Utah Reaches New Heights of Health Information Exchange

Published in the Sept. 26, 2011, Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

Preparation for a statewide, electronic exchange of patient data sprouted wings nearly 20 years ago in Utah, when healthcare industry leaders joined together to improve patient care through information sharing. Today, the state is a leader in the creation of health information exchanges (HIEs).

While electronic health records (EHRs) aren’t new to Utah, the latest endeavor to link patient records across the state via a HIE is only a little over a year old. Known as cHIE – clinical health information exchange, Utah’s statewide, vendor-neutral, patient-data repository is still under construction. The process hasn’t been wholly simple, even with buy-in from healthcare leaders and state officials.

“The easiest part has been the technical component behind cHIE,” says Teresa Rivera, COO of Utah’s Health Information Network (UHIN), a non-profit coalition of insurers, providers and government officials. “But, now we need to integrate all the pieces. All the data contributed by providers must be organized and mapped correctly.”

UHIN launched cHIE and is dedicated to controlling healthcare costs and improving the quality of care through electronic data exchange. So far, UHIN has been very successful. Not only does the Ogden-Clearfield area in northern Utah have the lowest healthcare spending in the country ($2,623 per capita), according to Thomson Reuters, but the state also has a higher EHR adoption rate than much of the nation. More than 60 percent of providers already contribute to the more than 30 EHRs housing Utah patient data.

Currently, the state’s four main hospital systems and one of three major labs are already filling cHIE’s data coffers, says Rivera. The ultimate goal is to enroll the remaining two labs, as well as all rural hospitals within the next year. The deeper the data well, the easier it will be for patients to receive the highest level of care even when they can’t see their regular physician. cHIE will give providers access to medical histories and medication lists for all patients who opt-in.

Enrolling Participants

Rather than debuting cHIE and putting the onus on patients to tell their healthcare provider they’d prefer not to participate (often called the opt-out process), UHIN made patient consent the lynchpin of the program’s success.

To date, nearly 7,000 patients have opted-in to adding their health data to cHIE. The state has 2.7 million residents, so the task ahead is large, says Rivera. Reaching 100-percent participation isn’t feasible; education will be the tool used for getting as many patients enrolled as possible.

“We’re informing the population about the benefits of cHIE, and explaining why it’s important to tell their provider if they do or don’t want to participate,” she says. “We’re at health fairs, we’ve had media events, we’ve placed information in school offices and even the Department of Motor Vehicles. Most people, however, learn about cHIE from their provider.”

Consequently, it’s the provider’s job to assure patient data submitted to cHIE is encrypted and secure. If patient choose not to participate, none of their information will be included in the system.

Overall, providers have been happy to take the extra time to make sure patients understand what cHIE is, and explain how submitting their health records could benefit them in the future, says Rivera. Having greater access to patient information, including the details needed to potentially make critical care decisions or avoid errors, far outweighs the added responsibility.

Although UHIN encourages all providers and facilities to submit patient information, there are instances where certain details of a patients’ history can be omitted. For example, providers aren’t required to submit some emotionally charged details, such as past or current substance abuse or HIV status.

Some groups also have leeway to forego submitting records without losing access to the information.

“There are cases where an organization won’t contribute but will still use cHIE information,” says Rivera. “Planned Parenthood might not contribute data, but it’s valuable for them to have access to the health records. When treating patients, they must have access to a patient’s medical history. Otherwise, they can’t offer the best care possible.”

Impact

When physicians have ready access to patient information, the patient almost always benefits from improved quality of care. cHIE also positively impacts the providers who treat patients. Using the system allows doctors to prescribe, order or deliver reports, or refer a patient electronically.  The system also provides access to all hospital reports, lab results and clinician documents.

According to Julie Day, M.D., Medical Director for Quality at the University of Utah Health Plans, having access to a state-wide HIE, such as cHIE, could bolster the services offered by a large provider.

“For a major system like ours, it would be very helpful to be able to pull a patient’s clinical background, history of chronic conditions, or medications, if they came into our emergency department and weren’t already one of our patients,” says Day, who is also part of the internal medicine team at University of Utah Health Care. “You can save time and cost that way by not having to potentially repeat every test you might need,” she adds.

The university is committed to providing patient data to cHIE, and is currently working to integrate its existing EHR system with cHIE technology, says Day.

