Patient Steerage Could Harm Radiologists, Confuse Patients

Published on the April 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

As implementation of the Affordable Care Act continues, all sectors of the healthcare industry are being called upon to increasingly rein in costs. For many insurance providers, patient steerage has proven to be an effective strategy. But the impact on radiology has been largely negative, industry experts said.

Patient steerage in radiology occurs when outside forces — usually insurance providers — actively direct patients or physicians to lower-cost radiology practices. And, this strategy is becoming more prevalent nationwide, said Geraldine McGinty, MD, chair of the American College of Radiology’s (ACR) Commission on Economics.

“Our feeling is that as radiology benefit managers have maxed out on the initial imaging volume savings they can offer to clients, so they’ve started participating in programs to drive patients to facilities where the payers have negotiated lower reimbursement rates,” she said. “Recently, it’s been more aggressive due to increasing involvement of patients as they take on more responsibility for their care through higher-deductible plans.”

In fact, according to an informal survey by the Radiology Business Management Association (RBMA) in September 2012, 65 percent of respondents reported experiencing active patient steerage from either radiology business management (RBM) groups, payers, or both. With active steerage, payers give patients incentives, such as gift cards, for choosing lower-cost providers. In addition, 47 percent confirmed the presence of passive steerage — simply making cost differential data available to patients and providers.

However, patients are also driving a certain level of steerage. A recently-published joint ACR-RBMA paper credits high-deductible insurance plans and patient cost awareness with some patient redirection.

What Payers Are Doing

While not all payers have patient steerage programs, many do. For example, in September 2011, Anthem Blue Cross Blue Shield in Ohio implemented a steerage program for imaging services through which company representatives called patients in attempts to redirect them toward lower-cost providers. Within nine months, more than 3,500 patients had been called and steered to different imagers.

In addition, WellPoint launched a passive steerage campaign with OptiNet, an Internet portal through which referring physician were encouraged to schedule patients with lower-cost imagers. When referrers largely ignored this resource, however, WellPoint enlisted RBM company American Imaging Management (AIM) to call patients directly. According to AIM marketing director Ana Perez, nearly 20 percent of patients chose lower-cost imagers in response to the phone calls.

Other payers, such as UnitedHealthcare, also provide radiologist cost information, but they do not actively contact patients. Still other payers successfully steer patients by classifying certain providers as out-of-network in a patient’s insurance plan.

The Impact of Patient Steerage

The increasingly prevalence of patient steerage can potentially impact practices and departments on a variety of levels, McGinty said. According to the ACR-RBMA paper, she said, radiologists should be aware of the three main ways patient steerage can affect everyday practice.

1. Daily operations: When payers redirect patients, providers can lose any time they’ve already spent in the pre-authorization process. They can also experience productivity dips , and if they don’t know patients have been steered elsewhere, they  could face vacant or missed appointment slots. Imagers could  also be asked to answer patient and provider questions about any steerage and why it occurred. Overall, up to 82 percent of RBMA survey respondents indicated steerage decreased their patient volume. However, some respondents — about 14 percent — actually saw volume increases due to patient steerage.

“The big item will be the loss of business, and virtually every practice is looking at a decrease in volumes,” said David Levin, MD, a radiologist with the Center for Research on Utilization of Imaging Services at Thomas Jefferson University. “It’s not like in the early 2000s when volumes were growing like crazy and it wasn’t a problem if we lost a little business because insurance steered our patients elsewhere. No one feels that way anymore.”

2. Legal issues: When payers actively steer patients to lower-cost imaging centers and away from a referring physician’s initial suggestion, they open themselves up to potential medical liability if findings, such as a lung cancer, are missed. In addition, legal action can also be launched against the chosen imager, the imager’s corporation, and the RBM. It’s also possible, especially with active steerage, that these activities violate the federal anti-kickback law that forbids any payments or solicitations that influence patient health decisions.

According to the ACR-RBMA paper, radiologists could also assert payer-directed steerage impedes their legal right to practice, defames their professional reputations by listing them as lower-tiered providers, or violates any existing contracts they have with facilities to receive a certain amount of referrals.

3. Provider relationships: Any payer-directed steerage can disturb existing healthcare relationships, McGinty said. Referring physicians often have a small cadre of imaging providers, chosen for their levels of quality and service, to whom they send patients. Redirecting patients to different imagers can damage long-term provider partnerships and can impose on referrers the additional cost of transferring all patient records to a new imager. Any instances of incomplete reads prompt the need for a second radiological opinion. And, the radiologists providing the second read do not receive reimbursement.

Impact on Patients

While survey data exists to support the negative effect steerage has on providers, the verdict is out on how much payer redirection influences patient care.

The ACR’s biggest concern, McGinty said, is that steerage can confuse patients.

“Patients build relationships with their physicians over time, and they value their doctor’s advice and guidance,” she said. “We don’t want to see those relationships disrupted or see patients’ confidence shaken when it’s suggested they see an imager their doctor didn’t recommend.”

It’s also paramount, she said, to make it clear to patients that payer recommendations are only cost-based suggestions. Many patients are unaware they have a choice to simply pay a higher fee for seeing the imaging provider chosen by their referring physician.

Payer steerage also increases the risk that patients will be sent to a facility without ACR accreditation. But that risk is small, Levin said, adding that ACR accreditation ensures a certain level of service quality.

“I don’t think steerage will impact patient care that much. People will get scans if they need them even if insurance companies steer patients to places they think are more affordable,” he said. “It’s not as if there’s a huge variation in quality so that if you go to my hospital you’ll get a great scan, but if you go to the hospital down the street, you’ll get a lousy one.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/patient-steerage-could-harm-radiologists-confuse-patients

Enterprise Imaging: Beyond Cloud-based Image Sharing

Published on the April 8, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Zero-footprint viewers. Vendor-neutral archives. Image mobility. Individually, they are helpful tools to radiology and becoming more ubiquitous. But together, they help create a cohesive enterprise imaging strategy.

Enterprise imaging (EI) isn’t a particularly new idea, but to date, it has been largely misunderstood, industry experts say. It’s more than simply implementing new technology. And, achieving the full benefits EI can provide will require both sophisticated software and provider engagement.

“Enterprise imaging is a hot topic, but there’s a big misconception around what we mean by it,” said Paul Chang, MD, University of Chicago School of Medicine’s enterprise imaging medical director. “Enterprise imaging is a much broader, more complex problem when you take the enterprise perspective rather than the silo perspective.”

What is EI?

Put simply, the goal of an EI strategy is to ensure the correct image is delivered to the right place at the appropriate time. It has the potential to fundamentally change how facilities, providers, and patients interact with diagnostic images. Reaching that goal, however, requires a great deal of collaboration, Chang said.

According to a 2012 KLAS report, many facilities are already moving in that direction. Of the 134 providers surveyed, most reported being in early EI stages. To create a fully integrated EI system, Chang said, these facilities and others must address five factors that affect how the healthcare system currently views and uses diagnostic images.

1. Archive architecture. For many providers, EI simply means implementing a vendor neutral archive (VNA), an archive-neutral vendor, or using a zero-footprint viewer, all methods for easily sharing images within the facility and off-site. However, the archive is only one part of a successful EI strategy, albeit an important component. It’s important, Chang said, to free radiology departments and practices from being tethered to one PACS, but identifying and employing an effective VNA is largely an IT responsibility.

“VNAs and zero-footprint viewers are just the middle wear that links commodity storage to the application layer,” he said. “We’ll do it, and we’ll go to the cloud. But it’s all buzzwords and plumbing. That’s designing the car. Now radiologists have to learn how to drive it.”

2. Multiple creators and consumers. Radiologists are no longer the only specialty that produces and uses diagnostic images. Today, cardiology, gastroenterology, pathology, and several other departments rely on imaging to provide proper patient care, so facilities must have a streamlined way to distribute scans throughout the health system.

“To do this right, you do need the architecture of a VNA or archive-neutral vendor, but there’s a bigger concept behind enterprise imaging,” Chang said. “This view is the realization of the modern enterprise that it must deal with both consumers and producers of images simultaneously throughout the hospital — not just radiology.”

 3. Ubiquitous electronic health records (EHR). The concept of an EHR isn’t new to radiology, an industry that has used PACS and RIS for many years. But now, meaningful use requirements are calling upon the specialty to interface seamlessly with patients’ records through an entire health system. Consequently, according to KLAS imaging research director Ben Brown, all new systems must be interoperable. It will be up to a facility’s IT department, Brown said, to create an infrastructure that manages and stores PACS, maintain a patient index to ensure proper patient identification, and determine how long images are stored.

4. The enterprise concept. Years ago, when radiologists discussed “the enterprise,” the term referred to anyone outside the department who still worked within the hospital’s firewall. But as health systems have expanded and more specialties have become image producers and consumers, the definition of “enterprise” has expanded, Chang said. Radiology groups have consolidated, many facilities within the same system are separated by hundreds of miles, and providers are now required to read scans for multiple hospitals.

The logistics of moving images from one facility to another aren’t difficult — the real challenge comes in coordinating the workflow needed to properly use transferred scans. According to Rasu Shrestha, MD, MBA, a University of Pittsburg Medical Center radiologist, however, the potential exists, for EI to have a significant positive impact on work  flow management.

“[EI] allows for a patient-centric approach to care versus an image- or application-centric approach,” he wrote in a 2012 Applied Radiology article. “It allows for the possibility of true collaboration among care teams, which would bring the value of imagers back into the spotlight.”

5. Tying it all together. The real challenge behind effective EI, Chang said, is to fuse the needed technology with the proper workflow perspectives. But it can be helpful, he said, to consider that EI is less about imaging and more about radiology’s need to re-invent itself as healthcare enters a new chapter of value-based purchasing.

“The concept of enterprise imaging is a proxy or code word for having to re-engineer a more useful, comprehensive workflow solution for a more complex enterprise,” he said. “It’s better not to talk about enterprise imaging but talk about re-engineering ourselves so we can continue to add value.”

How can you plan?

It’s no longer a question of whether EI is right for your practice or department. Radiology’s move toward EI is clear, and it’s up to you to determine how you will navigate these new waters. There are many moving parts with this imaging strategy, Chang said, but you can outline your course of action by remembering one question: “What is the role of radiology or the radiologist in this decision?”

For example, as the end-user, you can — and should —tell your IT department what you need out of a VNA, but don’t expect to be included in any purchasing decisions. The facility’s chief financial officer and chief information officer will make that determination, he said.

You will, however, have a greater role — alongside cardiologists and other providers — in determining how the VNA architecture will support your needs and workflow. In addition, you must make it clear to your hospital administrators and IT department that any EI system must offer interoperability for the strategy to succeed, said Robert Barr, MD, president of Mecklenburg Radiology Associates in Charlotte, N.C.

Through interoperability, he said, his practice — which has been using EI for several years — is able to quickly migrate images between all subspecialties, streamlining patient care and facilitating greater access to patient records.

Your biggest role, however, will be in providing evidence that supports the true value you bring to your facility. Your worth is no longer tied solely to the number of interpretations you produce daily, Chang said. You must now demonstrate your impact on patient outcomes, population management, and down-stream resource utilization and cost control.

“In the fee-for-service environment, we could be selfish and insular in our thinking. We floated everyone else’s boat,” he said. “But now we’re a cost center, and every CT you order better be worth it. Justify it, and demonstrate its positive impact.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/enterprise-imaging-beyond-cloud-based-image-sharing/page/0/1

Radiology Data Registries: Know How to Comply

Published on the March 14, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

The number of radiology practices and departments looking to benchmark themselves against their peers through data registries is growing. But many still need guidance on what these databases are and how they can correctly participate.

For years, your practice or department has likely followed its own protocol for diagnostic scans, using what you felt were best practices for radiation doses, for example. According to industry experts, data registries are pathways to double-check yourself and ensure what you’re doing provides the best care to your patients.

“These registries are effective in the promotion of quality improvement changes and changes in high-quality health,” said Cynthia Moran, assistant executive director of government relations, economics, and health policy at the American College of Radiology (ACR). “The use of registries is so that people can see where they are in the performance metric.”

Although the ACR Dose Index Registry has received the most attention recently, seven additional registries exist — CT colonography, general radiology improvement, IV contrast extravasation, mammography, oncologic PET, night coverage, and quality improvement for CT scans in children. Together, these registries comprise the ACR National Radiology Data Registry (NRDR).

By providing data to a registry, you’re contributing to the body of information that will be used to craft future best practices guidelines. According to Moran, these registries also make it easy for you to compare yourself to your peers.

“If you provide data to a group or registry, you periodically get a report to see where you stand respective to your other colleagues,” she said. “If your numbers are far off from the performance of others, you can create a process to see what’s wrong and how you can do better for your patients.”

While data registries are most often lauded for improving the quality of care available to patients,  they do make a more direct impact on radiology practices, said Judy Burleson, ACR’s director of quality and safety metrics.

“When quality improvement and quality reporting programs are used in combination with reimbursement mechanics, it enables payers — private or Medicare — to pay for services for their beneficiaries based on quality rather than fee-for service,” she said. “When you integrate a quality program within payment structures, you’re inserting and element of value there.”

Ensuring Compliance

To participate in any registry within the NRDR, your practice must complete a participation agreement. Not only does this document outline the specific registry or registries in which you want to enroll — it isn’t required that you participate in all registries — but it also mandates that you have the proper privacy protocols in place to protect the patient data you collect and submit.

There are also other rules you must follow, Burleson said.

“To be in compliance with a clinical data registry like the ACR registries or specialty society registries, practices just need to submit specific data elements in the format that’s required,” she said. “This could be problematic for some sites that must figure out the best way to get this data and from where to find it.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/articles/radiology-data-registries-know-how-comply-0

Taking the Pulse of Mobile Health

Published in the March 13, 2013 Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

It’s no secret the healthcare industry is going digital. Electronic health records, health information exchanges, and Web-based patient portals are becoming ubiquitous features in nearly all clinical environments. But the fastest, most widely adopted digital push, according to healthcare industry experts, has undoubtedly been in mobile health.

Frequently referred to as mHealth, this phenomenon is the practice of medicine and public health through mobile devices. And, in the great scheme of healthcare developments, mHealth is relatively new. However, it’s already proving to have a large and growing impact.

Consulting firm PricewaterhouseCoopers predicts that by 2017, mHealth will post revenues of $23 billion, with $6.5 billion coming from North America. It’s anticipated that, by that time, nearly two-thirds of the market will be dedicated to remote monitoring of chronic disease.

Although most insurance plans still don’t reimburse physicians for mHealth activities, the healthcare industry is already seeing the cost savings associated with these tools. According to a 2012 Benton Foundation study, mHealth improved medical productivity by $11.2 billion just in 2011. Those gains are expected to reach $305.1 billion by 2022.

The proliferation of mHealth, however, isn’t simply about boosting a health system’s bottom line. Ultimately, it’s about the industry’s end user – the patient.

“One of the big issues facing the healthcare system that isn’t often discussed is the sense of patient empowerment and involvement in their own healthcare,” said Jay Yadav, President and CEO of CardioMEMS, a medical device company specializing in wireless sensing and communication technology. “We all know that if you feel pushed along in an assembly line, your behavior will be quite different than if you’re engaged and have some charge over your care.”

The ultimate goal, he said, is to give patients a sense of ownership over the care they receive, while giving providers effective tools and good data that will enhance the care they provide.

Provider Enthusiasm
Providers aren’t being shy about adopting mobile technologies. According to the 2^nd Annual Health Information and Management Systems Society (HIMSS) Mobile Technology Survey, 93 percent of providers use mobile technology in their daily activities, and more than 60 percent use third-party apps.

But while on-the-go providers are naturally attracted to mHealth technology, the real driving force behind this mobile care trend is patients themselves. In fact, according to a Deloitte study, the number of mobile device users who downloaded at least one mHealth app doubled between 2011 and 2012.

A 2009 Brookings Institution study found that roughly 75 percent of patients nationwide want email appointment reminders, want to schedule appointments online, and want email contact with their doctors. Another 67 percent would prefer to see their diagnostic test results via email, and 57 percent would use a home monitoring device, such as one that transmits blood pressure readings.

Patients are also accessing information on their own. According to the 2012 Pew Research Center Internet & American Life Project, more than 30 percent of patients use their cell phones to research health information. And, GlobalData reports, more than 70 percent of health and wellness mobile apps target patients.

Consequently, according to Jonathan Dreyer, Director of Mobile Solutions at Nuance, the mHealth industry will play into those patient preferences through 2013. For example, more apps and mHealth technologies could use “gamification” – the use of interactive games that teach health information – as a way to reach patients.

“Patients simply want more responsibility over their own health, so we’re likely to see more patient-focused apps, such as health games, fitness and nutrition apps, and wellness tools,” he said. “In all likelihood, 2013 will likely see a great focus on making this technology more accessible and easier for patients to use.”

Payers are already on-board, as well. The Deloitte study reported that many encourage their customers to use mHealth technologies to monitor chronic conditions and share information with their providers. They also support using mHealth as a means to report and share information about facility and provider care quality.

Regulatory Hesitancy
Although mHealth is popular, it isn’t devoid of challenges. Mobile and smartphone technologies can be easy to use, but they have proven difficult to regulate because working with these types of developments is uncharted territory. The Food and Drug Administration (FDA) has grappled with how to ensure mHealth tools are both safe and beneficial.

So far, the agency has ventured timidly into mHealth regulation. In 2011, it published draft guidelines, focusing specifically on how effective mobile devices are in reading diagnostic scans. Its next step came in February 2012, when the agency acknowledged in the Federal Register that patients now have access to medical screening and diagnostic mobile apps. Official regulatory guidelines are still pending, but industry experts anticipate the FDA will claim regulatory authority over these types of apps.

One member of Congress is also trying to help the FDA augment and fine-tune its mHealth capabilities. Michael Honda, D-Calif., introduced the Healthcare Innovation and Marketplace Technologies Act in December 2012. If passed, this legislation would create a wireless health technology office within the agency, launch a support program in the Department of Health and Human Services to help mHealth developers ensure their technologies meet current privacy standards, and establish a tax incentive program for providers to deduct the cost of many health information technology systems. The bill has been referred to the Subcommittee on Health, but, to date, no vote is scheduled.

As of press time, lawmakers on the House of Representatives’ Energy and Commerce committee will conduct a three-day series of hearings in mid-March to better understand how the FDA should regulate mHealth apps on smartphones and tablets. According to the Washington Post, they plan to focus specifically on how regulation may affect patients, providers and developers looking to capitalize on this growing market.

What’s Out There?
The market, however, isn’t waiting for the FDA to craft its rules. Patients and providers alike already have unfettered access to mHealth tools that augment healthcare delivery.

So far, these tools are mostly remote monitoring technologies that help patients keep track of their own chronic conditions, such as congestive heart failure, pulmonary disease or diabetes, and digitally send information to their providers. Their intent is to improve patient outcomes, but a May 2012 Brookings Institution report revealed they could also save the healthcare industry nearly $197 billion in U.S. healthcare spending over the next 25 years.

For example, more than 24 million Americans live with diabetes, and more than 11 million of them use home glucose monitors, such as the GlucoPhone. This device, manufactured by HealthPia, reminds them to test their levels, keeps track of the results, and sends the information directly to caregivers.

Some chronic conditions, however, require a more intensive level of monitoring, said CardioMEMS’ Yadav. To provide that level of data collection and care, CardioMEMS has developed a two-part sensor – a wireless implantable sensor and an external monitor – to keep tabs on a patient’s heart function and eliminate the need for repeat heart catheterizations.

“This technology gives doctors the same kind of cardiac catheter information without actually having to do the procedure,” he said. “It gives doctor’s precise information tied to the patient’s heart disease from inside the body, and they can interpret it.”

In addition, providers have instant, real-time access to this patient data. Through a desktop graphical user interface, doctors and nurses can see how a patient is doing. That information – their blood pressure, heart rate and cardiac output – then feeds directly into the facility’s EHR.

mHealth solutions are also being used to combat substance abuse. Researchers at the University of Massachusetts Medical School developed iHeal, a remote-monitoring device that senses the changes in skin temperature and nervous system activities linked to drug cravings. This data, along with self-reported stress levels, helps providers offer text, video and audio interventions when needed.

These tools are also demonstrating that they can directly impact the day-to-day function of the health system. If a patient near New Hampshire’s Portsmouth Regional Hospital needs medical attention, he or she can text “ER” to a specific number to receive the estimated ED wait time.

Effect on Providers
The benefits of mHealth don’t stop with patients. They extend to healthcare providers of all types, as well, directly impacting the quality of care.

It has been documented that physicians using mobile devices read medical test results more quickly, have better data management and record-keeping skills, and make fewer medication errors at discharge.

These tools also help nurses avoid errors. A 2011 Nurse Educator study reported 16 percent of surveyed nurses said a hand-held device helped them avoid at least one clinical error, and 6 percent credited the tools with helping them to avoid making multiple mistakes.

To meet these provider needs, AT&T launched its mHealth platform, said Geeta Nayyar, MD, the company’s Chief Medical Information Officer.

“At a high level, there are so many connection points in healthcare that are lacking,” she said. “Patients see a primary care doctor, or a specialist, or they go to the emergency room, but there isn’t a streamlined way to communicate between those positions or facilities.”

Consequently, she said, providers often miss out on pertinent data that could impact the care they provide. By using mHealth platforms, physicians can better track their patients with chronic conditions. Patients receive access to an online log where they remotely input information related to their condition, such as diabetes or heart disease, and providers can access and review the data. This way, doctors can contact patients if anything seems amiss.

“This system gives patients just-in-time care when they need it so they don’t end up in the emergency room, or having to see a doctor who doesn’t know them,” Nayyar said. “Basically, it avoids potentially negative patient and quality outcomes.”

What Next?
mHealth’s recent growth has been explosive, and there’s no sign that it’s slowing down. Developers, health systems, providers, patients and regulatory agencies are already finding new ways to leverage the technologies and maximize their beneficial impact.

According to the Deloitte study findings, healthcare’s future will have a high level of digital integration. Not only will patients use self-monitoring sensors, but they will also have access to social health networks for information and support. Providers will have big data-smart dashboards to centralize patient records and minimize errors, as well as to digitally share patient information with colleagues. And, health systems will likely rely first – or solely – on mobile technologies to customize care.

Regardless of what mHealth tools health systems choose, it will become increasingly important that all stakeholders – providers, insurers, and pharmaceutical and medical device companies – work together to ensure privacy, security and efficacy as the industry forges ahead. According to Jon DeVries, Vice President of Product Solutions and the iConnect suite at Merge Healthcare, this is a trend that has irreversibly changed healthcare.

“Smartphones and mobile technologies have become a major driver in communications and will be a major driver in how we provide healthcare in the future,” DeVries said. “Our devices are here to stay, and as much as we like it or don’t like it, these mobile applications are making inroads that our health systems will have to find a way to work with. We have to listen to what the marketplace is telling us.”

 To read the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2013/Taking_the_Pulse_of_Mobile_Health

How Radiologists Can Improve Communication with Referrers

Published on the Feb. 26, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Communication. It’s been a big topic of conversation in the radiology industry, both at national meetings and inside individual practices. There’s a distinct need to improve the way radiologists and referring physicians talk to each other. The sticking point, however, has been how to do it.

There’s no question, though, the specialty needs to implement effective strategies to make communication faster, easier, and more effective. With more than 70 percent of referring physicians sending their patients to multiple facilities for imaging studies, according to one national study, it’s incumbent upon radiologists to make these working relationships as worry-free and attractive as possible, industry experts said.

“The overall effectiveness of an organization is highly dependent upon the radiology department’s ability to provide top-notch service to referring physicians, and streamlined communication is a very important piece of that puzzle,” said Mats Björnemo, director of radiology IT product marketing at Sectra, a Sweden-based radiology consulting firm. “Radiology lies at the very center of the healthcare chain. Most patients pass through an imaging department at one point or another in their treatment.”

Not only does this fluid information transfer allow for immediate input from radiologists, potentially staving off any inappropriate or repeat testing, but it also ensures patients experience fewer — if any — delays in care. In addition, these processes help radiologists quickly share any critical findings, as well as play an active role in multi-disciplinary discussions, Björnemo said.

Why Improve Communication?

While many industry leaders promote better communication as a way to raise your department’s profile within a health system or demonstrate the impact you make as radiologists, there are other reasons behind fine-tuning the way you connect with referring physicians.

According to an October 2012 Sectra report, doctors have a great interest in being able to access your schedule and book appointments for their patients online. But only 7 percent of surveyed physicians indicate the radiologists to whom they refer have web scheduling as an option. Many physicians included in the report consider offering this capability is vital to completing time-sensitive scans.

That doesn’t mean referring physicians want to eliminate all face-to-face or phone contact with you,  Björnemo said. This is where the pendulum that has lurched toward teleradiology in recent years is beginning to swing back toward having in-house radiology staff. When reviewing results, physicians want — and appreciate — being able to ask questions and talk with you directly.

