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

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

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

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

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

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

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

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

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


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


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


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


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


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


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


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


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


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


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

Moving Scotland to a Digital Medical Information Environment

NHS Scotland Health Boards

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

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

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

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

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

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

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

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

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

Aileen MacLennanAileen MacLennan, Director of Diagnostics, National Health Service (NHS) for Scotland – Greater Glasgow and Clyde


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

Crystal Ball

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

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

1) Top 5 trends from RSNA 2014 in Chicago

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

2) Big Data Underpins Five Health IT Predictions for 2015

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

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

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

4) Patients Want More from Their EHRs

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

5) Radiologists, Referring Physicians Work Better Together

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

Reinventing Radiology Reporting: Adding Value by Leveraging Emerging Technology

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

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

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

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

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

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

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

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

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

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

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

Diagnostic Reading #5: Five Must-Read Articles from the Past Week

Carestream Booth at RSNA 2014

Carestream booth at RSNA 2014 in Chicago.

This week’s Diagnostic Readings include findings that were presented at the RSNA conference over the past week. Ultrasound training, radiation safety and health technology are some topics that were prevalent at RSNA.

1) Radiologists Must Play Central Role in Point-of-Care Ultrasound Training

With the adoption of ultrasound technology across the radiology industry, it is becoming a necessity to train medical professionals. David Bahner, MD, and Brian D. Coley, MD, discuss how radiologists need to step up and ensure that patients are getting proper care. Additionally, the presenters express the need to provide better ultrasound training in medical schools.

2) Radiologists Across the World Need to Lead the Way in Radiation Safety

With few new technologies in the radiology field, imaging safety has become a point of emphasis. Radiologists from across the world met at RSNA to talk about ways to make radiology a safer field. Dose reduction, education and appropriate use are a few of the topics that are addressed.

3) Integrating Radiology, Pathology Would Improve Diagnostics, Aid Patients

Developing channels for radiologists and pathologists to exchange patient information could lead to better patient care. Professionals from both fields have begun to discuss the most efficient ways to exchange templates. Radiology has been moving towards implementing standardized templates that mirror those of pathologists.

4) Many Chest Radiographs in Children Unnecessary

A study presented by Mayo Clinic at RSNA found that 88% of chest x-rays performed on children did not alter patient care. Reducing the amount of unnecessary x-rays could also reduce dose and cost.

5) Patients Like Accessing Imaging Records

According to a study presented by Mount Sinai School of Medicine, 96% of patients responded positively to receiving their images through a web-based interoperable system. This shows the benefit that comes from having available patient portals and enhancing patient engagement in medical care.

Text-Only vs. Multimedia Enhanced Radiology Reporting (MERR)

RSNA 2014 logoThroughout RSNA 2014, we have seen that the world of radiology is evolving. Beyond practices and legislation, technologies are expanding the way in which we collect, analyze, and share data.

In a poster presented today, Dr. Gelareh Sadigh shared the results of the study, “Traditional Text vs. Image and Interactive Data Embedded Multi-Media Enhanced Radiology Reporting: Referring Physicians’ Perceptions about Value.”

In addition to capturing radiologists’ reactions to using the multimedia reports, Dr. Sadigh, Dr. Rich Duszak, and the team at Emory University also looked at referring physicians’ perceptions about value in radiology received within the reports.

When exploring referring physicians satisfaction, the study looked at the opinions of medical oncologists, radiology oncologists, pulmonologists, and neurosurgeons in the United States. All of those participating in the study had more than two years of experience in the field and were referring more than 10 patients per week. The end results yielded 200 survey responses, with 46 years being mean age, and the gender demographic being 85% male. In regards to receiving paper versus electronic reports, a majority were receiving their reports electronically, with another majority receiving their reports as text only versus reports with both text and images.

The results of the study, which used Carestream’s Vue Reporting to create the multimedia reports, found that 80% reported an increase in referral probability when including text and images. Also, while 80% were satisfied with the current format of radiology reports, satisfaction was significantly higher in reports with combined text and images vs. text only reports.

