Don’t Get Lost in Translation

Cristen Bolan, Executive Editor, Applied Radiology

Cristen Bolan, Executive Editor, Applied Radiology

Radiologists Add Real Value through Concise Communication

When the ER doc read my results from an ultrasound, all I heard was doom and gloom. In the report, the radiologist recommended a follow-up MRI, meanwhile the doctor told me I probably had cancer due to the appearance of blood flow to a small mass.

After two days of begging for the follow-up MRI, they found that there was there was no cancer – a gallstone had traveled into the biliary tract. That shouldn’t have been a surprise since I already had an appointment to have my gallbladder removed at the same hospital. Cancer was the ER doctor’s interpretation — not the radiologist’s conclusion. What ended up almost killing me was the anxiety I endured from the doctor’s strong certainty that I had cancer, which made me fear for my life and for the well being of my two small children.

An estimated 80% of serious medical errors occur between caregivers during the transfer of patients.1 These errors lead to more adverse events, more hospital readmissions, more unnecessary duplication of care, and higher costs.1 Clearly, the transfer of patient information falls within this category.

In the world of Accountable Care Organizations (ACO’s) radiologists will be tasked with demonstrating their value to the patient. At RSNA last year, Mary C. Mahoney, MD, chair of RSNA’s Patient-Centered Radiology Steering Committee Chair, said radiologists must be portrayed “as knowledgeable physicians and show they are patient advocates by demonstrating concern and knowledge about safety and risks.” But how do you demonstrate value to the patient when the results get lost in translation?

How can radiologists show their value? It’s hard to nail down a number, but in theory, as Bibb Allen Jr., MD, vice-chair of the ACR Board of Chancellors says, there would be a “measurable role for radiologists in improving population health and we would have a calculation of radiology’s value in reducing per capita cost.”

Lowering per capita cost may be immediately evident through imaging appropriateness. ACO’s may provide a framework for control costs by reducing avoidable, duplicative resources, but what about measurable improvements to population health?

Interpreting a radiology report just doesn’t cut it these days. This may require quantifying and tracking all the non-interpretation value-added activities, such as hours spent on conferences, committees, transcription time, teaching, and research. And how is this extra time supposed to cut down on cost? Radiologists are already doing these things, but it looks like CME credits are just not enough.

If you really want to add value to patients – go back the basics and ensure the referring physicians get the story straight before hitting the panic button. From the patient’s perspective, that might actually have a real impact on the patient experience.

Reference:

1. Joint Commission Center for transforming healthcare releases targeted solutions tool for hand-off communications. Joint Commission Perspectives. 2012;32:8.

Why User Groups Are Necessary for Technology End-Users

By Jim Travitz, Senior Imaging Analyst, Trinity Health, Holy Cross Hospital, and President, Carestream VIBE User Group. He is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.

When becoming an end-user of a particular piece of technology, one way to ensure you are able to get the most out of that technology is to join a user group, if the company has set one up. By joining a user group, customers are essentially creating a line of communication between not only themselves and the company, but with like-minded customers like themselves as well—and that is where some of the most important benefits exist.

Collaboration is the name of the game when it comes to user groups. The ultimate goal is for customers to discuss issues and solutions among each other, allowing the company to chime in when necessary. As an example, I am currently the president of Carestream’s VIBE User Group for its HCIS products, and am currently corralling more Carestream customers to join the group because of the benefits it offers. In addition to learning about the latest PACS, RIS, and other HCIS updates, there are several other initiatives in the works for VIBE:

How-to guides for users: We want users to have knowledge and informational materials available at their fingertips when joining the group. This is made possible by creating channels for users to reach out to one another, as well as Carestream delivering on providing the information we need to learn about its technologies.

Bring clarity to the user group:  As a group, we have the ability to decide what are the most important ideas/issues that need to be addressed. Collaborating to decide this is able to give Carestream a better idea on how to develop its products so it can meet our needs. Being from diverse organizations, we are going to have different needs we want addressed, so it becomes up to the group to deliberate on what the most universal needs are that can be focused on.

