Diagnostic Reading #9: Five Must-Read Articles From the Past Week

This week’s articles include: the limitations and applications of mobile devices in radiology; three things CIOs can learn from radiology analytics; how vendor neutral archives can reduce duplicate imaging exams; patients increased trust in the security of EHRs; and a study on communication errors within the radiology department.Doctors in Radiology Department

Analytics can illustrate radiology’s value to the healthcare enterprise. Radiology has a meaningful contribution to make within the context of value-based care. And artificial intelligence may transform the practice of radiology in the future. CIOs also need to understand the workflow of radiologists, and varying amounts of time required to read different types of exams. Continue reading

Diagnostic Reading #6: Five Must-Read Articles From the Past Week

This week’s articles focus on the role information technology will play in the moon shot for healthcare, topics CIOs should consider when managing PACS technology, the persistent value of the stethoscope, a program in which radiologists learn how to give patients good and bad news, and a projection that U.S. funding for on-demand healthcare companies will quadruple to reach $1 billion by the end of 2017.

Health spending in 2015 eclipsed $3.2 trillion a year, or 18 percent of the nation’s gross domestic product. CMS projects healthcare spending to reach $4.3 trillion by 2020 (18.5 percent of Diagnostic Reading PACSGDP) and $5.4 trillion by 2024 (19.6 percent of GDP). Here are six critical components for a moon shot that would give healthcare a chance to reach the ultimate goals it needs to achieve. Information technology isn’t the only answer in many of these, but it can play a powerful supporting role.

PACS can represent a particular challenge for CIOs. The technology has evolved from being confined to a silo within the radiology Continue reading

Radiology Insights #55: Five Must-Read Articles From the Past Week

This week’s articles focus on the move to personalized medicine, increased imaging use in the ED, an IDC reportCarestream, Radiology that predicts increased cyberattacks on patients’ healthcare data, the value of data stored in RIS and PACS systems for effective decision support, and a study that compared radiology findings with diagnoses provided by other clinical data sources.

Top 5 trends from RSNA 2015 in Chicago – AuntMinnie

This year, RSNA cast its gaze forward, looking at the trends that will shape medical imaging in the years to come. The move toward personalized medicine and data analytics will enable radiologists to find circumstances where imaging can be used most efficiently and economically. There is no doubt that the future of healthcare will be technology-driven, and it’s hard to find a medical specialty more grounded in technology than radiology.

Overall imaging use has slowed — but ED rates still high – AuntMinnie

Despite an overall slowdown in the rate of noninvasive diagnostic imaging in other settings, imaging use rates have continued to increase in the emergency department (ED), according to a study presented at the RSNA 2015 meeting by researchers from Thomas Jefferson University in Philadelphia. Why do imaging use rates in the ED keep climbing? It could be because emergency departments are a significant source of medical care in the U.S. In fact, nationwide ED visits increased from 95 million per year in 1997 to nearly 140 million in recent years, which translates into higher imaging use rates, Patel said. Other factors include defensive medicine, dependence on technology, and the difficulty of evaluating complex patients under tight time constraints, she said.

Cyberattacks will compromise 1-in-3 healthcare records next year – ComputerWorld

Consumers will see an increase in successful cyberattacks against their online health records next year. A new report from IDC’s Health Insights group claims that because of a legacy of lackluster electronic security in healthcare and an increase in the amount of online patient data, one in three consumers will have their healthcare records compromised by cyberattacks in 2016. “Frankly, healthcare data is really valuable from a cyber criminal standpoint. It could be 5, 10 or even 50 times more valuable than other forms of data,” said Lynne Dunbrack, research vice president for IDC’s Health Insights.

Too much Big Data may not be enough – Health Management Technology

The quest to mine and analyze meaningful, reliable, and useful data from the burgeoning plethora of electronic and online sources, healthcare organizations can allow the big picture to overshadow many underlying and valuable components contributing to patient care improvement. The clinical data and diagnostic images in radiology information systems (RIS) and picture archiving and communication systems (PACS) remain two examples. For clinical imaging and radiology executives, these visual clues and cues are necessary for effective, efficient decision support. Certainly a growing number of manufacturers and information technology companies recognize this. As a result, they’re offering providers a light at the end of the tunnel.

System compares radiology results with downstream clinical information – Health Imaging

A system comparing radiology findings with diagnoses provided by other clinical data sources was recently put to the test in a study published online in the Journal of the American Medical Informatics Association.  Early indications are that it passed. Lead researcher William Hsu, PhD, of Medical Imaging Informatics Group in Los Angeles, and colleagues evaluated their system, which pulls data from electronic health records and examines clinical reports for imaging studies relevant to the diagnosis. They said the goal of their system was “to establish a method for measuring the accuracy of a health system at multiple levels of granularity, from individual radiologists to subspecialty sections, modalities, and entire departments.”