However, patients and physicians aren’t the only beneficiaries of the services cHIE provides. Payers can also access portions of this mound of patient data to guide them through setting policies around various clinical conditions. For example, Rivera says, payers use the data to decide for which treatments patients must receive pre-authorization.

“Not only does having access to cHIE give payers the ability to make informed decisions based on real clinical data,” Rivera says, “but it allows them to receive the information in a far safer manner than fax or snail mail.”

The Challenge

Putting patient information at provider and payer fingertips might place Utah ahead of the curve in EHR adoption. And, making sure the systems work is important for meeting criteria associated with meaningful use under healthcare reform guidelines. But the attention given to climbing onto that bandwagon has made it harder – at least in the short term – for cHIE to reach its goals, says Rivera.”

Meaningful use and accountable care organizations have been a plus and a minus for us as we’ve been pushing cHIE forward,” she says. “Providers understand the importance of meaningful use and the incentive payments attached to it, so it’s sometimes been difficult to focus their attention on what we’re trying to put into place.”

This is where HIE technology vendor Axolotl (now OptumInsight) can step in and keep the ball rolling. The company, which has been involved in cHIE’s development since the early stages, is in the ideal position to keep physicians engaged and to continue offering enhanced services, according to Glenn Keet, Axolotl’s president.

Not only did the company play an integral role in developing and shaping cHIE’s guiding policies, including privacy and consent principles, but company representatives were also instrumental in implementing the HIE infrastructure. As cHIE grows, Keet says the company will continue to provide services needed for advanced analytics and interoperability.

“Axolotl envisions itself providing continued value services,” says Keet. “As an example, with UHIN being one of the participants of a Beacon community, Axolotl has an opportunity to help UHIN with innovative analytics reporting, providing unprecedented access and analysis of clinical information for improved chronic disease management.”

Putting cHIE To Work

Last year, the Office of the National Coordinator for Health Information Technology labeled Utah a Beacon community, giving the state funding to support existing EHR and HIE efforts. Called IC3, “Improving Care Through Connectivity and Collaboration,” Utah healthcare providers will use cHIE to actively improve diabetes care in the state.

The funding supports implementing HIE technology at HealthInsight, a community clinic offering coordinated, convenient care for diabetic patients, says Rivera. These patients receive primary, eye and kidney services under one roof. Having an operational HIE helps physicians track the treatments and services provided.

According to Chris Wood, M.D., Medical Director of Information Systems at 23-hospital Intermountain Healthcare, using Beacon funding to bring community physicians into the fold will benefit patients, as well as all providers.”

With the Beacon grant, we’ll be able to take information about the services we’ve provided to diabetic patients at Intermountain and make it available to the primary care physicians who see them more routinely,” says Wood. “That way, all the providers can see what’s been done for the patient and to determine what needs to be done next to provide the best care.”

To read the article on the original website: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/September/Utah_HIE.html

Natural Language Processing Underutilized in Radiology Despite Advanced Capabilities

Published on the Sept. 22, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

Natural language processing, considered the next generation of voice recognition software, makes it easier for you to summarize, find, and retrieve data from radiology reports. But a recent study shows many of you still aren’t using it.

Nearly 50 years ago, speech recognition software debuted on the healthcare scene, and providers used it to record radiology report findings. Technology improvements have taken the software to the next level with natural language processing (NLP), and it now plays a significant role in quality improvement efforts, said Ronilda Lacson, MD, a radiology research associate at Brigham & Women’s Hospital. NLP takes the voice-created narratives and makes them structured and searchable.

“NLP makes sure physicians report findings appropriately,” Lacson said. “They can record information in such a concise form so that when patient histories are pulled for review they’re like a thin cut of focused data.”

In a study published in the September Journal of the American College of Radiology, Lacson and her colleagues identified three main uses for NLP. The software can pull records that meet specific criteria to support effective outcomes research. Various versions also let you pinpoint specific data points, such as individual imaging findings, for analysis and quality improvements. However, the most valuable, long-term NLP use, Lacson said, is the brief reports it can create to highlight key content and critical findings. Other radiologists can study these summaries to improve their future documentation.

To read the article in its entirety: http://www.diagnosticimaging.com/voice-recognition/content/article/113619/1955806

What Bundled Payments Could Mean for Radiology

Published on the Sept. 20, 2011 DiagnosticImaging.com website

By Whitney L.J. Howell

The way you receive reimbursement for your services could soon transform. There are two problems, however: no one is sure to what degree it will change, and radiologists haven’t really had a voice in the conversation.

