Medical Imaging

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.

Get Moving – New Kinect SDK from Microsoft

dondennison Technology , ,

Using a Microsoft Kinect (motion, voice) as a healthcare application interface input (e.g. navigating images without touching a computer in the operating room) made a lot of press, but those folks that actually developed for it found the initial device release lacking an a mature API for PC application developers. Microsoft has since released a software developer kit (SDK), but it still required extra coding to have the device recognize desirable gestures. An update to the SDK was recently released and it adds several new gestures that can be recognized and made available to application developers through the SDK.

Check it out.

So, for those many Rads that played the clip from Minority Report (where Tom Cruise interacts with images and video by moving his hands around) during their talks at SIIM and elsewhere, we are one step closer to realizing your dream. 🙂 Though, do try and wave your arms around for a 4 to 8 hour workday and let me know how it goes—eye fatigue will be the least of your worries, my friends.

Too Many, Too Few …Just Right

dondennison Healthcare IT

One thing I have noticed (and was commented on by an esteemed panelist at the SIIM Regional meeting) is the wide disparity of the number of IT and Admin staff working on medical imaging systems among similarly sized facilities. One hospital has 10 FTE, while a peer has 2 FTE. I can’t imagine that there are productivity differences to account for such a variation. I have to think that one is simply doing more work (quality control, systems integration, user support and training, etc.).

This begs the question: how many FTE is the right amount?

I have not seen anyone come up with a ratio of the number of FTE per exam volume amount, modalities, etc.

PACS Challenges – A Perspective from the SIIM Regional Meeting

dondennison Healthcare IT ,

SIIM Reg Meeting Mar-2013 - PACS Challenges

“PACS” is used well beyond radiology; how can they still own it? It is being decomposed into discrete services, but it still has to come together and be fast and reliable (software is only valuable if it is available and responsive when needed).

Integrating patient records (different patient ID domains, order schema, different procedure codes, etc.) is critical to a patient’s imaging record interoperability, whether it is to consolidate records to a shared system (e.g. imaging studies in a VNA), or at access time (on demand cross indexing when viewing studies from different patient ID domains).

For all the pages of must have features that fill a PACS RFP, most people I talk to would trade most of them for a fast PACS that never crashes.

SIIM Regional Meeting in Philly

dondennison Healthcare IT ,

I am attending the SIIM regional meeting in Philadelphia. Keeping the sword sharp by listening to experts talk about challenges in radiology and informatics. Good turnout. Great to see some friends.

Noted some increasingly commonly reported trends…

  • Funds for PACS expansion, upgrades, and replacements are threatened by the focus on EMR adoption.
  • Enterprise imaging is becoming a focus for informatics professionals; a VNA is the most common place sought to store these images.
  • In addition to the VNA taking the “A” out of PACS, it seems most people are looking to PACS add-ons (“PACS Apps?”) to solve problems over looking for a solution engineered into their PACS. I wonder if this is because of the focus that a smaller vendor can apply to the problem space, or that PACS vendor resources are consumed with managing the installed base, or that they are strategically reducing R&D investment as the PACS market become saturated and radiology revenues decline.

SIIM Blog: Part 2 – Organizing Concepts to Focus Learning Efforts

dondennison Change Management , , ,

Part 2 of 2 of a SIIM blog post. Enjoy.

I have been discussing what it would take to create a “check list” of sorts (a scorecard?) to assess ones facility’s capabilities and strategies along the proposed themes listed. Would be fun to work on, but would need lots of help from people with bigger brains than mine. Stay tuned for a bonus Part 3, maybe? 🙂

P.S. Part 1 is here.

Article from HIMSS: PACS will not remain a self-contained data silo

dondennison Healthcare IT , ,

Have a read (may need an account).

Some thoughts…

  • The shift of the “archive” out of PACS has been well-discussed and is occurring today with the maturation of the VNA market; though these primarily serve PACS.
  • I believe that the next evolution will be a significant advancement in the ease at which a medical imaging record may be discovered and accessed. And these records will be dynamically transformed and provided to the wishes of the consumer (user or application). This will come through new REST-based Web protocols, such as those being defined in DICOM WG-27 and the HL7 FHIR initiative; as well as modern full text search methods.
  • With these new methods the lines between records in DICOM, document, or structured data formats will be blurred and the content much easier to cross-index and normalize.
  • The same evolution (easy to find, access, use) will occur to resources, such modalities and clinical specialists. The freedom I have to find and reserve a flight among dozens of providers within seconds compared to the ability to book an appointment for a CT exam would be laughable, were it not depressing.

Article: Global pioneer James Thrall reflects on 30 years in radiology

dondennison Radiology , ,

Worth a read (note: you may have to have an account on the site, but I believe it is free). Covers a lot of history and provides a sobering perspective of state of Radiology today…

Economically, radiology experienced a classic bubble in my 30 years as a department chairman. Tailwinds from new technology increased both the demand for imaging services and reimbursement per average case. These were coupled with increased efficiency from PACS, and led to remarkable increases in departmental income and compensation for individual radiologists.

While the economic vectors were all pointing up, we were lulled into thinking this was the way things were always going to be — and should be. Wrong. As soon as imaging became the fastest-growing cost segment in healthcare, the knives came out and reimbursement cuts began, however flawed their logic. The bubble burst.