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

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

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

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

2) The Ethical Radiologist– Diagnostic Imaging

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

3) Patients Want Information About Radiation Risk– Aunt Minnie

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

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

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

5) Ultrasound Exams Present Interpretation Challenges– Aunt Minnie

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

How Can IT Manage the Flood of Healthcare Data?

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

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

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

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

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

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

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

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

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

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

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




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

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

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

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

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

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

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

How a Hospital Improved Image Storage & Access with SaaS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Multimedia-Enhanced Radiology Reporting in Action

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

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

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

Cristine Kao, Healthcare IT, Carestream

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

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

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

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

Multimedia-Enhanced Radiology Reporting Infographic

Diagnostic Reading #18: Five Must Read Articles from the Past Week

Carestream logo

It’s Friday, which means it’s time for a new edition of Diagnostic Reading. This week’s articles focus on the standardization of reporting structures, how big data is used within a large health system, mobile technology in healthcare, imaging appropriateness, and an Imaging 3.0 case study.

1) Standardization Moves Streamline Europe’s Reporting Structures – AuntMinnie Europe

A joint initiative between the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA), RadReport (www.radreport.org), introduced two years ago and formalized last year, aims to promote and facilitate structured reporting through the creation of a joint open repository for radiology report templates. The initiative will be announced during ECR 2015.

2) UPMC Taps Big Data for Cancer Research, Cardiac Care – Information Management

UPMC provides researchers and physicians access to structured and unstructured data, including x-rays, CT scans, MRIs, pathology reports, physician notes, histopathology reports and post-op notes. The health system has a total of 8 petabytes of data that is readily accessible online, plus an additional 14 petabytes in long-term storage.

3) Making Mobile Work in Health – RealBusiness.com

Carestream’s Cristine Kao, global marketing directore, healthcare information solutions, talked with the publications about the company is working to improve clinician communication and handling data in the era of “plug and play” mobile devices and telemedicine. She goes on to discuss team-based care, the evolution of technology, physician access to data via mobile devices.

4) ACR Updates Appropriateness Criteria, Adds News Topics – Health Imaging

Included in the new criteria are breast pain, occupational lung diseases, and metastatic epidural spinal cord compression and recurrent spinal metastasis. There are now a total of 208 topics with 1,014 variants available. People can visit the ACR website for more information.

5) Imaging 3.0 Case Study: A Simulated Experience – American College of Radiology

The University of Florida developed “Simulation in Emergent and Critical Care Imaging” — a web-based program that tests residents by simulating a typical call rotation in an emergency room. The university is now working with the ACR to deliver its simulation product to radiology resident programs nationwide through the ACR Radiology Curriculum Management System (RCMS), which is a cloud-based platform that allows radiologists to collect, develop, distribute, and access educational materials and simulations.

Telemedicine Growth Points to Increased Adoption of Teleradiology

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.

If venture funding is any indication, we are in store for another year of impressive growth for telemedicine. It was the fastest growing category in digital health last year, increasing 315 percent with nearly $300 million in aggregate funding. This included funding for both new companies and current companies in the space.

In the U.S., licensure and reimbursement are the two key issues that surround telemedicine practices. A statement from the American Telemedicine Association said:

“The fact that every state medical board decides on their own what they believe best practice in medicine is, which is going to vary from state to state, presents a real problem.”  – Jonathan Linkous, CEO, American Telemedicine Association.

While this, and restrictions within Medicare and Medicaid, have limited the use of telemedicine within some U.S. states, it is promising that patients are responding favorably to the technologies.

Meanwhile in Europe, the telemedicine market is growing at a healthy rate every year. It is predicted that by 2019 the European telemedicine market will almost triple to $12.6 billion at a CAGR of 12.82%.

What does this growth in telemedicine mean for teleradiology?

As telemedicine expands, so will the need for images to be included in exams and patient diagnoses done via broadband.

The biggest area that is contributing to teleradiology’s growth is in rural areas. Last year at ECR, Russian presenters explained how teleradiology is contributing to providing care and analyses to sparsely populated areas in the county. While there are still a number of needs that must be addressed such as improving network infrastructure, training, and expertise, the country is devoted to expanding its use of the technology.

Adding on to rural areas, hard-to-reach locations also benefit from the ability to transmit medical images from one place to another. One example was when MSC Cruises became the first cruise line in the world to offer a multilingual pediatric teleradiology service on board, so care could be provided while out at sea.