Steps to Take

To effectively improve communication, however, you will need the right tools. In today’s mobile world, you will likely get the most use out of zero-footprint viewers that require no software installation or extra equipment, Björnemo said. It’s also important to consider communication products that are vendor-neutral.

For example, Carestream’s Vue Motion offers zero-footprint, vendor-neutral access to diagnostic images through any web browser or electronic health record. Without installing or downloading software, providers can use sticky-note communication, order information entry, side-by-side image display for comparisons, and synchronize images.

This type of universal product is particularly efficient in transferring critical findings in a timely manner, Björnemo said.

Clear communication can also be difficult because radiologists dictate reports in their own style and lexicon, and these differences can sometimes confuse referring physicians. And, communications products that standardize report narratives have eliminated this problem, said Aaron Brauser, Catalyst solutions manager at M*Modal. The M*Modal Catalyst for Radiology™ product uses the RadLex® Term Browser to create uniform reports.

“The biggest challenge to communication lies with the various inconsistencies of systems used in complex healthcare environments, and we’re starting to see people move toward uniformity,” Brauser said. “It’s important that no matter how the radiologists might dictate the report,  or who the report is from, that the referring physician be able to readily see what’s indicated.”

In addition to implementing a product that is compatible with almost any system and standardizing your reports, 60 percent of referring physician’s surveyed in Sectra’s report indicated 3D visualization would improve communication. Presenting findings this way would be one strategy for enhancing their ability to present and explain results to patients, they said.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/how-radiologists-can-improve-communication-referrers

Breast Imaging Market Is Picking Up After Slow Period

Published on the March 7, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

The tides are turning for breast imagers nationwide. After struggling through several years of declining demand and facility closures, the market is rebounding and more growth is expected.

The number of breast imaging facilities dropped by nearly 7 percent from 2002 to 2011, according to a recent report from global growth consulting company Frost & Sullivan. Roberto Aranibar, a Frost & Sullivan advanced medical technologies industry analyst, said several factors  — the  rise in breast cancer incidents, an increase in breast cancer surgical procedures, and an uptick in supplemental screening exams — are converging to prompt expansion in this area.

In fact, Aranibar said he anticipates breast imaging market revenues to climb from $1 billion in 2011 to $1.4 billion by 2016, crediting the rise in the number of exams performed. Diagnostic Imaging talked with Aranibar about this report, why the market has changed, and what the industry can expect.

What are the main factors behind the decrease in breast imaging facilities nationwide?

It’s part of a larger trend. There’s consolidation going on among healthcare providers, and individual facilities are reducing their own costs through staff reduction. Using their equipment more efficiently also helps them be more productive. We’re also seeing a lot of mergers between large facilities of chains of facilities. The decrease in the number of these imaging centers is just part of a broader trend.

What caused the drop in facilities to stabilize?

From a broad perspective, there’s a little more certainty in the healthcare industry after the Supreme Court upheld the healthcare reform bill last summer. Some of the major questions and unknowns have been answered. Consequently, it’s helped people better plan their next steps to maintain the stability of their facilities.

What do you expect will happen with breast imaging over the next five years?

There are many different trends going on right now. There’s a lot of controversy around X-ray mammography and its risks and benefits. Based on that, it’s probably the most highly-regulated imaging field. There’s a lot of technological innovation in this area — a lot of new imaging systems with different modalities, including MRI, ultrasound, molecular breast imaging, and tomosynthesis.

I think one of the biggest trends we see is there’s a lot of talk about breast density notification legislation. That’s a major factor when considering what will happen in the market over the next few years. By law, physicians must include in a woman’s mammography results letter if she has been identified as having dense breast tissue, explain the implications, and discuss whether they could benefit from supplemental exams. We saw a major increase in breast ultrasound procedures after the law went into effect in Connecticut. X-ray mammography is a great tool — it’s very efficient, fast, and cost effective, but it’s being questioned more than ever right now for its reliability. That leaves the door open for a lot of supplemental exams to come into the picture, and that’s where more of the growth in this field will be concentrated.

Breast ultrasound is also an area that is expected to grow. In addition, there’s a major study out that could help move tomosynthesis, which is currently really costly and not something that CMS reimburses for, into something that could get the agency’s approval for reimbursement. As soon as something like that happens, and the cost comes down, we’ll start to see it used more. It’s really proven itself to be a reliable and effective tool, and I think you’ll see a lot more of this as facilities try to stay at the forefront of technology. Rather than referring their patients out for supplemental exams, facilities are going to try to keep everything in-house.

Molecular breast imaging is a modality like PET and nuclear medicine. It involves an injection of radioactive tracers, and radiologists look at where those tracers are concentrated. It’s a more tedious process, and there’s as learning curve involved. Facilities must be licensed to handle radioactive material, and the procedure takes longer, is more costly, and it isn’t reimbursable by CMS. There’s work ongoing now to try to prove that molecular breast imaging is more diagnostically reliable in identifying cancers. But there are issues with it currently, such as managing the radiation dose. So, I don’t think it will be affected much as the market starts to grow again.

To read the remainder of the Q&A at its original location: http://www.diagnosticimaging.com/breast-imaging/breast-imaging-market-picking-after-slow-period

Mobile Computing in Radiology: the Challenges and Benefits

Published on the Feb. 12, 2013, Diagnostic Imaging website

By Whitney L.J. Howell

Hospitals and physician practices are full of electronic sounds. The whir and clunks of imaging equipment. The quiet hum of patient monitors. The background buzz of computers. In recent years, though, a new sound has become ubiquitous: the ding of the text message or mobile email. Smart device technology has come, full-throttle, to radiology.

More than 80 percent of physicians own and use mobile devices, according to recent surveys, and, a 2011 Jackson & Coker Associates study reported nearly 25 percent of radiologists were already using them clinically. That number has only grown in the past two years, said Jon DeVries, vice president of product solutions at Merge Healthcare.

“At any industry event or session, every single radiologist comes in with some sort of handheld device. Every single one of them is using mobile technology to some extent. It’s a massive trend,” he said. “It’s changing the way people practice. Diagnostics are still done at work stations, but it’s changed how they collaborate, form partnerships, and provide care.”

A Culture Shift

Radiology has always been the early adopter of technology in health care. But, even among this forward-thinking specialty, introducing and incorporating mobile devices into everyday use required a cultural shift. The biggest factor, said Rasu Shrestha, MD, vice president of medical information technology at the University of Pittsburg Medical Center (UPMC), has been provider age.

“One of the key things we’re seeing is an entirely new generation of clinicians that has always been used to technology, and they’re developing a level of comfort and acceptance of mobile devices in the industry,” he said. “Even other clinicians are getting accustomed to this notion of always being ‘on.’”

The ready-made access to colleagues that mobile devices provide has also helped nurture the spirit of collaboration within the specialty. As mobile devices and apps move from being novelties into mature technologies, Shrestha said, radiologists and other clinicians are more easily able to work together as a clinical care teams. Being mobile has gone from being trendy to being a necessity.

“A little more than a year ago, ‘apps’ and ‘mobile’ were buzzwords,” he said. “Now they’re accepted as part of workflow, and they’re well integrated.”

One of the greatest outcomes of increased provider comfort with mobile technology has been improved communication between provider and patient. Providers can now display images on a tablet for patients to see, and viewing the studies on a smaller, more familiar device — rather than a large, clinical screen — can be less intimidating for the patient.

Improving Communication

Perhaps the biggest way smartphone and mobile device technology has touched radiology is through enhanced provider communication, DeVries said. Whether it’s with critical care or emergency patients, mobile technology has streamlined the way radiologists and referring physicians discuss patient care.

“The big area where we see radiologists using smartphones and tablets is in the way they interact with colleagues,” he said. “These devices give them the freedom to get out of the reading room and out onto the floor so they can have face-to-face interactions with co-workers and patients. It’s enabled them to build better relationships.”

Mobile technology can even help you stay connected when you’re away from your hospital or practice. Various apps for the iPhone, Blackberry, or Android let you quickly look at scans so you can discharge patients or initially evaluate a trauma case. These apps aren’t intended to be used for true diagnostic reads, DeVries said, but they do keep the process of patient care flowing.

Herman Oosterwijk, president of Texas-based health care technology training and consulting firm Otech, agreed that mobile devices are the lynchpin of prompt communication and timely patient care. While reaction time to an email might be slow — often more than an hour — responses to text messages are frequently instantaneous.

“Texting and communication between smart devices is incredible,” he said. “People are always listening for that ‘beep’ or ‘ding-dong’ that alerts them that someone wants to tell them something.”

According to DeVries, Merge’s iConnect product offers you this kind of immediate access. The zero-client viewer can be launched through any electronic medical record system and can pull images from any PACS. Carestream’s Vue Motion software also offers similar capabilities, presenting you with patient information quickly to avoid any slow-down in care.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2128049

Report Offers System to Separate Useful and Wasteful Imaging

Published on the Feb. 20, 2013, Diagnostic Imaging website

By Whitney L.J. Howell

All repeat images are not created equal. Some are good; some are wasteful. So one radiology policy think-tank introduced a classification system Wednesday that could help determine whether a repeat image is necessary.

According to Richard Duszak Jr., MD, CEO of the American College of Radiology’s Harvey L. Neiman Health Policy Institute, “repeat image” is an overused and undefined term that offers no clarity about a scan’s medical necessity. The institute, , which researches medical imaging use, quality, and safety metrics, published guidance about how to categorize the various types of repeat images.

This paper, entitled “Repeat Medical Imaging: A Classification System for Meaningful Policy Analysis and Research,” aims to help quantify how many imaging studies have beneficial diagnostic value and how many can be avoided as wasteful spending.

“This classification system is in response to what we perceive as a global lack of clarity as to what repeat imaging means in medicine and when it applies to imagining,” said Duszak, who is also a practicing radiologist. “We’ve tried to be as thoughtful as we could be in creating something that would work both now and with future research as people have more and more robust data.”

The system divides medical images into four categories: supplementary, duplicative, follow-up, and unrelated imaging:

• 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.

