Ken Olbrish on PACS implementation best practices

In this day and age, Picture Archiving and Communication Systems (PACS) are essential for providing images immediately and anywhere. Main Line Health System Enterprise Imaging Administrator Ken Olbrish understands that firsthand.

Main Line Health System, located outside of Philadelphia, successfully completed an enterprise PACS implementation. We sat down with Olbrish to discuss lessons learned from the PACS implementation.

When a PACS must be integrated with other devices, what challenges do administrators face?
There are several challenges for PACS administrators to overcome.

First, there is the initial set up. It would be nice to believe that devices are all standardized in terms of their interfaces because they utilize existing standards such as DICOM or HL7. While these standards help to get device integration working at a basic level, vendors may choose to implement these standards differently or choose to implement only certain aspects of these standards. As a result a PACS administrator may find that while a device can communicate, not all the information that is needed is present in the transactions or images, or data may not appear consistently across devices.

Second, there is an ongoing problem of having to deal with differences in versions. In an ideal environment, all similar devices would be upgraded at the same time. But it is not uncommon that a hospital or healthcare enterprise could have several of the same devices all operating on different software platforms or versions because of the timing on when they were implemented, when money was available for upgrades, when devices were available for upgrades, etc. PACS administrators must be constantly aware of changes being made to existing devices to ensure they are tracked and integration is tested following updates.

How can these challenges be overcome?
For all of the integration challenges outlined above, there are several basic things a PACS administrator can do to address them:

• Attempt to schedule defined time for integration and testing into the PACS implementation project timeline. This obviously doesn’t ensure the time will be available when it is time for the integration if there are earlier delays in the project, but it does at least help to ensure that time is allocated for the integration. If nothing more, this will raise awareness within the organization as to how much time it takes to perform the integration.
• Maintain current documentation that outlines versions and other relevant information. By tracking this information, a PACS administrator may have a better handle on what devices may behave differently and have information necessary to work with vendors on resolving integration issues.
  
• Create a test environment and test as thoroughly as possible before new implementations and upgrades. A PACS administrator should create test scripts for each integration that can then be updated and reused for subsequent upgrades over time. By working out integration issues in a test environment, there is less likelihood that issues will arise in a production environment. It is extremely helpful to get key users engaged in the testing, whether these are physicians, technologists or other super users of the systems involved.

What are a few of your top tips to ensure a smooth PACS implementation?
1. Assess user needs and requirements before the PACS implementation begins. To obtain user buy-in, the users need to be engaged in the process and feel that their needs are being met through the implementation of whatever system is ultimately selected and implemented. When assessing user needs, it is also important to include representatives from all impacted areas.

2. Look at workflow and processes as much as or more than the system being selected. System implementations often fail not because the system doesn’t work, but because the processes associated with using the system fail. Trying to duplicate inefficient or bad processes with new systems or technology leads to failure.

3. Include more training in the rollout than you think you need. When systems are implemented and there is not enough training, it limits the likelihood of success. An environment and schedule need to be created to allow users to attend training and not be rushed or interrupted during training. Furthermore, training often works better when it is spread over time. Initially users will just need to learn the basics of the system. But after several weeks or months of using the system, users will most likely need additional training to take their use of the system to another level.

4. Budget accordingly in terms of costs and time. Estimating capital costs for a new PACS implementation is easy. Estimating ongoing operating costs, costs for professional services, costs for integration, etc., are much more difficult to assess without proper planning. Sites often look at PACS needs at the time of implementation, but fail to look at more long-term needs. For instance, it may take only one or two resources to support a PACS initially. But if use of the PACS expands significantly for referring physicians or multiple clinical areas, or additional support responsibilities are added for those resources, then more PACS support resources may be needed in subsequent years. These should be included in the initial planning.

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What does it take to ensure a successful Picture Archiving and Communication System (PACS) implementation?

No more than:

• Proper staff training
• The right PACS solution
• Thorough assessment of user requirements
• Accurate budgeting in terms of costs and time

And of course, an experienced, knowledgeable PACS administrator.

Scott Griffin, PACS Administrator

PACS Administrator Scott Griffin’s previous experience with several large-scale implementations helped Southeast Alabama Medical Center seamlessly install a PACS. The implementation was so successful, the hospital was able to go 90% filmless in less than six months.

We sat down with Griffin to learn what it takes to successfully complete a PACS implementation, as well as what it takes to be an effective PACS administrator.

How did you get into the field of radiology and imaging, specifically as a PACS administrator?
When PACS was first introduced to me, I thought it would be the best use of my skills in that I have always been fascinated by computer technology.  Also being interested in radiology management, I knew knowledge of the systems that would ultimately one day be the life blood of the department would be a great tool to have on my side.

What makes a good PACS administrator?
Some of the important qualities are:

• The ability to think on your feet
• Not always knowing the answer ahead of time is ok
• The ability to work well with physicians and hospital personnel
• Always looking for ways to improve things

To what do you attribute getting the PACS at Southeast Alabama Medical Center up-and-running so quickly and smoothly?
I attribute that to having a great install team, knowledgeable and supportive IT staff with superior infrastructure, and a supportive medical staff. And a little experience never hurts either.

SAMC was my third install at a large hospital (over 400 beds) so a lot of the anxiety that I felt at previous installs was replaced with a running mental checklist of what needed to get done, along with, “What have I missed?”

What tips would you give to a hospital that hasn’t yet implemented a PACS?
Look at everything!  Many hospitals fail to remember all the locations where they view images. In many cases, they forget to budget for necessary upgrades/replacement of computers throughout the organization.  This may include complete replacement of key computers, as well as upgrades to memory and monitors throughout the facility. Planning and budgeting for this ahead of time makes a huge difference for all involved.

What advice would you give a hospital at the early stages of PACS consideration?
Run the ROI and talk with other facilities that have grown volume with no additional Full-Time Equivalents (FTEs).

Learn more about the PACS implementation at Southeast Alabama Medical Center by downloading the case study.

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Health care IT leaders are standing behind the new rule proposed by the Department of Health and Human Services concerning the testing and certifying of Electronic Health Records (EHRs), according to an article on HealthLeaders Media. The rule, which was proposed and released in March, would turn over the certification process to a private sector, as well as provide a fast-track certification timeline and the ability to have EHRs certified from multiple vendors.

The rule would create a two-step EHR certification process:

1. First, organizations could get certified much quicker to meet deadlines to apply for the first round of meaningful use stimulus funding. The first round of funding would occur as soon as October for hospitals and Jan. 1, 2011 for physicians and other eligible professionals.

2. In phase two, the testing and certification would be transferred to private sector organizations.

HealthLeaders Media spoke with health care IT leaders from across the US, who by and large support the proposed rule. Health care IT leaders cited a number of benefits:

• Not only could financial incentives be provided more quickly, but patient care could be enhanced more quickly as well.
• Because meaningful use is a highly complex process, government would be slower to adapt to changes in technology
• Private certification organizations have worked well in other similar situations.

Tell us, do you support the new proposed rule regarding testing and certifying of Electronic Health Records (EHRs)?

For all the latest radiology and medical imaging technology news, subscribe now to the Medical Imaging Talk blog via RSS feed or email. Or follow us on Twitter today.

Frank Seidelmann has worked in radiology for 35 years and is currently chair of the board and clinical director of neuroradiology at Radisphere National Radiology Group in Beachwood, Ohio. He was recently asked by imagingBiz.com about the past and future changes in medical imaging. Here are the summarized highlights of the interview:

• Specialization and easy image transfer revolutionized medical imaging practice. As medical imaging technology improved, hospitals went from using medical imaging infrequently to demanding it in many different fields. PACS enabled radiologists and other medical imaging professionals to consult with one another easily, even if they were in different locations.
• Demand for radiology is not going to go down. It’s just too valuable as a diagnostic and interventional tool.
• Radiologists will have to adapt to a different payment model. Fee-for-service is slowly going away and quality-based payment is growing, which means that both in-hospital and independent radiology groups will probably have to get bigger and more efficient to survive. Radiologists will also gravitate toward larger groups when it becomes too cumbersome to be in a practice that demands lots of time without proportional reimbursement
• Radiologists need to get much more involved with their clinical colleagues, both as educators and consultants. Clinicians need interpretations on their patients’ schedules, and radiologists have to adapt to that.
• Full-service radiology practices will be the norm. These practices will include several specialties and subspecialties and will provide 24/7 service for emergency rooms and other after-hours practices.
• Constant improvement is a necessity. Hospitals and other healthcare providers want more value from their radiology and other medical imaging departments. Radiologists have to constantly learn how to deliver.

Subscribe to this blog for regular updates on improvements in medical imaging and other health care-related fields.

$100,000 doesn’t amount to much in the world of medical imaging. But in developing countries, it makes medical imaging available to thousands of people – and that’s just the first benefit.

Imaging the World (ITW), a US  based non-profit that develops medical training and technologies to bring medical imaging to remote areas around the world, recently received a $100,000 grant from Grand Challenges Explorations, which funds scientists and researchers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Grand Challenges Explorations is one of many global health initiatives funded by the Bill & Melinda Gates Foundation.

ITW aims to use the money to support its efforts to bring low-cost ultrasound technology to areas of high maternal and neonatal mortality. According to ITW, advance warnings of critical maternal conditions made possible by ultrasound technology can dramatically improve maternal and foetal morbidity and mortality in the most vulnerable populations.

McKesson Medical Imaging vice presidents Joe Biegel and Rex Jakobovits serve on the Board of ITW. “Joe and I were personally inspired by the ITW team,” says Jakobovits. “Serving on the ITW Board is a golden opportunity: A chance to leverage our unique expertise in a ‘ground floor’ effort that has a good chance of making a real difference in the lives of millions of people by helping to usher in the ‘age of imaging’ in the developing world.

Biegel and Jakobovits don’t just help govern ITW. They recently coordinated a McKesson donation of a PACS and time from experts to the organization, and they devote many hours of their own time to help spread medical imaging around the world.

Twenty years ago, very few people talked about the need for terabytes of data. Now, a terabyte seems like a pittance, especially to people in fields like medical imaging, which demand ever-greater data capacity to meet the ever-growing sophistication (and data hungry) imaging technologies.

But the growing volume of data leads to the growing number of data management problems. Information has to be organized to be meaningful, and today’s volume of information is too large for any one person to manage, especially in the high-volume fields of medical imaging.

A recent study published in Radiology, authored by a team headed by Katherine Andriole of Brigham and Women’s Hospital in Boston, offered 5 suggestions for dealing with the huge volume of data in radiology work:

1. Improving the Signal-to-Noise Ratio to more quickly direct a radiologist’s gaze to difficult-to-recognize abnormalities.
2. Using Motion and Color to Convey Change Over Time. According to Andriole, advances in 3D volumetric rendering and the addition of time and other functional measures can, if used properly, make change over time easier for radiologists to see and analyze.
3. Time-Saving Interface Devices like joysticks, touch-sensitive screens, voice-activated commands, and other developments (many from the world of gaming).
4. Easy Access to Multiple Relevant Studies would enable radiologists to consult a wide range of situation-specific literature without leaving their chairs or their medical imaging programs.
5. Easy Methods for Annotating Images so that radiologists can quickly convey their analyses to other medical professionals. Likewise, incorporating handheld devices, wireless networks, and cloud computing into medical imaging communications will make it easier to convey images and their interpretations to primary caregivers.

In order to keep up with the need to manage ever-larger sets of data, radiologists and other medical imaging professionals have to be somewhat revolutionary. The ongoing revolution in the volume and management of information technology is leading to a revolution in the role of the medical imaging specialist in direct patient care, says Andriole.

Learn how intelligent workflow tools and a system optimized for high volume data sets improves the radiologist experience by viewing McKesson’s Horizon Medical Imaging™ demo .

For over 60 years, the American College of Cardiology (ACC) has been renowned for its dedication to lifelong learning. Their Annual Scientific Session and Expo, being held this year in Chicago on March 24th-26^th, is due once again to be the premiere cardiovascular educational occasion of the year.

You’ll hear from some of the top leaders in cardiology – including several members of the McKesson Medical Imaging team – and learn about the latest advances in pharmaceuticals, imaging, medical devices, medical imaging software, electronic health record (EHR) technologies and the services you need to provide high-quality patient care.

This year at ACC, we are pleased to be showcasing some of our workflow management solutions listed below.  Please feel free to stop by our booth (#18027) or register in advance, for a complimentary onsite demo of any of the products below:

Featured McKesson Medical Imaging Products at ACC 2012

Horizon Cardiology – Assess a cardiovascular information system (CVIS) demonstrating our state-of-the-art medical imaging solution capabilities.

Horizon Cardiology Echo and Vascular Ultrasound – View ultrasound exams for echocardiography, fetal, congenital (pediatric through adult) and vascular monitoring.

Horizon Cardiology Integrated Cath Lab – We’ll demonstrate how this unique single platform design manages the complete peri-procedural workflow of the cath environment and supports workflows that eliminate redundancies.

Horizon Cardiology Hemo with Integrated FFR – When patient information flows seamlessly into one complete patient record, repetitive data entry is eliminated and information is intuitively accessible from any location.  Visit us to see more.

Horizon Cardiology ECG Management – Use our web-based client to demonstrate how anywhere, anytime access to ECGs for cardiologists, clinicians and departmental administrators improves efficiency.

McKesson Medical Imaging Professional Services – Learn how our hosted storage, staff augmentation, and data migration helps you reduce costs increase efficiencies and produce ROI faster.

Join us at Booth #18027 for a product demo and to learn more about these cardiology solutions.

To learn more about medical imaging software, cardiology solutions and other topics related to medical imaging, subscribe to the Medical Imaging Talk blog via RSS feed or email. Or follow us on Twitter.

Thinking of making big changes in your medical imaging system? Here’s some inspiration.

Take a look at the healthcare providers that were named Health Imaging and IT’s Top 25 Connected Healthcare Facilities. The list includes facilities in big cities (New York’s Montefiore Medical Center) and small towns (Minot, N.D.’s Trinity Health) with winners in every region of the country.

Their medical imaging solutions were both technical and procedural, but they all were toward the top of Health Information Management Systems Society (HIMSS) EMR adoption stages. Most were at stage 6 or 7, putting them in the top 4.5 percent of the nation’s medical imaging facilities.

Three of them singled out iPad use as a way of improving performance, part of a trend toward more remote-access options. Voice recognition technology also is playing a larger role. No two solutions looked that much alike, but common benefits were reduced times in sharing images, fewer steps in executing tasks, and lower costs through enhanced efficiencies.

The 2011 winners were announced in Health Imaging and IT’s August edition. And if you really want to get inspired, make your medical imaging system changes within the next several months, then enter your facility for the 2012 Top 25 Connected Healthcare Facilities contest. No word yet on the deadline for the contest, but last year, contestants could submit entries from June 6 to July 1.

Here’s a summary of what 10 of the top 25 achieved.

As pressures continue to mount for hospitals to provide better and more comprehensive care, efficient communications are the lifeline to managing information systems across the enterprise.

A key business driver for McKesson Medical Imaging is to seek out technology companies that are compatible with our portfolio and support the needs of our customers. Our recent acquisition of peerVue falls into that category. A provider of radiology workflow solutions, their IT solution simplifies diagnostic workflow and speeds up communications throughout the patient management cycle.

Qualitative Intelligence and Communication System (QICS)™, a Web-based technology platform by peerVue, provides the functionality to engage, analyze medical imaging data, alert users and facilitate workflow at every point of the exam life cycle.

peerVue’s reputation combined with the longevity of McKesson in the healthcare industry brings expertise, excellence and business acumen to the table. With more than 40 years’ experience in the Radiology market, the founders of peerVue have insight into the challenges faced by medical imaging organizations around the world.

As developers of medical imaging software, integration standards and market-changing workflow models, this recent addition to the McKesson enterprise imaging family makes great sense.

To stay up to date on the latest medical imaging software news and announcements, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

While doctors, in general, are in high demand, cardiologists and cardiovascular imaging specialists, in particular, are actively being recruited by a number of hospital organizations, such as the Mayo Clinic and Cleveland Clinic. The day-to-day costs of running and managing a private practice combined with declining reimbursements are pushing cardiologists to seek out hospitals as their first line of defense. Having willing recruits makes filling these critical positions that much easier.

What may pose a challenge is keeping your newly minted cardiologist happy. Where being held in high esteem and earning a six-figure income could almost guarantee a positive job satisfaction rating in years past, today, doctors want not only to be compensated fairly, but also have needs ranging from state-of-the-art cardiovascular imaging and information systems (CVIS) to maintaining appropriate staffing levels. Poor management can also pose a hurdle for keeping cardiologists content.

Hospital Culture Plays a Role in Retention

Morris Hospital in Illinois recently lost one of its cardiovascular groups due, in part, to an unresponsive administration, according to the Morris Daily Herald. So, just because a hospital is able to recruit and hire an individual doctor or cardio group, it’s also a challenge keeping them. The stresses and strains on the doctor population are well documented, so management styles may begin to play an increasing role in retention, especially for a younger generation whose peer group is more collaborative rather than closed off or competitive.

A survey the American College of Cardiology (ACC) conducted, identified activities that hospitals could offer as one way of communicating that they care: paying for physicians to attend conferences and/or reimbursement for medical education opportunities.

According to the ACC study reported in Cardiovascular Business, 79% of respondents said their organization internally provided continuing medical education opportunities for staff, and 36% said their organization pays the entire bill for education support for CV specialists. Seventy percent (70%) said their organization provided funding and reimbursement for attending conferences.

Market Forces Create Static Environment

As the medical industry continues to face financial pressures, specialties such as cardiology and cardiovascular imaging are particularly hard hit. New data from the Medical Group Management Association found the median total medical revenues in cardiology practices were flat. Market forces seem to be creating a business dynamic where more and more CV specialists have no alternative but to go “in-house.” Matching the specialist to the right culture and rewarding him or her with the right incentives is the challenge going forward for hospital executives regardless of market size.

To stay up to date on the latest cardiovascular imaging news and announcements, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

They’ve been called the Internet Generation. From shopping to socializing to watching TV, “Millennials” do almost everything online or digitally. This is the generation that will surpass the number of baby boomers by 2015, growing to 83 million.

Having grown up with technology, Millennials view technology, and the Internet, as an extension of themselves. This will fuel the increasing use of electronic and mobile devices, online communities and anytime anywhere access to data.

Here’s what a panel of young radiologists, who presented “The Millennials Vision: The World as It Could Be,” on June 7 at the annual meeting of the Society for Imaging Informatics in Medicine (SIIM), had to say. (Source: HealthImaging)

5 Predictions for What Millennials Will Bring to Medical Imaging

1. Tablets and smartphones. Old-fashioned, text-based reports will be supplanted by tablets and smartphones as the preferred platform. The ability to link to images, embed hyperlinks and create teaching videos, will streamline radiology consults and reporting.
2. Social networks and messaging. The primary advantages of both platforms are their ability to improve care and connection through one-on-one communication and collaboration. Millennials will be at the forefront of this shape shifting.
3. Qualitative improvements in safety, quality and efficiency. “The next decade will bring ubiquitous deployment of natural language processing, business intelligence, predictive modeling and decision support to provide the right information to physicians at the right time,” according to Luciano M.S. Prevedello, MD, of Brigham & Women’s Hospital in Boston. Highly standardized reports will drive quality improvements. Tessa S. Cook, MD, PhD, of Hospital of the University of Pennsylvania in Philadelphia, foresees a new era of radiation safety, enabled by multiple factors including rich decision support; ultra, low-dose imaging; improved CT dosimetry and patient-specific dose estimates, she said.
4. Anytime anywhere data access. Following Moore’s law, which states that the number of transistors on a CPU chip will double every two years, data mining will simulate other advances in medical imaging. “These functions will become real-time and ubiquitous,” said Woojin Kim, MD, of the University of Pennsylvania School of Medicine in Philadelphia.
5. Cloud computing. “Cloud computing will replace the CD for exchange of medical images,” said Wyatt M. Tellis, PhD, of University of California, San Francisco. He also expects connected applications to expand into blood pressure cuffs and measurement scales to transmit real-time data to providers.

Bridging the (Tech) Generation Gap

The challenge of any generation is to bridge the gap between old and new and to establish a balance among the “tortoises” and the “hares.” It would be wise to follow the intent of the Hippocratic Oath, the primary principle being to treat the patient to the best of one’s ability.

When it comes to technology, first, know your customer; then, choose the platform.

It’s up to the younger generation to show how technology can humanize the clinical experience and demonstrate why erasing boundaries improves patient care and practice.

What else do you think that the Millennial generation will bring to medical imaging?  I encourage you to share your thoughts via a comment below.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

The American College of Radiology (ACR) Commission on Human Resources conducted a survey, which Edward I. Bluth, MD and colleagues analyzed. They concluded that job prospects for new radiologists are solid.

In 2011, approximately 1,241 radiologists were hired, and 2012 estimates indicated that 1,103 positions will have been made available, according to Edward I. Bluth, MD and colleagues. Further, the authors forecast 1,227 radiologists being hired in 2014.

“Compared with previous attempts to evaluate the workforce, we feel that this survey methodology is more robust because … we are able to survey the universe of radiology practices,” Bluth wrote recently in the Journal of the American College of Radiology. (Source: HealthImaging)

While the prediction of a stable workforce may ease concerns radiologists have had in the past about the availability of jobs due to the tumult within the healthcare industry, the authors do pose one caveat: you are likely not to work in your chosen subspecialty or preferred locale.

“Approximately 1,200 residents complete their studies each year; according to our calculations, there seems to be a job open for each resident but not necessarily in the subspecialty, geographic area, or type of practice that the resident desires,” wrote Bluth et al. The South, West, Midwest and the Mid-Atlantic states will feature the most opportunities, and the greatest needs will be for general radiologists, followed by breast imagers, according to the authors.

Graduating Residents Open to Change

While the study does not identify the age range of residents who will be completing their studies and entering the medical imaging field, we can make a few assumptions based on the “typical” age of a person finishing his or her residency. These graduating residents most likely will be the first of the Millennial Generation born in 1982, which is good news all around.

According to the Pew Research Center, Millennials are confident, connected and open to change. So, relocating to another part of the country or adapting to the shifting realities of the marketplace is “all good” as a 30-something radiologist might say.

They’ve also been called the “Tech Generation,” suggesting a comfort level with technology that their predecessors do not share. This will serve radiologists well in their job search as advances in medical imaging continue to highlight the importance of possessing a tech-savvy skill set.

Do you see a generational difference in how radiologists interact with technology?

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As an industry, we should be long past the question of what we are trying to do; rather, we should be asking how, when and where. Your medical imaging vendor should be guiding you along this path. Unfortunately, in the medical imaging arena, some Picture Archiving and Communication System (PACS) vendors are notorious for being niche players. They know all the details of what to do at the radiology department level to improve workflow but get so caught up in those details that they fail to understand the big picture of how to spread imaging to the entire enterprise and when and where you store the vast amount of data. You need a medical imaging vendor who won’t miss the forest for the trees.

There are only a handful of companies, my employer included, that are translating their success with trees to the forest. McKesson, for instance, has a breadth of enterprise expertise including EHR adoption, billing and financials. We recognize how to economize and be effective in the ‘ology departments while at the same time understanding how to use the technology to connect your entire enterprise.  We’re the kind of partner that can move you away from the silo of trees to the enterprise forest – all while bringing forward the medical imaging workflow benefits already achieved. We don’t neglect the trees for the forest, either.

As you embark on a long-term strategy for an enterprise archive, towards a PACS neutral archive (PNA),  keep in mind the following five-point agenda to determine if your PACS vendor is ready to deliver what you need.

1. An enterprise imaging strategy must include an enterprise archive that can accept data from throughout the enterprise. And today’s definition of data has expanded to include all images and words used to see, observe, read and understand to make a patient diagnosis. The definition of enterprise has expanded, too, so all images and words need to be available to patients as well. One viable route to achieve an enterprise archive is a PNA — an image repository or archive that is PACS neutral. Regardless of the PACS the organization uses, images can be stored and retrieved from the neutral archive because it was built to exchange data with disparate systems.

When considering your archive, make sure the data is:

Readily available. You need to know what it is and where it is stored.

• Correctly identified. You need to be able to view any type of imaging data, including camera or motion, from all the ‘ologies.
• Easily accessed. You need to know what speeds and the technology used to bring it to you.

2. The enterprise footprint has already expanded to include storage, servers, networking and data centers. Now it comes down to broader participation with imaging. PACS vendors must recognize how much data is in a digital image and how important it is to the whole picture of the patient’s treatment. Many vendors that have proven successful in workflow and diagnosing patients at the departmental level are swimming upstream to take imaging to the enterprise. Make sure your vendor shows you how they are:

• Speaking the enterprise language
• Understanding the vocabulary
• Designing into the environment

3. Workflow gains cannot be forgotten. Your PACS vendor needs to introduce an enterprise archive solution that modifies the technology without breaking the workflow in the departments. As you broaden the enterprise footprint, your vendor must examine the nuts and bolts related to data. The leading questions should be:

•  How do we get all of our data into the enterprise archive?
• Where do we put it?

4. Data migration is as equally understood as misunderstood in the market. Some still believe that if you put data in an archive for the enterprise, you never need to touch it again. The reality is we don’t know what the applications or storage requirements are going to be going forward. When your tires need to be replaced, you don’t throw away the car. You change the tires. Migration strategies for moving data out of silos and into the enterprise are also changing and expanding. The fact is that somebody should always be managing the data, and it is highly unlikely that the data will be permanently stored in one location.

Ultimately, where data is stored is a location that the enterprise archive has access to and understands. Whether it is costly or cheap, successful or unsuccessful all comes down to the quality of the data and the expertise available. Find a vendor who can talk to you about:

•  How to get data from around the enterprise into a repository
• The importance of DICOM wrapping to manage the standard data everyone wants and the custom data some depend on
• Mass data move versus mass reindexing to save money and time

5. Don’t get lost in the chatter of cloud storage, which seems to be upsetting the market but is clearly a strategy that is here to stay. And there is a reason for that. Before the digital age, we used to put our data in filing cabinets. Now we need more options. The enterprise drives where data is stored. Large organizations continue to manage their own data centers. What about everybody else? Many are opting to outsource storage to a cloud provider to lower operating cost and capital cost. We have public cloud, private cloud or a blending of the two. Organizations using the hybrid cloud keep a primary copy of the data in the enterprise-owned data center and archive a second copy to the service provider.

If your vendor isn’t at least looking at a private cloud option, they should be. Ask them about the benefits of cloud. These include:

•  Security when pumping data outside of four walls of enterprise
• Fast and easy access to data with resiliency and redundancy
• Data ownership to ensure control

Our paths to an enterprise archive may not be identical but every long-term strategy should consider the forest as well as the trees.

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In the business world, “gatekeeper” has come to be known as the person who controls access to the decision maker. In medicine, a primary care physician monitors a patient’s health care and serves as gatekeeper for HMO services. If you’re a radiologist reading this, it’s likely that you’ve never considered yourself a gatekeeper of anything.

But, Alan Kaye, MD, recommended utilizing imaging gatekeeping as a means to hinder the increasing commoditization of medical imaging in his session presented at the annual meeting of the Radiological Society of North America (RSNA).

“Gatekeeping” Benefits Patients

A gatekeeper in a healthcare scenario is generally defined as the primary-care doctor who coordinates patient care and provides referrals to specialists, hospitals, labs and medical imaging services.

Kaye explains that the first role of any gatekeeper is keeping out unwanted elements. In radiology, that translates to unwarranted exams and needless costs. These can be controlled with medical imaging guidelines, tools and point-of-care decision support.

The other role of the gatekeeper is allowing in preferred elements, which include performing the right exam on the right patient the first time, as well as screening exams that can improve outcomes, quality and save money.

Enhancing Radiologists Leadership Role

In a time when medical imaging is coming under greater scrutiny, radiologists owe it to themselves to acknowledge the leadership role they may play in health care delivery. First and foremost, patients are consumers; they’re looking to save money but not at the expense of quality.

Dr. Kaye cited his company’s pilot project for screening mammography, which is a universally accepted metric for quality of care. The goal of the “Dropout Project” was to extract information from Radiology Information System (RIS) data about women who were eligible for screening mammography and who had also undergone other medical imaging tests.

The system identified 976 “patient prospects” and emails were sent to those who had established a patient profile; letters were sent to the remaining women. Almost 25% of those patients contacted responded by scheduling a mammogram, which can be viewed a successful outcome by any measure.

By taking a proactive approach and engaging with patients in a meaningful way, radiologists can be perceived as more than some interchangeable cog in a faceless health system. They can actually embrace the role of point-of-care decision support, enhancing their clinical image and practice outside the lab.

If you are a radiologist reading this, do you see yourself as a commodity or a clinician?  I encourage you to share your thoughts, via a comment below.

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Over the last several years, emergency department overcrowding has become a troubling issue, one that can become an easy scapegoat for the massive health care cost overruns we have become accustomed to hearing about.

But is emergency department overcrowding a cause – or a symptom – of something larger?  And whether emergency department overcrowding is a cause or a symptom, how can healthcare organizations use new technology, including medical imaging, as a cure?

For answers, we turned to Dr. Sandra Schneider.  An emergency medicine specialist, Dr. Schneider has been recognized several times for her leadership and service to the field of emergency medicine.  A current professor in the Department of Emergency Medicine at the University of Rochester Medical Center, Dr. Schneider is also a past president of the American College of Emergency Physicians (ACEP.) Her views are based on her experience visiting emergency departments across the country.

In part one of my three part interview below, Dr. Schneider helps identify the root cause of emergency department overcrowding, shares how medical imaging technology can help to reduce the impact overcrowding can have on patient care, and helps to dispel some commonly held health care cost myths.

What role can medical imaging play in reducing hospital emergency department overcrowding?

Dr. Sandra Schneider: First of all, it is important to note that hospital crowding is the primary cause of emergency department crowding. It has become routine for hospitals to ‘board’ inpatients who are waiting for a bed in the emergency department. Because of tight finances, hospitals try to approach 100% occupancy. They may shut down (‘brown out’) inpatient units because of staffing shortages.

As the Emergency Department serves as the primary entry point for most medicine admissions, admitted patients remain for hours or even days (in some cases a week or more) waiting for a bed. Statistics show that boarding inpatients is common in 70-94% of hospitals and is particularly severe in urban settings. In some settings, boarders may routinely occupy 40-50% of ED beds. In some hospitals, when ICUs are full, inpatients currently in a floor bed may be brought to the ED if they deteriorate. Boarding inpatients is associated with delays in care for all patients in the ED, increased adverse events, and an increase in mortality and morbidity.

It is true that public hospitals often see patients who seek care for non-urgent conditions. Nationally we know that the CDC has identified that 8% of ED patients have non-urgent conditions (defined as needing care within 12-24 hours.) However 2/3 of these patients seek care after hours and on weekends, times when traditional medical care is not available. While urgent care centers offer an alternative, most will not accept patients without insurance or those covered by Medicaid because of low reimbursement. Many providers will not accept patients without insurance or those with Medicaid, again because of reimbursement. These patients have nowhere else to receive care, particularly on a weekend. Increasingly providers are even limiting the number of patients covered by Medicare that they will treat. The ED, which under Federal law must see all patients regardless of coverage, remains the only means of medical care for these patients. This Federal law is an unfunded mandate and a factor in the finances of nearly every emergency department.

Medical imaging plays a large role in overcoming several aspects of crowding. First, increasingly imaging helps us avoid admission to the hospital. Appendicitis is a great example. In the past it was appropriate for 30-50% of appendectomies to be performed on a normal appendix. Now that number is likely <10%.

The number of medical images ordered through the ED has skyrocketed. In part, this is because imaging provides more definitive answers (rules in or rules out disease.)  In addition, many physicians see the ED as a portal to rapid testing. They can get same day results AND any necessary consultation for patients. ED has come under criticism for ‘ordering too many tests’. Some of these tests undoubtedly could be scheduled as an outpatient. However, few institutions have the ability to schedule patients after hours and fewer still can provide next day service.

It is important for the emergency physician, who is likely seeing the patient for the first time, to have rapid access to a patient’s history and previous test results. Emergency physicians need access to all recently acquired advanced imaging, whether it was done on site or at an outside facility on a 24/7/365 basis. In addition to preventing unnecessary repeat testing, this information allows the emergency physician to calculate and control the amount of radiation exposure of the patient.

Finally, ED efficiency is all about throughput. Unlike inpatient services, we monitor our care in minutes. Rapid turnaround time is critical, but so is having a formal final interpretation of medical images, particularly the more complex studies. To the extent that medical imaging can be done rapidly and the final interpretation by an attending radiologist can be available rapidly 24/7/365, emergency department flow can improve and length of stay can be reduced. Clearly there are issues for the radiology department which must manage multiple demands. In addition, in a field that is rapidly subspecializing, it is difficult to have an attending neuroradiologist available at all times. However, both patient safety and ED efficiency demand just that.

What are some ongoing efforts you’re making to educate people about when to seek emergency care?

SS: We feel patients should seek care when they believe they need it. We believe that all patients should have a PCP who is familiar with all aspects of their physical and mental health, and coordinates their care. We believe that the Patient Center Home Model will benefit those that can access it. However, we are concerned that a significant portion of the population will be unable to access that care, at least until there is greater capacity in primary care. We believe that good primary care, coordinated care for patients with chronic illness, and access to resources for all patients regardless of coverage will not only decrease ED visits, but will provide a cost savings and greater quality of life.

ACEP is a strong advocate for the Prudent Layperson definition of appropriate use of the ED. This definition is now part of the Affordable Care Act. Unfortunately many studies looking at appropriate use of the ED base their assessment on the discharge diagnosis, rather than the chief complaint. Until recently chief complaints were not coded and therefore not available in large insurance databases.

In addition, many authors have erroneously used the Billings Criteria for appropriateness, which Dr. Billings carefully states in his paper is not valid. When the discharge diagnosis is used, patients who come to the ED with chest pain and sent home with a diagnosis of GERD, are deemed to have used the ED inappropriately.

ACEP has developed patient education materials, many of which are available on EmergencyCareForYou.org. We provide a regular national radio show for both the public and emergency care workers covering topics that inform the public when to seek emergency care. Recently, the Washington State Chapter of ACEP has been collaborating with several other groups in their state to reduce the cost of emergency care. Their programs involve an integrated approach to patients who use the emergency department frequently and a network that allows providers access to pharmacy records. The very early results of this program suggest they have been successful in reducing costs.

Some EDs do care coordination centered within their department, while others have utilized the 24/7 availability of paramedics to monitor chronically ill patients in their home. The medical directors of many poison centers are emergency physicians. Over the past few decades their work has dramatically cut the incidence of childhood poisoning.

ACEP and emergency care workers have also developed public education programs for diseases where time-sensitive treatment is life saving. Media programs have highlighted emergency physicians discussing the early warning signs of stroke, myocardial infarction and sepsis. Rapid intervention in these diseases not only saves lives but improves the quality of life of the survivors.

Many EDs have fast track or urgent care centers embedded within the department. These function like urgent care centers in the community except that they see all patients regardless of coverage. While there is no obligation for the ED to treat non-urgent patients after initial assessment, deferral of care from the ED often is more problematic than there is cost savings. And without community resources to care for these patients, refusing to treat these patients who then have no other source of care is morally questionable, and in the long run likely increases costs.

There is a misconception that large amounts of money are wasted on these ‘unnecessary’ ED visits, and that the savings could be huge. The fact is that ALL of emergency care in this country represents just 2% of the total cost of health care. Again the CDC has identified that only 8% of patients have conditions that can wait, but only 1/3 of those occur during traditional business hours. We cannot count on the reduction of ED visits to save our healthcare economy.

Read part two of my interview with Dr. Sandra Schneider tomorrow to learn more about the impact the roll-out of health care reform will have on emergency department overcrowding.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

In part one of my interview with Dr. Sandra Schneider, we identified emergency department overcrowding as a symptom – rather than cause of – overall hospital overcrowding, while dispelling some long held myths regarding the true economic impact of this issue.

While yesterday’s interview provided more context, the fact remains that emergency department overcrowding is an issue all the same.  And with the roll-out of health care reform, many expect it to continue to grow in severity.

In part two of my interview below, Dr. Schneider offers her take on how health care reform will impact our overcrowded emergency departments, and shares how better collaboration between the leaders of the medical imaging and emergency medicine fields can help to improve patient care in this new environment.

The American College of Emergency Physicians (ACEP) surveyed emergency physicians in 2011. The vast majority felt that the current crowding problem in the emergency department (ED) will be exacerbated if/when the new health law is implemented.

The Affordable Care Act is quickly becoming a reality and there remain a number of questions regarding how it will affect EDs, specifically and hospitals, in general. Can you elaborate on your belief that “coverage doesn’t equal access”?

SS: Massachusetts provides the best window into what will happen when the ACA is fully enacted. In Massachusetts, ED visits increased after the start of universal coverage. While there are many reasons for this, the literature would suggest that this occurred for 2 reasons.

First patients who were newly insured had chronic conditions for which they could now get care. This pent up demand has been seen internationally in countries which initiate coverage.  Secondly Massachusetts lacked the capacity within the primary care practices to see all these patients.

As more patients get insurance coverage through Medicaid and exchange products, PCP practices will likely saturate, and access for these new patients may be strained. If this coverage does not prompt primary care physicians to engage these new patients, there will be more ED visits. Primary care providers and urgent care centers can limit their practice to patients with private insurance, which reimburses at a better rate than Medicare, Medicaid or any state run program. Coverage does not equal access.

There is also an increased tendency for patients to seek care. More conditions are being treated, there is more elective surgery and many patients’ lives are improved by this increase in care. Interestingly England recently attempted to control ED costs by building a large number of urgent care centers to offload busy EDs. However they found that ED visits continued to rise, and urgent care visits rose, and now they were simply providing more care, at a greater cost.

In discussing health care reform, cost savings and patient care seem to exist side by side.  How can medical imaging technology lead the way in helping to improve patient care in a cost-effective manner?

SS: There needs to open and honest dialogue between the leaders of medical imaging and the leaders of emergency care. We need to work together to understand the needs of our patients and our workforce. We should examine new models of care, together. And we should invite to the table all of the stakeholders.

Recently quality measures were developed by the American College of Radiology and the AMA which included several specified for the ED. The input from the emergency medicine community was very limited. The entire process is now being revisited.  Quality measures that involve imaging of emergency patients should have equal representation and input from both imaging science and emergency providers. In addition, other specialties should be at the table when appropriate, such as trauma, neurology, etc.

Guidelines for medical imaging should extend to outpatient practices as well as the ED to avoid a shift of services without a decrease in cost or utilization. The conversations should be transparent and collaborative, and the focused on the patient.