It is becoming clear that as telemedicine offerings expand, teleradiology is expanding alongside. The technology is able to provide a vital service to many who may not have access to quality care, particularly those living in rural or hard-to-reach areas.

To provide people with the high quality of care we all deserve, it goes beyond the need of technology. It extends into the realm of building quality broadband infrastructure to provide the access, and appropriate training for medical professionals to use the technology. With these three areas fulfilled, teleradiology will only continue its growth as an important component within telemedicine.

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



Global Worklist and the Connected PACS

Cheshire & Merseyside PACS sites

Dark blue crosses are Carestream sites, and light blue other PACS sites.

I will be taking part in two presentations at the European Society of Radiology’s ECR 2015 Congress, and each one will be related to the use of our Carestream Multisite Virtual PACS.

The first is a poster titled, “Establishing a regional on-call radiology service using a shared virtual PACS,” and was completed with co-workers K. Slaven, S. Dyce, and L. Anslow

Out-of-hours radiology has been delivered by radiology residents working on-call rotations in individual hospitals. As the intensity of work has increased, out-of-hours work has seriously impacted time spent during the day in the department. The need for compensatory rest has led to significant loss of training in what is already a relatively short training scheme.

Cheshire and Merseyside is a small but complex health economy in the North West of England. The system has the following facilities:

  • Seven acute hospitals
  • One tertiary cardiac hospital
  • One neurosciences centre
  • One tertiary paediatric centre
  • One cancer centre
  • One specialist obstetrics/gynaecology hospital

Six acute sites have resident radiology specialist registrars in rotations between four and nine in size.

None of the rotations were compliant with the European working time directive (EWTD). Four of the sites were on shared RIS/PACS, and the other two had PACS from different vendors.

The move to a shared global worklist (Vue Connect) and shared RIS has meant that the acquisition of images and reporting can be accomplished on separate sites. This also means that one resident can be on-call for more than one site at a time.

By combining the registrar workforce, we have been able to achieve compliance with the EWTD and significantly reduce the number of nights worked, hence allowing for a significant increase in training hours within the base  departments.

We are about to incorporate the last two acute sites. We have placed a Carestream agent on the last two sites, which allows image sharing seamlessly across all the sites including systems from other vendors. We plan to move to PACS-based reporting soon, so the residents will have a single workflow for their out-of-hours work, and to avoid having to work in three different PACS and three different RIS.

Our PACS has some unique features that makes this possible, and will be presented in the second presentation:

“Development of a shared multi-site virtual PACS”PACS - Cheshire & Mersyside

The co-authors for this presentation are S. Dyce, N. Pfirsch and S. Lomax.

As mentioned previously, Cheshire and Merseyside is a complex health economy. The previous system procured during the National PACS programme in England had PACS supplied by a single vendor in our region. However, image sharing was never a part of the programme and images had to be transferred by CD, DICOM push and latterly by a bespoke email-like system—the Image Exchange Portal.

There was a huge movement of patients from one acute site to another, or to specialist centres. Frequently, previous imaging was not available in a timely fashion, studies were reported in isolation, or even repeated when they could not be accessed. Regional multidisciplinary meetings were a massive effort to ensure all imaging was available for discussion, and image transfer was a huge overhead for all of our departments.

The goal was for all 10 trusts to have left the national PACS programme by June 2013 and this was achieved.

During procurement, we looked for a system that would behave as a single virtual PACS with seamless display of all current and prior studies. There was also a requirement to be able to view and report images from any site, and a requirement to support images from the two hospitals that had PACS from other vendors. A single mega PACS was a possible solution, but individual institutions wished to keep ownership of the images.

We selected our vendors based on these requirements:

  • Single master identifier – the NHS number
  • Acquisition and reporting are kept separated
  • Single instance of a study so annotations and reformats are applied to a single study
  • Seamless display of priors; the reporter could be unaware of the location of prior studies, but they appeared in local PACS

Carestream was chosen as a vendor that could support this workflow and deliver it in the six-month fixed timetable. The system was delivered before the cut-off date, and over 100TB of data was migrated into the system.

All of the above objectives were achieved, as well as the following:

  • Seamless multidisciplinary meetings with display of priors
  • Major reduction in overhead of image transfer
  • Specialist reporting e.g. paediatric, neuro is supported
  • Centralised on call centre for radiology residents
  • Significant Cost Reduction

The live presentation for “Development of a shared multisite virtual PACS,” will be given at ECR 2015 in SS 1805, on Sunday morning from 1030-1200.

Dr. Peter Rowlands, NHSDr Peter Rowlands, consultant radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT).