Some days, radiologists might feel like they’re on their own. Like an athlete training during the off-season, they’re working out to prepare for the season’s start—doing sprints, lifting weights and stretching. But just as an athlete could feel distanced from their team during these off-season workouts, in their day-to-day work, a radiologist might also feel siloed from the rest of the healthcare organization. In a typical day, a radiologist’s varied tasks may not necessarily include other members of the healthcare team; for instance, radiologists review images sent over from the emergency department, analyze the dozens of mammograms waiting in the PACS radiology queue, teach residents, and conduct peer review processes.

But radiologists are increasingly being called upon to become team players, perhaps even top hitters during post-season play, as teamwork in healthcare becomes a key goal at many healthcare organizations. A winning team in the playoffs requires a well-rounded set of players, as the strength of each player’s specific skill set makes the team stronger as a whole.

Multidisciplinary teams are likely to have varied configurations depending on patient needs, but may include members such as a primary care physician, nurse practitioner, pathologist, dietician, social worker and specialists. RSNA President Sarah S. Donaldson, M.D., called on radiologists to become more active on multidisciplinary teams at the most recent RSNA annual meeting last November. “While radiologists may feel they can’t free up personnel to participate in every clinic, conference, and tumor board, they must do so,” she said. “To succeed in today’s health care environment, we must be part of the team.”

Radiologists’ expertise adds strength and value to a multidisciplinary team, and they improve the patient care that organizations provide. Here are three specific ways radiologist contributions matter to multidisciplinary teams:

Improve Communication.

There’s a pop fly heading to the outfield; the centerfielder yells, “Got it!” and makes the catch. A study from the University of Sydney found that multidisciplinary teams are well organized and benefit from improved communications.

Radiologists around the world are speaking up about the importance of being a part of multidisciplinary teams. The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that multidisciplinary teams care for cancer patients, in part because of the improved communications between different team members who have a formal working relationship.

Dr. Jim Reekers, a professor and radiologist in Amsterdam, also encourages radiologists to ensure that radiology is at the center of a multidisciplinary team and to talk to patients face-to-face when possible. “Directly communicating imaging results to patients will enable radiologists top participate in the decision-making process as equal partners in their healthcare.”

Reduce Radiation Dose.

Going into a match-up, many baseball coaches review videos of the opposing team and analyze their strengths and weaknesses. As experts in radiation dosage, when taking part in teamwork in healthcare, radiologists can give valuable input about possible strategies that reduce exposure. Radiologists may recommend, for example, follow-up tests that emit less radiation, such as an ultrasound or MRI instead of a CT scan.

Medical professionals at Emory University are working as a team to implement radiation tracking reduction strategies and are finding success at reducing exposure. They’re tracking dosage both across the institution and at the individual scanner level, seeing success with dose levels being reduced below the average benchmarks. Depending on the scanner, the safety committee chair estimates that dosages have been reduced by 30 to 50 percent.

Improve Your Practice.

During a baseball game, the manager might head out to the mound to offer the pitcher tips about an upcoming hitter’s weaknesses or give a pep talk.

Radiologists on multidisciplinary teams benefit from receiving timely, helpful feedback from their colleagues. A study of Australian radiologists found radiologists who regularly participated in multidisciplinary team meetings for breast cancer saw numerous benefits. Not only did the care they provided patients improve, but so did their workplace satisfaction. Radiologists who are an active part of teamwork in healthcare have a reduced sense of workplace isolation.

Radiologists who join a multidisciplinary team will see a number of benefits. Like high-performing baseball players, they’ll be able to better communicate with their team, know what strategies to implement for best practices and attain valuable feedback to help them improve their game. And as they benefit, so do their employers and, most importantly, their patients.

Learn more about changes in the healthcare arena by downloading our e-book, The Evolving Enterprise Imaging Market.

Editor’s Note: In May 2014, Erkan Akyuz joined McKesson Technology Solutions as president of Imaging and Workflow Solutions (IWS). In his role as president, Akyuz interacts with customers on a daily basis and provides new opportunities for customers to learn about enterprise medical imaging technologies and achieve their healthcare IT objectives.

