Published on the Nov. 15, 2011, DiagnosticImaging.com website
By Whitney L.J. Howell
Mammography versus magnetic resonance imaging (MRI) has been a long-standing debate among industry leaders. The general consensus today, however, is while both tests effectively detect breast cancer and can work hand-in-hand, mammography is still indispensable.
According to the American Cancer Society, each year brings 1.3 million new breast cancer diagnoses, and catching these incidents early is critical to saving lives. While mammography has sliced the associated death rate by 30 percent since 1990, 465,000 women still die each year.
But breast imaging isn’t about choosing one scan over another, said Mitchell Schnall, MD, a Hospital of the University of Pennsylvania radiologist. Instead, you should focus on using both techniques correctly to identify cancers earlier when they’re smaller and potentially more treatable.
“We shouldn’t talk about MRI or mammography — they’re different modalities with different roles,” Schnall said. “Mammography is for general patient screening, and we use MRI to screen our high-risk patients. Their roles are complementary. The discussion should never be which one do we do.”
And the screenings aren’t interchangeable, experts said.
“Mammography is the backbone of how we diagnose breast cancer,” said David Dershaw, MD, a radiologist with Memorial Sloan-Kettering Cancer Center. “There are situations where MRI can add information we can’t get from mammography, but it can’t be a replacement.”
To read the remainder of the article (and the pros and cons of MRI and mammography): http://www.diagnosticimaging.com/womens-imaging/content/article/113619/1991558
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
Published on the Sept. 22, 2011, DiagnosticImaging.com website
By Whitney L.J. Howell
Natural language processing, considered the next generation of voice recognition software, makes it easier for you to summarize, find, and retrieve data from radiology reports. But a recent study shows many of you still aren’t using it.
Nearly 50 years ago, speech recognition software debuted on the healthcare scene, and providers used it to record radiology report findings. Technology improvements have taken the software to the next level with natural language processing (NLP), and it now plays a significant role in quality improvement efforts, said Ronilda Lacson, MD, a radiology research associate at Brigham & Women’s Hospital. NLP takes the voice-created narratives and makes them structured and searchable.
“NLP makes sure physicians report findings appropriately,” Lacson said. “They can record information in such a concise form so that when patient histories are pulled for review they’re like a thin cut of focused data.”
In a study published in the September Journal of the American College of Radiology, Lacson and her colleagues identified three main uses for NLP. The software can pull records that meet specific criteria to support effective outcomes research. Various versions also let you pinpoint specific data points, such as individual imaging findings, for analysis and quality improvements. However, the most valuable, long-term NLP use, Lacson said, is the brief reports it can create to highlight key content and critical findings. Other radiologists can study these summaries to improve their future documentation.
To read the article in its entirety: http://www.diagnosticimaging.com/voice-recognition/content/article/113619/1955806
Published in the Summer 2011 Summa Magazine
Software Created at Summa Helps Staff Speed Aid to Heart Attack Victims
By Whitney L.J. Howell
Last year, paramedics rushed a man in his late 40s with a blockage to his left coronary artery to Summa Akron City Hospital’s Emergency Department. He was a victim of a massive heart attack – the one frequently dubbed “the widow maker.”
“He was really as sick as you can get,” said Brenda Kovacik, R.N., cardiac care unit manager. “He was on a ventilator. We were using a balloon pump. Most people don’t survive that type of cardiac event.”
This patient did. Within a few days of his arrival, Kovacik said, he was sitting up in bed, talking and generally looked wonderful. His survival and speed of recovery are due, thanks in large part, to a new software system designed at Summa to help cardiac staff move patients through the door-to-balloon (D2B) process as quickly as possible.
Each year, according to the American Heart Association (AHA), nearly 400,000 people suffer an ST segment elevation myocardial infarction (STEMI), putting them at high risk of death. Both the AHA and the American College of Cardiology recommend healthcare providers treat these patients with a balloon angioplasty or a stent within 90 minutes of receiving the patient into the emergency department (ED). Extra minutes beyond that mean more cardiac tissue death, so truncating this time frame is highly advantageous.
Here is where the development of Summa’s STEMI computer software has made a measurable difference.
Changing the System
On average, Summa receives and treats 300 to 400 STEMI patients each year. In 2006, healthcare providers kept track of D2B performance with pencil and paper, relying on individual computational skills to keep accurate records. Kovacik noticed that, while Summa already had a fast D2B time for STEMI patients – 83 minutes – there was room for improvement. From the emergency medical technicians (EMTs) to the EKG technicians to the cardiac catheterization lab (cath lab) staff, Kovacik knew it was possible for Summa to streamline the process even more by shearing away any action that didn’t provide additional value to the patient.
“First, we had to recognize that each person along the path had an opportunity for improvement, as well as error and delay,” Kovacik said. “We broke down the process and gathered feedback from staff about what would help them increase their speed dramatically.”
At the same time, the AHA launched an initiative focused on using evidence-based research to cut D2B times nationwide, which bolstered Kovacik’s plan to help make the time savings a reality at Summa. She enlisted her husband, Mark Kovacik, a research associate in Summa’s Walter A. Hoyt Jr. Musculoskeletal Research Lab, to conceive and design a computer software system to assist in reducing the D2B time in Summa’s Akron City Hospital emergency department.
The result: a user-friendly computer interface that keeps track of the duration of each D2B step and allows nurses and doctors to pull reports about unit performance.
After implementing the system, changes happened quickly, Brenda Kovacik said. In the first year, D2B times dropped by 15 minutes. By 2010, they had fallen to an average of 48 minutes. Now, during the weekdays when all staff are on duty, the D2B time is often less than 20 minutes. The health system decided to push the envelope further and extend the time reduction efforts to the paramedics. It worked. EMT to balloon time – known as E2B – is now 56 minutes.
The time improvements are important from a monetary perspective because the Center for Medicare and Medicaid Services considers acute myocardial infarction incidents one of the core measures to determine reimbursement rates. However, that wasn’t the reason Summa decided to refine its D2B process.
“It’s more than just working to save a person’s life. If we don’t get them the proper treatment within 90 minutes, they could have continued problems after the cardiac event,” Brenda Kovacik said. “The faster we move and get the artery open, the better long-term outcomes the patient will have.”
How It Works
To be effective, a new software system must be readily accessible to users and easy to understand. According to Mark Kovacik, the STEMI software is written to accommodate all levels of computer skills and does not require any special training.
The system, which currently operates on a mainframe computer, allows staff to select the date of service. It then uses color-coded fields to record the times for all points along a patient’s journey through the hospital, such as when a patient enters the ED, when the EKG is complete and at what time the patient enters the cath lab. The patient encounters are transcribed retrospectively based on data manually recorded on the patient’s chart. Entering the data into the software system during the treatment process would cause undue delay.
Once all the times are in the system, the software automatically calculates the intervals, identifies spots where timing is sluggish and emails feedback to the patient’s healthcare providers within 48 hours. Giving feedback to staff in a timely manner is far more effective than waiting weeks to discuss performance, according to Mark Kovacik.
“Everyone recognizes that the data doesn’t lie,” he said. “And we’re not using these findings to point fingers. Instead, we’re problem solving, sometimes on a case-by-case basis. Maybe there’s a legitimate reason why some actions take longer and we can use that knowledge to make changes.”
Performance Improvements & System Benefits
Brenda Kovacik noted that some D2B timing issues were easy to identify once the STEMI software was implemented. For example, recorded data suggested having an ED-only EKG would be helpful.
“By having someone always in the emergency department to conduct EKGs, we managed to cut the time spent getting the test by 50 percent,”she said. “Without the data collected through the software system, we would not have known to make this improvement.”
Summa has seen further advances in EKG efficiency over the past year with many paramedics now performing the test on the way to the hospital, then faxing the results in to the ED. This step often allows the paramedics to make a quick stop-over in the ED before rushing the patient directly to the cath lab. It also helps EMS crews understand how big a role they play in ensuring patients receive proper care as soon as possible, Brenda Kovacik observed.