In many instances, how well researchers will be able to use this classification system will depend on how integrated and mineable the electronic health records they use are, Duszak said, as well as how standardized radiology reports are.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2129299

Radiology in 2013: The Year of Imaging Software

Published on the Jan. 3, 2013 Diagnostic Imaging website

By Whitney L.J. Howell

For radiologists and radiology vendors, the past 12 months have centered on health care reform – would the U.S. Supreme Court uphold the law, and if it did, what would it all mean? With the court’s decision, at least part of that question has been answered. Now, the industry has turned its focus to what can be done in the next year to make practice more efficient and improve how its providers interact with other specialties.

One of the biggest strategies for accomplishing this goal will be the implementation and use of new software offerings, experts say. The increasing use of more complex information in radiology practice has necessitated intelligent systems to more effectively capture and analyze data. Whether the new products impact work flow or patient care, new software developments will play an integral role in how you obtain, analyze, and share images in the future.

According to Eliot Siegel, MD, diagnostic radiology and nuclear medicine professor at the University of Maryland, the bulk of new software capabilities will target enhanced communication, taking how providers share information to the next level.

“So much effort has been put in during the last 20 years to actually get us to the point of being digital and having images available anytime, anywhere and being more efficient in image interpretation,” said Siegel, also the associate vice chairman of informatics. “But relatively little has been done about communicating radiology findings and information that’s important about the patient and making sure we receive return communication that our recommendations have been acted on.”

Within the next year, he predicted, radiology software will meet provider needs by not only recording when studies are completed, reported, and shared with referring physicians, but also by providing feedback on whether referring physicians acted on any radiology recommendations.

Main Provider Desires

A common provider complaint is the difficulty frequently associated with transferring images from one facility to another. In many instances, CDs are lost or referring physicians can’t download the images. Sharing studies between health care systems is also a particular challenge, Siegel said.

“It would be good to see hospitals and clinics having more universal use of images,” he said. “We should be able to transfer images directly and digitally, like sending an email. Only it would be in a safe, secure way from one facility to another.”

The Image Share Network, launched by the Radiological Society of North America (RSNA), is already moving the industry in this direction. Tested at five pilot sites nationwide, this initiative gives patients access to their diagnostic images via a patient health account, enabling them to transfer images to their physician much like they would in their email accounts.

Siegel also predicted the rise of software that can produce better analytics for radiology, as well as enhance natural language processing for radiology reports. Ultimately, he said, an effective system would summarize pertinent information and allow providers to either agree or disagree with the computer’s interpretation of the data. Such a system would offer improved text and structure capabilities.

What’s Coming in Communications Software

One of the most active areas in communications software development is work around speech recognition and natural language processing. Several companies are working to make these tools smarter, Siegel said.

For example, M*Modal and Nuance are developing software that will be able to understand and discern meaning from, and potentially act upon, information included in reports. Montage is also creating software that can mine current and previous radiology reports for specific words, such as pneumothorax, and correlate them with pathology reports.

“I’m really excited about this next generation of intelligent systems that generates reports and makes sure they’ve been read and acknowledged,” he said. “Computers can be useful tools to understand and extract information from the report, act on it, and allow for follow-ups.”

Additionally, many vendors are tackling improved image sharing software, using RSNA’s Image Share as a model. The most important advancement here is that these products will likely be standards-based rather than proprietary. Having a universal solution will allow health care facilities of all types — both in the same and different systems — to share all types of diagnostic imaging data associated with individual places.

Although the solution isn’t yet standards-based, information technology software developer mPlexus introduced its latest product — DICOM RadiX — at this year’s RSNA annual meeting. This automated software shares images and retrieves them from imaging archives instantly. When integrated with other mPlexus products, RadiX can transfer images between facilities, even those in separate institutions.

To read the remainder of the article in its original location: http://www.diagnosticimaging.com/informatics-pacs/content/article/113619/2121622

Barium Shortage Affecting Radiology Practices

Published on the Jan. 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

Since last fall, radiology practices and departments nationwide have grappled with a continued shortage of barium agents used in multiple imaging studies. Recent reports indicate the shortage shows no sign of slowing, and several providers say they’ve had to alter their approach to patient care.

According to Bracco Diagnostics Inc., a leading, worldwide barium supplier, barium is in low availability globally. A September 2012 letter to customers from the company announced a significant number of barium requests are on backorder.

“With the continued efforts of our barium suppliers, we are attempting to make all of the key backordered products available as soon as possible,” Tom Ortiz, Bracco director of North America CT business and worldwide product director of oral imaging, said in the letter. “However, at this time, there are procedures for which we are unable to provide products.”

For example, Bracco has not fulfilled orders for small bowel, esophageal, and other CT studies.
Scripps Health in California is among those facilities struggling to meet patient needs with a limited barium supply, said Jeremy Enfinger, lead radiologic technologist at the Scripps Mercy Chula Vista Hospital.

“We got to the point where we had scheduled patients but not enough barium to complete the studies for the day,” he said. “There were several times that we used a courier to deliver supplies from one of our other hospitals within the organization. But, eventually, they stopped allowing us to do that because they had also run out.”

With the future barium supply level still in question, Enfinger postulated the industry might be pushed into using more water-soluble contrast agents to fulfill patient needs.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/contrast-agents/content/article/113619/2123820