This article was originally published by Claudette Lew on Health IT Executive Forum and is republished here with permission.

1. You began your journey in health IT at Mitra in Waterloo, Canada. How will your technical and engineering background influence your leadership of McKesson’s Imaging & Workflow Solutions?

As a software engineering graduate, I believed that healthcare IT was on the leading edge of research and development and it remains an exciting field. Starting as a developer then moving into the business side provides me with good visibility and understanding of technical, clinical and business side of the industry. My varied experiences will help us to continue advance our customers’ strategic initiatives, as we continue to advance this successful business.

As president of the business group, I will continue to support McKesson’s already strong commitment to our customers and reinforcing that we must continue to be committed to them and their success. My role is to continue to support our teams and our customers in their initiatives and reinforce the longstanding customer commitment.

2. What do you see as the major challenges facing hospitals and health systems today regarding imaging technology solutions?

I remember when simply windowing/leveling and arranging CT images on the monitor was considered “value-add” to the radiologist, or when the physician was happy to have a dictated report one week later and when radiologists had sole purchasing decisions.

But that is not our world today. Today, there are more challenges than ever facing our customers and I feel that my time in the industry will help me to guide IWS to continue to develop solutions and services that not only add value to our customers’ bottom line but help them as they transition to value-added care.

Radiologists face key challenges and opportunities related to the evolution to value-based care, and must respond to reimbursement pressures with enterprise solutions that help enable interoperability and data consolidation. It is no longer enough to deliver siloed radiology or cardiology solutions.

3. Which of these issues represents the best opportunity for new technology solutions to influence change?

By providing the interoperability required to drive down cost and realize the true value of enterprise imaging and delivering flexible, interoperable products and services that meet those needs, we will help our customers to deliver better patient care. Professional services will provide the peace of mind and expertise to help customers mitigate uncertainty.

4. What are the immediate opportunities and challenges for developers of best-of-breed imaging technology in the healthcare enterprise?

Improving the quality and cost effectiveness of care delivery by consolidating information and breaking down data silos helps to bring users the right images and the relevant data when they need it and where they need it. We can help by empowering the providers with information, analytics and services to quantify their contribution to the value chain.

5. Healthcare IT functionality lags the performance of technology in consumer marketplaces. How do you envision McKesson closing that gap in medical imaging?

Our IT and workflow solutions provide the interoperability and flexibility required to drive down cost and realize the true value of enterprise imaging, in part by taking advantage of technology lessons learned in parallel markets.

Helping to connect imaging into the healthcare ecosystem ‑ through integrations and data standards ‑ is key to taking imaging from the dark reading rooms to the referring physicians’ offices, to the bedside during rounds, to the emergency rooms, to the operating rooms, and finally to the homes of the patients.

6. Where is healthcare headed over the next five years and how have you aligned your goals to help providers get there?

We know that healthcare will continue to evolve and value-based care will presents both challenges and opportunities for our customers. McKesson will continue to deliver flexible, interoperable products and services that meet those needs and work with our customers to deliver better patient care.

Our goals are twofold: To build profitable partnerships with our customers with solutions and services that help them manage change rapidly and effectively, and guide them through consolidation; and to develop IT and workflow solutions that provide the interoperability and flexibility required to drive down cost and realize the true value of enterprise imaging.

We know that it is now more important than ever that the radiology community prepares to actively guide the transition from volume to value-based imaging. As a vendor, we must support this transition by providing solutions and services that not only lower the total cost of ownership but help our customers adapt to the pressures they experience as they adopt new technologies, workflows and processes that allow them to add value in new payment models and delivery systems.

Read more blog posts by Erkan Akyuz on the challenges and trends facing today’s healthcare professionals.

When it comes to software development, CMMI Level 5 is the gold standard, taking five years on average to achieve and involving the highest possible performance. Developed by the CMMI Institute, the Capability Maturity Model Integration is a process improvement framework that helps organizations achieve high-performance operations.

Development teams that have achieved CMMI Level 5 are capable of reliably and sustainably creating robust applications that meet or exceed project goals.

Development teams begin at Level 1 (initial), with processes that are typically ad hoc and chaotic. At Level 2 (managed), process discipline helps to ensure that practices are retained during times of stress. At Level 3 (defined), processes are well characterized and understood, and are used to establish consistency across the organization. At Level 4 (quantitatively managed), quantitative objectives for quality and process performance are established and are used in managing projects. At Level 5 (optimizing), focuses on continually improving process performance through incremental and innovative process and technological improvements.

Given the fast pace of change in the healthcare industry and the enormous impact imaging can have on providers and patients, high performance is quickly becoming a must for those developing imaging software. However, climbing the CMMI ladder can be a demanding process requiring a strong commitment to quality improvement, but attaining a CMMI level should never be the primary goal.

In fact, teams that become too focused on achieving the next CMMI level — rather than concentrating on improving processes to achieve higher quality and business value — often fail, according to Jim Shaver, McKesson’s senior director of enterprise quality improvement. Shaver and his team supported McKesson’s IWS Cardiology Development Group, based in Tel Aviv, in its recent successful bid to reach CMMI Level 5. Note that only 321 organizations worldwide have reached Level 5, and only a handful of those are healthcare related. IWS Cardiology Development is the first FDA-regulated medical device group to achieve Level 5, as well and one of the smallest groups to do so.

Shaver said IWS Cardiology Development’s achievement is partly due to the culture in the 60-person group, led by Tomer Levy, vice president of cardiology at McKesson Medical Imaging. The group is passionate about what they do and recognize that it directly impacts people’s lives, said Shaver. “They’re driving toward perfection and are very open to constructive criticism. They did not set out to achieve CMMI Level 5; they wanted to do their jobs more efficiently and make sure they were delivering the best possible product to their customers.”

Indeed, the group’s passion led to the decision to pursue CMMI level 5, after having previously achieved CMMI level 3 two years earlier. Once that decision was made, it took the group only 10 months to reach level 5. Another reason for the group’s success is its ability to distill CMMI requirements down to their essence, said Shaver. Treating the CMMI framework as a prescriptive “cookbook” can lead to failure, especially for small teams, he explained. (CMMI was created to standardize large systems projects for the US Department of Defense.)

Instead, Levy and his team viewed CMMI practices as tools to help them mitigate the risks associated with software development and adapted each one as needed to work for their projects. CMMI is scalable, provided you are thoughtful about how you apply the model, Shaver said.

Shaver noted that the group’s development maturity level has also enabled a move to a more agile model for creating software. Previously, the group needed the rigor provided by the traditional phase-based approach, he said. Today, the group can respond more quickly to customers’ needs, using their processes to make sure product quality does not decline during the short development cycles.

Most recently, said Levy, this methodology facilitated the development of McKesson Cardiology™ ECG Mobile, an FDA-approved iPad® app that can be downloaded from iTunes®, allowing cardiologists to read and report on resting ECG procedures from any location.

For more information on McKesson Cardiology™ ECG Management and other cardiology solutions, please visit our website.

Editor’s note: Despite rising healthcare costs, inconsistent quality of patient care in healthcare organizations has necessitated a crucial shift in the delivery of medical care. Systems that seek change are beginning to transition to a value-based care approach that seeks to manage costs while giving the right care at the right time. As healthcare organizations move towards this new model, enterprise medical imaging technology will play a crucial part in the successful implementation of value-based care models.

This article was originally published by Cat Vasko on Health IT Executive Forum and is republished here with permission.

Preparing for the paradigm shift to value-based care remains a topic of intense focus and discussion while the concept continues to be defined in a meaningful way, according to Cindy Hardin, executive director, infrastructure product management, Imaging and Workflow Solutions at McKesson. “Organizations are working to understand the effects and prepare for the changes,” she says. “The transition to value-based medicine and payment necessitates that organizations communicate, collaborate and convey value and success in delivering quality care. Ensuring that all entities involved in the care episode — insurance companies, patients, referring physicians — participate effectively and efficiently has a direct effect on value.”

Medical imaging has a strong advantage when it comes to communication and efficiency, Hardin says. It offers near-instant communication with all entities involved in the care continuum: “One of the biggest roles for imaging will be communication — getting the right data to the right place at the right time,” she notes. “When a patient enters a healthcare organization, his or her care team needs to have all of the prior information available in order to make informed decisions. Prior imaging, whether it was done at another organization or in another state, is critical to making sure the right diagnosis is given.”

Gateway to Value

That’s not to suggest that challenges to reaching this goal don’t exist—some still do, and prime among them is interoperability, Hardin says. “From our perspective as an IT company, we strive to maintain a standards-based solution set so that we’re not asking customers to support custom interfaces and their associated costs,” she says. “Value-based care needs to be efficient. Communicating all of this information using standards is critical.”

Cross-enterprise document sharing is another area of opportunity. “This is still a very green technology in the US,” Hardin says. “Our organizations need to be setting up full registries and repositories for participation in health information exchanges, but because this technology is so new to them, they’re going to be looking to their vendors not only to set up the repositories, but to understand the workflows behind them. It would be a mistake to move forward without the proper analysis of workflows — organizations need to make sure they’re not plugging in new technology without considering all the aspects of what happens in the patient care event.”

Hardin is optimistic, however, that widespread adoption of new technology will not be an obstacle, even among the patient community. “I would no longer consider customer adoption to be a barrier,” she says. “Referring physicians and patients alike have been using this technology in banking, in music, in ordering stuff on Amazon. The comfort level with sharing information using the web is much higher than it used to be.”

Raising Value in Radiology

In order to effectively leverage imaging across the enterprise, organizations are going to have to define what imaging is. “We need a consensus on what constitutes an image,” Hardin says. “Is it any photo taken within that organization’s walls? It’s going to get interesting.”

She also circles back to the subject of the need for standards-based technology, “Many of our customers still have custom interfaces in place for certain systems just within their PACS worlds,” Hardin says. “They’re very unprepared to enter the world of enterprise imaging. The vendor side of the industry needs to get onboard with making sure whatever they install in an organization is standards-based — there are systems out there today that don’t even do HL7.”

Unfortunately, already-strapped healthcare organizations can only implement these technologies as they can afford them. “Having too many things to do at once dilutes the availability of funds,” she says. “Organizations are struggling with balancing the amount of money available against everything they have to do.”

Finally, Hardin observes that analytics enabled by the implementation of these technologies must be leveraged to support the evolving roles of imaging and the other players in the care continuum. “Improving perception of value is impossible without data,” she says. “The more imaging can demonstrate its worth through analytics, the better off it’s going to be. And, of course, the more information you have, the better you can continuously improve your value.”

Learn how our enterprise medical imaging solutions help healthcare organizations more effectively transition to value-based care.

As healthcare organizations develop strategies to engage with patients, a number of challenges arise —especially when it comes to communicating with elderly patients. Almost 25 percent of elderly patients live in rural areas, more distant from healthcare facilities. They’re more likely to have chronic conditions such as diabetes, heart disease and arthritis. Communications strategies for the elderly may require special consideration and multifaceted tactics, even for digital platforms.

When it comes to older patients and technology, the good news for healthcare leaders is that seniors are catching up with the general population and becoming more connected to the Internet. The bad news is that older, less affluent and disabled patients are experiencing a technological divide, according to a study on older adults and technology usage from the Pew Research Center. In other words, the patients who use the most healthcare and are most likely to have health problems are less digitally connected. While 60 percent of seniors (ages 65 and up) have Internet access, when you look at Americans ages 75 to 79, less than half do.

“[F]or today’s older generations, the ones with the highest demand on healthcare services, the digital age is a tough sell,” says Joe Marion, founder of Healthcare Integration Strategies, in a blog post about the digital divide and age. “Usage among people with physical impairments [shows they] have more difficulty using the internet and patient portals to view their health data.”

Healthcare leaders developing strategies and tactics to improve patient engagement will need new strategies when communicating with elderly patients.

What is Causing the Technological Divide?

The technological divide between the general population and the elderly is a challenge for healthcare organizations focused on improving patient engagement. Many strategies to connect with patients involve digital communication – text messages that remind patients of upcoming MRIs, apps that help cancer patients find support groups or email messages for patients with chronic pancreatitis about following a low-fat diet and avoiding alcohol.

