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Can Health Informatics Reduce Health Care Costs?
By Cheryl Proval
The answer to that question may appear obvious to imaging informatics professionals, but a study released earlier this year by the Government Accountability Office (GAO) disputed the ability of health informatics to reduce health care cost. Now, all of us in radiology have seen the ability of informatics to reduce imaging costs within the radiology practice, the radiology department, and the enterprise. In radiology, the deployment of health information systems has resulted in an unprecedented increase in radiologist productivity during the past 10 years. We've even seen the ability of decision-support systems to reduce the cost of imaging in the greater metropolitan Minneapolis market, in some practices by as much as 10%.
Back in May 2008, when the report was issued, the Wall Street Journal suggested that the study had put an end to the hope that the government would make a significant investment in health care IT. This isn't necessarily a bad thing. The more we chase a one-size-fits-all IT solution for health care, the more we pitch money into a black hole. Besides, we've already bought the banks.
The best places to see how a diverse set of information systems, thoughtfully applied, can result in reduced costs are the heterogeneous environment of the radiology practice and the imaging data centers of well-run health systems.
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Say Aloha to Your PACS:
The Selection Process
By Cat Vasko
 When Hawaii Health Systems Corp (HHSC), Honolulu, began shopping for a PACS solution for three of its five island regions, newly hired CIO Money Atwal had a few unique issues to take into consideration. Though multisite PACS configurations are increasingly commonplace, most don't have to cross water in order to work. Atwal needed a solution that could not only connect facilities on the east and west sides of the main island, but could also be shared by HHSC's Maui location-around 100 miles of Pacific Ocean away.
"First and foremost, we were looking for distributed architecture. We wanted to allow each of the regions to hold some short-term storage, backing up for the long term at a centralized location, but if a region wanted to keep something locally for more than five years, we still needed that flexibility."
—Money Atwal, CIO
In addition, the remoteness of HHSC's locations required exceptional customer service from a vendor with the reach and clout to be able to serve a client properly outside the continental United States.
Atwal was hired by HHSC just in time to spearhead the PACS-selection process. He had been through a similar process in his previous position, but while the first facility was bigger, the challenges were less daunting. "It was more difficult at HHSC because of the other regions' involvement," he notes. "The other regions have different workflows and personalities to be worked through." Of course, Atwal was interested in much more than simply finding the right multisite architecture for HHSC's needs. He was also looking for robust storage, thin-client Web access, CR and mammography integration, and the right image-manipulation tools to keep his radiologists happy.
With such diverse system requirements to meet and so many parties from across the health care continuum invested in the outcome, it was crucial that Atwal appoint the right people to the selection team.
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PACS/RIS Replacement:
Cheating the Big Bang
By George Wiley
Replacing technology is always nerve-wracking, but it is particularly volatile when the systems being replaced are a PACS and a RIS, systems at the heart of daily function for radiology departments and hospitals.
Anthony Jones, PACS administrator for the University of Utah Health Sciences Center (UHSC), knows the changeover terrain well, and on May 16, 2008, at the Society for Imaging Informatics in Medicine's annual conference in Seattle, he detailed for seminar attendees how his hospital is getting its PACS/RIS changeover done.
Jones says that the Salt Lake City facility is licensed for 425 beds, with a dozen affiliated clinics in outlying spots. It conducts roughly 250,000 radiology exams per year, he says. UHSC also operates a teleradiology system through which it reads for smaller regional hospitals and clinics.
UHSC installed its old PACS in 1998. It had installed its RIS earlier, in 1990. The PACS has 3,500 users and the RIS has 1,000, Jones says.
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How We Do It:
Using 3D MRI to Identify High-risk Vascular Disease
By Alan R. Moody, MD
Stroke and heart attack are major killers, not only in the Western world but, increasingly, throughout the developing industrial nations. The cost of these diseases is counted not only in lives lost, but in the health care costs incurred by those patients suffering the chronic manifestations of stroke and cardiac failure. While the acute and more chronic aspects of these diseases appear quite disconnected (for example, brain disease versus heart disease), and we are used to thinking of these conditions in terms of these end-organ manifestations, they do, in fact, share a common causality: vascular disease within the blood vessel supplying the end-organ tissue.
In the case of stroke, this is in the carotid artery, and for heart attack, the coronary artery, so coronary thrombosis is synonymous with heart attack. While much medical attention has been focused on the acute diagnosis and treatment of both of these conditions to avoid or restrict end-organ damage, knowing that the acute disease is preceded by a protracted period of developing vascular disease provides the opportunity to detect and treat the vascular disease before it has the opportunity to cause downstream end-organ disease. The diagnostic challenge is, therefore, to identify biomarkers that discriminate between those people with and without high-risk vascular disease.
Until recently, the most common and reliably used measure of vascular disease has been the degree of narrowing of the blood-vessel lumen (stenosis). It is known that as vascular disease progresses, the degree of stenosis will also increase. This has been readily measurable using techniques such as conventional angiography, ultrasound, and (more recently) CT and MR angiography. The diagnostic usefulness of stenosis, however, only becomes manifest once the disease is severe. Regrettably, symptom-provoking vascular disease is not confined to this advanced-disease group and often occurs in patients with lesser degrees of stenosis. In recent years, we have gained a better understanding of the biology of vascular disease, which accounts for this disconnection between stenosis and symptoms, but also gives us clues about newer markers of vulnerability.
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Change Management:
Influencing the Uneasy Alliance Between Man and Machine
By George Wiley
No one faces a constantly changing landscape more than the CIO at a large health care institution. Until
recently, Michael T. Balassone was CIO at West Virginia University Hospitals, a 522-bed teaching hospital and medical complex in Morgantown. He currently serves as senior information officer, University Medical Associates, Medical University of South Carolina, Charleston. His message, presented on May 16, 2008, at the annual meeting of the Society for Imaging Informatics in Medicine in Seattle was that the pace of change requires CIOs to create new paradigms to deal with the shifting status quo.
On one side, Balassone says, are the technological changes that are producing more capable (but complex) scanners, computer systems, and data-storage/manipulation systems all the time. While the lags between technological generations were broad in the early years, new versions of hardware and software are much more tightly spaced now, he says.
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ICD-10 Mandate to Break Physicians' Bank
The typical 10-physician practice will spend $285,240 to comply the new federal mandate to adopt the ICD-10 code set by 2011. The controversial proposal from HHS would significantly increase costs for physician practices and clinical laboratories, according to a new cost study initiated by a broad group of provider organizations and conducted by Nachimson Advisors, Reisterstown, Md.
"We are just now beginning to learn the increased costs on physician practices associated with moving to the ICD-10 code set—and they are staggering."
—William F. Jessee, MD, FACMPE, MGMA CEO
Researchers estimated much higher costs associated with implementing ICD-10 than CMS estimates, reported in the last issue of RadInformatics. This will place a major burden on providers, taking valuable time away from their patients and straining other resources needed for investment in health IT. Armed with this new information, the coalition that sponsored the study has called on HHS to reconsider its plan to adopt ICD-10 so quickly and to extend the implementation time frame, saying that the resources required would take physicians away from their patients and would use precious capital better invested in IT.
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IT's Cross-functional Business Agenda
Increasingly, radiology-practice CIOs and their hospital counterparts are being called on to interact with leadership across the organization to help drive strategic initiatives. This new level of responsibility requires CIOs to be precise and prepared for conversations with their peers across all of the organization's business functions.
New research from the CIO Executive Board, Arlington, Va, intends to equip CIOs with the tools to shape business discussions with leadership across departments and functions by providing intelligence on how CIOs in a wide cross section of industries anticipate emerging business needs, where functional agendas overlap in an organization to create opportunities for collaboration, and what a CIO needs to know about peers to have a meaningful discussion.
Researchers reviewed surveys from 35 research programs and more than 2,000 responses from top executives worldwide in identifying the IT implications of data capture and aggregation, shared service consolidation and automation, and cross-functional mediation.