Sharing content: The best source of content in a user group tends to be the users themselves. Coming across an article or research, and then sharing it with the group is one of the best resources available. The best user groups are those that are the most educated and participate often, so by sharing content, users are contributing to improving the education of the group.

Education from Carestream about new features: If users are to experience the benefits from Carestream’s technologies, then education will be needed on its part to educate users about new features. Be it in the form of webinars, demo videos, or downloadable guides, education about these features is a must, and one the company is looking forward to providing.

Regarding the future of VIBE, I am currently working to fill a couple positions in the user group. I am looking for a PACS Knowledge Manager and a RIS Knowledge Manager. These two positions will be tasked with organizing all of the content that is shared among the PACS and RIS sections of the group, and ensuring that this information is accessible for all members.

Additionally, I recently attended RSNA in December and was able to talk with other members of VIBE about what they are looking from joining the group. The two biggest needs users are looking for from the group are consistent user collaboration and webinars from current VIBE members. With these features being put into place, it is our plan than as VIBE evolves, so will the members of the group. That will be the most beneficial end-game for all of those involved.

If you are a Carestream HCIS user and are interested in joining the VIBE user group, you can click the link to sign up.

Below is an interview I conducted at RSNA about VIBE, what changes are currently taking place in the user group, and what improvements users can expect in the future.

The Benefits of Upgrading to DR Technology

Radiology and technology go hand in hand. Each year the advances we see at RSNA confirm that innovations are what keep radiology as a premier medical specialty. Regularly upgrading these technologies help to enhance patient care, throughput, diagnostic accuracy and personal confidence among the physician’s when diagnosing a patient. Dr. Shrinivas Desai, Director of Radiology at Jaslok Hospital in India, spoke with us at RSNA about his hospital upgrading its DR technologies and the many benefits that come from doing so. To him, it’s all about enhancing patient care and making a positive impact on the services rendered to them. Hear more about what Dr. Desai had to say in the video below.

Patient Portals Enable Immediate, Secure Access to Medical Images

Cobalt Imaging Center is a medical charity that provides state of the art imaging for a large population in Southwest England. The facility recently adopted Carestream’s MyVue patient portal to enable patients’ immediate, secure access to their medical images via the web. Peter Sharp and Roisin Dobbins-Stacey of Cobalt Imaging spoke with us at RSNA and emphasized the need for a patient portal over CDs–their current means of sharing patient images—which are costly and timely.

Patients want access to their images now and a patient portal allows them instant access at their fingertips to share with whoever they want whether it’s the referring physician, or friends and family. The facility will slowly roll out MyVue and get patients adapted to a timely, functional, and secure way of sharing medical images.

Hear more about the benefits a patient portal brings to patients and imaging facilities in the video below.

Digital Breast Tomosynthesis Brings Benefits to Patient Exams

Digital Breast Tomosynthesis (DBT) provides higher quality mammography images and is becoming more vital to breast exams. At RSNA we spoke with Dr. Harmindar Gill, Medical Director of Premiere Women’s Radiology in Bonita Springs, Florida, about the benefits of DBT and what patients get out of having it as part of their exam. Being the first office in Southwest Florida to offer DBT as part of breast exams, Dr. Gill noticed a decrease in patients’ recall rates and found that it’s easier to spot small lesions that go unnoticed by traditional mammography exams.  The video below provides more insight on Dr. Gill’s practice and DBT discussion at RSNA.

Medical Tourism Initiative Enables Nigerian Hospital to Deliver Quality Medical Care

Delta State University and Teaching Hospital is a 300-bed facility in Nigeria that is actively developing a center of medical tourism to deliver local quality medical services at standards comparable to international guidelines. The objective is to ultimately reduce the number of Nigerians traveling out of the country to seek medical care abroad. The Delta Hospital focuses on special areas such as radiology, minimal access surgeries, orthopedic services, and offers specialized treatments for patients with chronic kidney diseases, which occupies a severe percentage of Nigerians who seek medical care abroad. Kidney transplants will begin to take place in January of next year.