In line with the Affordable Care Act’s goal of slashing care costs, CMS is studying whether bundled payments, also known as episode-of-care (EOC) payments, can largely replace the fee-for-service model for single illnesses or courses of treatment. As lump-sum payments, EOC reimbursement would tie these payments together with the facility and providers receiving a portion of the total. It’s likely these payments will include most of the imaging procedures done in-hospital.

The testing ground for this model is CMS’s Bundled Payments for Care Improvement Initiative (BPCII). The agency is asking interested hospitals to test four new bundling-payment models and will use feedback to decide which groups of services can be easily moved to EOC payments. For radiology, this is a double-edged sword, said one radiologist who’s studied this topic for the past year.

“The issue here is that bundling could turn imaging from a for-profit center to a cost center,” said Joseph Steele, MD, deputy division head of diagnostic imaging clinical operations at the University of Texas MD Anderson Cancer Center in Houston. “If, under healthcare reform, we’re looking to keep costs under control, there’s a chance fewer tests will be ordered. It’s a 180-degree difference.”

To read the entire article at its original site: http://www.diagnosticimaging.com/healthcare_reform/content/article/113619/1953470

Protecting Patients

Published in the Summer 2011 Summa Magazine

The Role of Summa Health System’s Institutional Review Board in Advancing Medicine

By Whitney L.J. Howell

New drugs. New medical devices. New therapeutic protocols. Summa Health System tests them all through research and each has the potential to improve the health of different patients in different ways. But they do have one thing in common – Summa’s Institutional Review Board.

Most patients who agree to participate in clinical trials have likely never heard of an institutional review board (IRB). IRBs serve as objective third parties in all discussions about medical research involving human subjects. In addition to safeguarding patient safety, these committees ensure the nature and manner in which proposed research will be conducted are both ethically and scientifically sound. Think of them as the safety net for clinical investigations.

Formal, regulated IRBs are a relatively recent directive. The National Institutes of Health’s Policies for the Protection of Human Subjects, first issued in 1966, achieved regulatory status on May 30, 1974. Promulgated by the Department of Health, Education and Welfare (now the Department of Health and Human Services), the regulations established the IRB as one mechanism through which human subjects would be protected.

Despite being mandated by the Department of Health and Human Services, these committees – of which Summa has two – operate largely in the background. And their charge is more than merely greenlighting research, said Jessica Conrad, Summa’s IRB manager.

“Our IRB is here to minimize the risks associated with a study and to make sure our patients know exactly what to expect if they participate,” Conrad said. “We catch problems and ask questions about research projects that could affect human health – it’s something we take very seriously.”

Monitoring studies conducted at Summa keeps the IRB committees busy. In 2010, both groups completed approximately 1,600 reviews and approved 150 protocols. Proposals come from pharmaceutical companies and device manufacturers, as well as from Summa’s physicians, nurses and other clinical staff.

Who Serves?

As a federal requirement, all IRBs share some characteristics. Every committee must have at least five members, both male and female, and they must come from varied professions. Specifically, IRBs must include at least one individual from these areas: a scientific concentration, a non-science field, and sectors wholly unaffiliated with the reviewing institution.

Summa takes extra steps, however, to guarantee that it analyzes study proposals from all angles, Conrad said. To delineate between which investigations were conceived outside the health system and which are borne of the institution, Summa operates two committees – IRB1 and IRB2. IRB1 tackles submissions from pharmaceutical companies and device manufacturers. Summa investigator-initiated study protocols fall under IRB2’s jurisdiction.

Members appointed to serve on both committees reflect the nature of the studies reviewed. While both bodies have a medical librarian, a lab technician, and a nurse, that is where they part ways. IRB1 also relies on two infectious disease specialists, two oncologists, and an emergency room physician. IRB2 is rounded out with a psychologist, an obstetrician, a surgeon, an ICU doctor, a family practitioner, and a cardio-pulmonary statistician. The remaining members, such as retired nurses, school teachers, and lawyers, are recruited from the community. All members are selected based on their levels of expertise and how their knowledge can strengthen submitted protocols. They do receive instructions on how to work within the IRB framework, however.

“Once members accept the appointment to the IRB committee, we review the process and educate them so they know what IRB participation calls for,” Conrad said. “Every new member is paired with an experienced member who can mentor and train them.”

