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.

Addressing Concerns Behind Meaningful Use

Doug Rufer

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

By now, you have probably been feverishly working to meet compliance with Stage 1 Meaningful Use and right around the corner, Stage 2 is set to begin in 2014.  If you have been keeping up with the latest news on Stage 2, you are surely aware the requirements have suddenly become more difficult and are continuing to increase in complexity.

Stage 2 Meaningful Use requires higher thresholds than Stage 1 (for example, requiring that more than 80% of unique patients have their vital signs recorded as opposed to 50% from Stage 1).  Additionally, two very important changes take center stage that will drive future stages of this program: 1) patient engagement by providing them access to their medical records (allowing access, download, and transmission of that data) within 4 business days of their care and; 2) EHR system interoperability (i.e. data exchange).  But are these requirements being enacted too quickly and is our healthcare system ready for the change?

Chart via. http://cms.gov

Chart via. http://cms.gov

Patient Record Access

At a recent healthcare IT conference, many attendees expressed their concerns over providing patients access to their information, not that they shouldn’t have access but will providers be overwhelmed by questions from their patients?  An interesting outcome, in a few pilot programs, was patients actually do prefer to have access to their information. As a general rule, most providers have found that their patient’s are not continually calling and asking them questions at all hours of the day and the questions they do ask are more focused on allowing the provider to advise them on how to improve their outcomes.

Another concern that surfaced was meeting the objective requirements that the patient actually access their information.  Not only is it important that a tool be provided for patient access (portal solutions are now required by certified EHR vendors for patient record access), but to meet the measure, the site has to verify that 5% of their patients actually do access their information.  The good news is the CMS reduced this threshold so obtaining the 5% measure requirement should be much more attainable during this stage.

The bottom line is this: providing patients with better access to their health information allows them to ask better questions to their providers.  No longer are we in an era where the patient takes the word of the provider as “gospel” but they are truly, actively engaged in their care maintenance and delivery and can now collaborate with their provider for the best possible outcomes.  This is a key goal of the program and one which, over time, will help bridge the gap that has historically existed between patients and providers.

Data Exchange and System Interoperability

Another area of concern was with vendors being properly prepared for data exchange.  Although there are well established standards today, data exchange is costly and time consuming for many facilities.  Data exchange needs to become more fluid and simplified to allow patient data to be exchanged from one IT system to another.  This is critical for providing better patient care and lowering the cost of healthcare.  Health Information Exchanges (HIEs) are being established throughout the country to accommodate the exchange of patient information.  The HIEs purpose is to facilitate the exchange of key information which grants providers in other locations access to important patient information. This allows them to make better decisions on patient care and eliminate costly repeat procedures.

Finally, imaging of all types (radiology, cardiology, etc.) needs to focus on access as well.  These imaging systems have traditionally been silos of information.  Now that patient data will be accessible through HIEs nationally, imaging needs to be taken into consideration on how to share patient images when their imaging record may span across multiple organizations and PACS systems, yet be readily available with their patient health data.

Accountability and Making Sense of Meaningful Use

At the end of the day, the goals driving Meaningful Use were made simply to lower the cost of healthcare, provide better communication and collaboration among healthcare facilities and practitioners, and improve patient outcomes.  The program set three initial stages to accomplish this goal: 1) Stage 1 was meant to capture data; 2) Stage 2 is meant for use and data sharing in a meaningful way and; 3) Stage 3 plans to focus on data analysis and using the data to improve clinical outcomes (Stage 3 has not yet been finalized, however).

To accomplish the goals of Stage 3, a new model must emerge in the delivery of care and this is taking place with the rise of ACOs and Population Health Management.  ACOs are meant to establish, through a group of providers and physicians, an accountability for the care they provide.  In other words, there’s a shift from “fee for service” to a model where the caregiver is encouraged to deliver higher outcomes and is incentivized to provide this level of care.  Population Health Management is health outcomes by a group of individuals that aims to improve the outcomes of an entire population, not just the individual.  Population Health is getting a lot of attentioimage_myvue_laptop_3n because concentrating on an entire population creates a model to impact costs of care delivery over time.

When factors beyond a single patient are taken into consideration (such as socioeconomic status, environment, and resource distribution of care), and programs can be put into place to improve certain diseases or conditions within that population by equalizing access to the care, the long-term effects will be lower healthcare costs.

What’s Next?

We live in an era that has the most robust access to care and technology to help improve more lives than ever before in history.  But costs have spiraled out of control making access to care difficult for those who need it most.  Getting a jump on this trend by looking at key patient data and outcomes across a population, in time, can help bring these costs back under control.  Managing population health will help drive down costs of chronic conditions within a given population by better understanding the drivers for such a condition and developing and administering preventative programs early on.  All this can only be achieved by capturing data, having open access to the data, and the right tools to analyze it.  So the next time you are struggling with the “why” behind capturing data and the fuss of this program, know you are on the forefront of changing the delivery of patient care in the future, and that in and of itself, is a goal worth striving for.

Why Should Radiologists Be Mobile Friendly?

Cristen Bolan, Executive Editor, Applied Radiology

Cristen Bolan, MS, Executive Editor,  Applied Radiology

Radiologists should be mobile friendly. Have you heard that? As soon as someone tells you what you should be, you don’t want to be it, even when you already are. Most radiologists have already thrown out those archaic flip phones and all-thumbs Blackberrys and graduated on to the much sleeker, interactive interface of smartphones. Is it a sign of higher intelligence or just a new shiny thing in the corner? Visually, it may be eye candy, too tempting for a visual junky to pass up. But is it too personal; something you wouldn’t bring into the workplace…or would you?

The biggest reason radiologists should be mobile friendly is because their referring physicians are.

Physicians and other clinicians are using their personal devices, like iPads, iPhones, and Androids, to access patient information from anywhere, anytime. In a recent survey, primary care and internal medicine physicians indicated a strong preference for electronic health record (EHR) usability on their mobile devices.1  In the same survey, 83% of respondents reported they would immediately use mobile EHR functionalities to update patient charts, check labs, and order medications if available to them via their current EHR.1

Mobile-device medicine, ie, the use of mobile devices to deliver care, is a growing trend and the more forward-thinking radiologists are catching on.

When Siddharth Prakash, MD, DABR, Vanguard Medical Imaging P.C. (Melville, NY), was deciding on which PACS to purchase for his imaging center, he needed to make sure he could send radiological reports to the physicians at a relatively inexpensive cost. “I was looking for a PACS provider that was looking into the future and trying to incorporate other devices, such as iPads and smart phones, and a simple system for contacting referring doctors,” said Dr. Prakash. “I wanted to find a solution that was taking the next step—communication.”

For Dr. Prakash, delivering a report to a mobile device gives his imaging center a competitive edge.  “More doctors want to see reports on their mobile devices, and when we provide this, they remember that my practice was able to do that, while others were not,” said Dr. Prakash.

How quickly could mobile-device medicine become a reality?

Well, it already is among hüber techy radiologists. But even the Board of Directors of RSNA is pondering the practical application of using mobile devices in the clinical setting. This year, RSNA launched a new learning management system to make RSNA education content available on mobile devices, in response to member demand.2 And along Dr. Prakash’s line of thinking, the theme of the RSNA 2013 annual conference is Power of Partnership: Partnering with the referring physician. The theme underscores the importance of radiologists providing a service that meets the needs of their physician partners.

No doubt smartphones on some level are a distraction—and dangerous when talking, texting and driving at the same time. But they also are very useful and there is no sign of turning back. As radiologists embrace the EHR, just like moving from analog to digital, they are now moving from desktop to mobile because these systems become so much more valuable when they “talk” to one another.3

The Top EHR Mobile Applications1

  1. remotely review charts
  2. update charts
  3. assign tasks
  4. view schedules and appointments
  5. send messages to practice staff
  6. lab orders and result review
  7. permit electronic prescribing
  8. patient encounter documentation
  9. input vital signs
  10. access EHR data after office hours


1. Slabodkin G. Survey: Doctors overwhelmingly favor mobile devices and apps for EHRs – FierceMobileHealthcare http://www.fiercemobilehealthcare.com/story/survey-doctors-overwhelmingly-favor-mobile-devices-and-apps-ehrs/2013-06-03#ixzz2aeyazY5J. Updated June 3, 2013. Accessed July 31, 2013.
2. RSNA Board of Directors Report. RSNA. http://www.rsna.org/NewsDetail.aspx?id=8583. Posted March 1, 2013. Accessed July 31, 2013.
3. Shrestha R. Enterprise Imaging: Enabling true image exchange. Applied Radiology. 2013;5:20-21.

RSNA 2012 Preview: How To Achieve 50 Percent Patient Engagement

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

In October, the healthcare news headlines lit up with concerns about patient engagement measures. Like this story from FierceHealthIT, “CMS official: We might revisit Meaningful Use patient engagement rules, “ which indicated that the Centers for Medicare & Medicaid Services will reconsider its requirements for patient engagement in Meaningful Use Stage 2 if complying proves too onerous for care providers.

