Clinical Collaboration—Are You Providing Access?

Health IT systems  shift from record keeping to access that enables clinical collaboration

Until the middle of the last decade, the primary goal of the EMR/EHR was actually to capture information, cine_rotating2not to provide access to it – impeding clinical collaboration. It was a reference for doctors—a way to capture patient notes. It has since evolved from an archival role to an active collaborative role, providing access to reports, records, and images for all stakeholders involved in patient care.

Availability of a useful, problem-focused medical record

The idea for a comprehensive, organized medical record was pioneered by Dr. Larry Weed in 1956, but it didn’t become well accepted in the U.S. until after 1968. Dr. Weed—known as the father of the Problem-Oriented Medical Record (PMD)—described the concept in his often cited NEJM articles.[1]

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The Next Generation of Multi-Media Reporting in Radiology

Interactive features can boost referrals, and foster collaboration and communication

For decades, radiology reports have been limited to a short paragraph that describes a radiologist’s findings. If key images were available, they were often difficult Survey shows physicians prefer multi-media reportsfor clinicians to access and were not part of the report content.

The next generation of reporting contains hyperlinks as part of the radiologist’s findings so clinicians can easily view key images, measurement tables and graphs. These interactive reports can be easily accessed from the EMR using a zero-footprint viewer that delivers rapid access to key findings and data from multiple “ologies,” and provides side-by-side display of DICOM and non-DICOM images. It is so intuitive that users can be proficient within minutes of use.

EMR-driven access also offers a single point of entry to the entire patient folder including clinical data in multiple formats such as images, video, waveforms and PDF-formatted interactive multi-media reports with embedded hyperlinks to key findings that provide secure access to images from mobile devices and computers.

A paper authored by physicians at the National Institutes of Health (NIH) found that radiologists and oncologists preferred having hyperlinks to key data in reports. In a pilot study presented at RSNA 2015, NIH researchers found that the use of quantitative interactive reports led to an average of nearly nine minutes in time savings for the oncologist to assess tumor burden when compared to traditional text-only reporting.

Facilities that offer multi-media reporting also could gain increased referrals from physicians, according to a study conducted by the Emory University School of Medicine. This study found that 80 percent of physicians would preferentially refer patients to a healthcare provider with multi-media reporting—and 79 percent of physicians are more likely to recommend that their peers refer patients to a facility with multi-media reporting.

Equipping patients to access their own medical images is also becoming an important ingredient for increased patient satisfaction. A recent study of 1,000 U.S. adults conducted by IDR Medical, an international healthcare marketing company, confirmed two compelling benefits for delivering a patient portal: 79 percent of patients said they would return to the imaging facility and 76 percent of patients reported they would recommend the provider’s services to others.

Enabling patients to access and manage their own images also has the potential to reduce overutilization of imaging procedures since patients can easily send studies to providers or bring prior studies with them to appointments. And patient care can be enhanced by sharing diagnostic, procedural and evidence-related images, video, waveform and multi-media clinical content directly from the EMR.

The adage that an image is worth a thousand words still holds true. Actually it’s worth more than that. Efficient and contextual access to medical images can help improve care by expediting second opinions while simultaneously building referrals and increasing physician and patient satisfaction. #SIIM16 #enterpriseimaging #healthIT

Kiran Krishnamurthy, Worldwide Product Line Manager, HCIS, CarestreamKiran Krishnamurthy is Carestream’s Worldwide Product Line Manager for Healthcare Information Solutions. He participated in a panel at SIIM16 on Communication and Collaboration Using Enterprise Viewers in the EMR

EMR, EHR, PACS & VNA: Looking Beyond the Acronyms [Part Two of Two]

These Letters Have a Lot to Say about the Past, Present and Future of Healthcare IT

Per leggere la storia in italiano, clicca qui

Last week, Part I of this series looked at the motivations, challenges and standards involved in developing EMR / EHRs to support more efficient and effective patient-centered care. We also looked into the history of the PACS concept for acquiring, archiving, managing and accessing radiology images.

In Part II, we look at the evolution of PACS technology to serve diagnostic departments beyond radiology. And we introduce another acronym, the VNA (Vendor Neutral Archive), which points the way to a fully interconnected platform for sharing clinical images from every department across the enterprise. Thereby supporting the imaging requirements of the acronyms we began with in Part I: the EMR / EHR.  Carestream-clinical-collaboration-platform
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EMR, EHR, PACS & VNA: Looking Beyond the Acronyms [Part One of Two]

These Letters Have a Lot to Say about the Past, Present and Future of HealthIT

Per leggere la storia in italiano, clicca qui

Sometimes talking about health information technologies can feel like trying to read alphabet soup. More than most industries, ours can seem like a simmering stew of acronyms.2016-02-17 09_44_20-_ 2

Even if you’ve mastered the letters and what they mean, you may find yourself challenged by the need to converse with others who haven’t. And technologies can intersect in various ways, adding to the confusion.

Here’s a quick overview of a few important acronyms – what they mean, how they relate to each other and what they say about the past, present and future of healthcare IT – along with links to more information.

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Whirlwinds of Change — What Can We Anticipate?

Digital Imaging and Healthcare IT Challenges: Advances & Trends for 2016

Part One

It’s that time of year again – when industry publications, websites and blogs roll out their predictions on the imaging and IT trends that will be most influential in the coming year. As always, the changes are coming at us with ever-increasing speed.

For this post, I surveyed a range of respected industry sources and condensed many of their predictions for quicker reading. If you’d like to explore any of the viewpoints here further, the link to the complete article is always listed.

  • Healthcare IT Advances Set to Fuel Explosive Market Growth

Rajiv Leventhal reports in Healthcare Informatics that while the global digital health market is already valued at over $55.3 billion, it’s projected expected to continue expanding by a compound annual growth rate (CAGR) of more than 21 percent by 2020, according to a report from P&S Market Research.The report attributes this surge to the growing demand for an advanced healthcare information systems and growing investments by health IT players. Electronic health records (EHR), mobile health (mHealth)  and telemedicine will fill a pressing need for more efficient diagnosis, treatment, care and rehabilitation. Improved patient-provider communication via mobile devices and apps will support reduced medication errors and provide better overall care.

More details here.

  • Transitioning From Interoperability to Advanced Interoperability

Gary Palgon, VP of Healthcare of Life Sciences Solutions at Liaison Technologies, writes in Healthcare IT News that compliance with the Medicare and Medicaid EHR incentive program’s proposed rules for Stage 3 Meaningful Use will require enterprises to make a greater investment in connecting internal and external systems. With fundamental levels of interoperability largely achieved, the focus will now shift to advanced interoperability – seamlessly pulling together data from connected systems to present a holistic, uniform view of the patient’s health. This is crucial, as without advanced interoperability, there’s no way to bridge the gap between more data and meaningful data. More details here.

  • Stretching Budgets With Refurbished Equipment reports that the market for refurbished medical equipment will be worth $9.37 billion U.S. (8.3 billion euros) by 2019, according to a new report by MarketsandMarkets. Medical imaging equipment categories covered in the survey include x-ray, ultrasound, MRI, CT, nuclear medicine, and others systems such as C-arm and mammography devices. This trend is being driven by a growing demand for lower-cost medical devices due to financial constraints, the need to achieve more economical specialty exam capabilities and increasing privatization in the healthcare sector.

There is some resistance among public institutions regarding the purchase of refurbished medical equipment due to a perceived lack of standardization of policies governing its sale and use. Even so, MarketsandMarkets stands by their projections for this trend. More details here.

  • Progress to Come Gradually For the Less-Than-Half of Managed Care Organizations Without Access to EMR Data

Healthcare Economics recently reported on the results of a Digital Trends Study by Precision Advisors. Based interviews with 145 managed care executives, the study concludes that while Managed Care Organizations (MCOs) are aware of the benefits big data and predictive analytics, they are not able to fully implement them. Specifically, only 46 percent of MCOs currently have access to EMR data. And, while 73 percent of MCO executives surveyed expect to see this increase by 26 percent over the next several years, the specifics of this progress have yet to be seen. Survey respondents cited interoperability challenges as a key barrier to integrating EMR data. More details here.

Part Two will be posted on 12/29/15

JianqingBennettBWJianqing Bennett, President, Digital Medical Solutions, Carestream Health

Diagnostic Reading #48: Five Must-Read Articles From the Past Week

Carestream LogoIn this week’s Diagnostic Reading we look at a new breast screening study, response time for stat mobile x-ray, consumers and healthcare technology, EMR adoption, and gamma imaging dense breast tissue.

BMJ: Dutch Data Show Breast Cancer Screening Works – AuntMinnie

According to the authors of a new study published in BMJ, the Dutch example of breast cancer screening works, and mammography screening is a clear way of detecting cancer early, along with increased breast cancer awareness. Women have a greater chance of five-year survival if breast cancer is detected early while tumors are small, fewer in number, and early-stage, noted the authors from Erasmus University Medical Center in Rotterdam.

Hospital Slashes Response Time for Stat Mobile X-ray – AuntMinnie

According to an article in the Journal of the American College of Radiology, A Texas hospital was able to cut radiologic technologist response time to 10 minutes for orders for stat mobile x-ray exams from the facility’s medical intensive care unit (ICU). Implementing a series of improvements that included workflow changes, an equipment upgrade, and — perhaps most importantly — changes in ordering patterns by ICU physicians enabled the radiology department at Memorial Hermann-Texas Medical Center in Houston to reduce technologist response times from over 45 minutes to 10 minutes.

Deloitte: Consumers Using More Healthcare Technology – Healthcare IT News

Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles, according to a new report from The Deloitte Center for Health Solutions. The report, “Health Care Consumer Engagement: No One-Size-Fits-All Approach,” found that 22 percent of respondents used technology to access, store and transmit health records in the last year, up from 13 percent in 2013. Use was higher for those with major chronic conditions: 32 percent compared to 19 percent in 2013.

Study: Full EMR Adoption Can Help Hospitals Overcome “Weekend Effect” – Healthcare Informatics

The weekend effect refers to patients who undergo surgeries on weekends, leading patients to experience longer hospital stays, and hospitals to face higher mortality rates and readmissions. The study, published in the Annals of Surgery, identified five resources that can help hospitals overcome this effect: increased nurse-to bed ratio; full adoption of EMRs; inpatient physical rehabilitation; a home-health program; and a pain management program.\

Gamma Imaging and Dense Breasts: Clinicians Evaluate its Role Along with MRI and Ultrasound – Radiology Today

Looking for the best adjunct imaging to complement mammography for women with dense breasts can be as challenging as reading the mammograms themselves. Comparing the functional imaging that comes with nuclear gamma imaging modalities such as molecular breast imaging (MBI) and breast specific gamma imaging to anatomical imaging of ultrasound and MRI results in debates over the pros and cons of these options. The need for images to drive diagnosis and treatment decisions is continually weighed against the chance of false-positives and the potential long-term effects of radiation exposure.

What Does Clinical Collaboration Really Mean?

Carestream Clinical Collaboration PlatformWe’ve been talking about clinical collaboration and Carestream’s Clinical Collaboration Platform quite often since before RSNA 2014.

For us, clinical collaboration was born out the use of our vendor-neutral archive (VNA). The VNA served as a housing mechanism for medical images across a variety of –ologies, not just limited to DICOM images. With the VNA, the images remain safe and accessible when necessary, however, to enable intelligent, user-based sharing, more than just storage is needed.

To go beyond the VNA and expand the capabilities that truly lay within its technology, there remained a need to bring in other systems that could result in an enterprise-wide tool to unite departments. With our own Clinical Collaboration Platform, we break down the capabilities in four areas: capture, manage, archive, and collaborate.

Capture. The goal is to provide a unified, patient-centered clinical record that pulls together images and data from departmental systems across the enterprise, and even beyond it. The solution needs to be flexible enough to be where the data acquisition happens: bed-side, by specific modalities, even from mobile devices in a wound care/urgent care environment.

Manage. From a web-based portal the user can now manage clinical imaging data whether it’s at the point of care or as part of the administrative process. Having the right clinical context to each image or clinical data ensures that information can be properly stored, viewed, and share these clinical images and accompanying data. This capability involves advanced metadata tagging, quality control to ensure consistency, and leveraging latest industry standards to ensure interoperability.

Archive. This stage involves the storage and access of clinically meaningful data throughout the enterprise, with access across each patient’s clinical history. This consolidated repository for clinical data helps to support effect collaboration via intelligent lifecycle management, optimized storage and access anytime, anywhere, standards-based and vendor-neutral, and risk-free migration from legacy archives.

Collaborate. This is the ultimate stage that supports dynamic collaboration between providers, patients, payers, administrators and IT managers, with tools and views tailored to each user’s needs. The main goal is to put patients at the center of efficient, effective healthcare. This involves EMR/EHR integration, zero-footprint interface for administrators, user-specific functionality, patient engagement, and payer reporting.

With the evolution of the VNA going beyond the simplicity of storage and access, it is clear that these new capabilities will bring out the value of allowing clinicians to collaborate with each other and take part in valuable communication with their patients. This has been the direction healthcare has been heading in for sometime, and the time is now to embrace these advancements.

You can visit our website for more information about Carestream’s Clinical Collaboration Platform.

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


Diagnostic Reading #43: Five Must-Read Articles From the Past Week

Carestream LogoWe are back this week with a new issue of Diagnostic Reading. This week’s topics focus on structured radiology reporting, sonographer health, EMR data security, EHR usability standards, and radiologist performance tied to Physician Compare metrics.

1. Structured Reporting Improves Quality of MRI Reports – AuntMinnie

At Brigham and Women’s Hospital, a structured reporting template yielded a significant improvement in the quality of MRI reports for the crucial task of staging rectal cancer. A team led by Dr. V. Anik Sahni found that the percentage of reports deemed to be satisfactory or optimal nearly doubled after the voluntary adoption of structured reports, reaching more than 70%. Furthermore, more than 40% of reports were judged to be optimal after structured reporting was implemented, whereas none were prior to adoption.

2. Making a Difference as a Sonographer: Pain in the Neck – AuntMinnie

Doug Wuebben, registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers, goes through a number of exercises and stretches sonographers can do in order to prevent injuries.

3. Even with Encryption, EMR Data at Risk – Healthcare IT News

A recent security report by Microsoft finds that, even when cloaked in encryption technology, “an alarming amount of sensitive information can be recovered” from electronic medical record databases. For the report, “Inference Attacks on Property-Preserving Encrypted Databases,” which included 200 hospitals, researchers from Microsoft, University of Illinois and Portland State University examined four types of cyberattacks targeted at EMRs.

4. Study: Large Number of EHRs Do Not Meet Usability Standards – Healthcare Informatics

A significant percentage of electronic health record (EHR) vendors failed to meet federally mandated user-centered design requirements and did not conform to usability testing standards for their EHRs, according to a new report. The report, from the National Center for Human Factors in Healthcare at the Washington, D.C.-based MedStar Health, found that this lack of adherence to usability testing standards by EHR vendors could result in poor usability of EHRs.

5. Are Physicians Compare Metrics Missing the Mark on Radiologist Performance – Radiology Business

According to a recent study published by the  Journal of the American College of Radiology , the CMS Physicians Compare Initiative should include more imaging-specific metrics so it can accurately reflect a radiologist’s overall performance. Andrew B. Rosenkrantz, MD, of the department of radiology at the New York University Langone Medical Center, and colleagues studied how radiologists scored in six different Physicians Compare metrics compared to nonradiologists. In two of the metrics, radiologists significantly outperformed the nonradiologists. Radiologists scored 60.5 percent in PQRS participation, while nonradiologists scored 39.4 percent. And in receipt of PQRS Maintenance of Certification incentives, radiologists scored a 4.7 percent while nonradiologists scored 0.3 percent.

The Next Imaging Evolution Will Contain a New PACS

SIIM 2015 KeynoteThe theme of SIIM 2015 is “Creating the Image Enabled Enterprise”—a mission to bring radiology and imaging informatics to the forefront of healthcare enterprises.

This theme came through loud and clear in Donald K. Dennison’s opening keynote, “The Next Imaging Evolution: A World Without PACS (As We Know It).” Dennison was not explaining how PACS would eventually go away, but highlight how the way in which the technology is built, the capabilities it provides, and the way in which it is used will change–moving from a departmental technology to one that is integrated throughout the healthcare provider enterprise and EMR. In fact, that change is happening faster than we may believe.

Dennison kicked off the keynote describing the three main forces that are currently changing the world RIS and PACS:

  1. Payment reform shifting from volume to value-based reimbursement models
  2. EMR adoption
  3. Consolidation of healthcare providers with larger ones buying or affiliating with smaller hospitals, care facilities, or imaging centers

From there, Dennison moved on describe the current state of imaging in the 2010s. The section on departmental vs. enterprise imaging focused on how imaging is managed today, and how it will need to move to the enterprise model moving forward. Departmental imaging isolates radiology, but still contains numerous imaging informatics benefits such as uniting the VNA, enterprise viewer, image archive, PACS, radiology portal, and reporting within the radiology department.

Enterprise imaging will move this information throughout the organization, and will be dependent on the discovery, presentation, storage, and management of the imaging data.

To accomplish this, Dennison highlighted governance as being the key. If IIPs are not sitting down with Document Management and EMR people, this could lead to duplicate work. Governance on where the imaging data is going to be put and how providers will access it is a must. Doing so will result in an informatics that is sensible, indexed, and presented in context when accessed.

Dennison went on to tackle clinical decision support (CDS), interoperability with Web APIs such as HL7 and DICOMweb, multimedia-enhanced radiology reporting, and how there is a plethora of informatics that must be measured if quality is truly to be achieved today.

He arrived at what PACS vendors need to do in order to meet these pressing needs, and it essentially came down to using a PACS in a single-vendor system–encouraging vendors to make a better PACS. One that is engineered to integrate the worklist, image display, report center, and advanced visualization. It must be easier to deliver MERR, there should be one desktop to manage, and should add VNA-like features to the PACS server.

For providers, it is much easier for them to manage all of these capabilities with a single PACS vendor than managing a different vendor for each one.

In his closing remarks, Dennison commented on how imaging informatics professionals have a lot to offer in an era of consolidation, standardization, and integration. Professionals must have a plan in place and they must share it outside their department walls. Every IT investment must have measureable value, and a policy must be developed for imaging record quality—going back to the importance of having governance in place.

Consistency and completeness of records in the age of interoperability and EMR access will be vital, so professionals must be ready to prove their value, because as Dennison said, “Evidence is king.”

PulvinoRich Pulvino is the digital media specialist for Carestream. He is attending SIIM 2015 from May 28-30 at the National Harbor in Maryland, and will be publishing blog posts throughout the event.

Radiology’s Role in Medicine’s Mobile Revolution

Patient Portal

“Radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care.” – Jim Knaub, editor, Radiology Today

My dermatologist walked into the exam room, peering through his half-glasses at the smallish tablet computer in his left hand. He promptly looked up, greeted me, and shook my hand with his right.

“Last time you were here, we froze a couple spots on your scalp, one on your left hand and one your right lower leg,” he said, while dragging his finger across the touch screen and showing me the figure that represents me and my various lesions. “Have you noticed anything else you want me to have a look at?”

With that, he then slipped the tablet, which had one of those heavy-duty protective cases on it, into the flat pocket of his lab coat and started with my quarterly skin check. (That’s what happens when you’re a 54-year-old, sun-baked ginger.)

My adventures in aggressive skin cancer defense are not the point of this blog entry, but my dermatologist provides a good example of mobile medical imaging making its way into a clinician’s routine practice. Not long ago, that skin check visit would have started with the same greeting, followed by my doctor making his way to the laptop computer an assistant had placed on the counter next to the exam table. He would review my medical record on his EHR and then start the examination. The portability and ease of use of the tablet has upped his patient engagement game. I have seen doctors express concern about how working with a laptop EMR interferes with paying attention to the patient, but using a tablet, my dermatologist has worked it out.

Imaging did not come into play on my most recent visit because my dermatologist does not photograph the suspected precancerous lesions he freezes with his cryo-blister gun (not the technical term).  He has photographs of the melanoma he’s cut off me, the basal cell carcinoma he burned off, and the squamous cell he froze. Dermatology does not provide a good example of how radiology images are used by clinicians because the only modality is a digital camera that costs a few hundred bucks and almost all of a dermatology practice’s images are generated in house. The doctor takes the pictures and hands the camera to the assistant who then uploads the images to the EHR.

That said, my dermatologist’s use of his tablet beautifully illustrates how clinicians want their images available to them when treating their patients. And for specialties that you routinely provide images for, I believe radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care. As clinicians figure out how they will integrate tablets, images, and EHRs into efficient day-to-day care, they will increasingly expect their imaging providers to deliver patient images to their EMR, or at least in a way that the referrer can easily upload them to the EMR so they can be readily used in a clinical setting.

Radiologists will always do most of their reads at their workstations, with a small percentage of off-hour or emergency cases read on a laptop, tablet, or phone in various outlier situations. The greater mobile revolution will be among your referral customers—which any forward-thinking organization wants to serve better—and imagers will be asked to enable that by being able to deliver images readily usable at the point of care, or at least easily uploaded to where the referrer can easily make that happen.

JimKnaub_headshotJim Knaub is the editor of Radiology Today.