Medical Imaging is in a State of David vs. Goliath

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

How do facilities measure patient satisfaction and quality of care in the changing healthcare landscape?

Physicians are focused now more than ever on value of care over volume.. One would assume that the largest facilities would be the ones best equipped to provide the highest value to the highest number of patients, however, the evolution of technology and the changing healthcare landscape has armed smaller facilities with the ability to thrive.

Ten years ago, when medical imaging first became digitized, the focus was all on the volume of exams. It was how our work was being measured. As has changed to accommodate the changing health system, the conventional wisdom of volume over value from the pre-EHR, pre-digital days, has become outdated.

To say the U.S. healthcare system is in a volatile state would be an understatement. Hospitals are closing and merging across the country, accountable-care organizations are now the standard, regional health organization systems are uniting health facilities across the country, and the Affordable Care Act is now in full effect.

The state of the David and Goliath in the medical imaging world.

Group size of a health facility is no longer as important as it used to be. Mergers in the U.S. are creating facilities with the size to handle large populations and offer advanced health services, however, with with the mergers come the legacy—technology, infrastructure, bureaucracy, and organizational structure—that often can hold back facilities from adopting disruptive practices and technology.

Meanwhile, small facilities and practices remain agile, able to provide more attentive, high-value care. A small facility with superior technology (integrative non-imaging clinical data, order entry algorithms, and enhanced communication tools) can serve a patient population as well as, or better than, a larger, more traditional system.

The world through the eyes of a David-sized medical facility.

As an example of this, my hospital, Chinese Hospital in San Francisco, is the smallest consultative medical imaging group in the city with two full-time and three part-time radiologists.

By conventional wisdom, we should not exist. We are the last independent hospital in the area with 54 beds, and 200 beds is next smallest facility. Everyone talks about size, and assumes a small facility doesn’t have the expertise. But providing the best care is individualized; we must look at what tools and capabilities each individual possesses. Our facility has continued to thrive because we work in this mindset. We hire the professionals with the appropriate capabilities, and arm them with the tools to do their jobs as effectively as possible.

The unifying question that challenges large and small facilities.

Whether you work for a David or Goliath, there is one common challenge that we all face—what is satisfaction, and what is quality? It’s difficult to say what it is or how to measure it. What the medical professionals say satisfaction and quality mean will likely differ from what the patients say. Did they have a good experience? Do patients look for good bedside manner? Or, do they want the physician to be efficient and effective with little communication?

These are questions the medical professionals and facilities will be working to answer for years to come because the future of our industry depends on it. The groups that adopt and are disruptive—and these can be both small and large facilities—are the ones that are growing the most. These are the facilities that will define satisfaction and quality, and provide the best value of care to its patients.

Three Examples of Vendor Neutral Archives Transforming Healthcare Workflow

Doug Rufer

Doug Rufer, Director Technical Marketing and Clinical Sales Engineering, Carestream

Vendor neutral archives (VNA) can transform workflow across the healthcare enterprise and should be seen as more than an opportunity for IT hardware simplification or consolidation of radiology images. This broad view was explored in Cleveland Clinic presentations at both RSNA and HIMSS about the Imaging Institute’s VNA implementation and enterprise imaging support model.

As one of the world’s largest VNA suppliers, we’ve seen the true advantage of VNA realized time and again when hospitals and health systems look beyond radiology and build an image access and viewing strategy that reaches across departments and deeper into the enterprise.

Looking for proof beyond the Cleveland Clinic?

Consider these three examples that range from a large urban integrated health network to the world’s second largest Health Maintenance Organization:

Rochester General Hospital

When Rochester General Health System was planning updates to their older multi-site, multi-archive distributed PACS, the IT department recognized an opportunity to implement an enterprise architecture across eight clinically integrated affiliates.

Current clinical workflow needs were being minimally addressed, but were not sufficient to support the organization’s evolving needs and growing imaging volumes.

A single, unified Rad/Card PACS was implemented, with a virtualized Vendor Neutral Archive providing long-term online storage for 230,000 studies annually, from two hospitals and four outpatient imaging facilities.