Many providers feel that requiring five percent of patients to view, download or transmit healthcare information to a third-party was an aggressive target and outside a physician’s control. Patient access and patient action are decidedly different.

Ironically, as this debate reignited, our MyVue* Patient Portal trade trial with Houston Medical Imaging had three months of engagement data coming in. This timely trade trial, which allowed patients to access and share their imaging results online, gave us our own barometer on how achievable the Stage 2 patient engagement measures are.

In Houston Medical Imaging’s three locations, thirty percent of the patients they saw in that three month period signed up for this service. The facility also serves out of state patients and received phone calls from people requesting prints of their images from previous exams mailed to them. They’ve been able to share their imaging studies through the patient portal. All told, Houston Medical Imaging’s staff registered 2,662 patients. But even more important—particularly if you compare it to the 5 percent measure that has many providers concerned—more than 50 percent of patients actually log-on, view, download or share.

From the preliminary data from this trade trial, the current CMS measures are certainly achievable with the right technology to facilitate engagement. The technology must intuitive for patients. It must be accessible from a variety of Web-browser enabled devices. It has to provide value.

Here’s a quick and fun overview of how you can engage your patients with MyVue:

I’ll be at RSNA discussing the challenges and opportunities of patient engagement with other physicians and imaging directors. I hope to see you there in booth #2636 or stop by my session in RSNA’s Mobile Connect Area: “Easy, Secure Image Access and Sharing” on Monday, November 26 at 12:10 p.m.

Editor’s note: Book a MyVue demo appointment at RSNA 2012 online or stop by booth #2636 to speak with our application specialists about patient engagement strategies.

*Available February 2013

Six IT Principles to Encourage Online Patient Engagement

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Patient engagement measures have the potential to be one of the most transformative aspects of reform on the quality of care, but but we must recognize the challenge they pose to a provider’s IT strategy. The operational design of a patient engagement portal must provide enough value for patients to go online, and stay online.

In the lead up to Intel’s Healthcare Innovation Summit webcasts on October 23, I was invited to share with their community of healthcare IT professionals best practices for developing a patient engagement strategy or selecting a technology platform:

1. Offer access to full patient information.
2. Integrate core patient services
3. Deploy a simple and intuitive user interface that reduces need for support
4. Implement a device neutral solution that does not require installation or download
5. Include customizable sharing settings for administrators (critical results release) and patients (consent to access).
6. Carestream MyVueDistribute security protocols

You can read the full post here. These guiding principles serve as an important foundation as healthcare’s C-Suite balances compliance with Stage 2 meaningful use in the context of broader patient satisfaction goals.

What best practices are your facility grounding your patient engagement technology strategy in? What advice would you add to this list?

Schedule a demonstration of Carestream’s MyVue, a works-in-progress patient portal, at RSNA 2012. 

ACR Panel: Physician, Patient Demand Driving Mobile Application Adoption

Jeff Fleming, Vice President of Healthcare IT Sales/Service, Carestream

Today I’m speaking on a panel about the clinical value of mobile imaging, moderated by Dr. David Hirschorn, at the American College of Radiology’s Imaging Informatics Summit.

As the medical industry embraces mobile applications, healthcare providers need a strategy that delivers access to radiology reports and images “on the go” to radiologists and referring physicians and extends image sharing to patients. This new workflow can expedite patient treatment decisions. Faster decisions—along with access by patients to their own records—can deliver higher satisfaction and greater loyalty to a healthcare provider.

Recently, Imaging Economics looked at provider interest in mobile technology and the diverse choices available from diagnostic imaging vendors.

Two key challenges driving technology selection are how providers can support a wide variety of mobile platforms and offer patient image sharing. With user flexibility in mind, Carestream developed a vendor-neutral platform that uses HTML5 to communicate with any operating system. Our Vue Motion universal image viewer has many built-in security features and has been FDA cleared for iPad use. This image viewer acts as the foundation to Carestream’s MyVue patient portal (Available February 2013) that empowers patients to access, manage and share their imaging results between facilities, physicians, specialists and other healthcare providers from a variety of Web-browser enabled devices, including the iPad. Access to data from an EMR is also an important component, so our viewer links to the EMR so users-both physicians and patients-don’t have to download multiple applications.

Other companies have developed dedicated mobile applications and some suppliers offer specific applications tailored for Windows, Macintosh, and iOS platforms.

Regardless of the platform, every mobile application in the medical industry should deliver secure, on demand access, simple user deployment, and control mechanisms that do not allow data to be stored on the device.

