Article – Enterprise Imaging: Beyond Cloud-based Image Sharing

April 17, 2013April 17, 2013 dondennison Healthcare IT Interoperability, Medical Imaging, Patient Records, Quality, Radiology, SIIM, Vision

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

April 17, 2013April 17, 2013 dondennison Radiology Medical Imaging, 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

April 16, 2013April 16, 2013 dondennison Policy Medical Imaging, Policy, Radiology

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?

April 16, 2013May 2, 2013 dondennison Radiology 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.

Article – Creating a Clearer Picture of Patient Flow

April 12, 2013April 12, 2013 dondennison Radiology Analytics, Change Management, Radiology, Technology, Usability

This is cool.

It would be interesting to see the convergence of the output of SIIM‘s SWIM initiative and this application to understand real-time metrics of a Radiology department. The dashboard could show the actual location of patients, their spot in the prescribed workflow, and the comparison to statistical norms and/or KPIs.

Layered on top of a BI (business intelligence) platform for historic data analysis, and you would have something special.

Article – Imaging centers hit with surprise 30% cut for MRI codes

April 8, 2013April 10, 2013 dondennison Radiology Policy, Radiology

Full article is here, but requires (free) registration. A short summary (no registration required) is also available here.

The full article is worth a read as it goes into several reimbursement changes happening and pending.

An excerpt…

Because of adjustments made by the Centers for Medicare and Medicaid Services (CMS) in its assumptions about room use time for 2013, reimbursements for CPT code 73721 (lower extremity joint MRI) and 73221 (upper extremity joint MRI) have been cut dramatically, according to Mike Mabry, executive director of the Radiology Business Management Association (RBMA).

“To calculate [relative value units (RVUs)], Medicare estimates labor, medical supply, and equipment costs associated with every procedure,” Mabry told AuntMinnie.com. “For these two codes, CMS decreased its estimate of the amount of time the room would be used, from 63 minutes to 33 minutes. They cut the room time in half for those two codes, which results in lower equipment and direct costs and a lower technical component. That’s why freestanding centers are seeing cuts in the range of 30% for these two MRI codes.”

Rick Davis, vice president of Palm Coast Imaging, a freestanding center in Palm Coast, FL, was shocked when he saw his center’s Medicare explanation-of-benefits report.

“In 2012, reimbursement for CPT code 73721 was $427.21,” Davis told AuntMinnie.com. “This year, the Centers for Medicare and Medicaid Services reduced the reimbursement to $297.58. If managed care companies follow suit, freestanding centers will find it difficult to remain open.”

Blog – March Madness in Radiology: the Push for ACOs

April 5, 2013May 2, 2013 dondennison Radiology Policy, Radiology

March Madness in Radiology: the Push for ACOs

This excerpt…

Prompt, consistent report delivery must be available and employ current technologic standards that streamline this, including tablet and smartphone delivery to providers. Rigorous quality reviews, peer evaluation and communication between radiologist and technical centers must be used to improve quality. Electronic methods of tracing and evaluating incidents should be employed.

…is on the money, but this technology platform should be part of the EMR (probably sourced as an add-on) and managed by the same group that manages the EMR, not Radiology. Radiology should indeed provide the guidance to configure the platform to meet Radiology’s needs, but they aren’t the only specialty that needs these tools, so a shared service is the best approach.