Medical Imaging March Madness – Stage 2 and the Health Affairs IT Study Debate

March 27, 2012 by 1 Comment

Doug Rufer

Doug Rufer, North American Business Manager,RIS, healthcare information solutions, Carestream

March was an intense month for medical imaging. The proposed Stage 2 Meaningful Use Requirements were hot off the presses when a study in Health Affairs found that electronic access to imaging results increases ordering of additional tests. What is an accountable care organization and its team of radiologists and referring physicians to do? Let’s dissect each piece.

Imaging Inclusion in Stage 2

On March 7, The Office of the National Coordinator for Health IT (ONC) filed stage 2 meaningful use guidelines with the Federal Register. While still in the comment period and subject to change, the new MU rules finally recognize imaging—an area lacking attention in stage 1—in several ways including a measure focused on diagnostic image accessibility in EHR’s (40 percent of scans and tests being accessible) and more clinical quality measures relevant to radiology (60 percent use of CPOE and adding radiology and labs). CMS also requested comments about requiring 10 percent of images to be transmitted in HIEs. Health Data Management hosted a great MU Stage 2 Webinar (archive available now) that looked in detail at data exchange requirements, online patient access to medical information, and increased CPOE thresholds. With a more direct connection between radiology and the EHR, providers who are embracing meaningful use now have a more complete model for how to improve the quality of patient care while reducing costs.

Health Affairs IT Study

On the heels of stage 2, the results of a 2008 study, “Giving Office-Based Physicians Electronic Access to Patients’ Prior Imaging and Lab Results Did Not Deter Ordering of Tests,” ignited a debate between the study authors and Dr. Farzad Mostashari, National Coordinator for Health Information Technology over claims that the meaningful use of EHRs will have little impact on the cost or quality of care.

Mostashari’s position – the study was dated before the passage of the HITECH Act, lacked consideration for the clinical decision support in certified EHRs, used association to suggest causality, and had no regard to whether more testing was medically necessary.

The authors’ position – there have been no “game changing” developments in past four years, EHR products have undergone only modest tweaks, and “Dr. Mostashari’s unbridled faith in technology is mirrored by his belief that ACOs are the next panacea for health costs and quality.”

My position – the debate’s focus on EHRs is too narrow. To truly understand the study’s assumption you need a more detailed look at the health IT ecosystem vs. a single component—Carestream Radiology Information Systemin particular, the use of a radiology information system (RIS) and its interplay with the EHR deserves more attention. Were the providers studied using a RIS module within the EHR or a standalone RIS system? There is often cost-based pressure to use the EMR’s RIS module, but these modules often deliver limited functionality. Fully featured reporting and embedded voice recognition are usually not included. Built-in rules and triggers for complex exams at the time of scheduling, ordering, or even prior to the exam being started, (including angiography, contrast exams, positron emission tomography [PET], computed tomography [CT] and magnetic resonance [MR] exams) may not be offered—all deficits that could impede efficiency, lead to unnecessary testing and ultimately create higher costs. Perhaps the debate and study shouldn’t be centered on general “electronic access,” but the appropriate combination of health IT systems within the hospital ecosystem.

MU Certified RIS

With meaningful use, certification adds another layer of complexity and opportunity. RIS vendors, like Carestream, are developing certified standalone RIS solutions that both satisfy specific radiology workflow challenges while evolving to address changes in healthcare regulations. These advanced RIS solutions offer tools like:

  • Order entry decision support – The American College of Radiology (ACR) has been working to create a decision support database for several years. The objective is to outline which imaging exams are medically appropriate for a patient’s symptoms or diagnosis. The ACR’s decision support database is currently being tested in several hospitals. Certified RIS platforms are available that support user-defined rules so each facility can set its own standards for the “appropriateness” of an imaging exam. These platforms can be adapted to support the ACR criteria when they are finalized.
  • Exam protocols – Radiologists already use established protocols for ordering complex imaging exams at large teaching facilities and specialty hospitals. Protocol variations involve scan thickness, scan sequences, reconstructions, gantry tilt and other characteristics. The specific protocol is determined by a patient’s diagnosis, stage of disease, type of treatment level and other data. In the future, hospitals of all sizes and other imaging providers may adopt a list of protocols to ensure optimal imaging results based on a patient’s disease state.
  • Quality Outcomes – There is a movement toward establishing guidelines for capturing, maintaining and reporting radiation dose, speed of reports and other factors that can enhance diagnosis and treatment. The RIS is the likely platform to collect and store patient imaging data as part of this effort to help improve patient outcomes.
  • Structured Reporting – Conversion to structured reporting is driven by results from studies that show that up to 80 percent of physicians do not fully understand the radiologist’s diagnosis as presented in the report. Use of paragraph-style reporting based on dictation by a radiologist will likely be replaced with structured reporting that involves the selection of clear, standardized wording to convey a diagnosis. Standardized wording not only will make a diagnosis easier to understand, but it also will enhance the ability for data mining by research facilities nationwide. This can play into the goals of meaningful use and using population based data to improve overall outcomes by ensuring the correct tests are ordered the first time based on patient conditions, while also lowering the cost of care.

What do you think of the Health Affairs debate? Is RIS a missing link in this health IT and meaningful use discussion? 

Filed under Health IT, Health Reform, Meaningful Use, RIS Tagged with , , , , , , ,

Radiology Workflow, Data Transmission and Storage in the Age of Meaningful Use

January 4, 2012 by 1 Comment

Doug Rufer, Carestream health

Doug Rufer, Director Clinical Operations and Business Strategy, Healthcare Information Solutions, Carestream Health

Meaningful Use has been a moving target in 2011 and we see signs that there will be no slowing down in 2012.  Keeping abreast of changes and sifting through misinformation to determine your organization’s strategy can be a continual challenge—but one that is winnable.

Radiology workflow, IT system data transmission and storage, and the importance of using certified technology – either modular or complete – are often overlooked elements of the overall Meaningful Use process.

ONC ATCB Seal

Carestream's Vue RIS received modular certification for both Eligible Hospitals (EH) and Eligible Providers (EP) in October.

Once your organization decides it will comply with Meaningful Use, your journey begins with:

  • Determining the measures you will track by eligible provider
  • Evaluating your IT solutions and updating your technology to comply with all measures
  • Discussing  with your supplier their strategy for MU compliance and any potential gaps

As you move forward, you must look at the impact on specialties and the operations of your radiology department to chart the best course for success.

Understand the Measures

The first step is understanding your workflow and how and where data will be captured for a complete picture of how compliance will affect your radiology operations.  Much of the data you are now required to track, monitor and report against for meaningful use measures is data that has not traditionally been captured by radiology departments—and some may argue that such data is outside the scope of radiology.  However, having this data may be useful.  For example, recording smoking status may not, at first glance, be relevant to radiology.  But this information may become VERY important if a radiologist is reviewing a chest x-ray and sees an obscure nodule. Understanding more about a patient’s history could impact diagnosis.

Plan for Change

The challenge for radiology is where data is captured.  For EACH visit, information such as BMI, blood pressure, etc. must be captured, recorded and possibly transmitted to other IT systems or directly to the CMS, based on the measures you track.  Since this responsibility has traditionally fallen to a patient’s physician, the requirement for radiology to capture that data can be a workflow burden for many facilities.

Answering the questions below will help you plan for the full impact and ease the workflow adjustments of meaningful use compliance:

  • Where in the workflow process will we capture each measure we will submit?
  • What impact will capturing the data at that point in the process have on our overall operations and staff?
  • Will we need to increase our exam time slots when scheduling studies?  If yes, by how much?
  • Will we need to hire additional resources to capture the necessary data?
  • How will this impact patient wait times?
  • How will we ensure staff complies with capturing this required data for reporting?
  • How will we explain to patients that we need to capture this data during each visit?
  • How are we going to handle high throughput modalities (like mammography screening)?
  • Who will be required to enter data?
  • Who will monitor and provide daily checks and balances to ensure compliance?
  • What information will we need to send to other certified IT systems?
  • Will we directly submit data from our RIS to the CMS; to an EMR; or both?
  • What is the overall cost to our organization to capture this additional information?
  • How can we minimize the financial impact?

Read more of this post

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RSNA 2011 – Transforming Healthcare: The Role of Radiology

November 21, 2011 by Leave a comment

Diana Nole, Carestream Health

Diana Nole, President, Digital Medical Solutions, Carestream Health

One hundred and sixteen years ago this month Wilhelm Roentgen discovered the x-ray. While patient hopes and needs for professional care have remained constant, the world of healthcare is changing faster than he could have ever imagined.

As the international radiology community gathers in Chicago this week for the 97th Annual Assembly of the Radiological Society of North America, healthcare reform and evolving technologies have created a unique and unprecedented radiology environment—one filled with both hurdles and opportunity.

Take the current state of meaningful use and accountable care initiatives. These reforms signal a long awaited and critical acknowledgement that imaging data is relevant to physicians outside of the practice of radiology and present an opportunity to promote the role that radiology plays in providing better patient care. However, compliance can sometimes be met with capital constraints, challenging providers with how to allocate precious funding among competing priorities.

At the same time mobile devices are changing the way we think about medical imaging and IT.  Radiology workflow is no longer tied to a workstation. Web-based applications run on any platform or device, and are easily integrated with the EMR—they are different from anything radiology professionals have used before.

And secure cloud computing tools to empower patients to view their own medical imaging data and share it with physicians are on their way in response to patient demands for greater control and involvement in their care.

Even proven medical imaging technologies like portable x-ray imaging are being revolutionized. Mobile units are a critical component of patient care because they provide immediate and regular updates on patient conditions in acute areas like the ER, ICU and OR. With improved image quality, reduced dose, and better technologist workflow, products can truly make a difference in the care that is offered.

These are just a handful of reasons why RSNA couldn’t be happening at a better time. As this gathering of radiology professionals from all over the world is about to convene, we have had several guest bloggers share their insights on what to look for and what to expect, including:

The radiology profession is playing a leadership role in the exciting transformation of healthcare. Together we have real opportunities to improve the health and lives of people around the world. In just six days, the doors to RSNA will open, offering us a fantastic view of what the future holds. I can’t wait to see inside…

Stop by Carestream’s booth #1611 in Lakeside Center Hall D—we have a lot to show you. Not attending the show? Watch this space for real-time perspectives from RSNA. 

Filed under Digital Radiography, Health IT, Health Reform, Innovation, Meaningful Use, Mobile X-Ray, RSNA 2011 Tagged with , , , , , , ,

More cloud and mobile ‘buzz’ at this year’s IT-heavy RSNA

November 14, 2011 by Leave a comment

Cristen Bolan

Cristen Bolan, Executive Editor, Applied Radiology

If you thought “cloud computing” and “mobility” were just a couple of buzz words in medical imaging, well you can expect to hear them buzzing in your ear at this year’s RSNA 2011 annual meeting.

While RSNA mainly covers imaging hardware –- “Hot Topic” sessions will feature nine presentations on emerging techniques in CT, MR, PET, x-ray and interventional radiology — the show is definitely IT-heavier this year. That is why you will hear more about the magic of cloud computing and how radiologists are doing reads on iPhones — hopefully more will use an iPad or even a Kindle.

The fact is, there are a slew of new product introductions and sessions highlighting software that, in some cases, will have an even greater impact on imaging than the latest iteration in a CT system. Just look at where some of the biggest inroads in radiation dose reduction are happening  — in iterative reconstruction (IR). That’s so 2009, you say, but now it goes by just two letters. It’s confirmed, IR has spread beyond pediatrics or cardiac imaging. “There was increased interest in low radiation dose techniques and noise reduction software applications for CT in trauma and nontrauma applications,” reports the RSNA show program. Any way you say it, expect to hear more IR buzz this year.

What also might not come as a surprise is that the session “Image Sharing: From Digital Media to Cloud Solutions Employing IHE Profiles” will be packed. So get there early. Also, be sure to grab a seat at “Radiology Informatics Series: Mobile Computing Devices” because mobility is on the verge of being mainstream in radiology. Don’t just take my word for it, find out what Dr. Rasu Shrestha, VP of Medical IT and Medical Director of Interoperability & Imaging Informatics, University of Pittsburgh Medical Center, has picked as the Must-See Information Technology Sessions at RSNA 2011 available on Applied Radiology’s digital listing.

