Article – ARRS: Facial photos curb wrong patient errors

dondennison Healthcare IT ,

This is an interesting study.

Providing patient pictures were found to significantly improve the Radiologist’s ability to detect that images had been associated with the incorrect patient.

I have heard of the idea of using pictures to ensure the correct patient is involved in a procedure or treatment (when the patient is actually in front of you), but not in the diagnostic image review process. It would probably make sense to ensure that the patient picture was available in the EMR, and that the EMR was available (in context of the patient) at the PACS client—that way, even non-PACS users would benefit.

Article – HIStalk Interviews Keith Figlioli, SVP Healthcare Informatics, Premier

dondennison Policy , , ,

A friend shared this interview with me. Worth the read.

Some thoughts…

  • Keith (BTW, I have never met him) has a unique perspective having spent time on the vendor side, then the provider side, and is now also involved in policy. I think his points are spot on.
  • I believe that some of the EMR monolith disruption will come from HIE vendors. They are slowly taking more parts of the EMR, and generally have newer architectures than most EMR systems. This will allow them to adapt to new standard APIs and protocols, such as those being defined in HL7 FHIR. They are also more open—they have to believe in openness, because without data sharing, they have no business.
  • HIE vendors also typically have some form of clinical data repository, which can act as the data warehouse that Keith mentions. Adding moderns APIs to these can open the door to information freedom (without compromising security and privacy, BTW), without waiting for EMR vendors to do it.
  • I like the analogy to the transformation that the travel industry went through. I make this comparison often. I also look at how banking and telecommunications have transformed themselves to provide new and improved services. The lessons for healthcare are all out there—we just need the leadership.

Article – CHIME presses HHS for HIE certification

dondennison Healthcare IT , , ,

This makes sense.

If we are going to certify EMR technology, HIE should be held to the same standard. Especially as more physicians turn to their HIE to provide basic EMR-like access to patient records (mostly because the HIE interface is better than their own EMR’s, the collaboration tools are better, and there is more of their patient’s data from more sources in the HIE).

Article – Patient Steerage Could Harm Radiologists, Confuse Patients

dondennison Radiology , ,

This article explores the trend of “patient steerage”—a practice of payers directing patients to lower-cost imaging providers.

Some thoughts…

  • The article also touches on the idea of patients with high-deductible insurance plans, and awareness of costs, steering themselves to lower cost options. How long until consumer-driven review web sites rating costs and quality (like a travel review and booking site) become ubiquitous? The site could even broker the scheduling across involved facilities, like a travel site does this for airlines.
  • The frequent mention of quality of service as a method for imaging providers to differentiate themselves ties into the blog post I did on the SIIM web site here. The ability to offer services at a lower cost ties into my commentary on Productivity.
  • This trend could have another implication on the management of results. Often, referring physicians will refer to an imaging provider that not only provides quality of service (summarized in the article as “scan quality, turnaround time, communication with referrers and patients”), but convenient results access. So, I might send my patients to Imaging Provider A because they provide me with a secure portal to access the report and images, and send me notifications when the results are available. If my patients are steered to an imaging provider with lesser capability (just faxes reports out), I would not be as productive (or happy). If patients are steered to several imaging providers in the area, how results are accessed may vary significantly from one exam to the next. Referring physicians in regions that have an operational HIE, capable of managing both reports and images, and providing a so called “EMR Light” portal function will likely experience less of a negative impact from patient steerage when accessing results.

Article – When HIT “Progress” Lacks Compassion, Is It Really Progress?

dondennison Change Management , ,

A story of how computers fail to solve the problem when ineffective design and change management are used.

Article – Enterprise Imaging: Beyond Cloud-based Image Sharing

dondennison Healthcare IT , , , , , ,

Read this, seriously.

Some thoughts…

  • I agree with most of what the article covers. I believe that Radiologists will be more consultant than owner of the Enterprise Imaging (EI) platform.
  • One topic that is not covered is the informatics around the metadata to collect at the time of capture. DICOM and IHE provide guidance as to what metadata we want to capture and include when doing a CT exam, but what needs to be captured when a clinical images are captured and stored is far less defined (though this will evolve as EI is adopted). Hopefully, we can start defining this by using some standard lexicons and codes (like SNOMED CT), as these are more mature now than when we started defining metadata values for traditional radiology modalities.
  • There needs to be close attention paid to the indexing of metadata in the EMR and the EI platform; more than is traditionally done when doing a basic EMR and PACS viewer integration. If an HIE is in place or planned, this also needs to be considered. Not all systems will be capable of managing all the desired metadata (including unique identifiers).
  • The EI platform should be considered a component of the EMR and managed as such–don’t put EI in your radiology PACS; just don’t.
  • We need to develop EI professionals through education and shared experiences, if we want to succeed. I may be biased, but I believe that SIIM is one of the organizations well-positioned to provide this. Check out my two-part blog post (part 1, part 2) on the SIIM web site.

Article – MRI Use Dropped Since 2008

dondennison Radiology ,

MRI Use Dropped Since 2008

Source: Researchers from Thomas Jefferson University Hospital

Key stats…

  • 1998-2008 – Compound annual growth rate of 10 percent
  • 2009-2010 – Decrease of 3.1 percent
  • 2010 – 37.3% of all MRI exams are of the head

Article – MITA: Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care

dondennison Policy , ,

The medical device manufacturers’ industry association, MITA, says Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care.

Key notes…

  • President Obama’s proposed 2014 budget …includes a recommendation for a prior authorization system through for-profit radiology benefit managers (RBMs).
  • Several recent independent analyses have shown a decline in utilization of imaging technologies. The Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress in March 2012 confirmed that imaging services fell by 2.5 percent in 2010, while non-imaging utilization increased 2 percent. These data are consistent with an analysis commissioned by MITA which found that Medicare spending per beneficiary in the field has dropped 13.2 percent since 2006 and imaging utilization declined by 3 percent. This contrasts markedly with the overall Medicare program, in which spending per beneficiary increased by 20 percent and non-imaging utilization rose by 2 percent.

Article – Death of the general radiologist: Have reports been exaggerated?

dondennison Radiology

A friend shared this with me. Interesting stuff (requires registration, I think). Check out the comments, as well.

The author uses a phrase that I believe determines the outcome of many paths: “good enough”.

MP3 audio is lower audio quality than CDs, but people appreciated the flexibility that MP3 provided over fixed media—and the quality was “good enough”. The same battle of quality vs. cost/convenience is waging with monitors used for diagnosis, lossless vs. lossy image compression, mobile device access, dedicated equipment vs. app on multi-purpose device, etc.