It’s easy to see the advantages of mobile access for physicians and patients. Fortunately delivering mobile access also offers advantages to healthcare providers. Costs are reduced by a more automated, streamlined workflow—and support for patient engagement is required to satisfy Stage 2 Meaningful Use requirements. Healthcare providers that support convenient mobile applications have a lot to gain.

iHT2 New York: Balancing Cutting-Edge Informatics and Patient Care

Julia Weidman, Marketing Manager, Women’s Health & Healthcare Information Solutions, Carestream

Over 280 senior healthcare IT executives, thought leaders and vendors convened at the New York Academy of Medicine yesterday to exchange information and opinion on the technology forces of change that will drive improvements in healthcare delivery.

Meaningful Use, cloud security, HIEs and improved patient care were just a selection of the topics from the first day at the Institute for Health Technology Transformation (iHT2) New York Health IT Summit. But quickly one overriding theme emerged – maintaining the critical balance between patient care and cutting-edge informatics.

At the Meaningful Use panel, discussion centered as much on the patient experience as on data collection and analysis.  For patients, MU will succeed if there is an increase in their engagement with their own healthcare data through tools like patient portals. For providers, they must have both confidence in the data and the ability to modify workflow so that collecting patient data becomes an activity that engages the patient.

Dr. John Lumpkin’s keynote centered on the power of technology to ignite monumental change, far beyond what we’re seeing today.  He stressed that the electronic health record is not the end point.  Rather it’s the foundation that will enable the liberation of patient data from the constraints of the system that generated it, so that data can be used for predictive modeling to identify potential problems and develop solutions before there’s a health crisis.

During the cloud computing panel discussion, the importance of data security, business continuity and seamless user experience generated a spirited back-and-forth between attendees.  One thing the panel agreed on was the key to cloud success is in the planning with clinicians, vendors and IT stakeholders working together to develop “out of the box” answers that break down old ways of thinking and bring about a new vision for patient care coordination.

A session on workflow tips for clinicians emphasized that simple improvements in IT processes can win the commitment of clinicians – an easier logon process, better system stability, reliability and speed and the minimization of downtime. A happier clinician is more engaged in the technology, and supportive of its success and impact on patient care.

There’s still a lot of work to be done to prepare, implement and deliver the technologies that will revolutionize healthcare in the US.  Judging from the enthusiasm evident at iHT2 in New York, these healthcare professionals and IT industry leaders are up to the challenge.

Visit the Institute for Health Technology Transformation blog for more event information.

Stage 2 and the Shift to a Patient-Centric Radiology Workflow

Doug Rufer

Doug Rufer, North American Business Manager, RIS, Healthcare Information Solutions, Carestream

The final measures of stage 2 meaningful use start the 2nd chapter in changing the way all specialties will practice medicine.  For radiology, incorporation of patient images into the patient’s clinical record as a specific measure opened the door for future legislation that will take into account other specialty needs as future stages are rolled out.

The goal of meaningful use has always been to provide both clinical and technological avenues to share patient medical information without boundaries to those who require it to improve quality of care and reduce overall costs.  By adding medical images to the mix, the door has been opened for improved access to patient images, thereby reducing repeat exams; and from the patient perspective, decreasing overall patient exposure to radiation.  However, these changes are sure to propose challenges for radiology going forward.  Radiology is typically practiced as a departmental approach, not a patient centric approach.  Additionally, radiology has been the gatekeeper of the medical imaging record, not the EHR; and to date, there are no standard-based image archives and viewing platforms that allow any EHR access to patient images regardless of vendor or location; and this is where the opportunity for medical imaging vendors begins.

Providing measures to incorporate medical images into the EHR sets the stage for better image access, but one major hurdle still exists: how does one access the thousands of imaging silos of information?  Additionally, how do we create a standards-based, not simply vendor-neutral, open access image archive accessible by those who need it the most – the patient and their primary caregiver?

Meaningful Use will forever change radiology’s workflow. The new path keeps the patient at the center of care. This paradigm shift will prompt new technologies and new methods for practicing radiology as the future unfolds.

Consider the following:

  • Radiologists must focus more on the overall clinical condition of the patient when making an exam diagnosis, rather than the short patient history taken at the time of exam.  This change emphasizes overall patient outcomes, not just imaging outcomes.
  • Access to the complete patient record and forthcoming decision support rules will aid radiologists in taking a more holistic approach to image diagnosis.  While this will take more time in exam interpretation, overall patient outcomes can improve significantly.
  • Barriers to image access that exist today must be overcome to allow easier access across any platform for viewing.
  • New mobile technology must be developed to provide anytime/anywhere access to the patient record and images, further reducing the barrier to information.  This will further virtualize the medical industry.
  • Technologists must now focus on capturing better patient histories using a structured data approach during the exam to help radiologists better collaborate with the overall patient record and produce better reports that provide better data mining capabilities.

Although we’re still in the infancy of rolling out a more patient centric model of care that encompasses all medical specialties, radiology must begin to adapt today to prepare for the changes of tomorrow.  No longer can a radiology practice afford to focus on the inherent imaging needs of the patient, but rather the overall goal of improved patient outcomes needs to take front and center stage going forward.  The advent of new technology must take place for our reformed healthcare model to succeed. As you consider technology purchases today, make sure your vendor is devoted to developing the tools necessary for the future.

Webinar: IT Strategies for Imaging Growth & Quality Outcomes

Mary Tierney

Mary Tierney, VP, Chief Content Officer, TriMed Media Group

Earlier this month CMIO Magazine unveiled a new name, Clinical Innovation + Technology, and website, Clinical-Innovation.com. Our new focus mirrors healthcare’s technology-fueled transformation where C-suite executives are tasked with blending clinical and technological innovations to deploy new care processes and practices, evidence-based medicine and decision support, and enhancing communication and information access  across the care continuum through interoperability of clinical devices and IT systems.

Next week in a free Webinar, sponsored by Carestream, we’ll be looking at how this new environment – spurred by the convergence of reform and big data – is impacting the CXO’s approach to operational design in medical imaging.

You’ll hear from:

Kristina Kermanshahche, Chief Architect of Health for Intel Corporation

Maureen Gaffney, RN, the CMIO at Winthrop University Hospital in Mineola, New York


Dr. Eliot Siegel, Professor and Vice Chair University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine, and Chief of Imaging at VA Maryland Healthcare System in Baltimore.

Our panelists will detail how CXOs can collaborate with radiology and IT on intelligent IT strategies that do far more than improve department or hospital productivity and efficiency. These strategies must also facilitate image exchange, mobile access and patient empowerment, while unlocking new financial models for growth and scale and supporting imaging’s inclusion in health reforms like meaningful use Stage 2 and the position within the broader picture of health IT.

Please join us and participate in our live Q&A on September 18 at 2 p.m. EST.  Register for the event today!

The Stage 2 Opportunity for Zero-footprint Universal Image Viewers

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

As the radiology community makes sense of the final stage 2 meaningful use rules many provider CIOs, CMIO and radiology department heads are looking closer at their CEHRT image access strategy.

In the final rule, CMS set a threshold of 10 percent or more of imaging results accessible through certified EHR technology, with exclusions for providers who order less than 100 scans in an EHR reporting period, and for providers who do not have access to electronic images.

CMS also clarified that images do not have to be stored in the EHR, but there must be a link to where the image and information can be accessed.  This important measure provides easy access to patient images to reduce the ordering of duplicate, unnecessary exams, minimize exposure to radiation and help contain healthcare costs.

To prepare for compliance with stage 2, providers will now need to identify how they will merge EMR systems with RIS and PACS to enable image sharing and collaboration for improved care coordination.

One avenue to satisfy meaningful use criterion is a zero-footprint viewer than can serve as an intermediary between the RIS/PACS and EMR. To fulfill this potential, the viewer must be available remotely to enhance physician access to all PACS images. It must allow embedding in an EMR system to provide access to reports and images alongside the patient’s other medical information. Moreover, the viewer must provide access to DICOM, as well as non-DICOM image related data, such as JPEG images and PDF documents. The viewer’s use must not be restricted to a single IT-system or facility, but offer extensive compatibility to provide secure access to images across and beyond the enterprise—for physicians and patients alike.

Carestream’s Vue Motion vendor-neutral imaging viewer can be embedded in EMR and HIS portals to access images contained in the PACS, thereby image-enabling the enterprise. The viewer can be launched without calling up a separate application or logging into another system. Alternatively, it can be launched in a separate window without requiring a separate log-in, using a URL from within the system.  It leverages the PACS server to do the vast majority of the rendering, thereby significantly reducing the volume of data to be transmitted. And, because rendering is done on the server side, there are no data storage requirements on the zero-footprint side.  Features like the display of current and prior images side-by-side and the ability for clinicians to input order notes to the exam can facilitate better collaboration between referring physicians, specialists and other clinicians. Here’s a quick demo of how our Vue Motion works:

Are you evaluating zero-footprint image viewers as a piece of your strategy for stage 2?