA conference. It highlights what to look for, what to expect and how to plan for the 100th annual conference.

2) RBMA: What the Midterm Election Results Mean for Radiology

This article discusses how the Republicans’ wide-spread victories in the recent elections could change political agendas on programs such as the sustainable growth act and the affordable care act. Furthermore, this piece addresses how these changes could positively or negatively affect the field of radiology.

3) Analog in the Rearview Mirror

This comprehensive article covers just about anything you need to know about the shift from analog radiography to digital radiography. The author covers pricing and financial considerations, as well as providing an outlook on the future of digital radiography.

4) More Than a Software Program: Children’s Hospital of Philadelphia Experts Discuss Their Dose Optimization Practices

The importance of dose reduction in pediatrics is emphasized in this piece. Chris Tomlinson, MBA, CRA, the senior director of radiology at CHOP, adds his input about the importance of working as a team to institute a low-dose program. He adds that it is not only about using low dose software, but also how to be proactive in lowering dose in pediatric radiology.

5) Clinical Decision Support: A Radiology Practice’s Approach

 Radiologists and physicians have begun to team up using clinical decision support (CDS). Read more about how radiologists and physicians can consult before determining the appropriate imaging action to take. This article discusses the advances in technology as well as the potential increase in patient care and co-worker relationships that come with the growth of CDS.

Beyond Storage: Realizing VNA’s Full Potential Starts with Redefining Its Purpose

Long-term storage. Data redundancy. Easy integration. Freedom from PACS vendor lock-in. Reduced risk of data migration.  These are the topics that usually ignite a vendor neutral archiving discussion at a healthcare organization. But many VNA conversations stall because strategic goals beyond IT simplification and consolidated image storage are needed to make the project a priority and unlock funding and resources.

Jef Williams, chief operating officer at Ascendian Healthcare Consulting, agrees, writing in an AHRA Link article:

“I’ve realized that often the value of the VNA is not communicated sufficiently to gain organizational buy-in.  Healthcare is dealing with so many changes and impending deadlines around Meaningful Use, ICD-10, ACOs, and HIEs that a new initiative must contain robust communication and buy-in components for it to be successful.”

To get your project off the ground and add value to your enterprise, VNA must serve a larger purpose. Consider these three common health system goals:

  • EMR return on investment speed – The ONC reports that more than 75 percent of all physicians use an electronic records system. However, researchers calculating the five-year ROI found that the average physician would lose nearly $44,000, and only 27 percent of practices achieved a positive ROI on their EMR systems.Providers are under pressure to recoup their investment in EMR and will give projects consideration that help deliver on the promise of improved productivity and cost efficiencies in care coordination.The value of a VNA:  It acts as the foundation of an image-enabled EMR. Paired with an enterprise viewer, VNA can improve decision support and clinician productivity, as well as reduce costs by standardizing care practices, processes and infrastructure.  Bonus: For organizations planning to attest to Stage 2 meaningful use, the criteria requires that more than 10 percent of all images ordered by the eligible professional (EP) for patients seen during the EHR reporting period are incorporated into or accessible through CEHRT.
  • Patient satisfaction gains – One of the Affordable Care Act’s eventual goals is to tie Medicare payments to performance. Doctors who perform well on certain quality and patient satisfaction metrics (using the results from “CG-CAHPS” or “Clinician and Group Consumer Assessment of Healthcare Providers and Systems” patient surveys) will be paid more than those doctors who do not.Both ACOs and non-ACO healthcare organizations preparing for the future are setting ambitious goals and plans to improve the patient experience and satisfaction.  Projects that empower patients align well.The value of a VNA: It acts as the foundation for rapid, secure patient access to images.  Image access could be an enabler to drive patient satisfaction and engagement as an embedded workflow in an EMR portal. A recent study of 1,000 U.S. adults conducted by IDR Medical, an international healthcare marketing company, found that 79 percent of patients would be more likely to return to a facility that offers online image portal and 76 percent indicated they would recommend the facility to others.
  • Health Information Exchange (HIE) development – Health Information Exchanges are seen by clinicians as a critical piece to meet the demands of new care models, and participate in third-party reporting and incentive programs.  However, according to a recent study published in Health Affairs, only 14 percent of physicians surveyed in 2013 were electronically sharing data with providers outside of their organizations.Projects that address collaboration and interoperability, and set the stage for HIE participation will get the attention of the C-Suite.

The value of a VNA: It can act as the collaboration foundation for accessing patient imaging data locally AND regionally.  VNA can serve as a pathway for all care providers to access patient imaging data where it’s needed.  I agree with Ascendian Healthcare Consulting’s recommendation in an article for Imaging Technology News that advised providers to include VNA interoperability in the collaboration planning for both their enterprise and region.

These goals illustrate the importance of redefining the VNA’s purpose beyond storage. When planning, it is imperative to look at image sharing models as the most important VNA capability.  Then align your project with strategic health system priorities – beyond IT and department needs – that will return measurable value.

Interested in learning more about prioritizing access in your VNA project? You can download a SlideShare presentation or contact us to learn more about Vue Archive here.

Coming to RSNA? Schedule a discussion with our VNA experts and get a demo of your clinical collaboration platform.

AmosRobert Amos is a Healthcare Information Solutions Specialist for Carestream



Diagnostic Reading #1: Five Must-Read Articles from the Past Week

CSH-RIS-PACS-Blog-“Diagnostic Reading” is a new weekly series in which we will be sharing five articles we have come across in the past week that are worth reading and sharing. The topics covered will be across the spectrum–from radiology and medical imaging trends, to the most important issues affecting healthcare IT today. We hope you find these articles valuable.

1) Cloud Security and What it Means for Our Health

This article addresses many common questions regarding cloud security in healthcare. The article talks about the basics of the cloud before the discussion shifts to the transformation of healthcare with new technology.

2) Adding DBT to Screening Mammo Boosts Benefits, But Not Cost

Research conducted at the University of Washington has revealed that digital breast tomosynthesis (DBT) is cost effective and beneficial to mammography patients. This article analyzes the economic and medical benefits of DBT.

3) BYOD Security Risks: Strategies to Protect Your Hospital

The BYOD, or bring your own device, trend has started in many hospitals. This allows medical professionals to use their own phone, tablet etc. to access patient portals. This article talks about the potential security risks and how to deal with those risks.

4) Meaningful Use Problems Go Beyond Just Software, Say “Stage 2 Flexibility” Critics

This article touches on some of the current and potential difficulties of Stage 2 Meaningful Use.  As Meaningful Use progresses, healthcare teams will not have as much time to plan.

5) Assuring Quality: a Challenge that Must Be Met Now

In this article, Thomas Pope, MD, discusses the importance of peer-reviewing X-ray results in order to provide more successful diagnostic readings.

Radiology and Macro Healthcare Trends Part II: Cost

Part I of this blog series focused on radiology’s significant role in the capture and sharing of patient data.  This post will focus on costs.   At a time when 23% of U.S. adults either had problems paying medical bills or were unable to pay them, cost is top of mind for patients and practitioners.  Imaging costs now vary widely and, money spent on imaging has correlated to a reduction in hospital stays.

But what can radiologists do to have an impact on cost?  Here are two ways:

  • Imaging AppropriatenessCloud
    • Work with peers and other healthcare professionals to determine which radiology studies will be meaningful.  Better decisions directly correlate with keeping costs down and, with a focus on quality images, will make a difference in the diagnosis process.
  • Nurturing Expertise
    • The quality of images cannot be understated.  While technology plays an important part, the radiologist’s training and expertise contribute greatly to how well an image is captured.  In addition, being able to read an image and communicate that reading makes a radiologist an increasingly valuable asset to the diagnosis process.  By promoting professional development and advanced training, healthcare facilities are supporting cost-control and imaging effectiveness.

The fact is that inappropriate imaging exams and a lack of quality in images drives up healthcare costs. In the U.S., healthcare costs per capita are twice as much as the averaged developed country, and the quality of care is not necessarily better.

To combat these risings costs in healthcare, cloud technologies are being sought out by radiology departments around the globe. Implementing cloud solutions is resulting in reduced costs and improved quality, as turnaround time on reading images decreases, as well as costs associated with managing and storing images on infrastructure as it becomes outsourced.

According to the 2014 HIMSS Analytics Cloud Survey, the number one reason healthcare facilities looked to cloud technologies was because the costs were less than current IT maintenance. Cloud adoption is not only increasing in the U.S. Across Europe, healthcare facilities are looking to the cloud as a solution to boost productivity and decrease costs.

With these trends, it has become clear IT technologies—especially the cloud—are leading the way to improving costs. With medical images often using up the largest volumes of data, radiology is often becoming the leading department in using the cloud effectively.

What do you think? Are there other ways in which radiologists play a role in streamlining healthcare costs?

In part three of this series, we will focus the quality of healthcare and how radiology plays a part.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare is being published in three parts. Part I was posted in September and Part III will be published in November.



Digital Breast Tomosynthesis Necessary for Imaging Dense Breast Tissue

Digital Breast Tomosynthesis

The image on the left is a DBT image, and the image on the right is traditional 2D mammography.

Digital breast tomoysnthesis (DBT), or 3-D mammography, has often been referred to as being the key to advancement in breast imaging. With more and more states passing laws requiring that women be notified if they are classified as having dense breast tissue, DBT is proving to be beneficial in accurate detection—a JAMA study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers.

Dense breast tissue and the accompanying notifications to women who possess it has become a frequent conversation topic over the past couple years. As of now, 20 states have enacted laws that require medical professionals to notify women if their mammograms reveal them to have dense tissue. Organizations such as Are You Dense Advocacy are fighting the good fight trying to get more states on board with these notifications because of the major risk dense breast tissue presents— making it more difficult to detect cancer in a mammogram than normal tissue.

