Connecting The Dots
By Curtis Kauffman-Pickelle
The editorial staff at the Imaging Center Institute is very proud of the launch of RadInformatics.com as a separate on-line publication, published quarterly. Readers will recognize this information source as a regular column in ImagingBiz.com, and the fact that this valuable information service has grown to become its own separate publication is an indication of the demand for PACS/RIS and other IT information in our evolving specialty.
It is yet another way that we can help you stay connected and abreast of the trends, issues, ideas and news within this all important segment of medical imaging.
PACS administrators, IT directors, CIOs, and other executives have sought ways to demonstrate to hospital imaging departments and to outpatient imaging organizations the productivity gains, workflow improvements, enterprise communication solutions, and clinical applications that robust informatics programs and products have on the practice.
As we strive to bring you timely and relevant information that will help you make the business case for the decisions that you grapple with each day, the Imaging Center Institute is committed to developing content of the highest level, and we will continue to find ways to add value to the debate on topics such as informatics.
We hope that you enjoy this publication and look forward to your response.
Curtis Kauffman-Pickelle is a strategic business consultant to more than 30 imaging centers and radiology practices, and is CEO of the Imaging Center Institute. He welcomes your comments at ckp@imagingbiz.com.
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Ron Hosenfeld and RivRad: Building an Effective Distributed Reading Solution
By Cheryl Proval
The road to a distributed reading model is paved with WAN accelerators, DICOM gateways, and sleepless nights, to hear one practice CIO describe it. Nonetheless, three and a half years after he began building a distributed reading solution to support the subspecialty reading model of Columbus, Ohio-based Riverside Radiology, CIO Ron Hosenfeld sleeps better and Riverside Radiology has a robust and reliable information-technology infrastructure to support teleradiology over an expanding geographic area for its 60-plus radiologists.
As many radiology practices hope to compete based on the subspecialty reading model, the experience of Riverside Radiology's Hosenfeld will no doubt prove instructive.
Riverside has experienced systematic growth in the past four years. When Hosenfeld, a mechanical/electrical engineer with Air Force satellite communications experience, joined Riverside Radiology in 2004, the practice had 8 to 12 employees and 34 radiologists. Today, there are more than 60 radiologists covering six hospitals and 16 outpatient centers scattered over an area 160 miles in diameter. Last year, the practice read 900,000 studies and employed 150 people. Hosenfeld has four IT staff reporting directly to him and two additional employees who do operations and analysis.
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Optimizing Coronary CTA Workflow:
How We Do It
By Khan M. Siddiqui, MD
Coronary CT angiography (CCTA) provides an accurate evaluation of coronary-artery disease and coronary-artery anomalies, and it gives us the ability to evaluate the cardiac chambers, myocardium, and valves. Effective deployment of CCTA service requires optimization of workflow to make this procedure cost effective and practical.
After more than six years of experience doing all interpretation in volumetric mode, we applied similar workflow-enhancement principles to optimize our CCTA workflow.
Baltimore VA Medical Center was the first completely filmless department when it opened its doors in June 1993. Over the past 15 years of being filmless, extensive work has been done in the department to optimize every aspect of the digital imaging chain, from physician order entry to scheduling, acquisition, interpretation, andresults delivery.
Similarly, in 2002, the department made another transition to volumetric interpretation, with every CT examination acquired in thin collimation (less than1 mm) and interpretation done in volumetric/multiplanar mode for every study, irrespective of clinical indication. During this transition, volumetric interpretation tools were also deployed enterprise wide to give physicians access to the same tools that radiologists use for diagnosis. In short, we made volumetric interpretation part of routine workflow for radiologists and clinicians.
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Look, No Hands:
Reports Go Directly to Referrer EMRs
By George Wiley
John Griffith, CIO of Epic Imaging, Portland, Ore, says, "They asked us for it, and we had to come up with a solution." The radiology practice provides imaging for close to 2,000 physician referrers; what they wanted was electronically delivered radiology reports sent to their practices not via fax, nor even over the Web, where they had to reside as part of some queue. The physicians wanted the reports to show up automatically in each patient's electronic medical record (EMR). They wanted to open the patient's EMR and have the report right there waiting for them, with no staff time spent clicking links or handling paper.
"We realized we needed a solution, so we started looking for an HL7 interface."
—John Griffith, CIO, Epic Imaging
The physicians' requests came in 2006. Epic Imaging had successfully gone down the electronic report-delivery road once before, but had found the cost prohibitive. According to Griffith, the radiology practice had built an interface that would allow it to send reports to patient EMRs at the Kaiser Permanente hospitals in Portland. Epic picked up overflow imaging for Kaiser and provided studies that Kaiser didn't have then, like PET/CT, Griffith says.
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Taking Care of Maine
By George Wiley
Maine is a sizable state geographically, but its extreme northeastern positioning takes it off the beaten path. It's a place tailor-made for electronic transmission of radiological images, and Radiology Specialists of Maine (RSM) in Brunswick is turning to technology to expand coverage in ways that it hasn't before. It may be something of a pioneering effort. The motive isn't profit so much as improved patient care.
"One does not need to be a megagroup to perform good work or do good deeds. It just requires a neighborly attitude and a mutual desire to do what one can to serve patients well."
—Robert B. Finegold, MD, FACR, Radiology Specialists of Maine
Finegold says that the group of seven radiologists is moving with deliberate goodwill as it broadens coverage, careful not to encroach on competing radiologists' turf. It's the way things are done in a state where radiologists are familiar with one another, Finegold says. He has served as Maine chapter president for the ACR and on numerous ACR state and national committees.
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Better Than Aspirin: Modality Testing and Troubleshooting
By Herman Oosterwijk
Why does it typically take several days to get a new modality up and running, from a connectivity perspective?
Installing a new modality and upgrading existing modalities are recurring events. Some of these installations take just a few hours, but others could take days, or even longer. It is also not uncommon to have to roll back a new modality upgrade. Proper preparation and verification eliminate, in most cases, the potential disruptions and stress.
One should also know that it is critical to ensure that any issues that might jeopardize PACS availability or data integrity are identified and dealt with; examples of these data-integrity issues include the possibility that hanging protocols might not work anymore because the series description in the header is suddenly different, as well as the possibility that creating duplicate image unique identifiers will cause database-integrity problems.
To prevent these issues, one should follow these steps.
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Issue Tracking for Image Quality Improvement
By Kris Kyes
Paul Nagy, PhD, is director of quality and informatics research and associate professor of radiology at the University of Maryland School of Medicine, Baltimore. On November 27, 2007, he presented Developing the Infrastructure (Quality Control in Radiology) at the annual RSNA meeting in Chicago, with the stated goal of helping his audience understand how lack of communication in radiology can be decreased through the use of the appropriate information technology.
Most of the time, Nagy says, the improvement of quality in radiology lies within the radiologist's sphere of influence, even though this activity has often fallen to others. Operational quality is frequently the responsibility of administrative personnel, and image quality can easily become the technologist's domain. Radiologists, however, are uniquely qualified to help improve quality in both realms by bringing all concerned together as a team through enhanced communication.
Despite its many advantages, information technology has had an inadvertent but detrimental effect on image quality in many settings. Nagy explains that this has taken place because the technology is so good at improving efficiency and productivity that the waiting times that were once common in radiology have largely disappeared. Unfortunately, it was during these intervals that many of the steps needed for quality control and problem correction were taken, typically in the form of casual conversations between staff members and radiologists.
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Bookmark This:
Yottalook
Tired of sorting through attorney advertisements when you Google mesothelioma? Bookmark Yottalook, the search engine created by Khan Siddiqui, MD; Woojin Kim, MD; William Boonn, MD; and Nablie Safdar, MD. The creators used search algorithms to isolate and display only radiological content found in a Google search, but the tool is much more than a radiology-specific Google search. Yottalook has access to teaching files, research papers, and journals off-limits to the general-purpose Google search engine.
Siddiqui told RSNA's Daily Bulletin that Yottalook is proving particularly useful to on-call radiologists.
"One fourth of all our searches happen after midnight, meaning people are using it while on call. They're reading a case and need to find information."
—Khan Siddiqui, MD, VA Maryland Health Care System, Baltimore
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CIIP Update:
Getting Certified Got Easier
There's no single textbook, and no specified curriculum, but preparing for the certified imaging informatics professional (CIIP) examination just got a bit easier with the completion of the learning objectives for each of the 10 domains of the American Board of Imaging Informatics (ABII) Test Content Outline (TCO).
While the test is designed and administered by the ABII, the Society of Imaging Informatics in Medicine (SIIM) is coordinating and leading the educational effort to prepare certification candidates through its Education Advisory Network, created for this express purpose.
The new learning objectives document drills down more deeply than the ABII TCO outline to create a more specific study guide. For instance, under the Image Management domain of the ABII TCO, which represents 20% of the test, there are 20 bulleted items to study. The new learning objectives document features 40 items under the image management domain.
Richard Morin, PhD, ABII board of trustees chair, emphasizes the need for a educational resources to help applicants prepare for the test.
"Unlike radiologists, or dermatologists, imaging informatics specialists come from a lot of different backgrounds, and there is no standardized curriculum; there's no standardized degree yet. The backgrounds can vary quite wildly, and this helps to put everyone on the same playing field."
—Richard Morin, PhD, chair, ABII Board of Trustees
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| INFORMATION RESOURCES |
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Industry Mourns Passing of PACS Pioneer Sam Dwyer, PhD
With collective sorrow, the imaging informatics industry noted the death after a long illness of Samuel J. Dwyer, III, PhD, on February 6, 2008. An acknowledged pioneer of digital medical imaging and a friend and teacher to many in the field, he is widely acknowledged to be the man who built the first PACS at the University of Kansas in 1982-1983. SIIM has invited friends and colleagues to post remembrances on the SIIM Web site.
[Remembrances of Sam Dwyer]
Get Hip About ITIL
A recent article in Information Week outlined the top 10 things CIOs need to know about the IT Infrastructure Library, developed by the British government in the 1980s as an infrastructure of best practices to facilitate the delivery and management of IT services. With the recent launch of ITIL version 3, the new version of ITIL has been streamlined and its ability to demonstrate the business value of IT enhanced.
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Minnesota Mandates Electronic Filing
While it may be costly to some, the decision of the Minnesota Department of Health to require all health care organizations to use a standard computer system to verify patients' benefits and eligibility for services has the potential to speed payment for services rendered and ease radiology's verification of eligibility burden. Under the rules, insurers, payors, hospitals, clinics, and other providers must adopt an electronic filing system by January 15, 2009. Insurers and providers must electronically verify eligibility and benefits using a standard format modeled after Medicare standards.
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UPMC Interoperability Project
Semantics played a big role in the $35-million University of Pittsburgh Medical Center (UPMC) interoperability project. UPMC and Israel-based dbMotion, a provider of service-oriented, architecture-based middleware and software tools, collaborated to enable UPMC doctors, nurses, and other clinicians to access a single view of patient data previously available only by tabbing through multiple screens and multiple clinical systems. In devising a common language for the system, UPMC hopes to eliminate confusion or misinterpretation between the meaning and context of common and similar terms, such as blood pressure versus hypertension, or drugs called by their generic names versus brand names.
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IBM, Mayo Clinic Partner to Apply Video Game Chip to Imaging Applications
IBM, Armonk, NY, and the Mayo Clinic, Rochester, Minn, will collaborate on putting the Cell, a computer chip used to power the Playstation 3 console, to work in advanced medical imaging applications. A new facility on the Mayo campus will host researchers from Mayo and IBM in their efforts to apply the chip to medical imaging's clinical informatics challenges, such as tracking tumor growth and treatment response and speeding workflow.
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Fuji's ProSolv PACS Goes to Top of KLAS
ProSolv CardioVascular from FUJIFILM Medical Systems, Stamford, Conn, has earned the number-one ranking from KLAS in its 2007 Cardiology PACS Study. ProSolv ranked first in 26 of the 40 performance indicators.
[More Information]
College, 3DRinc Partner in Web-based Advanced Visualization Curriculum
Outsourcing 3D lab 3DR Laboratories, Louisville, Ky, and a local technical college have collaborated on developing a curriculum that awards college credits to technologists and others interested in developing their postprocessing skills.
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| COMING EVENTS |
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February
Health Information Management Systems Society Annual Conference & Exhibition
Sponsored by HIMSS
February 24–28
Orlando, FL
Former Sen Bill Frist, AOL founder Steve Case, Google CEO Eric Schmidt, and author Steven Levitt are among keynote speakers at the annual meeting devoted to health care informatics.
[Register]
March
Eighth Annual Digital Health Information Management System Conference
Sponsored by the University of Rochester Department of Imaging Sciences
March 25–29
The Westin La Cantera Resort, San Antonio
The five-day meeting will feature a day-long PACS Primer covering the basics of PACS administration, multiple education sessions, and hands-on opportunities for evaluation and comparison of workstations and advanced visualization software, as well as interoperability demonstrations.
[Register]
April
Interventional Radiology Coding Seminar
Sponsored by the Society of Interventional Radiology and Affiliated Professional Services
April 12
Hilton Boston/Financial District, Boston
This seminar will be led by Walt Blackham, MS, RCC, chair of the RBMA coding committee, and the RBMA representative on the ACR Committee on Coding and Nomenclature, as well as a contributor to the Interventional Radiology Coding Users' Guide published by the Society of Interventional Radiology.
[Register]
MAY
SIIM 2008 Annual Meeting
Sponsored by the Society for Imaging Informatics in Medicine
May 15-18
Seattle
Educational sessions are designed for the imaging informatics needs of physicians, researchers, administrators, and imaging informatics professionals, and the program includes educational and scientific sessions, debates, and hands-on experience in the SIIM Learning Lab.
[Register]
JUNE
HIMSS Summit 08
Sponsored by the Health Information Management Systems Society
June 9-10
Renaissance Hotel, Washington, DC
Billed as the premier senior IT leadership program in North America, the summit takes place during National Health IT Week. The event is designed to address the high-level policy issues of this election year and their practical implications. Program tracks include: Ambulatory-enterprise Cooperation, Consumerism and HIT, Financial Health of Hospitals & Physician Practices, and Strategic Relationships: The C-suite.
[Register]
JULY
Beyond Strategies: Best Practices for Excellence in Outpatient Imaging
Sponsored by GE Healthcare Beyond Program
July 23-25
JW Marriott Pennsylvania Avenue, Washington, DC
Top-notch keynote speakers and seminar leaders will present a variety of topics on trends in health care consumerism, merger-and-acquisition strategy, and marketing/demand management. Keynote speakers include Mark McClellan, MD; election analyst Charlie Cook; and futurist Jeff Goldsmith.
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