Compared to historically text-only reports, the multimedia ones included hyperlinks, graphs, viewing relevant comparisons images, data and key images. When using the multimedia reports,  the interpreted value included an improved understanding of findings by correlating images to text reports. The multimedia reports also provided easier access to images while monitoring progression of a condition,  and saved time trying to understand findings without supporting images.

Like all studies, this one was not without concerns. Out of all respondents, 28% responded having concerns. The most common ones were that the multimedia reports were too time intensive because of all of the information within them. In some facilities, clinic workflow does not allow itself to view reports with such a high volume of information.

But in the end, when it came down to enhancing value for radiology, 80% indicated an  increased likelihood of preferentially referring patients to facilities that offer MERR, 79% indicated an increased likelihood recommending peers use facilities offering MERR, and respondents also said they were much more likely to give the reports to patients to enhance education. Overall, respondants saw multimedia reports as being a big improvement over text-only versions because of the value of information and detail offered within.

PulvinoRich Pulvino is the digital media specialist for Carestream. He sat in on the digital poster, “Traditional Text vs. Image and Interactive Data Embedded Multi-Media Enhanced Radiology Reporting: Referring Physicians’ Perceptions about Value,” which took place on December 3 at RSNA 2014 in the Learning Center – Hall D from 12:15-12:45 PM.

How Cobalt Imaging is Empowering Patients with Vue Motion & MyVue

Cobalt Health is a medical charity that was started about 50 years ago to support mainly oncology services. As a part of the charity, the Cobalt Imaging Centre is responsible for delivering high-quality medical imaging services and diagnoses.

The charity worked with Carestream to implement Vue Motion and MyVue. With Vue Motion, Cobalt enjoyed that the medical images were easily accessible from anywhere within the country, highlighting how there are no more discs with saved images being sent around, and that the experience of viewing and sharing images is safer, cheaper, and more efficient.

Additionally, while Vue Motion has allowed for the access of medical images for the physicians from many different localities, the MyVue portal has provided that same access to the patients. This has helped with patient education, and solidifying the diagnosis for them because they can now see and understand what the physician does.

Diagnostic Reading #4: Five Must-Read Articles from the Past Week

This week’s Diagnostic Readings include a look at the history of the RSNA conference, healthcare technology updates, industry accomplishments and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.rsna_afiche

1) Constant Change Characterizes RSNA’s First 100 Years

As we prepare for the 100th annual RSNA conference on November 30, take a look at the development that the field has made since the first RSNA conference. This article examines current market trends and discusses how radiology has grown over the past century.

2) Health IT Enabled Quality Improvement: A Vision for Better Health and Health Care

According to the ONC, this paper “describes ONC’s vision for advancing the use of health IT to support transformational improvement in health care quality and value.  It invites health IT stakeholders – clinicians, consumers, hospitals, public health, technology developers, payers, researchers, policymakers and many others – to join ONC in shaping the future with a renewed focus on health and care quality as the ‘why’ that aligns with the ‘what’ of interoperable health information systems.”

3) DeSalvo Discusses Future of Health IT, Growing Pains

Karen DeSalvo, Acting Assistant Secretary for Health to the Obama administration, gives an overview of the adoption of health IT. She discusses the primary challenges that the healthcare industry is facing when it comes to technology. Furthermore, DeSalvo is encouraged that electronic health records can be implemented and facilitate the meaningful use process.

4) Emory Healthcare Shares Imaging Processes for Ebola Patients

Emory University Hospital was responsible for curing all four Ebola patients that went to their facility this fall. One of the most important factors in this success was the use of radiology. This article summary explains the importance of portable computed radiology to obtain chest x-rays from patients with dangerous infections such as Ebola.

5) Quality and Contract Negotiations: Putting a Price on Quality

Healthcare is facing a time where quality of patient care is as important as any other aspect healthcare. This article discusses how radiologists are not judged by the same criteria as primary care physicians (availability of parking, waiting time, etc.). Quality in radiology is judged by the ‘fast and accurate diagnostic imaging results and superior patient outcomes’—standards that are difficult to quantify. Read how the radiology field can add quality to the care of each patient that is encountered.