At Summa, simply agreeing to become a member of an IRB isn’t enough. Appointees must make the time commitment to read protocols and attend monthly meetings. According to Conrad, Summa experts must attend 70 percent of the IRB meetings, and community members are expected to be present at 50 percent.

Why Community Members?

Although all research submitted for IRB approval has a solid foundation in science, not everyone who participates as a study subject has the same levelof scientific understanding. This reality makes it necessary to incorporate community members – most of whom are from outside the hard sciences – to analyze proposals through a lay person’s eyes.

“Many times the medical people involved with the IRB wouldn’t see any problems with a proposal, and from their perspective, they were right,” said Richard Haas, a former Goodyear attorney who served on Summa’s IRB committee until 1997. “But, coming from a lay person’s perspective, I could see how some people could be confused about why they would be asked to participate and what they could and could not do if they did get involved.”

Community members are an excellent second set of eyes – outsiders who can step into a discussion and ask for greater clarity. It is also helpful, Conrad said, to include community members from a variety of ethnic and racial groups.

“Having board members of Hispanic or other ethnic descent will definitely give you a different perspective in your approach to conducting research,” she said. “You have a clearer view of what types of research will be accepted and what will positively impact your community.”

In fact, the U.S. Food and Drug Administration regulations require that, as part of being qualified as an IRB, the IRB must have “… diversity of members, including consideration of race, gender, cultural backgrounds and sensitivity to such issues as community attitudes ….”

How It Works

On the surface, the IRB committee’s job is relatively simple. It approves, disapproves, and modifies research. Through a continual review, it monitors changes and keeps a close eye on the informed consent process, as well as the methods used to move the research forward. If members don’t like what they see, they can, as a group, suspend or terminate any previous IRB approval.

Giving protocols the go-ahead, however, is more involved than that, and the step-by-step process depends on whether the proposed protocol comes from a company or Summa itself.

Pharmaceutical companies and device manufacturers often handle much of the process before Conrad’s office sees the proposal. They reach out directly to the physician or other investigator to gauge his or her interest in assuming the principal investigator role. If, after reading the protocol, the principal investigator chooses to move forward, a study coordinator begins working on the informed consent paperwork. For the most part, companies already have existing consent forms, and experienced coordinators will edit the documents based on the small changes Summa requires to protect its patients.

“Once the application and consent form have been prepared, the companies and principal investigator submit them to the IRB,” Conrad said. “Generally, we don’t ask companies to make changes to the protocols because the study could be ongoing at 600 sites. We do focus, however, on making sure the consent forms are as clear as possible.”

IRB1 receives the documents via an electronic system and reviews the protocol to catch anything problematic that might remain.

This is where Summa has a unique and beneficial agreement with other hospitals and universities in the areas surrounding Akron and even some in other states. Under the agreement, Summa and other institutions involved in the same project can rely on each other’s protocol review instead of conducting an additional one. Such a relationship exists between Summa and all institutions associated with the Austen BioInnovation Institute in Akron, as well as Kent State University, The Ohio State University and Duke University in North Carolina.

“This type of connection makes it easier to talk with each institution first,” Conrad said. “It’s easier to get things through the IRB process – it’s easier to get agreement.”

The process for investigator-initiated ideas, however, is frequently more involved and can take up to six months to complete. Sometimes, investigators bring Conrad a yet-to-be fleshed-out idea, giving her the opportunity to offer significant guidance before too much of the study outline is in place. Others submit what they deem to be finished proposals for the committee to read and dissect.

The Approval Process

First and foremost, the committee’s main concern is mitigating risk to study participants. And, that comes in two forms – ensuring the study’s potential benefits outweigh the associated risks and requiring and verifying that study coordinators secure written consent from each subject.

“Keeping track of informed consent is an important detail,” said Deborah Barnbaum, Ph.D., philosophy professor at Kent State University and Summa IRB community member, “because the majority of Summa’s research investigations are multi-site clinical trials in either Phase II or Phase III. With that many people involved in a study, proper documentation, and getting it done correctly, is a necessity,” she said.

“In light of the Belmont Report that looked at medical ethics after the Tuskegee Syphilis Study, those of us who are involved with the IRB process hold it as our first priority to make sure people who volunteer for research studies know what they’re getting into,” said Barnbaum, who also chairs Kent State’s IRB committee. “Are the documents detailing the study’s purpose clear enough so anyone can understand it and ask the right questions?”

“Effective informed consent procedures are equally important for the community at large,” said Marguerite Erme, D.O., M.P.H., Summit County Health Department medical director and member of Summa’s IRB1. “Frequently, the public has a negative perception of medical research and an uninformed view about the people who choose to participate in studies.”

“The people who participate in research are performing a wonderful service that may provide a benefit they’ll never see,” said Erme. “But they are certainly aware of the study’s intent and what they have volunteered to do.”

Beyond perfecting the informed consent process, IRB committees check to see if the projected study sample will be adequately varied. They also look for provisions, such as a data safety monitoring board, that will monitor data accuracy and protect patient safety and privacy throughout the investigation.

For researchers trying to determine whether to submit a protocol, Conrad offers specific advice. Make sure the proposal either furthers an existing area of research or is uncharted territory. Outline the study clearly, and include as much detail as possible.

“When, as an investigator, you think you’ve added enough detail, add more,” Conrad said. “We want to know how your study will play out step-by-step. Tell us the dosages of drugs, the medications that exclude patients from participating, and tell us how long things are going to take. We want – and need – to know it all.”

The IRB chair receives all submitted protocols and then assigns two reviewers – one scientific and one nonscientific – to each study. The research also falls into one of three categories: exempt, expedited, or full-board review.

The IRB chair can deem a study exempt from further review if there is no way to identify participants based on the data collected for research. For example, a protocol using a retrospective chart review would be exempt. Research can be expedited if it calls for minimal risk to any participants and if reviewers require only minor changes to the proposal.

Investigators must submit their study outlines for full-board review if they suggest research that puts participants at more than minimal risk and involves any protected groups, such as children, pregnant women, the elderly, psychiatric patients, or prisoners. These studies are intensely scrutinized, and occasionally they give committee members pause.

Red Flags   

“We wouldn’t be a good IRB board if we didn’t sometimes have questions about whether some parts of a proposal are ethical,” Erme said. “We’ve sent some protocols back for significant revisions, and we’ve denied approval to some.”

Conrad agrees there have been occasions when parts of a study outline made the IRB committee uncomfortable. For example, any proposals that would deceive participants about the study’s intent are circumspect. Investigators must not only prove it would be impossible to achieve their goals without deception, but they must also clearly outline their plans for revealing the truth to participants.

“Problems also arise when protocols aren’t sufficiently balanced,” Barnbaum said. Investigators testing a new drug or medical device must design the study to test the unverified product against a well-understood, standard-of-care therapy. Otherwise, it is impossible to determine if the proposed treatments produce better results with less risk.

“Identifying pitfalls is a large part of why IRBs exist,” she said. “Ninety-five percent of the research we see has no problems. We’re here for the five percent that make it through the drafting process and still raise questions.”

To read the article in the original publication: http://www.thesummafoundation.org/media/11058/18979.pdf pg. 6

Saving Time, Saving Lives

Published in the Summer 2011 Summa Magazine

Software Created at Summa Helps Staff Speed Aid to Heart Attack Victims

By Whitney L.J. Howell

Last year, paramedics rushed a man in his late 40s with a blockage to his left coronary artery to Summa Akron City Hospital’s Emergency Department. He was a victim of a massive heart attack – the one frequently dubbed “the widow maker.”

“He was really as sick as you can get,” said Brenda Kovacik, R.N., cardiac care unit manager. “He was on a ventilator. We were using a balloon pump. Most people don’t survive that type of cardiac event.”

This patient did. Within a few days of his arrival, Kovacik said, he was sitting up in bed, talking and generally looked wonderful. His survival and speed of recovery are due, thanks in large part, to a new software system designed at Summa to help cardiac staff move patients through the door-to-balloon (D2B) process as quickly as possible.

Each year, according to the American Heart Association (AHA), nearly 400,000 people suffer an ST segment elevation myocardial infarction (STEMI), putting them at high risk of death. Both the AHA and the American College of Cardiology recommend healthcare providers treat these patients with a balloon angioplasty or a stent within 90 minutes of receiving the patient into the emergency department (ED). Extra minutes beyond that mean more cardiac tissue death, so truncating this time frame is highly advantageous.

Here is where the development of Summa’s STEMI computer software has made a measurable difference.

Changing the System

On average, Summa receives and treats 300 to 400 STEMI patients each year. In 2006, healthcare providers kept track of D2B performance with pencil and paper, relying on individual computational skills to keep accurate records. Kovacik noticed that, while Summa already had a fast D2B time for STEMI patients – 83 minutes – there was room for improvement. From the emergency medical technicians (EMTs) to the EKG technicians to the cardiac catheterization lab (cath lab) staff, Kovacik knew it was possible for Summa to streamline the process even more by shearing away any action that didn’t provide additional value to the patient.