Rendering this level of service requires a well established radiology department. They are one of the first hospitals in Nigeria to acquire a 64-slice Computed Tomography (CT) scanner. The facility is also equipped with a Digital Radiography (DR) department, digital mammography unit, and ultrasound services to aid patient care. Dr. Abraham Inikori, consultant radiologist and director of clinical services and training, Delta State University and Teaching Hospital, further explains the organization’s medical tourism initiative.

Meaningful Use, VNAs, and Addressing the Challenges Each Present

Meaningful Use (MU) Stage 2 has been a challenge for many healthcare facilities throughout the U.S., but that appears to be especially true for private practice radiologists. Industry statistics show that radiology adoption for MU is still low, and Cristine Kao, global marketing director for HCIS, Carestream, explains that this is an opportunity for education on what Stage 2 adoption means, especially for the private practices.

In addition to MU Stage 2 challenges, Marianne Matthews, chief editor for Imaging Economics, and Kao also dive into the use of vendor neutral archives (VNAs) in hospitals, and provide advice around implementation strategies. The discussion revolves around reducing costs for the hospital, while also being able to improve workflow, from storing the information to providing efficient and secure access.

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What does the Power of Partnership really mean?

The theme of RSNA 2013 was “The Power of Partnership,” and it didn’t take long to discover that theme throughout the halls among vendors, and in the educational sessions. Greg Freiherr of Imaging Technology News took some time to speak with us at RSNA and provided some insight on what partnership means in the medical imaging space, and the trends he saw at RSNA, as well as what he expects to see heading into 2014. Cultural development in the healthcare environment and the mission to bring the radiologist further into the medical process is what Freiherr saw as being the ultimate goal behind the theme. The video below provides the complete interview that expands on the RSNA theme, and how it was put on display and practiced throughout the week.

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RSNA 2013: What did we learn?

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

There has always been so much information to digest at RSNA that it becomes difficult to pick out some of the key learnings and trends we experience every year. With the “Power of Partnership” theme for 2013, we saw a convergence of radiological practices, and most importantly, a drive for radiologists to partner with the most important people in their jobs–the patients. The remainder of this post will highlight the key ideas and technology trends that were prominent at RSNA 2013, and are sure to guide the medical imaging world throughout 2014.

1) More face-time with patients: While scanning Twitter throughout the week, the most common quotes that were being reposted by attendees were those that implored radiologists to get in front of their patients and spend more time with them. The healthcare industry is moving to a quality over quantity model. By taking the time to meet, speak with, and learn about their patients, radiologists are able to provide that better quality care.

2) Patient access: Patients are asking for access to their own medical images more often these days–either for record keeping, reference, or to provide to a referring physician. We learned patients want access to their images via a patient portal earlier in 2013 with a study we commissioned with IDR Medical. Patients want more control over their own healthcare these days. To seize control, patients must be educated, and providing them with medical images and reports in one way to improve patient learning. Tied back to the “more face-time with patients” trend, radiologists should also be spending time going over the images and reports with their patients. That way the patient not only has the access but the understanding to accompany it.

3) Multidisciplinary teams: This is a trend we heard called out on the first day of RSNA from RSNA President Dr. Sarah S. Donaldson. By creating multidisciplinary teams and having radiologists serve as members of these teams, health facilities are able to improvRSNA2013_RGB_Logo_Datese collaboration and cooperation between departments instead of isolation. By effectively coming out of the dark, radiologists are able to ensure their spot a key department for hospitals through demonstrating the importance of diagnostics in medical imaging.

4) Tomosynthesis: The benefits of tomosynthesis are becoming all too clear. 3D imaging is leading to increased detection rates, decreased recall rates, and the ability to deliver a more complete image while exposing the patient to a lower radiation exposure. RSNA has had several sessions focused around the results of tomosynthesis studies. There still more studies to be done, particularly around implementation strategies, but tomosynthesis continuously shows its benefits in the medical imaging environment.