Another key trend in IT to look for is, you guessed it, Meaningful Use. Add to that: appropriate imaging, personalized imaging, EMR and the RSNA’s PHR pilot project. Dr. David Mendelson of The Mount Sinai School of Medicine, New York, NY, provides a preview of the RSNA/NIBIB pilot project in “Image sharing: Where we’ve been, where we’re going by” available in print and online in the November issue of Applied Radiology. Radiologists are actually handing over the keys to the patient records to the patients? Well, not exactly. But listen for a lot of buzz about it.

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One CIO’s Guide to RSNA

November 3, 2011 by Leave a comment

Steven F. Fischer, CIO, Center for Diagnostic Imaging, Minneapolis

Editors Note: Leading up to RSNA 2011 we’ve asked Carestream’s Medical Advisory Board members for their insight into the radiology trends we expect to be hot topics at the show. 

Q: What emerging technologies do you anticipate capturing CIO attention at this year’s show?

Several technologies I will be investigating include:

  • Consumer facing technology leveraging mobile devices to improve patient care and their experience.
  • Applications leveraging mobile technology to improve workflow process from patient registration to technologist workspace through results delivery.
  • Technologies, both modalities and post processing, which will reduce radiation dose/exposure as well as learning of any new standards and regulations that may facilitate dose and exposure tracking.
  • Getting an update on the progress of various vendors in the development of thin and no-client reading solutions which provide server-side rendering capabilities.
  • Expansion of Vendor Neutral Archives (VNA) into other “ology” spaces as well as becoming document and “blob” repositories for any “bulk” data storage within the enterprise.
  • See if vendors are starting to address the need for care co-ordination, i.e. women’s health risk assessment, interventional, etc.

Q: Meaningful use will certainly be a hot topic again this year. You’re speaking on a panel about CDI’s experience. What was the biggest challenge you’ve dealt with? The biggest opportunity you see?

The biggest challenge that our meaningful use team dealt with was not the technical integration of computer-based pharmacy ordering into our system, but getting through the certification process (not for meaningful use, but for Surescripts).  We were caught off guard on the lead time it took to do this.

Going forward see at two challenges:

1)      Tracking and reporting the metrics, and managing our processes to ensure our radiologists meet the criteria necessary to qualify and attest

2)      Understanding and implementing Stage 2 and 3 requirements — whatever they are.

To that end I would urge everyone in this industry, radiologist, technologist, support and business people to work with groups like the ACR, the e-Ordering Coalition to lobby for specialty specific metrics for determination of meaningful use e.g. 90% of exams are read digitally;  80% diagnostic reports are available to the referring physician within 12 hours.

This way maybe meaningful use can be truly meaningful for radiology versus meaningless!

Q: You’ve been in the industry for 10+ years. What is your advice to a first time RSNA attendee to make the best of the show?

Couple of items:

1)      Don’t just look at the national vendors. Look for those fringe vendors which may offer new ideas, disruptive technology.  Often they are the smaller booths (as they haven’t been bought by the big guys yet)

2)      Plan your days, but not too much. Leave free time to just wander and investigate the aforementioned fringe vendors, if nothing else it can be interesting.

Last, but not least, make sure you have great shoes; your feet and legs will thank you!

Filed under Meaningful Use, RSNA 2011 Tagged with , , , , ,

What You Need to Know About RIS Meaningful Use Certification

November 1, 2011 by Leave a comment

Doug Rufer, Carestream health

Doug Rufer, director sales operations and business strategy, healthcare information solutions, Carestream Health

The road to meaningful use has many moving parts that make this initiative complex.  Here on Everything Rad, we’ve spent a lot of time discussing the current state of legislation and regulations, as well as the implications of MU for radiologists in terms of compliance and incentives and penalties.  Today we’ll look closer at IT product certification—more specifically RIS certification.

Product Certification Process

First it’s important to understand that Health and Human Services oversees two federal agencies set up to manage meaningful use:  CMS regulates the providers; ONC regulates the technology.

There is a set of federal regulations with 33 ONC vendor criteria for complete EHR certification and 25 CMS measures that are specific to radiology.  Vendors submit their health IT systems for testing and certification by an authorized testing agency (set up by the ONC).  Eligible professionals purchase certified technology and then submit an attestation to the CMS that they are using the certified technology in a meaningful way.  In year 1, the attestation is simply a signed document.  In future years, they will have to submit data to the CMS electronically.  Finally, eligible professionals receive their lump sum payment!

Understanding RIS Certification

When planning your meaningful use technological and operational strategy, it’s important to meet with your radiology IT vendor to discus their certification plans.

Vendors can choose to opt for either complete EHR certification or modular certification:

  • Complete EHR certification – adheres to all 33 ONC criteria, which includes 25 functional criteria and 8 privacy and security criteria
  • Modular certification - product can meet any single or multiple criteria. You can combine modular certified products to achieve meaningful use.

If you use modular certified products you need to be certain they cover your MU measure requirements. In addition, ONC regulations state that you need to “possess” all certification criteria, even if you don’t use them for your MU measures—even if they are not all deployed.

Implementing Modular RIS

I speak with many customers about how to determine if a modularly certified RIS or complete EHR/EMR is necessary for their facility’s meaningful use compliance. From a radiology standpoint, there are a few things to consider when making your purchasing decision:

  • Will your certified EMR / EHR system address the unique worklow and data needs of radiology?
  • Are there existing technologies and systems that could be used together for attestation?
  • Could a modular RIS send structured data to a certified EMR to support an organization’s broader plan?

In addition, a standalone RIS could play an important role in areas where meaningful use may expand for radiology:

  • Order Entry decision support – decision support to make sure exams ordered match patient conditions
  • Exam protocoling – Radiologists may begin protocoling exams more frequently using established protocols for patient conditions
  • Quality Outcomes – More established guidelines around capturing, maintaining, and reporting radiation dose and exposure
  • Structured Reporting – Radiology reports will move from paragraph style reporting to standardized structured reports

This week Carestream’s Vue RIS received ONC-ATCB 2011/2012 certification as an EMR module that meets the first stage of U.S. meaningful use initiatives.  Why’d we choose to certify as a module? We wanted to offer our customers a flexible system that captures MU data at the right time in the workflow and shares that information with other health IT and HER systems, as well as offer a RIS that could adapt as meaningful use standards and criteria change, which they are sure to do into the distant future.

Discussions like these are crucial to be having with your health IT and radiology IT vendors as you prepare your meaningful use strategy.

Looking to evaluate MU certified products from multiple vendors? Visit the Certified Health IT Product List to see how systems stack up against the 33 criteria and 25 MU measures: http://onc-chpl.force.com/ehrcert .

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NYMIIS 2011: The Radiologists’ Efficiency Wish List

September 26, 2011 by Leave a comment

Belimar Velazquez, Carestream Health

Belimar Velazquez, MBA, Director of Marketing and Inside Sales, United States and Canada, Carestream Health

At last week’s New York Medical Imaging Informatics Symposium, several radiologists shared their productivity wish lists for better patient care:

  • More meaningful use information: During a live poll at the session, 60% of the attendees indicated that theyneeded more information to put a meaningful use strategy and plan in place.  Dr. Dreyer of Massachusetts General Hospital shed some light on compliance requirements and provided some resources to help with this process.
  • Easy patient and physician sharing: The ability to easily share images with the patient and referring physician is still elusive for many.  One idea shared by Dr. Siddiqui of Johns Hopkins University challenged the audience to think about a system in which patients and doctors could privately exchange images “a la Facebook,” thus allowing them to comment on the results while maintaining a record of the “conversation.”
  • Next-generation PACS: Dr. Siegel of University of Maryland School of Medicine presented a comprehensive wish list in his session that ranged from achievable wishes such as vendor neutral archiving to the more innovative idea of having the equivalent of IBM’s Watson as a “radiologist assistant” to help with diagnosis.

I always find the NYMIIS event extremely thought provoking, and the speed at which information and technology is advancing will soon make radiologists’ wishes a reality.

What’s on your radiology wish list?

Filed under Digital Radiography, Health IT, Meaningful Use, PACS Tagged with , , , , , ,

Will the Future of Imaging Include the EMR?