“First, we had to recognize that each person along the path had an opportunity for improvement, as well as error and delay,” Kovacik said. “We broke down the process and gathered feedback from staff about what would help them increase their speed dramatically.”

At the same time, the AHA launched an initiative focused on using evidence-based research to cut D2B times nationwide, which bolstered Kovacik’s plan to help make the time savings a reality at Summa. She enlisted her husband, Mark Kovacik, a research associate in Summa’s Walter A. Hoyt Jr. Musculoskeletal Research Lab, to conceive and design a computer software system to assist in reducing the D2B time in Summa’s Akron City Hospital emergency department.

The result: a user-friendly computer interface that keeps track of the duration of each D2B step and allows nurses and doctors to pull reports about unit performance.

After implementing the system, changes happened quickly, Brenda Kovacik said. In the first year, D2B times dropped by 15 minutes. By 2010, they had fallen to an average of 48 minutes. Now, during the weekdays when all staff are on duty, the D2B time is often less than 20 minutes. The health system decided to push the envelope further and extend the time reduction efforts to the paramedics. It worked. EMT to balloon time – known as E2B – is now 56 minutes.

The time improvements are important from a monetary perspective because the Center for Medicare and Medicaid Services considers acute myocardial infarction incidents one of the core measures to determine reimbursement rates. However, that wasn’t the reason Summa decided to refine its D2B process.

“It’s more than just working to save a person’s life. If we don’t get them the proper treatment within 90 minutes, they could have continued problems after the cardiac event,” Brenda Kovacik said. “The faster we move and get the artery open, the better long-term outcomes the patient will have.”

How It Works

To be effective, a new software system must be readily accessible to users and easy to understand. According to Mark Kovacik, the STEMI software is written to accommodate all levels of computer skills and does not require any special training.

The system, which currently operates on a mainframe computer, allows staff to select the date of service. It then uses color-coded fields to record the times for all points along a patient’s journey through the hospital, such as when a patient enters the ED, when the EKG is complete and at what time the patient enters the cath lab. The patient encounters are transcribed retrospectively based on data manually recorded on the patient’s chart. Entering the data into the software system during the treatment process would cause undue delay.

Once all the times are in the system, the software automatically calculates the intervals, identifies spots where timing is sluggish and emails feedback to the patient’s healthcare providers within 48 hours. Giving feedback to staff in a timely manner is far more effective than waiting weeks to discuss performance, according to Mark Kovacik.

“Everyone recognizes that the data doesn’t lie,” he said. “And we’re not using these findings to point fingers. Instead, we’re problem solving, sometimes on a case-by-case basis. Maybe there’s a legitimate reason why some actions take longer and we can use that knowledge to make changes.”

Performance Improvements & System Benefits

Brenda Kovacik noted that some D2B timing issues were easy to identify once the STEMI software was implemented. For example, recorded data suggested having an ED-only EKG would be helpful.

“By having someone always in the emergency department to conduct EKGs, we managed to cut the time spent getting the test by 50 percent,”she said. “Without the data collected through the software system, we would not have known to make this improvement.”

Summa has seen further advances in EKG efficiency over the past year with many paramedics now performing the test on the way to the hospital, then faxing the results in to the ED. This step often allows the paramedics to make a quick stop-over in the ED before rushing the patient directly to the cath lab. It also helps EMS crews understand how big a role they play in ensuring patients receive proper care as soon as possible, Brenda Kovacik observed.

“The electronic and automated format also allows staff to run performance reports in a quicker, easier way,” said Don Noe, a research information analyst at the Musculoskeletal Research Lab who completed the now patent-pending software programming. Performance reports that once took two to three hours to create can now be compiled in three to four minutes.

“The software also removes the potential for human error,” he added. “Before we had the software, times were entered manually and staff was doing the interval calculations themselves,” Noe said. “Necessity really is the mother of invention. Now we let the computer do the math.”

According to Kenneth Berkovitz, M.D., chair of the department of cardiovascular disease and system medical director, Summa Cardiovascular Institute, creating and using the software has improved patient outcomes by uniting the staff in a common goal of enhancing both individual and group performance in cardiac care.

