Diagnostic Reading #24: Five Must Read Articles from the Past Week

Carestream LogoIt’s finally Friday and that means it’s time for another Diagnostic Reading. This week’s articles include big news about the SGR repeal legislation, an update from HIMSS 2015 about patient engagement, information about reducing hospital readmissions, issues with modern American healthcare, and information on what to do if an ultrasound is necessary but there is no sonographer on duty. Enjoy!

1) Congress Passes SGR Repeal Legislation, Ushers in New Era in MD Value-Based Payment – Healthcare Informatics

The Sustainable Growth Rate (SGR) formula has been a topic of tension with physicians for quite some time. This week, Senate voted with an overwhelming majority to repeal SGR. The formula was set to cut Medicare reimbursements by 21% only three hours before the legislation passed. This legal action will encourage the pay-for-value model that healthcare leaders have emphasized as the most realistic way to distribute Medicare reimbursements.

2) HIMSS15: Patient Engagement among Top Priorities for Providers – FierceHealthIT

A survey of hospital IT executives conducted by HIMSS has found that 72% of respondents said patient engagement would make up a large part of their organizational strategy over the next couple of years. A hospital executive, Bill Feaster, from Children’s Hospital of Orange County, said, “We’re not going to improve the health of our population unless we get patients engaged in their own care.”

3) A Hybrid Approach to Avoiding Readmissions – Hospitals & Health Networks

Hospital readmissions are costly. A nurse practitioner and a social worker have teamed up in order to address the issue of hospital readmissions, particularly for senior citizens. This article discusses a different approach to reducing readmissions. The author says that in order for this hybrid system to work, it is important to keep up-to-date with elderly patients. Physicians can educate patients while they are in the hospital, and with the support of an electronic health record, they can make sure patients are educated and adhering to everyday medical needs.

4) Four Healthcare Issues the Government Must Tackle – Fierce Healthcare

Healthcare expert, Paul Keckley, PhD, gives advice on how the United States can catch some of the world leaders in providing quality healthcare while using a smaller percentage of GDP. Keckley’s ideas include adjusting the structure, incentives, employer-based insurance and developing a transparent pricing model.

5) Teleradiology Prompts Shift in Use of After-Hours Ultrasound – AuntMinnie

The use of ultrasound is growing in healthcare facilities around the world. Unlike other forms of medical imaging, ultrasound is dependent on operator techniques. Many facilities are using teleradiology in order for after hours CT or MRI images (6 p.m. – 8 a.m.). This means many facilities might share one radiologist. A study in France wanted to find whether or not ultrasound images could be taken using other modalities or postponed until a trained sonographer was on hand. The study found that most ultrasound requests can be postponed until working hours or replaced with a different mode of imaging.

Clinical Collaboration Platform Grown from the Enterprise VNA

We have discussed the evolution of the vendor-neutral archive at length on Everything Rad, and that conversation will not dissipate any time soon.

Healthcare facilities are dealing with petabytes upon exabytes of data, and not only do they need technological resources to store this data, but they also need a system that can properly categorize the data, and provide access to it across different -ologies.

The animation below shows how VNA owners can build upon their systems to create the Vue Clinical Collaboration Platform. The platform is able to capture data from various sources without changing departmental workflow.

A patient-centric repository is created that stores all of the medical imaging data whatever the format or modality, and distributes the images via the appropriate clinical viewer.

Diagnostic Reading #23: Five Must Read Articles from the Past Week

Carestream LogoSince HIMSS 2015 kicks off on Sunday in Chicago, we thought it would be best to focus on healthcare IT articles in this week’s and next week’s issues of Diagnostic Reading. This week’s articles focus on the interoperability roadmap, an infographic showing one doctor’s computer clicks in one day, the importance of patient-generated data, turning healthcare data into useful information, and how patient portals and tracking devices are driving engagement.

