Cloud Strategy: An Enterprise Imaging White Paper from Carestream and HIMSS

What is your cloud strategy for medical imaging? Two large hospitals see it differently

Joe Thornton, Carestream Health

Cloud strategies for storing and accessing medical images across the enterprise are front and center in healthcare IT these days. The increasing sophistication of imaging technology has resulted in substantial increases in imaging data.

The upside of this evolution is that clinicians have more imaging information available to aid in diagnosis and treatment. The downside is that the vast increase in imaging data is putting pressure on provider data centers everywhere.

As storage requirements increase with every new modality, the cloud is no longer an optional part of your enterprise imaging strategy. It is rapidly becoming an essential component. Our new cloud strategies white paper shares the experiences of two different imaging providers with a cloud strategy. Continue reading

Video: Meaningful Use and Clinical Decision Support Dominated HIMSS15

Dave Fornell, editor for Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC) Magazine, stopped by the Carestream booth at HIMSS15 to discuss the biggest trends he saw at the conference.

Meaningful Use (MU) was the biggest trend Fornell saw, and he noted the different stages being focused on by vendors and hospitals. VNA, PACS, and EMR vendors he spoke with are focused on complying with Stage 3, but they are seeing that the hospitals are focused on consolidation.

Fornell also touched on clinical decision support, and how its part of Stage 2, but a much more important part of Stage 3 MU. As imaging exams are ordered, patient history is going to be ask for, and used as an integral component of the process.

The complete interview from HIMSS15 can be veiwed below.

Video: Discussion on Healthcare Data Storage & Interoperability Guidelines

Marianne Matthews, chief editor, Axis, and Cristine Kao, global marketing director, Healthcare Information Solutions, Carestream, discuss the challenges in today’s healthcare IT environment, particularly the high volumes of data and what facilities must do to manage it.

Matthews and Kao had this discussion at HIMSS15, and expanded on the role that healthcare providers play in the management of data, as well as how they are working with vendors to address data storage needs.

The ONC Interoperability Guidelines were also discussed. Particularly, the advantages of these guidelines becoming more widespread, the benefits of having DICOM medical images continue to be a standard, and the role radiology can play in the digitization of healthcare moving forward.

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.

Executive Perspective: How to Achieve Efficient Enterprise Data Management

Julia Weidman, Marketing Manager,  Healthcare Information Solutions, Carestream

Julia Weidman, Marketing Manager, Healthcare Information Solutions, Carestream

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

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

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

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

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


Portals Provide Benefits to Physicians and Patients, With Few Barriers to Access

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Clinical applications continue to be a vital part of our ever-evolving health care system as Meaningful Use Stage 2 increases in adoption and patient engagement receivers a higher participation rate. Not only is engagement occurring between patients and physicians in regards to accessing their EHRs, but patients are increasingly asking for access to their medical images so that they have their entire medical history at their fingertips. As proof of this, we have seen the value of providing patients with access to medical imaging portals, and the long-term benefits it has for both them and physicians, according to a study conducted by IDR Medical GmbH [full disclosure: the study was commissioned by Carestream].

From the study, it became clear that physicians need to be offering patients access to these portals because the patients are demanding it. Among the 1,000 people surveyed, the results found that 83% of the patients see value in being able to access their medical images via a patient portal. The financial advantage for providing patients with access is that patient satisfaction increases, according to the study. Respondents said (76.5% of them) they would recommend such a portal, and a physician who provides access to the portal, to family and friends.

Patient satisfaction allows healthcare providers to engage their patients in a way that both improves the overall care for the patient and allows for providers to retain and attract more patients. The study showed that 79.3% of respondents would return for future scans based on having access to their medical images via a portal. With Meaningful Use Stage 2, healthcare providers must have patient engagement capabilities in place with at least 5% of their patients. The reason being that engaged patients are more educated about their healthcare and because of this knowledge, they will want to be more invested in their care.

It is common for healthcare providers to claim that not only do patients not want the access to portals (which the study says is not true), but that there are barriers that would prevent patients from adopting the new technologies.

  • Age: Older populations take more medical images and receive medical care more often than younger patients. The study sought to answer whether age would be a detriment to portal deployment and adoption, and it turns out that age is not a barrier. On a scale of 1 to 7, with 1 being “extremely unlikely” and 7 being “extremely likely,” all seven age-segmented groups rated their likelihood of using this tool greater than 4.75. Most importantly, while patients age 71 and above scored the lowest at 4.76, the age group 51-60 scored the highest at 6.08. A score of 4.76 still shows a more likely interest in portals, with the overall results being high.
  • Technology: On the same 1 to 7 scale, respondents who characterize themselves as having very basic, moderate and advanced levels of IT competence scored 5.44, 5.79 and 6.09, respectively, for the likelihood of using an imaging portal. Similar to age, level of knowledge about technology will not prove to be a barrier to patient portal adoption among patients.
  • Image retakes: A hypothesis about image retakes hindering the use of an imaging portal was proven incorrect in the study. On the 1 to 7 scale, those who have not had to undergo an image retake scored 5.8, compared to those who have needed to have their image retaken at 6.0. Respondents’ overall scores ranked from 5.75 to 6.02 across X-ray, ultrasound and mammogram testing. Like age and technology, having images retaken proves not to be barrier with interest remaining high across all segments.

Patient portals are now in a phase where they are a “must-have” for healthcare providers. Aside from Meaningful Use mandates and incentives, the benefits of deploying a patient portal are proving that these technologies are benefitting both the healthcare providers and the patients. A more educated and knowledgeable population of patients is not only inevitable, but is already here. Mobile and wearable technologies are keeping people more in tune with their bodies, and now patient portals are keeping them in tune with their medical visits and exams.

HIMSS 2014: Enterprise Data Management—An Executive Perspective

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Enterprise data management has always been a daunting task. Best practices and case studies are often shared because telling these war stories is how facilities can best learn from one another. It is a way to cope with the challenging and vital task at hand.

Since enterprise data management encompasses so many components, it is best to break down the different components that are maintained throughout the enterprise—capture, analysis, storage, access, sharing, etc.

The essence is the exchange of information—from the patient to the physician, to the departmental system, to the storage of the data—and the exchange needs to remain fluid to allow optimal care for the patient.

At HIMSS14, in partnership with the HIMSS organization, Carestream will be sponsoring a panel titled, “Executive Perspective: How to Achieve Efficient Enterprise Data Management.” Jennifer Horowitz, Senior Director of Research for HIMSS Analytics, will moderate the session that consists of four executives who can each provide different perspectives and best practices in designing and maintaining an efficient data management system.

Panelists include:

Among the variety of technologies present at HIMSS, data management is certainly the trend that is holding some of the most attention. This is because it affects the physician, healthcare facility, and, most importantly, the patient.

The four executives on this panel are sure to shine a bright light on the successes and struggles they have experienced and the lessons that all attendees can take away: how to achieve higher revenue and lower costs while enhancing productivity for IT staffs and radiology departments. Effective and efficient enterprise data management is not impossible, but it is difficult. This panel assures attendees that they are not alone in their quest, and provides insights on how to stay on the right path.


HIMSS 2014: Personal Health Technologies Help to Answer the $4.6 Trillion Dollar Question

Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group

Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group, Intel Corporation

Below is a guest blog post from Eric Dishman, Intel Fellow and General Manager of the Intel Health & Life Sciences Group. If you will be at HIMSS14, be sure to attend his educational session (#74) on Tuesday, Feb. 25, at 10 a.m. in Room #320. During his talk, Eric will share his own experience battling cancer and the lessons he learned about the importance of a customized care treatment plan. You will also hear about the future of genomics and personalized medicine. Find out more information and read the latest blog posts on health IT in the Intel Health and Life Sciences Community.


In the currently raging debates about healthcare, there’s little attention to population aging and the cost of care — two critical trends that I call the $4.6 trillion question.

By 2020, there will be 55 million Americans over age 65, reflecting a global population aging trend that could be as important to our future as global climate change.  Also by 2020, according to federal government projections, the nation’s healthcare costs will be $4.6 trillion, close to doubling in a decade.

One of the ways we must respond to these trends is to use technologies that enable a model I call “care anywhere.” Thanks to a range of personal health technologies available now—mobile health (mHealth) capabilities for smart phones and tablets, telehealth technologies for remote patient monitoring and virtual visits, intelligent software assistants for prompting and coaching, and social technologies for connecting patients, families, and providers in powerful new ways—we have the opportunity to move away from costly, institution-centric care delivery for the majority of needs.

The core necessity is this: care must occur at home as the default model, not in a hospital or a clinic. We need this to curb escalating costs, increase access and improve patient experience and outcomes.

Policy makers are paying attention.  Last month, committees in both the House and Senate passed Medicare reform through Sustained Growth Rate (SGR) bills with bipartisan support, encouraging greater interoperability and data exchange for electronic health records (EHRs). And a discussion of telehealth measures led to an agreement between the Congressional Budget Office director and Senate to work together on how to estimate savings, an issue that has plagued telehealth and mHealth for years.

But even with all of the excitement, reforms and investment activity around mHealth, the promise of care anywhere – made possible by mobile technologies, data analytics and real-time connectivity – is far from being realized.

I think about the importance of care anywhere from three perspectives:

  1. As a patient who tried to force in-home, mobile and virtual care models for myself while undergoing cancer and chronic kidney disease treatment for 24 years, my fight was not just against cancer but against a flawed healthcare system.
  2. As a social scientist who has studied the cultures of healthcare innovation, I have seen the many challenges we must overcome to redefine the roles of patient, caregiver and provider.
  3. And as a business executive responsible for health innovation opportunities globally, I have learned a lot from other parts of the world that are deploying social, political and technical infrastructure for care anywhere.

A new Intel study found that more and more people are feeling empowered through new technology tools to become fuller participants in their own care. More than half of the respondents globally believe the traditional hospital will become obsolete in the future.HIMSS14

Today, technology is reducing unnecessary emergency room trips using real-time video collaboration between patients, EMTs and doctors and reducing doctor office visits with innovations such as in-home blood pressure, ultrasound and eye tests that instantly send information from your smartphone to your doctor.

In Indianapolis, where cardiac patients were treated using remote care technology, St. Vincent’s Hospital saw a 75 percent decrease in hospital re-admissions, proving that care anywhere can take costs out of the system and better support patient recovery.

In the future, doctors will be able to track patients’ health instantaneously through ingestible tracking devices in their bodies. More than 70 percent of respondents in our research are even receptive to using tools like toilet sensors, prescription bottle sensors and swallowed monitors.

But no amount of technology innovation investment alone can help us mainstream mHealth. We need a shared roadmap and strategy to create a movement around these care models. Remote care will never gain momentum without laws that allow doctors to be reimbursed for effective patient care no matter how it is delivered.

Medicare reform through the SGR includes telehealth as a method for physicians to transition to alternate payment models. Reform should provide incentives to use advanced technology innovation, when appropriate. As Congress makes needed changes in payment, let’s take this opportunity to make bold changes in the way people access care. By expanding telehealth reimbursement for all chronically ill patients in their homes, not only will patients benefit, but the United States will see a reduction in Medicare costs.

The Wyden-Isakson-Paulsen-Welch Better Care, Lower Cost Act of 2014, introduced last week, offers a targeted approach for providers to focus on chronic care management by offering preventive services through new technologies such as telehealth.  This bipartisan, bicameral legislation would encourage providers to coordinate care and reward them for achieving healthy outcomes rather than for the number of services they provide. It’s about time we change the formula for smart care and payment in the United States

Our nation is aging and traditional healthcare costs are unsustainable. Technology advancement has outpaced our laws. Patients have told us that they are ready to embrace care anywhere. It is time for policy makers to help patients, their families and a broader range of health workers innovate answers to the $4.6 trillion dollar question.


Eric Dishman
Intel Fellow and General Manager of the Health & Life Sciences Group, Intel Corporation

Eric Dishman is an Intel Fellow and General Manager of the Health & Life Sciences Group, responsible for driving Intel’s strategy, R&D, new product and policy initiatives for health and life science solutions.

He is known for pioneering techniques that incorporate anthropology, ethnography, and other social science methods into the design and development of new technologies. Eric’s organization focuses on growth opportunities for Intel in health IT, genomics & personalized medicine, consumer wellness, and care coordination technologies.

HIMSS 2014: The Challenge of Image Sharing

Greg Freiherr

Greg Freiherr, a frequent contributor to Medscape and Diagnostic Imaging Europe, as well as a consultant to the medical imaging industry.

Before LAN there was sneakernet. Highly reliable but time-consuming, sneakernet transfers data the old fashioned way via CD, DVD, floppy disk or USB-drive walked from one computer to another. It has lasting appeal. Obviously.  Consider the range.  Flash drives holding from 4 to 512 MB can look like just about anything: minions…surgeons…thumbs.  (Gotta love ‘em.)

It shouldn’t be surprising, therefore, that patients are carrying their CTs, MRIs and other medical images from one doctor to another.  They might be shared over networks, but these are uncommon, their implementation restricted by provider cost concerns and patient privacy issues.

Having a simple way to share medical images across providers and between far flung locations has obvious benefits for everyone.  The sheer volume of data and the importance of images to patient management underscore this. And this will only grow.  Radiology is evolving, its role expanding from diagnostic to therapeutic assessment, screening to patient follow-up. Little wonder, then, that an efficient means to transfer images among providers has enormous potential to impact the quality and cost of care.

This shouldn’t even be an issue.  For most of the past decade, medicine has been working toward  regional health information organizations (RHIOs) and health information exchanges (HIEs) to enable the sharing of medical information. Yet these have fallen short.  Even the most successful only share summaries, leaving the transfer of actual data to private solutions.

Vue Motion

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

The most promising of these solutions leave no footprint. They are compatible with multiple operating systems and browsers; run on mobile devices – smartphones, tablets and other computing “surfaces;” and draw data from telecom networks being built out to handle YouTube, Netflix and Instagram.  Whether they should replace shoe leather goes without saying.

While easy and seemingly inexpensive, sneakernet is resource intensive for both patient and provider. The patient must obtain the images from where they were generated, transport them, and then hope that the receiving facility can read the discs. Images are valueless, if they cannot be read by the referred institution, an uncertainty amplified by the number of facilities to which the patient is referred as the time between facilities raises the risk of losing or damaging the storage media.

As we approach another HIMSS, sneakernets clearly have run their course. Image transfer through RHIOs or IHEs is beyond reach. Zero footprint technologies are at hand, but not widely applied. Their adoption depends on demonstrating the degree to which they can efficiently exchange data, and whether their use can help increase revenue and control costs.

HIMSS 2014: Proposed Medicare Imaging Rule May Boost Need for Clinical Decision Support Software

Dave Fornell, editor, Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC)

Dave Fornell, editor, Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC)

As an editor for two medical technology magazines, I am always on the lookout for the next big trend in radiology or cardiology. This is especially true when legislation prompts action. This year at the Healthcare Information and Management Systems Society (HIMSS) annual meeting in late February, I will be on the search for new software to help physicians meet appropriate use criteria guidelines in medical imaging.

Stage 2 meaningful use guidelines for electronic medical records (EMRs) suggest use of clinical decision support (CDS) software to help clinicians choose appropriate labs, diagnoses, therapies and imaging exams. A draft policy to replace the sustainable growth rate (SGR) formula being considered by the a joint U.S. Senate Finance and House Committee on Ways and Means Committee might make this suggestion a requirement in the future. The draft policy would deny Medicare payment for the exam if the ordering physician did not consult appropriateness criteria and require prior authorization for outlier providers whose ordering is inconsistent with that of their peers.

The American College of Radiology (ACR) applauded the proposal in early November.  “This landmark step by Congress is a validation of a cornerstone of the College’s Imaging 3.0 initiative that increases quality of imaging care and preserves healthcare resources,” said Paul Ellenbogen, M.D., FACR, chair, ACR Board of Chancellors. “We strongly urge Congress to follow this approach which helps medicine transition from volume-based to quality-based care without interfering in the doctor-patient relationship.”HIMSS14

The policy draft would require the Secretary of the Department of Health and Human Services to specify appropriateness criteria from among those developed/endorsed by national professional medical specialty societies. The secretary must also identify mechanisms, such as clinical decision support (CDS) tools, by which ordering professionals could consult these appropriate use criteria (AUC) CDS systems in Minnesota and at Massachusetts General Hospital have been shown to cut down on duplicate and/or unnecessary scanning and their associated costs.

Studies show that imaging exams reduce unnecessary hospital admissions, shorten length of stay and are directly linked to greater life expectancy.  ACR said Medicare imaging use and imaging costs are down significantly, the same levels as it was in 2003, and that imaging is the slowest growing of all physician services among the privately insured. ACR contends the use of appropriateness criteria can help streamline the ordering of these services.

If this policy is enacted, and it appears to be that it would be a no-brainer decision to help cut the staggering costs of Medicare, I predict it will result in a rapid explosion in and adoption of new CDS systems.

This software is not yet widely offered by PACS, CVIS or EMR vendors because it is difficult to keep up-to-date with the latest data from multiple societies, clinical trials and studies regarding all specialties. To stay current, vendors will have to issue a large number of updates each year, including rapid software revisions each time societies update their AUC. For this reason, AUC/CDS software might be best managed as a Web/cloud-based application, which makes regular software updates much easier.

It will be interesting to see what CDS solutions vendors introduce at HIMSS and other conferences throughout 2014.

Dave Fornell is an editor for Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC).