Be Aggressive to Boost Your Imaging Referrals

Published on the Oct. 28, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

If you’ve seen fewer and fewer physicians referring patients to your center for imaging services over the past five years, you’re not alone. The decline is a nationwide trend, and many industry consultants believe that to fortify your bottom line, you must go on the offensive.

Referrals are falling for all services – MRIs, CTs, and X-rays. The reasons are many, but one factor is consistent: money.

There are three main ways finances impact referrals, according to Deborah MacFarlane, West Coast service manager for Laguna Niguel, Calif.-based Management Services Network. Specialty providers, such as orthopedists, frequently choose to keep imaging – and the reimbursement – in-house by purchasing their own equipment. Radiology benefit management companies, through cost-control efforts, drive down imaging utilization. And, patients forgo imaging services because their insurance co-pay or deductible is too high.

“Imaging centers are now fighting for a much smaller pool of patients,” MacFarlane said. “We’ve gone from growth and educating referring physicians about how to better use imaging services and imaging centers to if you’re going to get more volume, you must take it from another imaging center.”

This is the battle currently facing Genesis Diagnostic Center in Lansing, Mich. Except, according to office manager Matt Barnum, the practice needs to woo back clients siphoned away by area hospitals. Recently, two nearby hospitals enacted contracts with the private practice offices that once sent patients to Genesis for imaging services.

To read the remainder of the article online: http://www.diagnosticimaging.com/practice-management/content/article/113619/1979119

What Does the Future Hold for Healthcare IT in Long-Term Care?

Published in the Oct. 25, 2011, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

When healthcare leaders use long-term care (LTC) facilities and health information technology in the same sentence, they’re coming from one of two points-of-view. Either the facilities are behind the curve with digital adoption or the institutions are the last sector of the market for vendors to conquer.

Regardless of the perspective, the reality is the same: long-term care facilities have not implemented healthcare information technology (HIT) strategies and solutions with the same vigor as other providers, for a variety of reasons. And now they’re playing catch-up.

“Long-term care seems to be the final mountain when it comes to healthcare technology,” says Greg Goodale, Marketing  Manager at HealthMEDX in Ozark, Mo. “Hospitals and physician practices were the early adopters, but now the focus has shifted to long-term, post-acute, and home care and hospice.”

According to a 2009 Agency for Healthcare Research & Quality HIT report, LTC facilities have encountered significant roadblocks to adopting new technology over the past decade. Today, however, they are finally beginning to upgrade their HIT systems, first purchased seven or eight years ago. While the facilities face both financial and cultural trials, Goodale says, they have the benefit of learning from the mistakes acute and tertiary care facilities have already made.

The Challenges Facing Long-Term Care

With Medicare’s 2015 meaningful use deadline looming in the distance, healthcare providers are rapidly taking steps to adopt effective HIT systems. The fire fueling their fervor is a $43,000 incentive payment if they can prove they’re using these technologies effectively. However, Medicare has left LTC facilities out in the cold.

“To not be included in meaningful use and have the opportunity to receive those incentives is a big issue,” says Siobhan Sharkey, Principal with consulting firm Health Management Strategies (HMS). “For most, it means they don’t have the money to adopt a good health information technology system and keep in step with other providers.”

Without the extra funding, many LTC facilities feel hamstrung. Others are pushed to create a piecemeal system – picking and choosing technology strategies based more on what they can afford than on what they need to improve patient care and workflow.

But sufficient financial means to purchase a modern HIT system doesn’t mean facilities are safe from facing pushback from within. Many of the physicians, nurses, or certified nursing assistants (CNAs) are wary of implementing a digital system that will largely replace the paper processes they’ve used for years. The thought of abandoning a familiar workflow produces two sentiments, says HMS Principal Sandra Hudak – intimidation and fear.

“There’s a growing sense of anxiety that healthcare is moving to something they still don’t fully understand,” she says. “They don’t have a clear idea of how the electronic systems work or how [those systems] will improve their abilities to do their jobs.”

For example, CNAs at Seton Health Schuyler Ridge in Clifton Park, NY, resisted switching to a HIT system when the facility made the move in September 2007, according to Executive Director Sandra Smith. Their unfamiliarity with computers was the main obstacle to implementation. To overcome that discomfort, administration provided significant support services during the transition and offered rewards, such as pizza parties, to units that achieved certain levels of compliance.

Even with these challenges, facility administrators recognize the trend toward electronic health records (EHRs), electronic prescribing systems, and other HIT strategies has now become a best practice. And they’re looking for efficient strategies to bring them up-to-date.

“A few years ago, there didn’t seem to be the pressure or the sense of urgency to adopt technology,” Sharkey says. “However, with new regulations and changes in payment, long-term care facilities realize they need to be part of this system and are trying to find out what they need to do.”

What HIT Offers

Stream-lining how LTC facilities share information with each other, as well as hospitals, is a paramount concern, says Kate Galambos, director of technical services for the Community Health Center Association of Connecticut, as well as an instructor in the HIT program at Capital Community College in Hartford. There are constant concerns about pressure sores, medication errors, and hospital re-admissions, so facilities should first concentrate on greasing those lines of communication, she said.

“Having data flow between facilities is so important to patient safety,” she says. “It could, hopefully, reduce the administrative burden, giving supervisors and nurses more time to actually spend with resident and supporting staff.”

To foster a fluid information chain, most HIT systems include computerized physician order entry (CPOE) and an electronic medication administration record (eMAR). CPOE immediately transfers provider orders to the pharmacy, eliminating confusion over hard-to-read, hand-written orders, and it alerts providers if they’ve prescribed a patient take a drug longer than is customary.

What makes a HIT solution most desirable and easy to navigate, however, is the personalized dashboard, says Rick Hammer, Marketing and Product Manager at SigmaCare in New York.

“The dashboard is role-based. If you’re a physician, it pulls up only the information you need. If you’re a nurse, you’ll see only what you need,” Hammer says. “That way you’re never bothered with alerts or documentation that has nothing to do with you.”

Once activated, systems can remind providers to help patients with their daily living activities, prompt them to take vital signs, and help them avoid duplicating services.

Does It Work?

Since choosing the cloud-based Care Tracker module from Cerner Corporation, Schuyler Ridge staff has seen significant improvement in how they use the patient information they gather, Smith says. The technology helps them manage the EHR, revenue cycle management, patient tracking and referrals.

“After the initial phase-in, staff began to see how important the information they had regarding resident function was to the overall care team,” she says. “Utilizing reports from Care Tracker during weekly stand-up meetings with the caregivers helped them see the care team relied heavily on this documentation and that they were part of that team.”

Since 2007, Schuyler Ridge’s pressure ulcer rate has dropped. Also, thanks to on-time reporting and the ability to easily analyze information in the records, staff can identify problems, such as weight loss, early and start the proper intervention to avoid a negative outcome.

Smith credits the efficiency and user-friendly nature of the kiosk touch-screen documentation system for the facility’s success. Not only does a digital system eliminate the habit in some LTC facilities of putting the most important care updates on sticky notes on the outside of patients’ files, but it also drastically reduces the amount of paper used in the facility.

In addition to workflow benefits, Hammer says, some SigmaCare clients have reported clinical improvements, including an 84-percent drop in medication errors and 30-percent decrease in accidents after launching a technology solution. Others have seen proper CNA documentation rise to nearly 100 percent.

An Insider’s Perspective

For Galambos, a former LTC nursing supervisor, human error is the number-one enemy of facility efficiency and safety. Transferring hand-written patient information from one form to the next provides ample opportunity for mistakes, especially when moving a patient from the LTC facility to the hospital or home care, she said. Electronic systems eliminate that possibility.

“What concerned me most was that my handwritten [forms] would serve as the sole source of information about the patient once they arrived at the hospital,” she says. “If I missed something or made an error, what effect might that have for the patient? The entire workflow was duplicative, risky and inefficient.”

HIT technology would also slice into data entry time, she says, by requiring staff to enter patient information, such as name, date of birth, or diagnosis once. Having a central record system that everyone uses also simplifies information exchange between shifts. Previously, Galambos says, she left voicemail messages and written notes for nurses on other shifts – a method both inefficient and careless with patient privacy.

Making Your HIT Strategy a Success

While HIT solutions will function in any LTC environment, only those that approach digital strategies as an investment will see significant benefits, says Goodale.

“If administrators make the decision to pursue digital strategies but then set out to find the cheapest product, they’ll have poor results,” he says. “But if they view it as a long-term investment, even in this down economy, they will see sustainable improvements in patient care, staff satisfaction and workflow.”

Facilities should also take steps to choose HIT solutions that best suit their needs, Hammer said. He recommended administrators identify workflow or patient care problems they’d like to solve before meeting with vendors and put together a team of three or four people who can pinpoint the best technology solutions. The same group should evaluate the system’s performance after a year.

All possible preparation, however, cannot replace proper buy-in, Galambos explains. Individuals from throughout the LTC facility should be onboard.

“Everyone – owners, physicians, nurses, staff – needs to be supportive. In my experience, LTC nurses tend to be negative about computers. That needs to be addressed because without the nurses’ support, the likelihood of success is diminished,” she says. “Best case scenario: The residents and families demand HIT.”

To read the article in the original newsletter: http://www.billianshealthdata.com/news/SiteNews/news_items/2011/October/LTC_HIT.html

Offering Manicures and Massages to Boost Mammogram Screenings

Published on the Oct. 24, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

The last time you performed a mammogram, your patient probably didn’t have freshly manicured nails, and she likely didn’t leave her cocktail outside the exam room door.

But many practices and hospital imaging departments nationwide are using manicures, wine, massages, and other activities to bring women in for their annual breast screenings. These so-called mammogram parties have received an extremely positive response from patients, officials said.

Since March, the diagnostic imaging department at Provena St. Joseph Medical Center in Joliet, Ill., has held a monthly mammogram party. An uptick in scheduled appointments was evident almost immediately.

“These parties have been received really well by both our patients and our technologists,” said Jan Ciccarelli, Provena’s director of marketing and community relations. “For our techs, it’s been great because the women are festive. They’re in a good mood, and it’s a great opportunity to educate them about self-exams and annual testing.”

Along with desserts and drinks, the women receive manicures, pedicures, and chair massages from graduating cosmetology students. These treats are free to the women – they’re only responsible for their normal insurance co-pay. But, Ciccarelli said, these events don’t have to cost you much either. Partnering with your hospital’s chefs and spa professionals who will volunteer their time can keep these events from impacting your bottom line.

To read the remainder of the article: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/1976076

Diabetes researchers take aim at dangerous complication: kidney disease

Published on the Oct. 18, 2011, Ohio University College of Osteopathic Medicine website

By Whitney L.J. Howell

Take a moment to consider the largest health epidemic the United States faces today. Obesity may have flashed into your mind first. But America’s expanding waistline isn’t society’s lone health danger. It’s strongly linked to another crisis—diabetes. Nearly 24 million Americans live with the disease, and physicians will diagnose an additional 1.6 million cases this year, according to the American Diabetes Association (ADA).

What’s worse is that developing diabetes increases the likelihood that a patient will experience additional complications, such as kidney disease. In fact, diabetes is the No. 1 cause of kidney failure and, based on ADA statistics, accounts for 44 percent of all new cases diagnosed annually.

This problem―diabetes-induced kidney disease, or diabetic nephropathy― has brought Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) researchers into the lab. The group studying this aspect of the disease includes Felicia Nowak, M.D., Ph.D., associate professor of molecular neuroendocrinology; Sharon Inman, Ph.D., assistant professor of renal physiology; Ramiro Malgor, M.D., assistant professor of pathology; and Karen Coschigano, Ph.D.,associate professor of cellular and molecular biology. The team is looking at the issue from various angles in hopes of learning why it occurs, how to prevent it and how to treat it.

Testing the Impact of Diet

 Type II diabetes, traditionally referred to as adult-onset, accounts for 90 to 95 percent of all cases of diabetes nationwide. A significant amount of oxidative stress—a process that produces free radicals in the body that can damage cells—is common with the disease, Nowak said, and can adversely affect the kidneys. This stress affects the nitric oxide system that controls the dilation of blood vessels in the kidney by inducing inflammation and causing constriction, which cuts down the perfusion of the kidney, leading to tissue damage and impaired function.

Together with Inman and Malgor, Nowak works with rats that are genetically bred for obesity and hypertension research to determine if introducing a diet rich in antioxidants—molecules known to protect cells from harm—can shield the kidneys in diabetic animals. A fourth member of the team, Yuriy Slyvka, M.D., Ph.D., came from the Ukraine to work for four years as a postdoctoral fellow on the project. The team’s results were published in the February 2009 issue of Endocrine and the January 2011 issue of Nitric Oxide: Biology and Chemistry. 

“One would never treat diabetes with only an antioxidant diet, but it could have clinical relevance as a supplement to controlling blood glucose and insulin levels,” Nowak said. We are also extremely interested in its potential as a proactive preventive therapy. The importance of this is underscored by the recent rise in incidence of obesity and diabetes in children and adolescents.”

With funding from the National Institutes of Health (NIH) and the Diabetes Research Initiative of Ohio University, the team divided 115 four-week-old rats into two groups, giving one the antioxidant diet and one a standard rat diet. The antioxidant diet was composed of the regular diet containing moderately increased amounts of vitamins E and C, beta-carotene, zinc, selenium, copper, and manganese. At six weeks, 13 weeks, and 20 weeks, the team tested the rats’ blood glucose levels, blood pressure, and how well their kidneys filtered waste.

To determine the diet’s effect on the rat kidney tissues, the team removed and dissected the organs and examined the pieces under a microscope, Malgor said. They treated the kidney sections with stains that highlight scarring on the organ’s blood vessels that separate urine from blood as well as any damage to kidney tissue.

The team then compared the results from each test. While results at 20 weeks showed more damage than those at six weeks, they found the antioxidant diet did provide a protective effect for one group.

At 20 weeks, antioxidant diet females had better kidney filtration than either the females eating the regular diet or any of the male rats. In addition, those females exhibited lower blood glucose levels at 13 weeks than any other rats.

Although the antioxidant diet requires further study and clinical trials to determine its ultimate usefulness, Inman said that applying the diet in humans will likely have a beneficial impact.

“We know that oxidative stress is a big factor in diabetes, and it has a deleterious effect on the kidney,” she said. “We also know that a big problem is poor nutritional education. If we can introduce an antioxidant diet, perhaps we can help people control the disease before it becomes chronic.”

Diabetes at the Genetic Level 

While outside stimuli can affect diabetic activity in the body, much of how the disease behaves depends on genetics. In a previous study, Coschigano used transgenic mice—mice genetically engineered to over-express a gene—to link the over-expression of growth hormone (GH) to the increased inflammation present with kidney damage. Her latest work, funded by the NIH, investigates how disturbing GH signaling impacts the same inflammation.

She is particularly interested in mesangial cells—specialized cells that help regulate blood flow through the capillaries in the kidneys.

“We’re focusing on inflammation genes and inflammation pathways to see if there’s any cross-talk between the growth hormone signal and the inflammatory paths,” said Coschigano, who published recent findings in an article in the October 2010 issue of Growth Hormone & IFG Research. “We want to see which path for growth hormone receptor signaling is responsible for kidney damage and protection.”

Based on her previous work, Coschigano hypothesized that mice with broken signaling below the growth hormone receptor would be protected from kidney damage. To test her theory, she used knockout  mice—genetically engineered mice that have one or more genes silenced—to specifically look at the growth hormone signaling pathway involving STAT5 proteins, members of a family of proteins that affects cell growth and differentiation. She injected mice that had both intact and disrupted STAT5 pathways with streptozotocin, a natural toxin in insulin-producing cells, inducing Type I diabetes in the animals.

Once the mice reached 11 weeks of age, she measured blood sugar levels and kidney weight—both of which were elevated in mice that had a dysfunctional STAT5 pathway. In addition, GH levels were higher in these mice. These results, she said, indicate that STAT5 plays a protective role in the kidney rather than a destructive one. Coschigano hopes to ultimately use her findings to develop targeted approaches for diagnosing, treating and preventing diabetic nephropathy.

Clinical Implications 

With diabetes currently ranked as the seventh leading cause of death in the United States, properly controlling it is a medical necessity. Patients with poorly monitored diabetes can develop additional medical conditions, including heart disease, high blood pressure and nerve damage. For some patients, the disease can progress so far that they lose a lower extremity. It’s also an extremely costly disease. The ADA reports that average medical expenditures for people diagnosed with diabetes are 2.3 times higher than those for healthy individuals.

But it’s the emotional price tag that often prompts patients to be proactive about the disease.

“Diabetic nephropathy is, in part, familial, so many diabetic patients have witnessed the consequences of losing kidney function in their relatives. They’re motivated to prevent complications and would be agreeable to implementing this or other therapies,” said Alicia Parks, D.O. (’05).  “So, the possibility of ameliorating the effects of diabetic nephropathy with an antioxidant-rich diet is very exciting.”

Parks focused on diabetic nephropathy in her second fellowship. She investigated ways to identify diabetic patients at risk for progression to overt kidney disease.

“There’s still so much to learn about diabetes and its complications,” she said. “We need to keep investigating the mechanisms underlying kidney disease in diabetes, the prevention of diabetic nephropathy and the best approaches to treatments.”

To read the article at its original site: http://www.oucom.ohiou.edu/News/stories/DiabeticNephropathy/index.htm

Academic Medicine, Industry Collaborate on Better Partnerships

Published in the October 2011 AAMC Reporter

By Whitney L.J. Howell

Partnerships between academic medicine and pharmaceutical and device makers are increasingly seen as beneficial for progressive bench-to-bedside research. Medical schools and teaching hospitals have ramped up initiatives to release information on faculty relationships and help faculty navigate these murky waters.

Over the past several years, corporate support of medical research conducted by academic institutions, including medical schools and teaching hospitals, has attracted increased public and congressional scrutiny for potential financial conflicts of interest. As a result, new guidelines are emerging on how to manage these alliances.

The National Institutes of Health (NIH) last August released its final rule on conflicts of interest in federally funded research that provides a framework for identifying and managing an investigator’s potential conflicts. AAMC President and CEO Darrell G. Kirch, M.D., called the final rule, “an important step forward on the path to strengthening the integrity of biomedical research through enhanced requirements for disclosure and transparency.”

On the industry side, companies are changing their practices, including how they invest in academic research. For example, in June, Pfizer announced a $100-million investment for drug discovery at several Boston-area facilities, including Partners Healthcare, Tufts University School of Medicine, and the University of Massachusetts Medical School.

Pfizer has formed similar partnerships with the University of California, San Francisco, and with seven medical centers in New York City.

The ultimate goal of these kinds of partnerships according to Michael Rosenblatt, M.D., executive vice president and chief medical officer at Merck, is to create genuine, mutually beneficial partnerships, as well as an environment in which the investigations that industries need are conducted in an ethical and scientifically sound manner.

“The most important thing for both sides to understand is that they both bring essential pieces to the collaboration,” Rosenblatt said. “Without that realization, they will not succeed.”

The interest in bolstering these relationships springs from two changes affecting the medical world, said Lans Taylor, M.D., director of the University of Pittsburgh Drug Discovery Institute.

“In the face of spiraling research and development costs, the historically large revenue producers for pharmaceutical companies will be coming off patent in the next few years, and the pipeline for new drugs is relatively dry,” Taylor said. “And academic medicine has its own financial worries, as federal funding is becoming harder to secure.”

The discovery institute employs a milestone approach to funding. External companies now issue funding after yearly reviews, instead of providing lump-sum grant payments, Taylor said. If investigators have not made sufficient progress during the year, the company can fund new projects.

A major concern for academic medicine and industry is intellectual property, said Lawrence Botticelli, Ph.D., chief business officer for Tufts University Institute for Biopharmaceutical Partnerships, which currently has partnerships with several companies and offers a searchable Web clearinghouse that matches industry interests with appropriate faculty.

In the past, Botticelli said, individual investigators usually negotiated agreements alone, which sometimes allowed industry to claim sole ownership of all data and analyses associated with the research. To eliminate this possibility, Tufts handles negotiations on investigators’ behalf. The strategy helps faculty identify opportunities and safeguard the medical school.

“It’s important to have a clear description of which responsibilities lie with industry and which lie with the university,” he said. “What happens to the intellectual property must be written out, and each party must know what the agreed-upon rights are.”

Even with these changes in place, there is no guarantee these relationships will be bona fide partnerships, said Howard Brody, M.D., Ph.D., director of the Institute for Medical Humanities at the University of Texas Medical Branch-Galveston. Brody, who wrote the book, Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, warned that the public does not have a clear understanding of the issue, and until it does, medicine and industry will continue to battle against a lack of public trust.

“Industry cannot simply say, ‘Trust us,’” Brody said. “They must demonstrate how these relationships are balanced and how they are based in the advancement of science. At the same time, the U.S. taxpayer must understand they can’t get their science on the cheap. They can’t have tax cuts and state and federal budget cuts that slash research funding.”

Succeeding in this new playing field requires much from both academia and industry, said Barbara Barnes, M.D., the University of Pittsburgh Medical Center’s vice president of contracts, grants, intellectual property, and continuing medical education. All researchers must receive research integrity training and participate in educational discussions about fair relationships.

“Both parties must set objective timelines for projects and set realistic milestones,” she said. “It’s also extremely important to establish good communication. To be successful, you must really understand each other.”

According to Heather Pierce, J.D., M.P.H., AAMC’s senior director of science policy and regulatory counsel, the association is helping medical schools and teaching hospitals identify ethically sound practices for these interactions.

“The AAMC is creating tools to help institutions find their way,” she said. “There’s no one-size-fits-all guideline, but we’re providing assistance to ensure they’re working together toward effective, safe treatments that will improve patient care and the health of patients and populations.”

To read the story on its original site: https://www.aamc.org/newsroom/reporter/october2011/262392/partnerships.html

MRI Safety Concerns Prompt FDA Meeting

Published on the Oct. 13, 2011 DiagnosticImaging.com website

By Whitney L.J. Howell

In recent years, speculations about imaging safety have swirled around the long-term effects of CT scans. But, industry leaders are hoping to now turn the water cooler conversation toward making MRI safer for both you and your patients.

Even though MRI scans themselves are widely considered to be extremely safe, data from the FDA Manufacturer and User Facility Device Experience database reveal patients and providers are sustaining injuries during the MRI process. In fact, from 2004 to 2009, the number of injuries spiked four-fold to 193 accidents.

Whether more accidents are really occurring or injury reporting is on the rise is up for debate among radiologists. But the trend is concerning enough to prompt the FDA to hold a conference later this month to examine the biggest MRI safety concerns and discuss best practices to truncate the number of incidents.

“There are increasing numbers of MR scans and an increasing demand to scan patients with implants or accessory medical devices and other equipment. With the increased use, we are also seeing a number of preventable incidents,” said Sunder Rajan, PhD, of the FDA’s Center for Devices and Radiological Health Division of Physics Biophysics Laboratory. “Given the new experience base, this is a good time for FDA to learn what MR practices are being used and what changes practitioners feel would improve safety to the MR environment.”

The Main Concerns

MRI accidents and injuries fall into three main categories: thermal burns, projectiles, and hearing loss in poorly protected patients.

According to Tobias Gilk, president and MRI safety director at Mednovus and senior vice president at the design and architecture firm Rad-Planning, thermal burns pose the greatest risk to patients because they are associated with a relatively recent technology advancement – gradient improvements that allow for better image quality and scan efficiency.

“Burns are a newer safety issue that have grown out of the advancement of stronger, faster gradients,” Gilk said. “Moving to a stronger magnetic field from 1.5T to 3T makes it necessary to use more radiofrequency, increasing the chance that a patient will be burned.”

In addition, ferromagnetic objects in the MRI suite also pose a real danger to patients and providers. The 2001 Colombini case in which a 6-year-old boy died when an oxygen tank flew across the room and struck him during his imaging procedure brought this risk possibility industry-wide attention.

Although these incidents are rare, they are expensive. A U.S. Department of Veterans Affairs’ Center for Patient Safety study found that each occurrence costs more than $43,000, accounting for MRI machine repair, injury treatment, and legal costs. It doesn’t, however, take into account lost revenue due to an inoperable MRI machine.

Regardless of the reason, Emanuel Kanal, MD, director of magnetic resonance services at the University of Pittsburgh Medical Center and chair of the American College of Radiology (ACR) MR Safety Committee, said you must still take precautions to prevent projectile accidents.

“The most serious incidents, albeit quite rare, involve projectile effects,” he said. “These need to be addressed if we are to significantly lower the incidence of MR-safety relative adverse events.”

Unfortunately, there are no regulations that require proper identification of materials unsuitable for being in a MRI suite, Gilk said. And, sometimes it’s the MRI suite itself that creates the risk. When it comes designing a new suite, he said, many office architects look at a prototype design and implement it without taking the unique factors of the hospital or physician office into account.

To read the remainder of the article: http://www.diagnosticimaging.com/mri/content/article/113619/1970950

Radiology Associations Call for Congress to Ignore BCBS Plan

Published on the Oct. 13, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

The Blue Cross Blue Shield Association plan unveiled last week that touches on advanced imaging services has industry leaders up-in-arms, calling for Congress to leave plan-of-care decisions between doctors and their patients.

In a move that would shift the healthcare system away from fee-for-service to a patient-centered model, this proposal would require prior authorization for advanced imaging services. Some economic analyses estimate the measure could save $319 billion over the next decade.

However, many in radiology say there is no proof that adding this step as a blanket measure will produce any benefit. In fact, they say, the change would affect not only radiologists, but it could also delay treatment options for older patients who rely heavily on imaging studies for diagnoses.

“No evidence exists that mandating prior authorizations for medical imaging will actually result in any cost savings,” said Tim Trysla, executive director of Access to Medical Imaging Coalition (AMIC). “And requiring it for services that the Medicare program already covers for seniors will only result in denial or delay of services.”

To read the remainder of the story: http://www.diagnosticimaging.com/practice-management/content/article/113619/1970868

 

C-Suite Struggles to Find a Fit for Nurses with Higher Degrees

Published in the October 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Nurse practice doctorates look for executive support to influence change

Health care, thanks to reform efforts, has become a cohesive team sport. Hospitals need providers at the top of their game, but the emergence of one professional has some administrators scratching their heads about the best way to put these individuals to work.

From 2009 to 2010, the number of graduates from doctorate of nursing practice programs nearly doubled to 1,300, according to the American Association of Colleges of Nursing. After completing the degree, these nurses apply science and research to improving patient care and health systems performance.

C-suite executives have noticed the advanced skill set associated with the DNP, says Mary Terhaar, R.N., interim director of the Johns Hopkins University School of Nursing’s DNP program. But many still grapple with maximizing these nurses’ capabilities.

“CNOs, CEOs, and CFOs know DNPs can find signals pointing toward something actionable to address problems or enhance best practices,” Terhaar says. “Many just don’t know how to put a DNP in that position.”

Returning a DNP nurse to his or her previous job isn’t enough, however. For these nurses to enhance patient care or improve workflow, hospital administrators must provide resources, she adds. DNPs need data, clear directives on problems to attack, an infrastructure conducive to transprofessional collaboration, time during the workweek to pursue projects, and a publicly supportive C-suite champion.

For some hospitals, though, reaching this goal can be difficult.