August 15, 2011 by 2 Comments

One of the most prominent topics since last year’s AHRA has been the meaningful use (MU) of Electronic Medical Records (EMRs).  In the past year it has been established that radiology qualifies to participate in the incentives, but for radiology the real MU opportunity is about more than just incentives.

Stage 1 requirements are clear:  your RIS vendor can either receive modular or complete certification as an EMR, and by taking advantage of exclusions the radiologist can qualify as an eligible professional.

A new dimension was introduced to the ONC HIT Policy Committee Meaningful Use Workgroup and anticipation is shifting towards Stage 2 and the incorporation of imaging data into the EMR.  This signals a critical acknowledgement that imaging data is relevant to physicians outside of the practice of radiology and opportunity to promote the role that radiology plays in providing better patient care.

Keith Dreyer, DO, Ph.D., Massachusetts General Hospital, introduced the concept of Enterprise Imaging at the May ONC meeting focusing on MU for specialties and the implications of including imaging data in the EMR are significant for radiology.

Consider the emergence of zero-footprint technology and an increase in the use of mobile devices in healthcare.  This trend sets the stage to allow images to integrate into the EMR and give physicians access to data across the hospital.  The incorporation of imaging data into meaningful use requirements will reinforce the importance of closed-loop communication between specialties and would go even farther to improve consistency in patient care – at the same time increasing the value of radiology.

How is your facility currently incorporating images into its reporting?

Need to brush up on Meaningful Use for radiology?  Listen to Dr. Dreyer in a series of podcasts explaining how radiologists can qualify for incentives. 

Filed under AHRA 2011, Health IT, Meaningful Use Tagged with , , , , ,

Meaningful Use in Radiology is Still Top of Mind

July 15, 2011 by Leave a comment

While it’s been established that Meaningful Use applies to radiology,  the topic still challenges radiologists as they prepare for compliance.  Earlier this week we sponsored “The Evolution of Meaningful Use in Radiology” seminar in Dallas, Texas, featuring Keith J. Dreyer, D.O., Ph.D. , Associate Chairman, Medical Imaging, Massachusetts General Hospital, Assistant Professor of Radiology, Harvard Medical School, and David S. Mendelson, M.D., FACR, Professor of Radiology, Chief of Clinical Informatics MSMC, Director of Radiology Information Systems, Pulmonary Radiology, The Mount Sinai Medical Center.

The goal of the session was to help attendees better understand the path to meaningful use, what compliance would look like at their facility and encourage the radiology department to get actively involved in the process.

Miranda Sullivan, St. Francis Hospital, Tulsa, Oklahoma, is responsible for Quality Control for Radiology and came to the seminar to be able to ensure her IT department, which is leading  meaningful use compliance efforts, understands the implications for radiology .

Rob Brull, Corepoint Health,  also attended the session and blogged about the importance of events like this focused on educating the radiology community and  setting expectations for future meaningful use criteria.

To hear more from Dr. Dreyer and other Meaningful Use experts, listen to our Meaningful Use Podcast Series.

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Meaningful Use: Leveraging Core Competencies for Success

June 9, 2011 by Leave a comment

Diana Nole, President, Digital Medical Solutions

Last week, Carestream Health joined other imaging informatics providers at SIIM 2011 annual meeting.  Obvious trends emerged throughout the conference, among them compliance with Meaningful Use. I had the opportunity to participate in a vendor panel to give our perspective on this topic that continues to challenge the radiology profession. The area of Meaningful Use continues to be a learning process for all of us, so opportunities to participate in discussions that provide more insight into this topic are always extremely valuable.

Our approach to Meaningful Use is to support compliance without compromising workflow efficiencies that our customers have already established. We are on track to certify our RIS to support a facility’s full compliance with Meaningful Use, while still addressing the unique needs of radiology. Our technology will be certified as a module to directly provide data for attestation, or for sending structured data to a certified EMR to support an organization’s broader plan to achieve Meaningful Use.

You can view our full panel presentation here.  I welcome your questions and feedback on this relevant topic.

Filed under Health IT, Meaningful Use, Videos Tagged with , , ,

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