Consolidation of the Rochester Health System infrastructure occurred in conjunction with an assessment of enterprise clinical viewing needs across the enterprise. Clinical viewing consolidation was achieved using a zero-download viewer for enhanced access via the system-wide EMR to the information stored on the VNA. Clinician productivity, decision support and clinical learning have all benefited from easy access to historical information.

Winthrop University Hospital

When planning their PACS infrastructure upgrade, Winthrop-University Hospital determined it would be a good time to leverage enhanced vendor neutrality.

They implemented a cloud-based VNA and migrated existing online and offline diagnostic and interventional radiology, radiation oncology, vascular ultrasound and cardiac CTA studies. Cardiology and Orthopedic data are now being added and include DICOM and non-DICOM studies and scanned JPEG files.

The enterprise view adopted by Winthrop-University Hospital extended to providing clinicians with “universal” workstation access. The goal was to leverage the “neutrality” of the VNA storage infrastructure and single backend interface that was no longer limited by multiple unconnected systems.

Separating clinical storage from clinical viewing is expected to simplify future technology deployments by the hospital and increase the technology options available for future consideration.

Clalit Health Services

A patient-centric approach drove Clalit Heath Services in Israel, the world’s second largest Health Maintenance Organization, to implement a centralized storage architecture for standardized enterprise-reading and clinical-viewing workflow.

Shared worklists and an image-enabled EMR provide 10,000 physicians, across 12 hospitals and 40 imaging centers, access to 5M annual Radiology, Cardiology and Ophthalmology studies.

Dr. Arnon Makori, Radiologist and Director of Imaging Informatics at Clalit Health Services, feels, “The only way to achieve increased quality of care, centered on patient needs, is to provide universal access to clinical information and eliminate independent, site-specific workflows. If the workflow is optimized, then everyone benefits: the patient, radiologist, specialty physicians and IT.”

As these examples have illustrated, success is often driven by an enterprise imaging plan that reflects the organization’s overall needs – and not just those of a single department.

Interested in learning more about VNA? You can download an intro to VNA presentation on Carestream’s SlideShare channel or a quick VNA evaluation checklist here.

Monash Health Benefits from a Vendor-Neutral Archive

As part of its RIS/PACS implementation, Monash Health in Victoria, Australia, has implemented a vendor-neutral archive (VNA) to store, secure, and access its medical images and other clinical data.

Tony Gabbert, operations manager at Monash Health, told us that the facility has many sources of imaging, and that using a VNA provides a better experience for the physicians and the patients. The VNA unites a multi-vendor based infrastructure, bringing the medical images from different departments together into a single depository.

You can watch the complete interview below or on YouTube.


[Webinar] Image Quality: Does it Matter, and How Should We Define It?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Where is image quality? In the capture device? In the image processing? In the display system? In the brain of the viewer? Is it everywhere, or nowhere in particular?

These questions were answered recently in a webinar titled “Does Image Quality Matter?” by taking a closer look at the imaging chain.

Any imaging chain (also a medical one) contains five distinct functions:

  1. Capture (the creation of the image),
  2. Process (which itself consists of three sub-functions: preprocessing of the captured image, optimization for interpretation/viewing, and processing for the output device),
  3. Display (assuming a human is the viewer),
  4. Storage
  5. Distribution.

The answers depends on which image quality we mean: the objective image quality we can measure, the subjective image quality perceived by the viewer, or, particularly important in medical imaging, viewer performance using the image for some interpretation task.

In modern imaging systems, these three “flavors” of image quality are weakly, if at all correlated, which makes the prediction of one kind of image quality from another rather tricky, but also interesting.

The entire webinar has been embedded below. By the end, the questions asked at the outset should be answered, though the path to get to those answers may surprise you.

The Top Five Trends Seen at ECR 2014

Ludovic d’Apréa, General Manager, Carestream

Ludovic d’Apréa, General Manager, Carestream

Once again we saw a variety of trends at the European Society of Radiology’s European Congress of Radiology (ECR) in Vienna. Medical imaging and healthcare IT presentations and technologies were abundant, but there were several trends that were seen more frequently than others. Tomosynthesis (for lung and breast imaging) was widely talked about. Dose reporting, efficiency, and reduction remains a popular topic, especially with the creation of ESR’s EuroSafe Imaging organization. On the healthcare IT side, mobile devices and rich reporting were popular topics, as was the efficiency of relying on the cloud for data storage and access.