As healthcare systems respond to value-based care models and Meaningful Use Stage 2 guidelines by implementing digital communication tactics, different strategies are going to be necessary for some elderly patients, especially those over the age of 75. They are less likely to be online, more likely to have physical limitations that impede their access to patient portals, and more likely to experience health challenges.

Learn more about Meaningful Use Stage 2 by downloading our paper, Some Practical Advice on Image Results and Meaningful Use Stage 2.

“It seems to me that healthcare providers will have to be creative in finding alternatives to transition from the digitally illiterate to the digital literate base of patients,” says Marion.

Bridge the Gap to Connect with Elderly Patients

Tactics to help healthcare organizations counter the technological divide may include developing bridging technologies that improve communication with elderly patients, even as more high-tech, digital communications engage the rest of the patient population. Marion suggests using automated phone calls for elderly patients. For example, it’s common for patients to have an automated phone call reminding them of upcoming appointments. This technology could be used to leave automated phone calls with test results for patients who prefer it, especially the elderly who may lack Internet access to their patient portal.

In order to ensure elderly patients with hearing difficulties are not frustrated by automated phone calls, any voice messages should use concise language with simple sentence structure. Any healthcare providers leaving a message or speaking with an elderly patient live should consider their clarity and volume when making phone calls.

When it comes to imaging results, elderly patients may need to have hard copies of their medical images sent to them with arrows noting “before” and “after” images (for example, indication of the “before” image of a vertebral compression fracture and the vertebroplasty in the “after” image), along with simplified written explanations. Other traditional forms of communication may need to be utilized when communicating with elderly patients.

“Maybe healthcare providers could take a page from Amazon and other consumer-oriented companies to enhance the delivery of healthcare,” says Marion. “Amazon seems to have the delivery mechanism down pat, in that I can order something today and have it delivered in some cases overnight. Why couldn’t the same be true for diagnostic results?”

Utilize Face-to-Face Opportunities

When healthcare providers are working with elderly patients face-to-face, this is an opportunity for the health team to lay groundwork for future engagement. For example, a healthcare organization could hire a staff member whose job description includes communicating with elderly patients as part of an exit interview process. The support staff member might ask for permission to see the elderly patients’ mobile phone (if applicable) and offer to provide the patient with a free tutorial on using tools that would help improve his or her health.

When communicating with elderly patients face-to-face, healthcare providers should also write down instructions and obtain permission from patients to share information with a designated caregiver, such as a spouse or child. Caregivers can also learn about engagement tools so they are able to help the elderly patient if he or she has further questions.

Develop New Strategies

Healthcare leaders may choose to create a focus group designated to identify new ways to communicate with elderly patients. Perhaps the focus group decides to implement a test group that gives out iPads to a small group of elderly patients with apps pertaining to certain chronic conditions. Charts, models and other visual aids typically help elderly patients better understand their health conditions and recommended treatments.

Many elderly patients fear the cost related to adopting new technology. Healthcare providers may need to get buy-in from family members or other caregivers when encouraging elderly patients to try using their patient portal to access their EHR.

As healthcare systems work to engage patients, a “one size fits all” tactic will not suffice. Many of the elderly will need healthcare information via traditional means of communication, even as the rest of the population moves toward digital technologies. Healthcare leaders can implement different tactics for patients, depending on if they have online access, do have access but struggle to use it, or lack online access completely.

Learn more about how other generations are influencing radiology by reading our blog post about the Baby Boomers and medical imaging technologies.

Toys, shoes, dresses, musical instruments, fossil replicas, drones, cars and even houses are all amongst the many things being 3D printed today – there is even a specially designed 3D printer being sent to the International Space Station to be used to create replacement parts in zero-G.

The field of medicine is no exception to this revolution, and a lot of this is driven by medical imaging. In this post I’ve highlighted six ways medical imaging solutions and 3D printing are being used in combination now in the real world and also will be in the near future.