1) Patient-Generated Data: One Cardiac Surgeon Explains its Increasing Impact Healthcare Informatics

In an interview with Healthcare Informatics, Sunil Malhotra, M.D., explains how he has been collaborating with vendors to ensure patient data is collected and provided as part of the record of a patient’s health. Dr. Malhotra said that he plans to monitor patients using applications that allow patients to enter data manually or through devices. Through a platform, a care team dashboard will give Dr. Malhotra and his team information that can be monitored.

2) Infographic: One Doc’s Clicks Per DayHealthcare IT News

The aim of the infographic is to show how IT interactions impact patient wait times, provider efficiency and documentation. The image show the daily technilogy interaction of a physician and her staff: 24 patients over 16 hours for a total of 2,541 clicks.

3) Turning Health Data into Useful InformationHealth Data Management

The Robert Wood Johnson Foundation has issued four recommendations on how health data can be collected, shared, protected, and translated in ways that are useful to consumers, organizations, and communities nationwide.

4) Patient Portals and Tracking Devices Driving EngagementEHR Intelligence

A Harris Poll surveyed 2,000 adults across the U.S. and found that 84% of respondents have access to patient portal through their physician’s practice. An additional finding is that adults older than 55 years of age are more likely to access their medical records through these tools than adults between 18-54.

5) Hospitals, CIOs Call for Increased Patient Identifier Action in Interoperability RoadmapFierceHealthIT

The College of Healthcare Information Management Executives (CHIME) and the Association of Medical Directors of Information Systems  call patient identification vital to the formation of interoperable Learning Health System, and stressed this last week to the Office of the National Coordinator for Health IT in regard to its draft roadmap.

Combating Mobile Health Skeptics by Highlighting the Benefits

There are two camps in the mobile health (mHealth) issue: those who find the technologies to be beneficial and embrace adoption, and those who remain skeptical and refuse to adopt, or are slower to.

If anything, current market statistics are siding with the first camp—the global mHealth market is expected to be worth $49.1 billion by 2020, up from $1.2 billion in 2012; an estimated 500 million smartphone users worldwide will be using mHealth apps this year, and those users will have more than 100,000 mHealth apps available via the iOS and Android platforms.

With all signs pointing to the mHealth explosion, challenges still exist. The most common ones being clinician adoption, lack of apps specific for medical use, improvement of medical apps that already exist, an authoritative collection of medical apps, security/privacy protection, and inability for healthcare organizations to handle Bring Your Own Device (BYOD) policies.

These are challenges most can agree on but the skeptics still hold out on mHealth technologies until the benefits in efficiency and cost outweigh the disruption and expense of adoption. Those specific benefits include:

mHealth Benefits

How Providers Currently Use Mobile DevicesContrary to the skeptics’ beliefs, as the chart to the right indicates, mHealth is already intertwined into the healthcare space. Providers are using smartphones and tablets to share information with patients, look up reference material, learn about new treatments and clinical research, or even help to diagnose patients. mHealth is proving to be beneficial for the providers and the patients receiving the care.

While there is still a high population of physicians who do not believe in the benefits of mHealth, they will not be able to ignore their patients. Millions of people are using mobile apps and wearable technology to track calorie intake, sleep patterns, miles jogged, and other health habits. As they become more in-tune with their own health they will expect that their physicians will do the same, using similar devices.

For more details about the mHealth phenomenon and what providers can do to move adoption in the right direction, you can view and download the eBook, “The Healthcare March to Mobility.”

The eBook includes commentary from myself and Dr. Woojin Kim, MD, Perelman School of Medicine at the University of Pennsylvania Health System and Montage Healthcare Solutions, that explains the needs, challenges, and benefits of mHealth.

Ben Wilson, IntelBen Wilson is the Director of Mobile Health at Intel Corporation. He is responsible for development and execution of mobile health strategies and programs at Intel. Ben is also Co-Chair of the Accountable Care Community of Practice, a consortium of healthcare IT leaders committed to collaboration in the development of Accountable Care healthcare organizations. A Stanford graduate, Ben’s MBA and MPH in Health Management were earned at UC Berkeley.