Read the third and final part of my interview with Dr. Sandra Schneider tomorrow to learn more about the evolutions to patient care and medical imaging technology that will be crucial in our new healthcare environment.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Earlier this week, emergency medicine specialist Dr. Sandra Schneider identified emergency department overcrowding as a symptom of hospital overcrowding in part one of my interview with her.  In part two yesterday, we identified better collaboration between medical imaging and emergency care leaders as critical towards managing overcrowding.

In the final part of my interview below, we put our focus squarely on the patient, as we learn how all of medicine must work together to improve the cost efficiency of care, without sacrificing improvements to patient outcomes.

How do you see the new focus on improving patient outcomes impacting emergency medical care and/or reimbursements?

SS: Providers have always been interested in the outcome of their patients. Quality measures are simply one mechanism to assure that focus. As a patient care is now often quite complex, involving many well trained, intelligent providers, quality measures should never be developed by one specialty that involves care provided by another. Radiology should not dictate when medical images are preformed in the ED, nor should emergency physicians dictate timing for final attending interpretation of those studies. The development of these quality measures must incorporate all stakeholders.

The largest identified area of potential savings in healthcare is that spent on defensive medicine. Without safe harbor, clinicians will continue to order many tests in order to have a zero miss rate. Radiologists will continue to suggest advanced medical imaging of innocent appearing nodules in order to have their own zero miss rate.

Medicine, all of medicine, needs to work toward reforming our medical liability system so that screening tests with a very high sensitivity will be an acceptable standard of care. Unless there is safe harbor afforded those who follow established national guidelines for care, we will not be able to curtail utilization, cost and radiation exposure. Medical imaging, which plays a central role, would be a natural leader for such an effort.

Patient satisfaction is an important measure of quality and is now measured in nearly every department. Patients often present to the emergency department anticipating advanced testing and imaging. Many patients are sent to the emergency department by their PCP with specific instructions to have a CT scan or MRI. Others have been advised to have such testing by their friends or recent media reports. While the emergency physician may attempt to dissuade the patient from such testing, these attempts are largely unsuccessful and lead to intense patient dissatisfaction.

Emergency care interfaces with nearly all specialties of medicine. We have important outreach in the community through our ties with EMS. We have facilities that are staffed 24/7/365 that can be used to close the gap for patient follow-up. There may be cost savings to the institution to utilize our excess space during down times to see patients who cannot see their PCP. Under an ACO it may be prudent for all patients with acute unscheduled visits to be seen within the ED facility. Forwarding thinking institutions are incorporating ED leadership into care models in innovate ways.

What necessary evolutions in medical imaging have you seen, or expect to see come about, in response to health care reform?

SS: There will be increasing pressures to reduce cost, reduce radiation, improve patient outcomes and increase patient satisfaction. Two of these are possible, three difficult, but all four will be a challenge. Patients perceive extra value in visits that include testing, especially advanced imaging. There is an increased degree of patient confidence if the diagnosis is based on a CT or MRI. Equally important, advanced imaging does improve outcome. Appendectomy rates are down, thrombolytic treatment for stroke is only possible because of medical imaging, and countless lives have been saved because of imaging of a subarachnoid hemorrhage and pulmonary embolism. Trauma care has been significantly improved and countless unnecessary surgeries avoided because of rapid, highly sensitive CT scans.  But radiation is a serious issue for our future, particularly in children. MRI can be substituted in many cases, but at a much greater cost. The challenge for medical imaging is to retain the accuracy of its testing while reducing radiation and cost, and increasing availability.

Medical imaging is a critical part of patient assessment. In the future, this role will increase as our ability to detect and visualize disease increases. Forty years ago, grainy CT images of the brain gave us our first glimpse of cerebral bleeding. Now CT, MRI and PET scanning provide us evidence of the structure and function of the brain. It is likely that medical imaging in the future will help us identify some of the diseases we struggle with today, such as sepsis, mental illness and perhaps even pain. Advancing the care of patients will necessitate a collaborative approach to research and clinical care throughout all medical specialties. Radiologists and Emergency Physicians working together with mutual respect and transparency on a national and local level would be an important first step.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Dave Burda is editorial director of Better Thinking for Better Health, an online McKesson forum. Here industry leaders can exchange, discuss and debate ideas with the shared goal of maximizing the performance of the healthcare delivery system.  Recently, Burda had the opportunity to ask members of the healthcare community about their biggest financial and clinical challenges.

In the video above, representatives from organizations including PresenceHealth and Catholic Health Initiatives share concerns ranging from how best to maintain state-of-the-art medical imaging solutions, to how new federal regulations will impact patient care.

I invite you to watch Dave’s video above – and share more about the challenges your organization is facing via a comment below.

To learn more subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

For radiologists, much of their hard work goes unseen. For example, take a radiologist who pulls up a dozen images from the vendor neutral archive, carefully compares a number of studies from one patient, goes into the RIS and makes notations about findings, and then documents a number of specific details for the final report. Details noted might include a specific or differential diagnosis, impressions, and other information that will be sent to the referring physician and synched to the patient’s EHR. “When we start with exquisite renderings of anatomy and hypersensitive recognition of physiology, how is it that the product we deliver to the world is often just words on a page?” asked Geraldine McGinty, M.D., in a post on her blog. The lack of visibility of radiologists’ work is one reason that radiologists have been speaking for some time about how to make the value of their work more apparent to the public, and why the ACR launched its Imaging 3.0 initiative last year. As best-selling author John Maxwell said, “A leader is one who knows the way, goes the way, and shows the way.” In the initiative, the ACR called on radiologists to take the lead in enterprise medical imaging and value-based care initiatives. Let’s follow up on the Imaging 3.0 conversation as it is today.

What is Imaging 3.0?

To give some background, the term was first coined by the America College of Radiology (ACR) about a year ago, which calls on radiologists to play a strategic role in the evolution of healthcare as it changes. Communication is a key component, according to McGinty, “Essential to the Imaging 3.0 philosophy is the imperative to communicate the value of imaging to our colleagues and most importantly to our patients.”

What is its purpose?

Imaging 3.0 initiatives are designed to help radiology departments respond to changes as value-based, not fee-for-service, models of care become the norm. Imaging 3.0 highlights ways that IT solutions, such as data mining, clinical decision support (CDS) and communication tools can support moving to value-based care models. “The legislation that passed requiring the use of CDS in Medicare was a giant step towards aligning payment policy with Imaging 3.0,” McGinty said in an interview. “What we need to do is continue to build the toolkit that our members can use, especially around the areas of image sharing and structured reporting. We also need to continue to fight back against reimbursement cuts so that members are not consumed by worrying about how to pay their staff and can focus on innovative practice methods that put patients first.”