5) Dose: While a hot topic for a few years now, dose continues to be involved in many discussions. X-ray provides a lower dose in the medical imaging world, so many conversation related to dose revolve around CT and working to make sure CT imaging remains safe while not compromising image quality for effective diagnoses. Yesterday, a session about the unpredictability of CT dose given by Dr. Douglas G. Larson focused on how the dose of a CT scan can be almost two times higher for a patient receiving an identical repeated CT in identical conditions. Because of this, Dr. Larson encourages the finding of the things that can manipulate about the scan and the patient, and the intrinsic features of dose variability. While CT releases the highest dose, the ability to examine the controllable variables and use those appropriate to provide the patient with the safest dose is a practice that can be used throughout the medical imaging industry.

RSNA has always been the event that sets to tone for the next 12 months in the medical imaging industry. The research, education, technological advances all under one roof results in an inspiring and motivational path forward. These five trends listed above are surely not the only ones of focus or of importance. Just our observations. The next few weeks will certainly be providing plenty of observations and analyses on trends, insights, and projections. It will be fun to sift through all of the information as we all work to continue evolving.

“Tomosynthesis” a Key Area of Focus at RSNA 2013

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

Among the many trends and buzzwords floating around RSNA 2013, one of the key areas that seems to be popping up everywhere is “tomosynthesis,” which is 3D imaging using X-Ray technology. With enhancements being made to DT technologies, as well as numerous laws being written related to breast density, tomosynthesis is sure to be an important topic in the medical imaging community for a long time to come. Yesterday, Carestream presented “Stationary Chest Tomosynthesis System using Distributed CNT X-ray Source Array,” with the University of North Carolina School of Medicine. The results of this study showed the feasibility of a stationary chest tomosynthesis system. This has the ability to improve image quality and enhance detection of small lung nodules and other chest pathology.

In addition to our presentation, multiple sessions have focused on the benefits of tomosythesis. Two in particular that caught our attention were focused about digital breast tomosynthesis (DBT) and its superiority to conventional mammography in breast cancer detection, and a session focused on how tomosynthesis is more beneficial in detecting lung cancer. The former looked to expand upon the usual benefits of using DBT, which are reduced recall rates, improved diagnostic accuracy, and improved cancer detection. From there, Pragya A. Dang, M.D., of Massachusetts General Hospital, Boston, lookedCARESTREAM-Vue-Mammo-Workstation at the data her team collected after using DBT for more than two years. Dr. Dang looked at the cancers in the study using both DBT and conventional mammography. Radiologists then looked at the visibility and morphology of the studied cancers with both tomosynthesis and conventional mammography. The findings showed that the degree of visibility vastly improved using tomosythnesis. An additional benefit that Dr. Dang pointed out was that a higher percentage of the cancers were more definitively characterized as masses compared to asymmetries when using tomosynthesis for diagnosis. In her conlcusion, Dr. Dang presented that when compared to conventional radiology, tomosynthesis allows for increased cancer detectability upon screening because of its improved visibility and the precise morphology of cancers allow for a better lesion diagnostics in initial imaging.

James T. Dobbins III, Ph.D., associate professor of radiology at Duke University,  used dual-energy imaging and also looking at a broader range of expertise among radiologists when analyzing lung nodules. Dr. Dobbins saw that tomosynthesis had a threefold improvement in sensitivity, which is consistent with studies done in the past. He concluded that tomosynthesis is much better than conventional radiology when it comes to detecting lung nodules, and offered three options tomosynthesis implementation strategies:

  1. Using it as a problem-solving tool for suspicious findings on radiography
  2. Using it as alternative to CT for tracking changes in nodules over time, though Dr. Dobbins did state that additional studies on this would need to be conducted to validate this option
  3. Implementing it as a lower dose, lower cost model for lung cancer screening

From these studies, it is clear that we have only seen the beginning of DT and DBT. Study after study are showing the benefits of this technology, and as future studies are conducted, it becomes much more likely that we will start seeing wide-spread usage of tomoysnthesis for more accurate and efficienct diagnoses.