Diagnostic Reading #22: Five Must Read Articles from the Past Week

Carestream logoAnother Friday means another Diagnostic Reading, with five must-read articles from the past week. This group of articles covers radiology workflow, technology’s role in the patient experience,  a U.S. Supreme Court ruling related to Medicaid, breast density’s correlation to diagnosis, and a new study that reinforces the importance of mammography screening exams for screening-age women.

1) Rethinking Radiology Workflow to Improve Patient Care—Today – ImagingBiz

This article takes a look at vRad, the nation’s leading radiology practice. With over 2,100 clients across the United States, vRad has become an industry leader in teleradiology. Additionally, vRad has created algorithms that optimize workflow. The author of this article discusses the benefits of optimizing workflow algorithms along with providing advice to improve workflow in your own practice.

2) Technology Plays ‘Supporting Role’ in Optimal Patient Experience, Survey Finds – FierceHealthIT

A recent survey has indicated that 97% of respondents are comfortable with the use of technology in medicine. This staggering percentage is a positive thing when it comes to the adoption of technology in healthcare. While patients are comfortable with the use of technology, the survey also indicated that their personal interactions with physicians are more important. This article discusses how technology should be used realistically when it comes to patient engagement.

3) Supreme Court Rules that Providers Cannot Sue States Over Medicaid Payment – Healthcare Informatics

An important he Supreme Court decision ruled in Armstrong et al v. Exceptional Child Center, Inc., et al that private healthcare providers cannot sue states for low Medicaid reimbursement.  The Supreme Court took the case when healthcare systems in Idaho sued state officials based on the state’s inability to appropriately reimburse them according to national regulations. Read the article for more information about the ruling.

4) Low Breast Density, Poor Breast Cancer Prognosis – Diagnostic Imaging

A study in European Radiology has found that women with low breast density. Researchers found that mammographic breast density (MBD) is inversely related to the severity of breast cancer in women.   These findings are interesting in the wake of recent breast density notification laws.

5) Missing Breast Screening Exams Raises Mortality Risks – AuntMinnie.com

According to a new study published in American Journal of Roentgenology, missing mammgraphy screening exams increases mortality among screening-age women. The researchers found that missing two exams doubles the risk of all-cause mortality, and risk rises with the number of missed exams. 

Managing Extra-Radiology Data within a PACS-like Framework

Saskia Van Den Dool

Saskia Van Den Dool, Wordwide Marketing Manager, Healthcare Information Solutions, Carestream

Dr. Marco Foracchia, Medical IT Systems Manager, Santa Maria Nuova Hospital, Reggio Emilia, Italy, gave an online presentation as part of HIMSS Europe’s participation at ECR 2015 earlier in March. The presentation focused on residual radiology IT needs and how facilities should go about managing this low quantity, yet highly-specialized data.

Most of the residual data is media in the form of images, video, traces, etc. These media are emerging now because of three reasons:

  1. Clinical pathways providing access to all evidence for all professionals involved
  2. Regulatory legislation requires all data to be readily available in case of patient request
  3. Research requires evidence-based medicine

The clinical pathway is key and includes the following:

  • Referral from periphery to competency center
  • Collective evaluation of all available evidence
  • Comparison of evidence from previous events/different patients

Dr. Foracchia and his organization partnered with Carestream to sponsor and perform a one-year survey of all potential data (media) sources in the hospital—managed, improperly managed, and currently managed.

The remainder of his presentation at ECR went through this study and explained the findings. Dr. Foracchia touched on how radiology may be the solution to managing this residual data since radiologists have been managing data (images) for the last 20 years. The positives and negatives of having radiology lead this change were both be presented, and will leave it up to you, the viewer, to decide on what the right decision is for your organisation.

Dr. Foracchia ended by saying that Reggio Emilia is currently going through a number of projects that will force the organization to address its present and future challenges. This includes gradually extending the number of data sources connected to the central vendor neutral archive, immediately connecting all DICOM sources, and gradually connecting all other non-DICOM sources. The plan is to connect all DICOM sources by end of 2015, and connect all non-DICOM sources by the end of 2016.

The entire presentation has been embedded below for viewing.

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.