What actions have radiologists been called upon to do?

Radiologists have called upon to act as leaders within healthcare and communicate more about their value, to both colleagues and patients. As part of this effort, they should be documenting the care they provide that may have previously gone unnoticed. Value-based care models mean that radiologists will continue to be expected to provide better care to patients, but at a lower cost.

• Lead. The ACR continues to urge radiologists to become leaders in shaping America’s future healthcare when it comes to imaging policy. The value of imaging is no longer judged by the quantity of images but quality; not volume but value. The Centers for Medicare and Medicaid Services (CMS) determine quality by looking at, for example, procedures using fluoroscopy that include documentation about radiation exposure. Many of the ways in which radiologists provide quality care are not readily visible. Therefore the ACRS is calling upon radiologists to speak up and be vocal within healthcare about the value of imaging.

• Document. The care that radiologists provide before and after studies is taking on added weight and needs to be thoroughly documented in their radiology information systems (RIS), picture archive and communication systems (PACS) and patients’ electronic health records (EHRs)—which hopefully are already linked via the enterprise medical imaging system. For example, a radiologist may work with the radiologic nurse and the patient’s family to develop the appropriate care plan that will help the patient understand the procedure and recuperate from it. Work to improve patient care should be apparent.

• Communicate. Furthermore, Imaging 3.0 asks radiologists to talk to and empower their patients. “The initiative asks radiologists to go beyond interpretation to assure appropriateness, document the quality and patient safety that radiologists provide, provide actionable reporting with evidence-based follow-up recommendations, and empower patients,” said Bibb Allen, Jr. M.D.

“We have been so energized by the response of the radiology community,” says McGinty. “Despite very real challenges associated with cascading payment cuts we are seeing examples of practices all over the country that are living the Imaging 3.0 concept.” The ACR has a number of examples on their Imaging 3.0 website. Hospital leaders have an important role to play as well. They should intentionally connect with their radiology groups to understand the value that’s being delivered. For example, Dr. Samir Patel documented more than 9,000 hours of non-clinical work that his group did for their health system. “Make radiologists part of the planning around new payment models,” says McGinty. “Radiologists, using clinical decision support with consultation, can significantly drive appropriate imaging utilization in a way that is collaborative and educational and will be important in shared savings models like ACOs.” As changes are made to healthcare, including medical imaging, radiologists are being called upon to speak up and take action as the conversation about Imaging 3.0 continues. Learn about upcoming changes and advances in medical imaging by downloading our eBook, “The Evolving Enterprise Imaging Market.”

Americans receive twice as many MRIs and CT tests — 100 and 265 each year respectively for every 1,000 people — than the average in other countries that are members of the Organization for Economic Cooperation and Development. But extra tests aren’t benefiting patients. Despite spending 18 percent of the U.S. Gross Domestic Product on healthcare, Americans have shorter life spans than citizens of our peer countries.

Individual radiologists may feel like reducing the number of studies their healthcare organization undertakes is beyond their power — how can one practitioner make a difference? There are concrete ways that radiologists and leaders can collaborate to make a difference by working toward value-based care in medical imaging.

“It is critical for radiologists to be heard,” says Rasu B. Shrestha, MD, MBA. “They need to speak up, they need to participate in committees, they need to engage in the care of their patients, and in the design of the healthcare system that is about the patient in the center of the care collaborative.”

Here are three ways that healthcare leadership and radiologists can use value-based care strategies to influence change.

1. Educate referring physicians. Physicians want to give their patients the highest quality of care and ease their suffering. Radiologists can work with healthcare leaders about ways to have helpful conversations — without blame or criticism — about alternatives that referring physicians can offer patients who are asking for certain testing that may not be appropriate.

   For example, a patient who has severe headaches may persist in wanting an MRI or CT scan, which is used to rule out a life-threatening problem such as a brain tumor or aneurysm. However, only a tiny percentage of headaches are caused by something that can be detected by a medical imaging test. Unless a patient has risk factors or symptoms that indicate a possible tumor or stroke, testing is not appropriate, according to guidelines set by the American College of Radiology. Instead, physicians may offer patients ways to manage their headache pain per recommended guidelines.

2. Follow evidence-based guidelines. According to a study that analyzed evidence-based guidelines for CT and MRI tests, between 26 and 30 percent of the imaging tests were deemed unnecessary or inappropriate. That equates to a cost of $200 billion a year.

   One tool that healthcare providers can use to support their efforts to implement value-based care is clinical decision support (CDS). Medical imaging decision support contained within physician workflow gives providers objective guidance about testing. CDS analyzes characteristics of individual patients and makes recommendations to caregivers about what testing is proper for the right person and when, helping to reduce rates of unnecessary testing.

   “Radiologists are best able to set the right decision support rules in place with the right availability of appropriate clinical data, based on evidence based guidelines and the patient’s presenting symptoms,” says Shrestha. “This, if done well, ensures that the patient ends up with the most appropriate imaging test (if one is warranted) and this not just is in the best interests of the quality of patient care, but also saves the system money!”

3. Analyze gaps and redundancies. Radiologists have a critical role as part of the integrated healthcare team. Over a full cycle of care, from prevention through treatment and management, any redundant testing or inconsistencies that veer away from best practices should be pinpointed and changed.

   Radiology department supervisors have an important role to play here as well. They should take a step back and ensure that their team isn’t simply following the usual routine that has “always been done this way.” Instead, value-based care entails ensuring that tasks aren’t redundant,  filling in gaps to help promote care that is determined by clinical quality, and providing necessary care for patients.

   “The conversation needs to start with what is in the best interests of our patients, and end with tangible methodologies to optimize costs through the system,” says Shrestha. “Radiologists need to work hand in hand with leaders from IT, finance, administration, operations and the payers to really transform imaging to where it needs to be.”

By the time radiologists provide care, they may feel as though it’s too late to make any changes to ensure that value-based care strategies are being followed. However, they can work alongside healthcare leaders to pinpoint areas where they can offer valuable input and feedback to the entire healthcare team, including referring physicians.

“Radiologists need to control their own destiny,” says Shrestha. “There is much talk in the industry today about how radiologists are being commoditized. But I ask, what then is the solution to this problem? They are not mere diagnosticians who sit in a dark corner of a hospital churning out reports all day long – they are, first and foremost, clinicians. They are healers. They are physician consultants that need to ensure that their true value is seen, heard and felt across the system right to the patient level.”

Radiologists are being urged to view and affirm themselves as critical members of the care team who have valuable voices to be heard on implementing value-based care strategies to benefit both healthcare organizations and patients.

Learn more about value-based care in radiology by downloading our e-book, The Evolving Enterprise Imaging Market.