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| INFORMATION RESOURCES |
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How IT Improved NYC Public Health
A study commissioned by the Commonwealth Fund, New York City, found that health IT transformed a public hospital in New York City serving primarily low-income patients into a higher-performance institution through the use of an electronic medical record, computerized physician order entry, medication management and reconciliation, and evidence-based decision-support systems.
[Read Report]
WSJ Report: Health IT on the Brink of Major Expansion
According to a report in the Wall Street Journal, IT security is poised to meet the expectations of the health care industry—and when it does, powerful IT networks crisscrossing the globe will change the way that much of health care is delivered. Look for an increase in outsourcing and offshoring of medical and nonmedical services, the swift and safe transfer of medical records, global access to data on topics such as medication safety, and authoritative and current information for health care professionals and consumers.
[Read more]
That Desk Job Is a Health Hazard
Computerworld explored how the IT lifestyle—hours in front of the monitor and a 24/7 tether to the mother ship—can wreak havoc on mind and body, identifying stress, poor posture, heavy keyboard action, and grazing from vending machines as risk factors for carpal-tunnel syndrome, rotator-cuff disease, anxiety, depression, and obesity.
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| VENDOR RELATIONS |
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PACS and 3D Tools Tightly Integrated
Barco, Kortrijk, Belgium, and FUJIFILM, Stamford, Conn, have introduced a seamless integration of the new Voxar 3D 6.3 version advanced visualization product into the FUJIFILM SynapseŽ PACS platform. The new integration makes use of off-the-shelf hardware and provides a fivefold increase in image-loading performance. The package includes maximum-intensity projection, multiplanar reconstruction, and 3D tools, as well as applications for vessel analysis, CT cardiac analysis, CT colonography, and PET/CT reading.
[Read More]
Hologic Earns FDA Clearance for Breast-density Tool
Hologic, Inc, Bedford, Mass, has received FDA 510(k) clearance for the R2 Quantra volumetric breast-density-assessment tool. The software creates an internal 3D model of the breast to calculate fibroglandular volume and total breast volume. The tool provides a numeric value for each breast, taking the subjectivity out of the assessment of breast density, considered to be a clinically significant predictor of breast-cancer risk.
[Read More]
Thin-client AV Tools Advance
Visage Imaging, Carlsbad, Calif, will show a new version of its CS/Thin Client/Server platform at the upcoming RSNA meeting. Enhancements to 2D, 3D, and 4D visualization are featured, including CT and MR angiography, cardiac analysis, perfusion analysis, and oncology applications. All tools are fully integrated within the platform, which is scalable from the imaging center setting to meet the needs of the enterprise.
[Read more]
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| COMING EVENTS |
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NOVEMBER
Annual Meeting and Exhibition of the Radiological Society of North America
Sponsored by the RSNA
November 30-December 5
McCormick Place, Chicago
This year, the exhibits will span three halls, with a new layout intended to help attendees see more exhibits in less time. Hall D in the Lakeside Center will now hold exhibits, and the posters and education exhibits will move down a level to Hall E. Nonetheless, comfortable shoes are recommended.
[Register]
FEBRUARY
TEPR+2009: Rehydrating Health IT
Sponsored by MRInstitute
February 1-5, 2009
Palm Springs, Calif
Celebrating its 25th year, this health IT conference features sessions on choosing a physician-practice EMR; linking hospitals to physician offices; preparing health IT leaders for the patient-centered medical home; and using modern cell phones, PDAs, and smart phones to connect providers, patients, and payors.
[Register]
APRIL
HIMSS 09 Annual Conference & Exhibition
Sponsored by HIMSS
April 4-8, 2009
McCormick Place, Chicago
Next year, health care's largest IT event, the HIMSS meeting and exhibition, moves from February to April. The event features keynotes, education, and exhibits on a broad spectrum of health care IT topics.
[Read more]
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PRESIDENT/CEO
Curtis Kauffman-Pickelle
VP, PUBLISHING
Cheryl Proval
VP, CLIENT SERVICES
Steve Smith
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