NYMIIS: Medical Imaging and Meaningful Use – It is No Longer an Option

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

With the creation of RIS, PACS and speech recognition, radiology once led the technology revolution in the healthcare industry. Unfortunately, now it is a sector of that industry that has fallen behind, on account of it lagging in the adoption of Meaningful Use (MU) criteria. But just because radiology is behind does not mean adoption is impossible.

This was the discussion presented by Dr. Keith Dreyer at New York Medical Imaging Informatics Symposium (NYMIIS) in New York City on September 16. In fact, MU adoption is picking up in the industry, but not as fast as the rates among physicians and hospitals. The numbers say that as of 2013, about 14% of radiologists are involved in the MU stages, while 50% of physicians are participating. Dr. Dreyer explained that this gap exists because of the silos and compartmentalization that exists between radiology practices and other departments in health facilities. RIS/PACS currently function separately from the EHR, and while progress is being made is alleviating this issue, there is still much to be done.

Ordering, scheduling and communication between physicians and patients are improving, but there remains a vital need for workflow and interpretation of studies. Between the information housed in the RIS/PACS and the EHRs, this is essentially two programs doing practically the same thing in terms of the information stored. Convergence is necessary if workflow and interpretation are to be improved.

Dr. Dreyer explained the fact that only 14% of radiologists are involved in MU is troubling considering that 90% of radiologists are eligible for the incentives. But the growth is promising—while 450 radiologists participated in MU in 2011, that number increased by 3,500 in 2012, and is predicted to increase by 6,000 in 2013, and by 8,000 more in 2014. Growth is occurring, but radiology is still going to be playing catch-up to the rest of the healthcare sector.

To provide guidance, Dr. Dreyer outlined a 10 step plan to help radiologists work their way through MU:

  1. Understand the MU program—the deadlines and responsibilities.
  2. Understand your organization’s plan for MU of eligible professionals (EPs)
  3. Gain institutional acceptance for participation in the organization’s MU/EP plan
  4. Understand and identify the certified EHR technology (CERHT) to be used for compliance
  5. Determine MU measures that are available and required in your practice
  6. Decree MU policies for activities, interpreting the regulations specific to your radiology practice
  7. Create a comprehensive set of MU compliance documents
  8. Review compliance documents with institutional stakeholders (CMIO, CIO, etc.)
  9. Review MU compliance documents among radiology staff
  10. Implement the strategies early with the appropriate dashboard to measure successes

Following the run-through of these 10 steps, Dr. Dreyer then went on to provide advice for radiology departments of different sizes—small practice/imaging center, medium practice/single hospital and large practice/multi-hospital system/imaging centers. The larger practices are the ones more likely involved in MU because these are the organizations that either already installed their own CEHRT or are able to access the health system’s CEHRT. Because of this, Dr. Dreyer went into more detail about the two smaller categories.

With the small practices and imaging centers, Dr. Dreyer recommended investigating the technology that is common across all centers similar to this size. This should provide some essential background information on the most appropriate solutions to implement. Based on the research collected, he said that it is possible for smaller practices to install a stand along CEHRT solution.

For the single hospital and medium practices, he recommended using existing CEHRT for program compliance. These smaller practices should convince hospital leadership to expand their MU program to include radiologists, since it is most likely focused only on physician EHRs. Much of the data entry will be performed by others, which makes it difficult to take advantage of special exclusions, and may require a pack for use of the technology.

To wrap up his talk, Dr. Dreyer reiterated how MU is marking a new era for radiology. He said that once that complete execution could help and hurt some depending on financial costs and ability to properly maintain the data. Overall, there is no denying that imaging health records are beginning to play a great role in the healthcare space. So much so that we are now beginning to see patients access their images, which is not required until MU stage 3. The MU pace of adoption is speeding up, and radiology cannot afford to be fall behind any further than it already is.

User Groups: An Important Component of Innovation and Customer-Vendor Relationships

Finn Mathiesen, CMIO, MD Administration and  Department of Radiology  Vejle Hospital - a part of  Hospital Group Lillebaelt

Finn Mathiesen, CMIO, MD,
Administration and
Department of Radiology
Vejle Hospital – a part of
Hospital Group Lillebaelt

User groups have been an important part of my career in health IT. I work for a county hospital group that consists of five hospitals and about 1000 beds, which conducts about 400,000 medical imaging exams per year throughout the entire group. As a frequent user and administrator of these technologies, I need to be in the know of not only what updates are coming from the vendors I work with, but also how other customers are using the technologies.  The culmination of these relationships between customer-vendor, and customer-customer, happens at user group meetings where the event turns into a hive of people looking not only to improve the product/service, but to learn from one another as well.

Throughout my time as a member of users groups and attending these events, I think there are two major advantages a customer can gain from participating, which I will address throughout the remainder of this post:

Collaboration: Working with other customers and the vendor(s) to develop new features/applications/products that address the customers’ needs

As an example, I have been using Carestream’s RIS for quite some time now. The tools needed in RIS must provide the user with fast functionality and provide the appropriate features for booking, scheduling, reporting, etc. and these need to be accomplished in very few clicks—this is information that must be accessible right away.

User group meetings are important for me as a RIS administrator because I can have a hand in influencing product developments to make sure that they are going in the right direction. What we see are that the meetings come up with suggestions that people want in their programs and not necessarily the same functions that all the regions want.

There is one important caveat that must be addressed among the users: there is always going to be a wide spectrum of needs that will be addressed and it is next to impossible to please every member in such a diverse group.  Users from different countries will have various needs, and these will differ among organizations. Be it hospital, or small practice, or between public health systems and private hospitals, needs and development of programs will differ and not all issues can be solved.

Because of this, prioritization is a must at user group meetings. I have experienced such meetings where input was given, but nothing came to light. Situations such as this make it vital for attendees (both users and vendors) to sum up the major requests that everyone can agree on. Customers are never going to be happy if there is the collection of ideas, and then those are brought to development, but then the customers never hear about the ideas again. Questions start coming to mind: Are we going to have our requests fulfilled? When can we expect the updates? Are the vendors listening?

I can attest that users have the perspective that there is a path to development and we must coordinate our expectations to the vendor’s road-map for product and services. This makes it common practice to create a group statement from users about which features are needed the most. For example, by the end of the user group meeting, stating, “These are the five functions that are most important to us.”

As users, we believe that all of our requests and needs are equally important, but priority needs to be established, or else no plans will be put into action. At a meeting, user must get a consensus for programmers and get different options. For example: “Does everyone need this feature, or just the guys in NY?”

Networking: Meeting and speaking with other customers can allow one to learn features/processes that perhaps were not known before. Additionally, it is always good to meet others who have experienced similar situations so that collaboration can be more efficient and fulfilling.

Connecting with users from other Scandinavian countries allows me to learn valuable ideas, set ups, and ultimately learn from one another. We invite each other to look at set ups and see how things are done differently. For example, at the last user meeting in Sweden, I learned about functionalities from system administrators based in Danish Sealand Region that used some fancy tricks that we could use in our system. They taught us a work around that we haven’t thought about before. We met them, talked to each other, and learned a valuable new lesson. This is one of the most important benefits from networking at user group meetings.

When it comes to user group meetings it is clear that there are many positives that can come out not just being in attendance, but also making sure that users remain active in the user group through the remainder of the year. Face-to-face communication is always the best, but beginning and extending conversations online in the actual user group has the ability to make these events even more beneficial.

The Ideal RIS: A Perfect Link Between Clinical and Financial Management

Dr. Ivo A. Bergamo-Andreis C.S., MD, Chairman, Department of Radiology/Diagnostic Imaging, Legnano City Hospital

Dr. Ivo A. Bergamo-Andreis C.S., MD, Chairman, Department of Radiology/Diagnostic Imaging, Legnano City Hospital

The ongoing development over the last 20 years of the radiology information system (RIS) has been a dramatic turning point in the management of the radiology department. What used to be a system meant to be the simple backbone for a way of dealing with radiology in the digital era—allowing rationalization of the daily activities by running them within an IT-based framework—has turned to be a major player in the financial management of the radiology department, no matter the country one works in.

The revolution of the 1990’s, with the goal of turning radiology paperless (as well as filmless) virtually overnight, was the starting point of a completely different way of looking at our daily routine. The web-based scheduling and reporting system, the increasingly sophisticated speech-recognition system, the possibility for every patient to access his/her own medical information (reports and images) via the Internet, have all been aimed at two primary goals:

1)    Improved productivity: On the one side, RIS allowed the increase in overall productivity within the radiology department by reducing the number of time-consuming steps to be followed before a report could be made available

2)    More efficient staffing: On the other side, RIS allowed a more rational use of the staff–a strong front office vs. a no-longer-so-important back-office, since no person other than the radiologist is necessary to type a report. Our ultimate target was actually the patients, independent from the “customer satisfaction” statistics!

If the evolution of RIS had stopped at this point we would have lost vital developments. The world moves on. Other paths have to be forged since the simple outsourcing of some activities as a way to achieve financial savings cannot be considered the ultimate solution to achieve a sound return on investment. We can now achieve advantages in the overall management of the radiology department because of the possibilities the new products provide and the mandatory flexibility of the RIS versus the single customer. It is of critical importance to be able to check with a simple click on the computer to timely detect critical areas which require immediate solutions.

Equally important is the ability to assess the data real-time, sitting at our desks, analyzing the material used and at what price, and keeping the stored material (a cost) to a minimum. Simultaneously, we must allow foresight into which bill will likely be needed for the near- or long-term future.

The fully integrated RIS, comprised of both the clinical and financial management of the radiology department, should be a “must” everywhere. This requires a flexible, user-friendly, “customer-designed” system—no cumbersome or time-consuming systems are welcome.  If this works—and it can work—the hours spent in the past collecting data and analyzing them will soon be history. The possibilities offered by the RIS today will allow for both a sound clinical management of the patient, and a constant, easy control of the complex financial management of the radiology departments we are running, turning both into success stories.

Dr. Ivo A. Bergamo-Andreis is a member of Carestream’s advisory board.

Doing MORE with Lesion Management and Clinical Applications

Michael Hornback, RIS and PACS Specialist, Carestream

Michael Hornback, RIS and PACS Specialist, Carestream

A health facility’s PACS station should always be equipped with the proper applications to ensure that the administrator can do his/her job to the fullest degree. Workflow is everything to a radiologist, and when time is of the essence, an efficient workflow can lead to a faster diagnosis, which can result in better patient care.

Having the applications to create a seamless workflow within a PACS makes the radiologist’s job more convenient. Take for example lesion management—an application in our Vue PACS that provides native oncology follow-up capabilities. The comparison tools allow the radiologist to automatically register current and prior exams slice by slice. The integrated lesion management tools enable the user to then track and document all of the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.

Some of the more enhanced capabilities include the following:

  • Native MPR – Often, patient movement, position and/or respiration will alter images between prior and current exams.  Significant body tilt can be automatically corrected with MPR by linking the images in 3D which registers the images on the X, Y, and Z planes. The volume rendered image is built into the display protocol for the radiologist to see when the study launches.
  • Bookmarking capabilities are also including in the lesion management tool. In addition to the semi-automatic lesion segmentation tools, manual measurements can be conducted and saved as bookmarks for reference and follow up at a future date.
  • The follow up tool allows the radiologist to see what has changed from one study to the next, note increases or decreases in size and volume of the lesion along with doubling time in days. This information is then charted in a graphical format that can be inserted into the final diagnostic report.
  • Lesion management provides semi-automatic segmentation for three categories—lung , liver, and non-lung-liver. The system is able to extrapolate volumetric measurements, bookmark them, and update the increase or decrease in size, volume and doubling times. The RECIST criteria is then documented and displayed in the context of the final diagnostic report.

The ability to handle so many functions from a single workstation results in EFFICIENCY! The consistency in image analysis and reporting provides meaningful communication and collaboration between radiologists and clinicians for a quality diagnosis and ultimately, better patient care.

For MORE information on lesion management and streamlining workflow with clinical applications, you can download an eBook about the topics and learn about Carestream’s offerings in this area.

To see how facilities are using lesion management, the video below is a testimony from Tufts Medical Center in Boston, MA.


SIIM 2013: Mobile & Medical Imaging Create Quite the Couple

Jeff Fleming, Vice President, Healthcare IT Americas, Carestream

Jeff Fleming, Vice President, Healthcare IT Americas, Carestream

When it comes to medical imaging, mobile applications may not be the first technologies that come to mind. But in the midst of a healthcare environment dominated by X-ray systems, RIS, PACS, CT, etc., mobile apps are beginning to poke their heads out of the ground, becoming an important tool to provide enhanced features to physicians. Last year at the Society for Imaging Informatics in Medicine’s (SIIM) annual meeting, much of the discussion focused on mobile imaging for the radiologist and physician. While that is definitely important, it is time to include the patient in the conversation. We at Carestream brought that up in SIIM conversations last year and it is now up to vendors and medical professionals to get patients more involved in their own healthcare.

Recent studies have shown that 60% of patients want to connect with their physicians electronically, and mobile apps are becoming the most convenient and best way to provide this experience. In addition to communicating with their medical providers, patients are demanding online access to clinical data—a Harris Interactive poll claiming that 65% of patients consider this ability to be either “important” or “very important.” With this demand for digital capabilities so high, vendors must ensure that the design and user experience of these technologies is clean and simple to use so that patients get the most out of the use.

Much of the debate around how to create these apps centers on building them in a native operating system (OS), such as Apple iOS, or in a coding language like HTML5. Here at Carestream, we built our MyVue patient portal in HTML5 to ensure that users could access information via a Web browser on a desktop, laptop, or iPad.* The key capability for mobile applications must be accessibility—both for the patient and the medical professional. Limiting access and features to certain devices, while understandable from a development standpoint, is confusing from an access one. Versatility is the name of the game and it was an important focus of ours when building MyVue.

If there’s one trend that mobile devices have highlighted, it’s that people respond to richer content such as images and videos. Think of all of the photos and videos that have been downloaded, watched, and shared using mobile devices, and it becomes easy to see why access to medical images needs to head in this direction. Our culture has shifted to mobile. Healthcare is in the process of making the shift, and medical imaging needs to make sure it isn’t left behind.

At SIIM 2013, I’ll be participating in a session entitled “Medical Imaging? There’s an App for That!” The session will be held Thursday, June 6, from 2:45 pm–3:45 pm at the Longhorn Exhibit Hall Innovation Theater at the Gaylord Texan Resort and Convention Center in Grapevine (Dallas), Texas. The moderator is nationally recognized researcher and speaker Dr. David S. Hirschorn, Director of Radiology Informatics at Staten Island University Hospital.

You can go to the Carestream website for more information about our attendance at SIIM 2013 and the products we will be demoing.

* Among mobile devices, MyVue is based on Vue Motion technology, and the technology is FDA cleared for only the iPad

UPDATE – June 12, 2013: Below is an embedded version of the presentation I gave at SIIM on June 6, 2013.

Why Multiple Modalities are Key for RIS/PACS

The ability to look at multiple modalities on one display is an important feature for PACS/RIS and one that technologists routinely rely on for studying medical images.

In the video below, Neil Halin, Chief of Cardiovascular and Interventional Radiology at Tufts Medical Center, demos the Carestream Cardiology PACS. Dr. Munn explains how the products of PACS/RIS vendors that can handle larger systems have a big advantage. This is because if those vendors can handle larger systems well, then the accumulation of quality data for submission in terms of ACO status will become important and helpful.

For more information, you can read about Carestream Vue PACS and its various features.


The Invisible Gorilla Study and Inattentional Blindness: Are Radiologists at Risk?

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

NPR released an article recently that talked about the Invisible Gorilla Study, which is a piece of research that explains why when you ask someone to perform a challenging task their attention narrows and blocks out other things. This behavior is called “inattentional blindness” and when a similar study was conducted with radiologists, 83% of them missed the gorilla in the image. This was due to the fact that the radiologists in the study weren’t focused on looking for a gorilla, but the lesions, tumors, etc. that they seek out on a routine basis.

A statistic like this can raise some questions among patients and the radiological community in general. The most obvious questions being that if radiologists are looking for something specific, does this mean that they could miss signs that aren’t tied to an exam’s original purpose?

We reached out to Dr. Roger Eng, chairman of radiology, Chinese Hospital, and president of Golden Gate Radiology Medical Group, to get some answers about ‘inattentional blindness’ and what radiologists can do to combat it.

Is there technology available that might help address ‘inattentional blindness?’

Recently, there has been more interest among vendors in addressing performance and quality aspects of the interpretive part of imaging. How does a radiologist approach evaluating an Abdominal CT scan? Followed by: how does he communicate those findings in written format to the referring clinician and/or patient? PACS systems may eventually offer the ability to double check if the radiologist mentioned specific findings or aid in identifying potential pathology outside of the breast and lung. Systems that decrease interruptions and allow the radiologist to focus more on interpretation itself will also help.

Can a radiologist train his/herself to overcome ‘inattentional blindness?’

A large body of evidence has shown there is significant variability in interpreting imaging studies. Part of this is due to inherent limitations in imaging technology differentiating normal from abnormal, along with the human error component. We also cannot underestimate the importance of clinical context of an imaging exam which is the interplay of multiple disparate data points from laboratory to patient history. IBM’s Watson supercomputer can trounce the best Jeopardy champion in raw knowledge, but cannot match the relational capabilities of human brain.

Radiologists may find answers from other industries where organizations and their personnel standardize workflow processes. Airline pilots and their checklists is the most obvious example that comes to mind.

Do you personally do anything to guard against this?

My practice approaches each imaging modality in a consistent algorithm. This workflow process is adjusted as data presents an improved way. Moreover, I am fortunate to be using RIS and PACS technology that minimizes the extraneous steps and distractions that can lead to inattention blindness.



UPDATE: The Wall Street Journal published a similar story here