Tomosynthesis: Do a quick search of “ECR 2014” and “tomosynthesis” and you are sure to see a slew of information about how the topic was discussed and presented at ECR. Multiple vendors presented their tomosynthesis offerings, while multiple poster presentations discussed the benefits of the technology in medical imaging. As more present on the benefit of digital breast tomosynthesis (DBT), excitement snowballs around the possibilities of improved image readings and diagnoses thanks to the 3D modality. As example of the benefits of lung tomosynthesis, one poster demonstrated a phantom study in which the tomosynthesis module presented more accurate node measurements than computed tomography (CT). It is clear that tomosynthesis is going nowhere and will is steamrolling in becoming a more prominent technology in medical imaging.

ECR 20

ECR celebrated its 20th year being hosted in Vienna, Austria.

Dose: Discussions related to dose at ECR centered around the launch of EuroSafe Imaging.  The launch took place as part of a session about radiation protection. The presentation included a segment by the ESR’s director of radiation protection, Dr. Madan Rehani and a panel discussion took place that included representatives from the IAEA, WHO, ICRP and other European and international organizations focused on protecting patients from the potential harms of overexposure to radiation. Radiation dose continues to be an important focus for radiographers and radiologists as they focus on providing the least amount of dose to create the appropriate images that will provide the best diagnoses.

Use of mobile devices: To say mobility is a popular topic would be an understatement. During ECR we posted about mobile device usage and how it is no longer a trend to expect down the road. Mobile device use is at an all-time high, and adoption will only increase. Dr. Ratib at the University Hospital of Geneva spoke in European Hospital about how physicians at his hospital now wonder how they worked in an age before mobile devices. The ease of accessing images and information via a tablet is improving efficiency, and allowing for an environment where being in-the-know can be possible in a matter of seconds. This is leading to both improved quality of care for the patient, and an improved patient experience.

Reporting: Creating radiology reports revolves around more than presenting numbers. Rich reporting is a must-have in today’s department, and it is because radiology is interacting with more departments and referring physicians who rely on more than the numerical reports. Images, videos, and robust graphs are vital to today’s radiology department. As the demands of radiology increase, so must the capabilities of the applications radiologists use to do their work effectively and efficiently.

Cloud: Storage capacities are filling up faster than facilities can manage them. As the volume increases, which it is doing exponentially as more images and videos are saved, facilities are looking to the cloud to provide the scalable, flexible, and accessible capabilities needed to effectively manage the vast size of data storage.

Overall, it was another exciting year at ECR. Attendees were enthusiastic and vendors provided impressive displays showing the latest and greatest in the industry. Now that ECR 2014 has come and gone, it is time to begin with ECR 2015.

Executive Perspective: How to Achieve Efficient Enterprise Data Management

Julia Weidman, Marketing Manager,  Healthcare Information Solutions, Carestream

Julia Weidman, Marketing Manager, Healthcare Information Solutions, Carestream

Enterprise data management is one of the biggest topics in healthcare IT today. It involves integrating various silos effectively into the ecosystem and presenting relevant clinical data to the physicians who require it at a moment’s notice. At HIMSS14, Carestream wanted a deeper insight into the real challenges at various clinical settings.

We worked with HIMSS Analytics to sponsor a panel—moderated by Jennifer Horowitz, Senior Director, Research, HIMSS Analytics—that consisted of four executives from health facilities in the U.S. and Canada. The panel offered insights that pertained to the successes and issues they have experienced when implementing data management throughout their organizations. The panel consisted of:

The discussion is about 45-minutes long, so if you are interested in only viewing particular segments, we have provided links to each of the questions asked throughout the discussion:

  • [01:05] Panelist Introductions
  • [02:56] HIMSS Analytics about radiology PACS data
  • [04:44] How would you characterize your organization’s approach to managing patient-related images? What are your plans to incorporate images into the electronic patient record?
  • [10:50] How are you alleviating image storage issues?
  • [15:54] Retention Policy: Are your organizations putting in place formal image retention policies and what do they include?
  • [19:38] Are any of the federal regulations like HIPAA and Meaningful Use affecting your image storage?
  • [20:37] Are you considering cloud technology?
  • [23:20] Workflow: How are you making sure images are accessible, and how are you managing the workflow?
  • [26:13] How are you managing remote access of images and the workflow?
  • [28:17] How do you assess and measure clinician satisfaction with the environment?
  • [34:22] What does your future state look like?
  • [36:20] Are you archiving telehealth consults?
  • [38:13] Audience question: Is anyone doing telepathology and streaming of the images?
  • [40:12] Audience question: What is the right infrastructure for patient engagement?
  • [43:33] Audience question: What is the size differential between streaming pathology data and a large imaging file?
  • [45:13] Audience question: Do you have any experience with cancer pre-screening, prostate pre-screening, and their image retention?

The entire panel discussion can be watched below, and we owe a big thanks to HIMSS for allowing us to sponsor such interesting, information-rich discussion.


Teleradiology Providing an Increasing Number of Opportunities in Europe

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

In January 2014, the European Society of Radiology (ESR) updated its white paper about best practices in teleradiology. The purpose behind this publication was to explain how facilities should best implement the services since teleradiology is becoming increasingly popular across Europe.

The ESR found that teleradiology is bringing new opportunities for both the users of the services and the providers. The main goals behind the white paper were broken down into five key messages:

  1. Teleradiology describes the provision of radiology services remote from the site where the images are obtained

  2. Teleradiology should form part of and be integrated with the wide spectrum of radiology services, and not a separate tradable commodity

  3. The quality of radiological reports and services delivered by teleradiology should not be less than those of local radiologists

  4. International quality standards for teleradiology need to be established

  5. Patients need to be fully informed when teleradiology is used

The ideas behind this white paper were meant to address members of the European Union, as well as the members of the ESR teleradiology subgroup, which was formed recently and served to update the original paper that was written in 2006.

As a testament to the advantages that teleradiology provides, AuntMinnie Europe reported on how Russia is seeing teleradiology as a way to bridge gaps in healthcare. In a “ESR Meets Russia” session on Friday at ECR 2014, it was explained how teleradiology is able to provide services to areas of the country that are not heavily populated. And while teleradiology services can take time to implement, the benefits they can provide pay back with many benefits.

The practice of teleradiology has come a long way in Russia. Today, departments, such as one in St. Petersburg that has been implemented it in its emergency department, is proving the evolution of the practice. Oleg Pianykh, PhD, an assistant professor at Harvard Medical School, said that teleradiology is eventually going to move beyond Moscow and St. Petersburg, and expand in scope across the country, in Siberia, for example, where the population is more scarce.

Pianykh explained to attendees in the ESR session that it is important not to take one successful teleradiology solution in a facility and think it can be duplicated in another facility. Each one is different and will requires a different strategy for planning and implementation. Resources must be optimized for every particular clinic and Pianykh said it is important to grow solutions from the bottom-up, based on the needs of a particular hospital.

The examples of teleradiology being implemented in Russia shows the benefits of such a service. When populations are more spread out, teleradiology will be able to bring the quality of service and care to areas that may not have access near by. It is this type of change in a healthcare system that has the potential to provide important benefits to diverse populations.

Mobile IT Earning its Place in European Radiology

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

In a recent article in European Hospital, Osman Ratib, MD, PhD, FAAC, Professor and Division Chair Department of Medical Imaging and Information Sciences, University Hospital of Geneva, talked about the future of mobile IT and the role it will play for radiologists in the future.

Dr. Ratib explains that radiologists will use mobile applications for on-call situations where they need to access studies quickly for review and that these applications are not used as often for final interpretation. Another point Dr. Ratib made was that it is often not the radiologists using the mobile devices, but the referring physicians, and other care staff. This is because these medical professionals need to access the images in situations where they are not close to a workstation. As an example, he said that surgeons often take the images with them into the operating room.

One type of application Dr. Ratib highlights is the web-based application where access to images enabled through a web portal and no data is actually stored on the medical–it remains stored on the servers. The advantages this offers is that it is easier to implement because access is granted with a web browser, and doing this allows for similar features to the desktop computer because all work is done via the web server, and both rely on the web browser for use.

The mobile trends are not just pointing to radiology, but all hospital departments relying on mobile devices in their everyday work. Dr. Ratib said that all of the physicians and staff in his hospital walk around with a tablet in their hands. Market penetration is continuously increasing, and while risks exist related to making sure patient dates remains safe and secure, the advantages that mobile devices are presenting are numerous.

Vue Motion

Image sharing is becoming increasingly popular on mobile devices among physicians.

As an example of this mobile access, Spire Healthcare in the UK recently upgraded their Carestream PACS to include cloud services. The mobile access, zero-footprint image viewer Vue Motion was part of this upgrade and an important application for physicians in the hospital. The fact that Vue Motion works across different platforms allows Spire to access images no matter what site they are located at within the 37 hospitals and 10 clinics that make up the health system. The physicians see the advantage due to the flexibility of the application and the patients experience the advantage too because this access allows for more efficient examinations.

Spire is not the only hospital experiencing these benefits. It is part of a wider trend where mobile IT and the advantages it provides are leading to more efficient and higher quality care. Dr. Ratib said that one day medical professionals will wonder how they ever worked without mobile devices, and with mobile adoption increasing as fast as it has, that day may arrive quite soon.

[Infographic] Electronic Access & Medical Images: Are You Connected?

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

We have been talking about providing patients with electronic access to their medical images since mid-2013, and it is not a topic that is going to go away anytime soon. Patients want more control over their healthcare, and providing access to their information is a vital component to gaining that control.

The infographic below provides some statistics that prove patients want more access and control, and that electronic methods are the best ways to comply. Highlights include:

  • 80% of Americans with online access to their healthcare information take advantage of it
  • 65% of Americans who do not have access to their health information electronically say that it is important to have it
  • 2 out 3 people would consider switching to a physician who offers access to medical records through a secure internet connection

Along with these stats, we have collected additional data from a study commission with IDR Medical and via customer test cases where they allowed patients to use the Carestream patient portal MyVue. This information can be found in the final half of the infographic below.

Are You Connected Infographic

[Webinar] Does Image Quality Matter?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

You would think that the answer to this question would be an easy “yes,” but it is not as clear-cut as you would believe. The reality is that many factors influence actual and perceived image quality. A so-called “poor” image detector can still produce good-quality images, while a “good” detector can easily produce poor-quality images. The bridge between the detector and its images involves exposure techniques (e.g., kV, mAs, filtration, anode, dose, etc.), image processing (e.g., optimization, compression), and the characteristics of the display system itself. Finally, the observer at the end of the imaging chain also plays a critical role..

On March 4, I am going to be conducting a webinar for members of the Carestream VIBE user group that will seek to answer the question, “Does Image Quality Matter?” The definition of image quality often differs from person to person, depending on whether the focus is on objective evaluation, subjective perception or task performance.  This makes the subject of image quality both interesting and complex.

The webinar will attempt to reduce this complexity by focusing on three basic questions about image quality:

  • What is it?
  • Where is it?
  • Who should care, and why?VIBE_Graphic_1_2

To answer these questions, we’ll look at the contributions to image quality from detector performance (e.g., contrast, spatial resolution, noise), from image processing (preprocessing, display optimization), and from display performance (e.g., perceptual linearization, calibration). At the end, we’ll also examine the role of observer performance (e.g., human visual system characteristics) in the final determination of image quality.

At the end of the webinar, attendees will have a clear understanding of what we/they mean when we/they say “image quality” and how it may differ across its three main categories—objective, subjective, and performance-based.   Attendees will also understand the important role that the observer plays in determining the success or failure of an imaging chain. By the last slide, attendees will be able to answer with greater confidence the question “Does image quality matter?” and be able to explain the complex balance of factors in the imaging chain that makes this simple question significantly deeper than might first appear.

You must be a Carestream customer to join the VIBE user group. If you are a customer and would like to join, you can click here.

If you would like to register for this webinar, please click here.