“The DNP is so new many hospital administrators don’t really understand what it is and what these nurses can do,” says Mary Chesney, R.N., clinical assistant professor in the University of Minnesota School of Nursing. “As we move toward accountable care organizations and patient-centered medical homes, the DNP can make this transition more successful.”

With proper support, DNPs can affect noticeable change in their hospitals, says Judy Pechacek, vice president of patient care at Minnesota’s Fairview Southdale Hospital. One of Fairview’s DNPs analyzed obstetrics protocols and improved delivery outcomes associated with vacuum-assisted births.

Additionally, some DNPs have employed their skills to move into administration. Valerie Overton leveraged her education from enrollment to graduation this January from UMSON. She secured medical home certification from the Minnesota Department of Health for Fairview’s 40 clinics by designing a system to integrate all care provider services. Her work took her from nurse practitioner to a vice president of quality role.

She recommended that administrators actively work to understand what DNPs offer.

“Ask a DNP to show you his or her toolkit,” Overton said. “Once you see the value of these skills, you’ll see how they can apply to future projects.”

To read the original story: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/10OCT2011/1011HHN_Inbox_nursing&domain=HHNMAG

Specialized Social Networks Connect Radiology Community

Published on the Oct. 6, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

Social networking in healthcare isn’t new, but there is a growing trend to create groups focused on particular specialty areas. And radiology is in the middle of it all.

The American Society of Radiologic Technologists (ASRT) recently launched ASRT Communities, a social networking site specifically for radiologic technologists who want to connect professionally and share experiences. The network offers 19 communities devoted to individual modalities, and each gives medical imaging professionals, radiation therapists, and radiology students information about radiologic disciplines.

Members can post questions, start conversations, or share ideas on what the association calls its “one-stop-knowledge-shop,” said Liana Watson, ASRT’s chief governance officer.

“The goal is to give ASRT members a place where they can come together and talk with someone who does the exact thing they do,” Watson said. “CT techs can talk with CT techs. MRI techs talk with MRI techs. It’s a one-stop shop where they can get information relevant to what they do every day.”

Participants choose one community to be a home page, but they can contribute to all 19 groups, Watson said. In addition to comparing opinions about cases, ASRT Communities provides access to news affecting the radiologic technology profession and links to certification and accreditation sites.

Nearly 30 percent of physicians connect professionally through online physician networks, according to a survey from QuantiaMD, the largest mobile and online physician community. Specialized social networks hold great potential for enhancing professional development and performance, said Garry Choy, MD, a Massachusetts General Hospital radiologist.

To read the article in its entirety: http://www.diagnosticimaging.com/practice-management/content/article/113619/1965360

Ergonomic Designs Make Imaging Workstations More Comfortable

Published on the Oct. 4, 2011, DiagnosticImaging.com website

By Whitney L.J. Howell

Aching hands and a sore back are familiar ailments for many of those working in a digital imaging department. However, there is a trend among radiology practices and hospitals to provide workstations that are far more comfortable.

Over the past few years, industry vendors have taken great pains to produce ergonomically designed imaging tables and chairs and workstations. The goal is easing the physical stress of repetitive motions associated with

Echo Pro echocardiography ergonomic table from Biodex

performing and reviewing imaging tests, as well as chronic conditions such as carpal tunnel syndrome and tendonitis.

“There are some sonographers who suffer career-ending injuries because they don’t have comfortable workstations,” said Richard Schubert, product manager of imaging tables at design company Biodex.

In a 2008 study published in the Journal of the American College of Radiology, Phillip Boiselle, MD, reported 58 percent of radiologists at Beth Israel Deaconess Medical Center experienced repetitive stress injury symptoms associated with their work. The study also determined 70 percent saw symptom improvements after using an ergonomic chair, and 80 percent had the same experience after switching to an ergonomic workstation.

“Repetitive stress symptoms are highly prevalent among radiologists working in a PACS-based environment but are responsive to ergonomic interventions,” Boiselle and his colleagues wrote. “Radiology departments should implement ergonomic initiatives to reduce the risk for repetitive stress injuries.”

To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/1962878