1. Anatomic Models

The first and most obvious application of 3D printing in medicine is to create physical models of anatomic features for education of physicians, patients, and the public. The NIH has a free library of examples of organs, proteins, viruses, bones, and other biological structures all of which are ready to print into 3D plastic models. The anatomical structures were, of course, primarily made from CT or MR scans.

However, printing a general anatomical model is a little different from ordering one from a medical supply company. As Dr. Rajiv Chopra, Associate Professor of Translation Research at UT Southwestern’s Advanced Imaging Research Center, says, “Once you own one example model normal heart, you really don’t need another. That alone certainly does not justify getting a 3D printer.”

Where 3D model printing actually starts to make real sense is when it is used to create a model from a specific patient’s particular anatomy using medical imaging data. This has been shown to be particularly useful when surgeons need to plan complex surgeries.

2. Custom Implants

Medical imaging can also be used with 3D printing to go a step beyond and create not just models, but actual replacement implants customized to exactly fit the patient’s needs.

There have been a number of recent dramatic examples of replacing parts of a patient’s face, skull and cranium with plastic analogs.

Researchers at Peking University have begun 3D printing patient-specific custom vertebrae and implanting them in patients with a range of conditions including cervical spondylosis. In this case titanium was the medium of choice.

Such custom implants need not be permanent. One early success at the University of Michigan involved creating an artificial trachea via 3D printing for an infant at risk of suffocation death due to tracheobronchomalacia. The baby’s body would eventually naturally dissolve and eliminate the material from which the artificial trachea was made, but by that time the child’s own windpipe would have grown strong enough that the risk of fatal obstruction was in the past.

Traditionally manufactured implanted devices like hip and joint replacements can also be improved with 3D printing. The end parts that come in contact with the patient’s skeletal structure can be custom shaped from CT scans to be a perfect fit. Traditionally the orthopedic surgeon would use a saw, chisel, and hammer on the bone to make room for a standard replacement to fit the patient. Now the part can be made to fit the bone instead of simply fitting the custom end pieces.

3. Custom Prosthetics

There are numerous examples of amputees, their friends, their families and volunteers designing and printing customized prostheses that are preferred over  available commercial versions. This is also true in parts of the world where advanced electronic prosthetics are difficult to acquire for cost or logistics reasons.

In some cases people are adding flourishes to add a sense of style or fun to something they need but which is usually utilitarian in design.

4. Experimental Medical Devices and Lab Equipment

Another application is for researchers who need to create a device that does not yet exist. Dr. Chopra said, “The ability to create specific equipment parts as needed for your experiments makes a 3D printer an essential part of any research lab.”

There are a number of laboratory component designs available at the NIH 3D Print Exchange web site. However, some researchers have gone beyond fast-tracking lab equipment assembly to the creation of patient-specific mechanical devices to aid physicians in treatment.

As an example of such experimental devices, Dr. Chopra and his colleague Dr. Travis Browning, a Radiologist and Assistant Professor in UT Southwestern’s Department of Radiology, are investigating making patient-specific biopsy guidance devices in order to simplify challenging needle approaches and increase the chance of a successful extraction from the target tissue.

5. Pharmaceutical Delivery Devices

Researchers at Louisiana Tech University have also managed to adapt low-cost printers to create an alternative to the beads often used to implant antibiotics for smart drug delivery. In this case, medical imaging would not be used to custom design the printed devices but would be involved in implantation and tracking.

6. Artificial Organs

While all of the other examples above involve printing objects made of plastic, metal and other non-living materials, there is another kind of 3D printing in the experimental stages that intends to print objects composed of living cells.

While this “bio-printing” technology is still in its infancy, earlier this year researches at the University of Sydney, MIT, Harvard, and Stanford worked together to develop a device that allowed them to successfully print blood vessels. In a TED talk in 2011, Dr. Anthony Atala discussed the potential of this technology to print functioning organs (e.g. kidneys) for transplants instead of having people on long waiting lists for compatible organs to come available from a donor.

Is your organization making any strides in combining medical imaging and 3D printing? If you have an interesting story to share, I’d love to hear from you. Just leave a comment.

Sometimes, you’ve got to get creative. Like when you’re asked to help providers increase quality of care and help improve patient outcomes while reducing cost.

Indeed, we’ve found that creativity is the best way to generate customer value, and I am proud to announce that Frost & Sullivan reinforced that idea in its recent whitepaper describing its choice for McKesson as company of the year. In the whitepaper, “Amplifying the Value of Medical Imaging Services to the Enterprise through Efficient Workflow Solutions,” Frost & Sullivan makes the point that this notion is circular: creativity brings about customer value excellence, and customer value excellence reinforces the spirit of creativity.

Author Nadim Michel Daher writes in the whitepaper that companies receiving this award represent the top 10% of their industry in visionary innovation and customer value excellence. “To win an award like Company of the Year is to be recognized as a leader not only in the industry, but among non-industry peers as well,” writes Daher.

The paper describes how McKesson Imaging and Workflow Solutions (IWS) Group’s medical imaging informatics solutions were benchmarked against key competitors in the areas of growth strategy excellence, growth implementation excellence, degree of innovation with products and technologies, leadership in customer value, and leadership in market penetration.

“Throughout the last several years, McKesson’s imaging and workflow business has been highly proactive in aligning its product portfolio and value proposition with these new care models, while preparing its customers to transition to these higher levels of operational efficiency and quality outcomes,” writes Daher, referring to value-based care, higher patient volumes, and lower per-procedure bundled reimbursement.

Daher highlights McKesson’s continual drive toward helping providers minimize the  TCO of their imaging systems, pointing out how McKesson Qualitative Intelligence Communication System (QICS™) helps streamline communication between stakeholders. Writes Daher: “By leveraging interoperability to enhance the mechanisms of collaboration and the overall workflow productivity of the imaging enterprise, it can lead to more efficient patient management and higher quality of care across the continuum of care.”

As gratifying as it is to be recognized for innovation and market leadership, the only success measure that matters is genuine utility to providers. Since, as Daher notes, most providers are still hard pressed to meet the high-level objectives of higher quality and better care with reduced cost, the best accolade we can receive is this: “McKesson imaging and workflow business has taken the necessary steps to innovate, expand and harmonize its solution set to address the key challenges of enterprise-wide medical imaging informatics and has been highly proactive over the last several years in aligning its product portfolio with emerging care delivery models, while preparing customers to transition to higher levels of operational efficiency and quality outcomes.”

For more information about the award, read the Frost & Sullivan whitepaper, “Amplifying the Value of Medical Imaging Services to the Enterprise through Efficient Workflow Solutions.”

Read the press release and view the multimedia web site.

When we study dramatic failures like those that bring down power lines, we usually discover multiple issues. It’s the same with imaging — numerous forces have combined to decrease profitability, including saturated markets, a more complex patient population and declining reimbursement.

In her webinar, “2014 Imaging Market Outlook,” Sruti Nataraja of The Advisory Board Company takes a comprehensive look at all the factors contributing to imaging’s current state and observes the following:

1. We’re getting diminishing returns from traditional growth
2. The worst is yet to come with hospital reimbursement cuts
3. Imaging exams are firmly on the chopping block in risk-based payment
4. Price pressures are threatening bottom lines
5. Poor coordination is stunting imaging’s ability to demonstrate value

Clearly, imaging executives can do little about most of these issues. But Nataraja points out that imaging leaders can address number five by what she calls unlocking imaging’s value. She outlines four mandates for value in the new healthcare economy:

1. Better align imaging strategy with institution strategy (internal alignment)
2. Cultivate radiologist integration (external alignment)
3. Pursue opportunities for traditional volume growth (internal growth)
4. Explore frontier growth (external growth such as becoming a preferred provider for payers and a preferred partner for ACOs and medical homes)

Nataraja believes the only way to better align imaging strategy with institution strategy is to move away from fee for service, exam-growth directives, efforts to reduce direct costs, patient-satisfaction efforts and service-line operations and toward risk-based payment models, efforts to grow patient share, programs that reduce total cost of care, patient-activation efforts and collaborative care efforts. This is the way to demonstrate value beyond profitability, she says.

To achieve a better aligned strategy, imaging executives must fully understand the institution’s goals and thoroughly communicate these goals to imaging department managers. Key personnel must be prepared to (1) demonstrate their department’s value to the institution beyond profitability and (2) leverage imaging program skills to build collaboration.

