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Magical Thinking Obscures the Goal:
Improved Outcomes
By Cheryl Proval
High hopes have been pinned on the potential of IT to improve health care delivery here and around the world, but the current focus on standards may be misplaced, according to a new paper1 published online on August 19, 2008, by Health Affairs. The authors draw on the observations and surveys of Connecting for Health (a public-private collaborative operated by the Markle Foundation, New York City) in concluding that applying standards in the absence of policy is like trying to push string.
Standards develop over time, gaining acceptance only after they have been widely adopted—and this step is not easily mandated. History, in fact, is littered with failed, vendor-approved standards, the authors argue. Serious structural obstacles to the adoption of IT include current legal and financial incentives, which provide scant motivation to share information across institutions. In addition, despite three years of effort by the newly created Office of the National Coordinator for Health Information Technology, the Healthcare Information Technology Standards Panel, and the Certification Commission for Healthcare Information Technology, the authors note, we remain far from the use and implementation of these standards to enable health information sharing.
The authors maintain that protocols are created, but standards are adopted. "The process of standardization is incremental, never solving every problem at once and often leaving prospective data-sharing protocols to be worked out in the field, and only then submitted for ratification after the fact," they write. One need only look at the work-arounds being created by savvy radiology-practice CIOs for the purpose of centralized reading for distributed sites for evidence of the preceding.
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Information Theft:
How to Prevent It
By George Wiley
What do hospital administrators and their CIOs fear above all else? It may be information theft, especially if that information includes sensitive patient data. Nothing grabs the attention as completely as learning that a laptop laden with patient data has slipped out the door. With preparation, though, such an event may be prevented, and if it is not—because no system is perfect—then its impact can be minimized. 
That was the message of George Bowers, MBA, in What Keeps CIOs Awake at Night: Information Theft, which he presented on May 16, 2008, at the Society for Imaging Informatics in Medicine's annual meeting in Seattle. Bowers, principal at Health Care Information Consultants, LLC, Baltimore, is the former CIO of American Radiology Services and the former vice president for information services and CIO at the University of Maryland Medical Center.
As Bowers summarizes HIPAA regulations, "Covered entities must maintain reasonable and appropriate administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of their electronic protected health information against any reasonably anticipated risks." Reminding his audience that in that single sentence there is room for all kinds of interpretation, he says, "What is reasonable, and to what extent are protections adequate?"
"One thing we have learned is that
if it is not bolted down, it can develop legs and it can walk."
—George Bowers, MBA
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How I Do It:
Maximizing Efficiency in CTA Interpretation
By Robert Falk, MD
They're coming, and in many hospitals, they have already arrived: multidetector CT (MDCT), CT angiography (CTA), and advanced 3D imaging. This wonderful new modality offers the promise of evaluating disease processes from atherosclerosis to cancer to trauma more quickly, safely, and accurately than older techniques can. CTA is already replacing diagnostic catheter angiography in many institutions. The emergency evaluation of chest pain is changing rapidly, with MDCT used to evaluate the coronary arteries, pulmonary arteries, and aorta (often in a single breath hold), while at the same time allowing adjacent soft tissues to be seen for assessment for lung disease, chest-wall abnormalities, and upper-abdominal disease.
Complex fractures are being evaluated in 3D for presurgical planning, with the anticipation of shorter, smarter surgical procedures and improved outcomes. Complex organs like the liver and pancreas can now be evaluated in detail prior to surgery, allowing surgeons to define optimum dissection planes for resection of disease. CT perfusion is being used more and more in the acute setting for stroke, in order to guide patient management in the crucial early hours after the onset of symptoms. New applications for this technology are being developed every day. It is clear that advanced visualization has moved from being a luxury to being a necessity in the practice of medicine.
This article will focus on ways to maximize radiologist efficiency in processing and interpreting CTA studies. In the world of 3D, CTA is far and away the highest-volume procedure. It is critical, therefore, to develop both the skill sets and the workflow processes to handle ever-expanding volumes of cases as efficiently as possible. For the time and effort involved, professional reimbursement for CTA is low, generally being about $15 to $30 more than for a conventional CT. If it takes four times as long to read a CTA of the carotids than to read a CT of the neck, you are losing money. How, then, can we, as radiologists, offer high-quality CTA to our patients and referring physicians without getting bogged down in workflow inefficiencies? There are four key steps to maximizing efficiency in CTA: knowledge, support, access, and routine.
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Leverage PACS IT Support to Grow Referrals
By Cheryl Proval
While radiology practices and imaging center operators spend heavily on marketing liaisons to help cement favorable referral patterns, few understand the role that hands—on PACS IT support can play.
John Griffith, CRA, CIIP, RT, and CIO of Epic Imaging, Portland, Ore, operates in a market that grew from three providers of outpatient imaging to dozens. Recognizing that referring physicians had multiple PACS viewers to use and a proliferating choice of imaging centers to send patients to, Epic Imaging implemented a tiered approach to IT support, and last year added an applications specialist to visit referring physician offices, install an application, and assist office staff in understanding its use.
One year later, the applications specialist has visited several hundred referring physicians' offices—some of them multiple times, because of high staff turnover-to install the viewing software and offer user support and training. The total referring—provider login count now stands at more than 2,000. In addition to its IT help desk, WebEx™ remote access to physicians' desktops, and vendor-supplied marketing collateral, Epic Imaging has recently closed the loop by rolling out electronic results communications.
"The referring physician will choose the path of least resistance."
–John Griffith, CRA, CIIP, RT
CIO, Epic Imaging
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Avoiding Nightmare PACS Outages
By Kris Kyes
Preparation is the difference between unexpected PACS downtime and a nightmare, Michael D. Toland told his audience in Seattle on May 17 at the 2008 annual meeting of the Society for Imaging Informatics in Medicine. Toland, who is PACS administrative team manager for the University of Maryland Medical System, Baltimore, presented PACS Worst Case Scenarios: Understanding the Implications of Major Downtimes and Avoiding Them.
It is vital to understand the effect that PACS downtime has on the entire enterprise, not just the operation of a single department or service. It is particularly important to note the clinical, business, and risk-management implications of PACS downtime, Toland says, especially as PACS use spreads further beyond radiology.
The effects of downtime should be limited in advance through the development of policies for communication and for escalation of staff intervention in the event of system failure. Of course, procedures should also be established to reduce downtime in the first place. The development of strong relationships with vendors will be a valuable step in this direction.
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Long-term Data Management and Migration for PACS
By Kris Kyes
PACS data migration is so important that every PACS acquisition should include a plan for outbound migration at the end of that system's life, according to Frederick M. Behlen, PhD. Behlen is an officer, director, and shareholder of LAITEK Inc, also known as Migratek™ Data Migration Services, Homewood, Ill. He serves as cochair of the DICOM-HL7 joint working groups.
On May 15, 2008, Behlen presented Policies Surrounding Migration during the PACS Operational Policies and Procedures session of SIIM U, held in Seattle during the Society for Imaging Informatics in Medicine's annual meeting. The following day, Behlen covered the practical aspects of his topic by presenting Data Migration: Plan Early and Sleep Better. Together, his presentations provide a framework for devising and implementing a solid, cost-effective plan for data migration.
Behlen points out that while the retention requirements for patient images and other information vary by state, they have become more serious over time, particularly since the 2005-2006 two-stage implementation of the HIPAA Security Rule. In addition to the need for confidentiality and accountability in handling patient data, standards of practice for data management have risen in recent years. Because electronic records became vital to business operations, uninterrupted access to them became vital, in turn, to business continuity. For this reason, disaster recovery has turned into an indispensable function and long-term data management is a part of strategic planning.