“This software is a really incredible tool that allows us to easily see and identify where in the D2B process we have issues with slowdown and where we have opportunities to improve,” Berkovitz said. “It’s visually powerful to see all of the data or look at a case-by-case basis to see where we’ve shaved time. We now have some of the fastest D2B times in the country and this is the tool that helped get us there.”

Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data.

Next Steps

Mark Kovacik began developing the STEMI software in 2006. It entered beta testing – testing by a limited external audience – in 2009 and officially went online in the cardiac care unit in 2010. Its resounding success prompted Summa to look toward expanding its uses.

“After a rigorous evaluation of the software, the hospital is now testing the waters to see if the system can be applied to all time-sensitive services,” he said. “The biggest immediate potential is with stroke.”

Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data. Discussion includes the possibility of hospitals across the country purchasing or licensing copies of the STEMI software, then sending their information to Summa to be housed in a main data repository.

In the meantime, Summa will continue to work toward providing the highest quality care in the fastest time possible. Future success will depend on every team player.

“Everyone needs to see how their part in the process makes a difference,” Brenda Kovacik said. “This software shows them their work is important.”

To read the story in the original publication: http://www.thesummafoundation.org/media/11058/18979.pdf pg.2

MRI Machines Becoming More Patient-Friendly

Published on the Sept. 12, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

Imagine telling your patients you can conduct their MRI in a tranquil meadow, under the ocean, or any location they find relaxing. What do you think they’d say about reading their favorite book during the scan? There’s a chance they’d be much happier about being subjected to the scan.

Patient-friendly MRIs aren’t new, but they’ve generally given you poor-quality images. There’s a new generation of machines on the market now, and they offer more room and high-resolution scans.

Courtesy of Philips Healthcare: Panaroma High-Field Open MRI with Ambient Experience.

“New scanners offer huge benefits in both comfort and quality,” said William Morrison, MD, associate radiology professor at Thomas Jefferson University Jefferson Medical College. “Some machines allow us to only focus on extremities, and others are helpful for people who suffer with claustrophobia. Newer scanners also enable us to scan larger patients.”

Arms, Legs, Wrists, and Ankles

There are times, especially if you have athletic patients, when you only need to scan a small body area, such as an ankle or wrist. In those situations, sliding a patient into a traditional MRI machine isn’t your best option, Morrison said, because image quality is poor in those areas.

Instead, extremity scanners target particular spots and produce high-quality scans.

“Patients appreciate these scanners because they aren’t stuck inside a tight-fitting tube,” he said, referring to the GE Optima MR430 scanner GE-produced extremity scanner used at Thomas Jefferson University Hospital. “It’s fantastic for people with claustrophobia, and it’s good for kids because they get to have their parent right there beside them.”

As an added benefit, it’s cheaper to run extremity scanners than traditional MRI machines, he said.

To read the remainder of the story: http://www.diagnosticimaging.com/mri/content/article/113619/1947286?CID=rss&cid=dlvr.it

Concussion Apps for Coaches and Parents: Will They Affect You?

Published on the Sept. 2, 2011, DiagnosticImaging.com Website

By Whitney L.J. Howell

If you opened a patient’s file before ordering or reading a CT or MRI scan and saw a note from a sideline coach saying the patient exhibited all the signs and symptoms of a concussion, what would you think? Would you be surprised?

You might have to get used to these notes thanks to iPad and smartphone technology. Radiology applications (apps) are becoming more common, but the concussion apps are unique. They aren’t designed for you, the radiologist.

Concussion signs and symptoms checklist from the UNC-Chapel Hill-produced concussion app.

They’re meant for coaches, trainers, and parents.

“These apps aren’t designed to diagnose a concussion,” said Jason Mihalik, Ph.D., assistant professor of exercise and sports science at the University of North Carolina at Chapel Hill. “But they do put into the hands of coaches or parents the ability to assess whether an athlete who’s been hit in the head is showing signs and symptoms of such an injury.”

Mihalik and his colleagues developed a smartphone app that presents concussion signs and symptoms as a checklist. Based on the user’s answers, the app can recommend seeking physician attention for the athlete. Cleveland Clinic biomedical engineer Jay Alberts also created an app for the iPad2 that records a baseline assessment of an athlete’s cognitive, balance, vision, and motor skills. This information can be compared to athlete performance anytime he or she sustains a head injury. Both apps offer the option to email information to a parent or health care provider.

To read the rest of the article: http://www.diagnosticimaging.com/news/display/article/113619/1941368