“The electronic and automated format also allows staff to run performance reports in a quicker, easier way,” said Don Noe, a research information analyst at the Musculoskeletal Research Lab who completed the now patent-pending software programming. Performance reports that once took two to three hours to create can now be compiled in three to four minutes.
“The software also removes the potential for human error,” he added. “Before we had the software, times were entered manually and staff was doing the interval calculations themselves,” Noe said. “Necessity really is the mother of invention. Now we let the computer do the math.”
According to Kenneth Berkovitz, M.D., chair of the department of cardiovascular disease and system medical director, Summa Cardiovascular Institute, creating and using the software has improved patient outcomes by uniting the staff in a common goal of enhancing both individual and group performance in cardiac care.
“This software is a really incredible tool that allows us to easily see and identify where in the D2B process we have issues with slowdown and where we have opportunities to improve,” Berkovitz said. “It’s visually powerful to see all of the data or look at a case-by-case basis to see where we’ve shaved time. We now have some of the fastest D2B times in the country and this is the tool that helped get us there.”
Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data.
Mark Kovacik began developing the STEMI software in 2006. It entered beta testing – testing by a limited external audience – in 2009 and officially went online in the cardiac care unit in 2010. Its resounding success prompted Summa to look toward expanding its uses.
“After a rigorous evaluation of the software, the hospital is now testing the waters to see if the system can be applied to all time-sensitive services,” he said. “The biggest immediate potential is with stroke.”
Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data. Discussion includes the possibility of hospitals across the country purchasing or licensing copies of the STEMI software, then sending their information to Summa to be housed in a main data repository.
In the meantime, Summa will continue to work toward providing the highest quality care in the fastest time possible. Future success will depend on every team player.
“Everyone needs to see how their part in the process makes a difference,” Brenda Kovacik said. “This software shows them their work is important.”
To read the story in the original publication: http://www.thesummafoundation.org/media/11058/18979.pdf pg.2
Published on the Sept. 12, 2011, DiagnosticImaging.com website
By Whitney L.J. Howell
Imagine telling your patients you can conduct their MRI in a tranquil meadow, under the ocean, or any location they find relaxing. What do you think they’d say about reading their favorite book during the scan? There’s a chance they’d be much happier about being subjected to the scan.
Patient-friendly MRIs aren’t new, but they’ve generally given you poor-quality images. There’s a new generation of machines on the market now, and they offer more room and high-resolution scans.
“New scanners offer huge benefits in both comfort and quality,” said William Morrison, MD, associate radiology professor at Thomas Jefferson University Jefferson Medical College. “Some machines allow us to only focus on extremities, and others are helpful for people who suffer with claustrophobia. Newer scanners also enable us to scan larger patients.”
Arms, Legs, Wrists, and Ankles
There are times, especially if you have athletic patients, when you only need to scan a small body area, such as an ankle or wrist. In those situations, sliding a patient into a traditional MRI machine isn’t your best option, Morrison said, because image quality is poor in those areas.
Instead, extremity scanners target particular spots and produce high-quality scans.
“Patients appreciate these scanners because they aren’t stuck inside a tight-fitting tube,” he said, referring to the GE Optima MR430 scanner GE-produced extremity scanner used at Thomas Jefferson University Hospital. “It’s fantastic for people with claustrophobia, and it’s good for kids because they get to have their parent right there beside them.”
As an added benefit, it’s cheaper to run extremity scanners than traditional MRI machines, he said.
To read the remainder of the story: http://www.diagnosticimaging.com/mri/content/article/113619/1947286?CID=rss&cid=dlvr.it
Published on the Sept. 2, 2011, DiagnosticImaging.com Website
By Whitney L.J. Howell
If you opened a patient’s file before ordering or reading a CT or MRI scan and saw a note from a sideline coach saying the patient exhibited all the signs and symptoms of a concussion, what would you think? Would you be surprised?
You might have to get used to these notes thanks to iPad and smartphone technology. Radiology applications (apps) are becoming more common, but the concussion apps are unique. They aren’t designed for you, the radiologist.
They’re meant for coaches, trainers, and parents.
“These apps aren’t designed to diagnose a concussion,” said Jason Mihalik, Ph.D., assistant professor of exercise and sports science at the University of North Carolina at Chapel Hill. “But they do put into the hands of coaches or parents the ability to assess whether an athlete who’s been hit in the head is showing signs and symptoms of such an injury.”
Mihalik and his colleagues developed a smartphone app that presents concussion signs and symptoms as a checklist. Based on the user’s answers, the app can recommend seeking physician attention for the athlete. Cleveland Clinic biomedical engineer Jay Alberts also created an app for the iPad2 that records a baseline assessment of an athlete’s cognitive, balance, vision, and motor skills. This information can be compared to athlete performance anytime he or she sustains a head injury. Both apps offer the option to email information to a parent or health care provider.
To read the rest of the article: http://www.diagnosticimaging.com/news/display/article/113619/1941368
Published on the Aug. 26, 2011, DiagnosticImaging.com Website
By Whitney L.J. Howell
Smaller hospitals might worry they don’t have enough staff or time to effectively reduce CT dose exposure for patients, but one hospital’s success proves it can be done.
By changing protocols for CT angiographic imaging, Gundersen Lutheran Health System, a physician-led, La Crosse, Wis.-based health system serving 19 counties, endeavored to reduce dose exposure after purchasing a dual-source CT system in 2006. Rather than use a generic protocol for all patients receiving CT angiographic imaging, radiologists and technicians determined proper dosage based on patients’ body mass index. The result: a 29 percent drop in dose exposure.
This accomplishment prompted radiologists to apply reduction efforts to all protocols.
“Expanding the dose reduction plan fit with our overall strategy at Gundersen Lutheran to provide the highest quality services and protect patient safety,” said Mary Ellen Jafari, Gundersen’s radiation safety officer and medical radiation physicist. “The program fit nicely into the organization’s goals, and we had a lot of administrative support to make this happen.”
To read the remainder of the article online: http://www.diagnosticimaging.com/low-dose/content/article/113619/1936917
Published on the Aug. 2, 2011, DiagnosticImaging.com Web site
By Whitney L.J. Howell
Calling the results flawed, many in the radiology community are protesting a study released last week that suggested mammography hasn’t played a major role in the drop in breast cancer-related deaths.
The research, published in the July 28 British Medical Journal, compared the reduction in breast cancer deaths from 1989 to 2006 in several Northern European countries and concluded that improved disease management – not mammography – could most likely be credited with the decrease in deaths.
“Our study adds…to the evidence of studies that have used various designs and found that mammography screening by itself has little detectable impact on mortality due to breast cancer,” wrote the study authors, led by research director Phillippe Autier from the International Prevention Research Institute in Lyon, France.
Industry leaders in the United States, however, disagreed. According to them, these results are flawed and contradict proven research on the efficacy of using screenings to catch early-stage breast cancer.
“Improvements in therapy have, likely, played a role in the decrease of breast cancer deaths, but therapy cannot cure advanced cancer,” the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) said in a joint statement. “Early detection via mammography is clearly the major reason for the decrease in deaths in the U.S.”
To read the article in its entirety: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/1917528
Published in the July 2011 American Hospital Association Hospitals & Health Networks
By Whitney L.J. Howell
Teleradiology is growing, but experts caution about potential pitfalls
Hospitals never close, but that doesn’t mean someone from every specialty is always on call. A growing number of facilities aren’t scheduling radiologists for overnight and weekend shifts, and others no longer have them on staff. Instead, they rely on teleradiology companies to fulfill their imaging needs.
Also known as nighthawking, teleradiology steadily has grown in popularity in recent years. A 2009 study by VHA Inc., a nationwide network of community-owned health systems, reported 56 percent of U.S. hospitals use it. Many hail the service for its convenience and instant subspecialty coverage.
“Teleradiology is essential for small, rural practices that want to deliver high-end care, but don’t have enough volume to offer fellowships for subspecialty providers or that can’t afford to hire more staff to cover nights,” says William Bradley Jr., M.D., University of California–San Diego’s radiology chair. “Diagnosis quality also goes up because radiologists’ reading scans are already awake and alert. Someone who’s been awakened in the middle of the night is likely to miss finer details.”
Contracting with a teleradiology company also can help hospitals attract and retain talented radiologists, says Michael Modic, M.D., chairman of the Cleveland Clinic’s Neurological Institute. “Some radiologists are willing to forgo the additional reimbursement—sometimes as much as 10 to 15 percent of business—if they can avoid the night shift,” Modic says. “They want more work-life balance, and hospitals use teleradiology to retain them.”
But not everyone agrees teleradiology is financially sound or safe. Relinquishing additional reimbursement could have long-lasting effects, says David Levin, M.D., chairman emeritus of the department of radiology at Jefferson Medical College of Thomas Jefferson University. Having outside companies read scans could cause a permanent dip.
“It’s possible that reimbursement could start to drop because teleradiology companies bill less for reading scans,” he says. “If they’re billing $40 for reading an MRI, but hospitals bill $80, insurance companies will start wondering why they’re reimbursing at higher levels.”
Hospitals without in-house radiologists also lose an advantage when shopping for new imaging equipment, Levin says. Knowledgeable in-house radiologists can be intermediaries who negotiate with vendors for significant cost concessions on updated imaging equipment.
Levin disagrees that teleradiology improves diagnosis quality. Teleradiologists not only lack access to all patient records with potentially pertinent information that could alter a diagnosis, but neither can they consult with other providers if they have questions.
To read the article on the original Website: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2011/0711HHN_Inbox_telehealth&domain=HHNMAG
Published in the American Hospital Association’s October 2010 Hospitals & Health Networks
By Whitney L.J. Howell
Mom-to-Mom Blogs: Hospitals Invite Women to Share Experiences
Ask a mom where she finds advice about parenting, nutrition or child safety, and she’ll likely mention several other mothers before naming her pediatrician. Increasingly, moms are turning to social media as the vehicle to connect with other mothers, and now some hospitals are joining the conversation.
According to the Nielsen Company, which tracks consumer information, women between ages 25 and 54 with at least one child constitute 20 percent of daily online activity. In a July Yahoo! poll, women self-reported spending 20 percent of their time online interacting with women in similar life situations.
“Moms don’t necessarily want to hear from health experts all the time,” says Michelle Davis, marketing operations and community development director for Boston’s Lowell General Hospital. “They want to talk with people who are going through the journey of raising children with them.”
To fulfill that need, Lowell General and Boston’s Floating Hospital for Children held a Facebook contest to recruit five mom bloggers. They launched the Merrimack Valley Moms blog in June and, as of September, have received more than 4,000 unique hits. The hospitals have received more positive feedback about the blog than from any other community initiatives, Davis says.
Each blogger writes at least one post monthly on topics ranging from nutrition to getting children involved in volunteer efforts. Lowell’s communications office ensures topics are appropriate for the blog and corrects grammar mistakes. Hospital officials do not edit content.
Running the blog through the hospital—even if bloggers do not offer medical advice—ensures readers the posts are credible, says Jane Marshall, a Merrimack Valley Mom blogger.
“As a mom, you learn through experience, and not everything works for everyone,” Marshall says. “But it helps to see different parenting techniques other moms have tried.”
Confusing experience for expertise is easy, but a medically trained mother’s voice can stop others from overreacting to a flu epidemic or provide details about safely helping babies sleep through the night, says Wendy Sue Swanson, M.D., a mother and pediatrician who works and blogs for Seattle Children’s Hospital. Swanson has posted more than 100 blogs since January and says her patients connect with her blog and often ask questions during appointments.
“I have limited time with my patients during the day, so the blog gives them more of my attention,” Swanson says. “For providers, it’s an excellent way to arm patients with information to protect themselves and their children against disease or injury.”