Radiology

Article – Readers Write: 256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS

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Contrary to what the title suggests, this article debates whether radiology has succeeded in solving the problem of going digital (by using PACS).

I believe that PACS solved the initial problem that it was intended to solve: get rid of film. Whether it provided more value than that had a lot to do with the design of the PACS, and who was managing it.

But, the value of PACS has a lot more to do with how it is deployed, configured and managed. If a PACS owner fails to use informatics and operational best practices, they and their users will suffer. If they fail to invest in and manage the infrastructure—such as the networks, servers, and storage—they will suffer.

I have seen too many PACS operators with too heavy of a dependence on their PACS vendor. Radiology and IT too often lack staff that understand informatics, integration best practices (e.g. as defined by IHE), or how their system operates. I have seen two hospitals with the same software application doing very similar exam volumes, and one experienced high levels of user satisfaction and operational excellence, while the other had chronic issues.

I would argue that in today’s mature PACS market, it is not what you buy, but how you use it. Provider staff need skills and knowledge about best practices. They need to know more about PACS in general, and be less constrained to knowing only what their PACS vendor tells them. And one of the best places to develop these skills and broad knowledge is SIIM.

I’ll be at the SIIM meeting—stop and say ‘hi’ if you see me.

Article – 9 ‘Cs’ lead to accountable care

dondennison Policy , ,

Here is part one of an article outlining 9 ‘Cs’—five that directly concern the patient and four that are focused more on providers. Check it out.

Cheat list for the patient criteria…

  • Contact
  • Comprehensive care
  • Continuous, longitudinal, person-centered care
  • Coordinated care
  • Credibility and trust

…the provider criteria will be published later.

Thought: Much of the article describes physicians interacting directly with the patient. This is not common for Radiologists tucked away in a reading room.

Article – Radiology Staffing: How to Do More with Less

dondennison Radiology , , , ,

A lot of people are talking about using analytics to make operational improvements (read as: lowering costs while improving quality of service), but this article describes some specific ways to do this within a Radiology practice.

Examples (from the article)…

  • Use actual procedure data to determine the specialty needed, as well as the number of staff needed in each facility/location. It also helps determine if full-time or part-time staff are needed.
  • Adapt the daily shift schedule based on hourly exam volume peaks.

The article also explains how technology is used to improve efficiency…

  • Cloud based image sharing, integrated with PACS, to distribute reading of exams among distributed Radiologists.
  • Shared worklist across facilities

Article – CPOE use can reduce unneeded CT scans

dondennison Radiology , , ,

Not a mind-blowing revelation, but when doctors are told that the information they want already exists, they don’t order more tests (usually).

And while the results of the study summarized in this article reflect only a small decrease in new CT exams being ordered (“physicians canceled orders after receiving the alerts about 6 percent of the time, making for a net cancellation of 1.7 percent of studies. In a control group, physicians canceled only .9 percent of alerts.”), every bit counts.

And it reduces the radiation the patient receives, as well as helps keep the Radiology schedule free for really important exams.

A goal to simply reduce the number of exams performed is misguided. This blog post summarizes a proposed model to help separate the necessary from unnecessary exams.

Article – The 8 RIS innovations you need now

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Here is a summary (note: may need to register with site to access) of some RIS (Radiology Information System) innovations that providers should be looking for.

Sneak peek…

  1. Digital dashboards
  2. Electronic medical record aggregation
  3. Clinical decision support
  4. Critical results reporting
  5. Customer service
  6. Technologist feedback
  7. Peer review
  8. Data mining, surveillance, and outcomes

I am working on an article on how (and why) RIS and PACS will be deconstructed and will not exist (as we know them today) in the future. Stay tuned for that.

Article – Report Offers System to Separate Useful and Wasteful Imaging

dondennison Radiology ,

In this article, the authors describe a simple classification system for defining different types of additional imaging exams. Too often, additional imaging is deemed wasteful, so having a model to separate the necessary from unnecessary is a good idea.

The model excerpted from the article…

  • A supplemental image — many of which are medically necessary — would occur during the same clinical encounter but utilize a different modality, such as a non-contrast CT scan and a renal ultrasound to identify kidney stones.
  • Duplicative images involve the same modality during the same or subsequent clinical session. These images are taken for a variety of reasons, including the unavailability of previous scans or a change in the patient’s condition.
  • Follow-up imaging can involve the same or different modalities during later clinical meetings, such as repeated imaging in cancer patients to verify there’s been no relapse of disease.
  • Unrelated imaging — scanning of the same body area with any modality — is often an unforeseen event. For example, in its paper, HPI discussed unrelated imaging in a woman who had CT screenings for breast cancer staging two weeks prior to a car accident that prompted identical scans.

Blog – Bundled Payments Could Short Change Radiology

dondennison Policy ,

In this blog post / article, Dr. Douglas G. Burnette Jr. expresses his concerns over Radiology reimbursement cuts, and bundled payment in particular. Provides a good perspective of how those affected by policy are feeling these days.

Article – Survey finds growth in use of department dashboards

dondennison Radiology

This article has some stats from a survey on the use of dashboards in Radiology.

Some key stats…

  • 62% of the respondents used dashboards for managing accessibility, financial, and productivity indicators; of these…
    • 50% started using dashboards < 2 years ago
    • 10% had used dashboards for > 10 years
  • 73% of departments used their RIS (only) as the source of data, 6% from their PACS (only), and the remainder from both the RIS and PACS
  • 35% viewed productivity metrics more than once a month, only 8% viewed the information daily
  • Most commonly viewed access metrics: department turnaround time and patient backlog were the most frequently used
    • 50% regularly reviewed transcription times
    • 60% were interested in the time from preliminary findings to report finalization and sign-off
  • Most commonly viewed financial metrics: reporting revenue, actual expenses compared to budgeted expenses, and the number of days that billable exams were in accounts receivable
  • Most commonly viewed productivity metrics: total examination volume, volume per modality, and productivity performance by radiologists and technologists

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.