At the International Congress of Radiology (ICR) in September 2014, Dr. Marwa Adel from Misr University for Science and Technology and Cairo Scan in Egypt presented two cases:

  1. The first case, Dr. Adel and company compared breast cancer visibility in digital mammography with that of DBT. Cancer visibility was ranked higher for DBT than for digital mammography in 52% of cases and was equivalent in 49 cases (33.6%). When observing the group with higher breast tissue density, the cancers were rated more visible in 64.6% of the cases.
  2. In the second study, DBT also proved better than digital mammography in image quality of masses. DBT was rated as equivalent or superior to digital mammography in 96% of the total findings.

Dr. Adel and the other authors of the studies concluded that DBT is superior to digital mammography in diagnostic performance. Particularly when it comes to dense breast tissue, it is clear that the use of DBT is vital to providing improved diagnosis to patients.

There are important questions regarding financial, technical, product, and workflow issues related to DBT that should be answered before a facility installs a system. As women’s healthcare continues to evolve, more and more facilities are able to implement DBT machines and be in a position to provide the highest quality of care to their patients.

At RSNA 2014, Carestream will showcase enhancements to its DBT module including a DBT image map that indicates the location and orientation of the currently displayed slice in the breast, a slabbing tool that allows  adjust of the slab thickness , improved workflow settings and the display of DICOM-compliant 2D synthetic views, which are calculated from the 3D dataset.  For more information, you can visit us in South Hall at booth #4735.

UPDATE, NOVEMBER 10, 2014: According to an article published last week by Health Imaging, “the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.”  You can click the link to get more details about the designated codes and payment amounts for DBT. CMS said it will also “revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.”

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream Ron Muscosky, Worldwide Product Line Manager, Healthcare Information Solutions, Carestream 



Challenges of Stage 2 Meaningful Use Require More Allies

ONC, Meaningful Use, Stage 2

Click the picture to go to the website to learn more about Stage 2 meaningful use certification.

Stage 2 of Meaningful Use is a vital component to the initiative since it, as the U.S. government defines, “intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.”

As reported by Hospitals & Health Networks, only 140 hospitals have achieved Stage 2 of meaningful use. Throughout 2014, hospitals have been claiming that requirements such as this are more difficult to implement than originally thought. Assistance is needed in the form of decreased time for reporting periods or providers fear that they will face the severe penalties.

From the vendor side, to properly help providers, it is clear that we must be able to provide the answers to two key questions:

  • Can the technology be optimized with the existing solutions in place?
  • One of requirements for Stage 2 states that more than 5% of unique patients during the reporting period must use the hospital’s portal to view, download or transmit their health info to a third party. Since patients will be using the technology, is it intuitive and secure?

For both of the questions, I feel confident that Carestream would be able to answer, “Yes.” Our Vue RIS platform recently achieved Stage 2 certification, making it one of the first RIS platforms to achieve both Stage 1 and Stage 2 certifications. This means that those facilities using the system can exchange patient medical records and clinical documents with other certified EHR providers.

Beyond just being having an integrated solution, working with your clinical departments can enable capturing specific clinical data required: i.e. smoking cessation, BMI etc. In the case of the University of Virginia, the organization shared that radiology helped meaningful use attestation because it was able to capture the data that would not otherwise be captured.

With the Stage 2 certification, Vue RIS includes the following capabilities: family health history, the transfer and sharing of health information, and online patient access to information and communication. Additionally, the RIS platform can also be coupled with the MyVue patient portal to allow for patients to view their exam results, view and reschedule appointments, and also share the exam results with their primary care physicians.

Stage 2 of meaningful use has been deemed so vital to the future of healthcare because it is the first stage that involves the patients becoming ingrained in the process. As the patients become more in tune with their own health, we must make sure that we not only provide them with the tools to take action, but also the guidance and education on how best to use them, as well as the benefits these tools provide.

What have been your biggest challenges when working to achieve Stage 2 meaningful use? What have you been doing to combat these challenges, and what successes have resulted?

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing manager, Healthcare IT, for Carestream.




NHS Ayrshire and Arran Works to Improve Radiation Dose with Radimetrics

NHS Ayrshire and Arran serves 400,000 people at 10 hospitals across East, North, and South Ayrshire in Scotland. Two years ago, the organization worked to integrate Bayer HealthCare’s Radimetrics with its Carestream Vue PACS. The integration was completed in weeks, and the facility immediately found how well the two work together.

With Radimetrics, NHS Ayrshire and Arran became able to track radiation dose and room utilization as a way to collect data and act swiftly if issues are to arise. The big questions that the facility can now answer include, “Are we minimizing radiation dose for our patients?” and “Are we making the best use of our resources?”

As the video above explains, the organization was able to bring protocols together, standardize them, and oversee the management of dose. With this newfound efficiency, NHS Ayrshire and Arran can now easily spot discrepancies in the data, and seamlessly update patient information.

As volume of exams and complexity exams goes up, the organization needs to justify its decisions. As an example, it can view dashboards to determine room utilization, which allows for specific acquisition on how a room is being used, with Radimetrics, that information is now at their fingertips.