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ICD-10 Deadline Brings on IT Headaches
No sooner did CMS call for an October 1, 2011, compliance date for the switch from ICD-9 to ICD-10 codes than a hue and cry arose from the health care industry, claiming that the change comes too soon.
Not only does ICD-10 contain 10 times the number of codes in ICD-9, but the implementation of the new codes coincides with a HIPAA mandate to implement the next generation of electronic transactions (ANSI X12 version 5010), which many organizations believe needs to be implemented and fully vetted prior to the transition to the new code set.
No one disagrees that the greater specificity of the ICD-10-long implemented by most industrialized nations-can bring about improvements in clinical documentation, administrative transactions, and quality-improvement programs. This conversion, however, represents one of the greatest IT challenges that the US health care system has ever seen, affecting every health care provider in the nation.
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| INFORMATION RESOURCES |
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How Efficient is Your Data Center?
A study by McKinsey & Co reports that data centers will exceed the airline industry as greenhouse-gas polluters by 2020, according to an article in the New York Times. The carbon-dioxide emissions attributable to the electricity consumed by data centers will increase fourfold over that time. According to the study, data-center servers are used at just 6% of their capacity and data centers are used at just 56% of capacity, underscoring squandered cost and energy-saving opportunities.
[Read more]
Most HIPAA Complaints Entail No Investigation
Despite the fact that 38,000 US residents have complained of HIPAA violations in the five years since HIPAA was implemented, not a single fine has been levied by the Office of Civil Rights, and more than half of the complaints have been disposed of without an investigation, according to an article in the Des Moines Register.
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Three Groups That Can Kill Your IT Project
Be advised that there are three groups that can kill your IT project, according to an article in Baseline. Those groups are the executive committee that approves the project, the IT department that will support it, and the end users who will work with the new system. This savvy advice applies to senior IT project managers, consultants, and vendors alike.
[Read more]
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| VENDOR RELATIONS |
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Wireless Cassette-sized DR Detector
Carestream Health, Inc, Rochester, NY, has announced the development of a wireless DR detector the size of a standard cassette that can be used with an existing wall-stand or table-based bucky. A work in progress, the DRX-1 system incorporates a console and a wireless 14x17-inch wireless, cassette-sized DR detector, the use of which requires no modifications of analog equipment. The detector is lightweight at 8.5 pounds, and wireless technology provides full flexibility in patient positioning. The company hopes to make the product available in the first quarter of 2009.
[Read More]
Web-based Cardiology PACS Version 4.0
FUJIFILM, Stamford, Conn, has announced the availability of ProSolv CardioVascular Version 4.0. The new software release features ProSolv as a Web-based application for full viewing and reporting via Web communications protocols, fully integrated with FUJIFILM's Synapse PACS. Version 4.0 features enhanced clinical tools such as pediatric echo reporting and a Z-score module, which enhance reporting efficiency; a new default echo-measurement analysis package; improvements to coronary-tree functionality; and resting ECG management, including Holter monitoring support.
[Read More]
PACS Features Distributed Reading Module
INFINITT North America, Phillipsburg, NJ, has developed a Tele-RIS module that enables radiology reading services to provide advanced hosting capabilities to their referring customers. The module was developed to meet the needs of a large radiology reading service in Texas where fellowship-trained radiologists read images from 23 different imaging facilities. Its users can now archive images, orders, technologist notes, and patient information so that all are accessible from a single workstation/viewer.
[Read more]
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| COMING EVENTS |
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NOVEMBER
World of Health IT Conference & Exhibition
Sponsored by a global consortium of health IT organizations
November 4-6
Bela Center, Copenhagen, Denmark
This global networking and education event will feature keynotes by Viviane Reding, European commissioner, DG Information Society and Media, Belgium; Nicholas Negroponte, chairman emeritus, MIT Media Lab; and Esko Aho, former prime minister of Finland.
[Register]
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]
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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