Imaging departments must also work to better align with care partners such as referring physicians, hospital (or ACO) leadership and payers. Nataraja says the goal is to be able to collaborate on executing care partners’ current and future strategic priorities as they relate to imaging.

Finally, Nataraja outlines what she calls The New Growth Equation:

Appropriate Utilization + Strategic Pricing + Purchaser Marketing = Secure Long-Term Growth

Imaging programs that are able to demonstrate their appropriate utilization, coupled with competitive pricing and effective marketing of their value to purchasers, will be able to secure growth in the long run. While certainly more complex, and requiring some tough decisions, this imaging strategy is a more secure way to grow long-term.

To learn more about imaging strategies that support growth, register to download the recorded webinar, 2014 Imaging Market Outlook.

Each year, about 45 percent of Americans set goals, make resolutions and strive to start the year off on a positive note. In enterprise medical imaging we too are looking at the year ahead and discussing predictions about medical imaging trends. Here are 5 predictions for 2015.

1. Data analytics will increase in importance and usage.

The first big medical imaging trend for 2015 is a continued emphasis on data analytics. Solutions that merely collect data and store it are insufficient. Mining useful data is increasingly valuable to healthcare organizations. For example, data can be collected and analyzed to give information about equipment usage, patient backups and other stats to determine what to invest in next. Or data could be inspected to determine whether one brand of stent is performing better than another or whether an implant has a better outcome on a certain patient group. Data analytics continually prove their value as healthcare leaders want solid data to help them make informed decisions, and this trend will likely continue in 2015.

2. Health Systems Will Continue to Seek Improved Efficiency.

Healthcare organizations are continually being pressured to provide better care while reining in costs. Solutions that help improve efficiency are expected to be an important medical imaging trend in 2015. One example is McKesson QICS™ for Throughput Management, which automates and tracks a variety of exam workflows. It helps pinpoint areas where departments may be inefficient or a particular employee is struggling so that interventions, such as extra training, can be taken.

3. Solutions that Foster Collaboration will be Critical.

Due to the growth of multidisciplinary teams, ACOs and care management, the next prediction for medical imaging trends in 2015 includes using tools that facilitate collaboration. Healthcare professionals will seek tools that help them improve communication and more easily work together. For example, if a radiology department wants to improve how it works with the ED, a prioritization rule can make a trauma study that’s been in queue for more than 15 minutes available to other radiologists, helping to improve interdepartmental collaboration.

4. Images Need to Support Transitions to More E-visits and Telehealth Use.

Another medical imaging trend in 2015 is the importance of images’ ability to be easily accessible as e-visits and telehealth continue to grow. One report estimates that by the end of 2014, there will have been a total of 75 million e-visits in the U.S. and Canada. Healthcare providers who are distant from their patients will need to be able to view images and access patient data remotely. Ideally, relevant clinical data from the patient’s EHR will be integrated with medical images and test results, giving tele-providers the information they need when treating remote patients.

5. Patient Engagement will be a Continued Focus.

The last medical imaging trend predicted for 2015 is a continued push for improved patient engagement. Medical imaging is a valuable tool, supporting patients’ visual understanding of their conditions so they will be more likely to follow their physicians’ recommendations for treatment and care. Furthermore, mobile images that can be sent (with a patient’s permission) to family members or other caregivers facilitates an engaged support group.

As you reflect on 2014 and look at the year ahead, what medical imaging trends seem most important to you? You’re invited to leave comments below.

For more information about medical imaging trends in 2015, download our information on 3 Diagnostic Imaging Trends You Must Watch Closely.

Percutaneous coronary intervention (PCI) procedures, commonly known as coronary angioplasty, rank among the most common surgeries performed in U.S. hospitals, with an estimated 2.48 million procedures a year. While that figure has declined 27% between 2007-08 and 2010-11, it still represents a significant portion of all cardiovascular surgeries.

As hospitals adapt to new payment models and treatment modalities, a lot of attention is being paid to evidence-based practices, including those related to cardiac procedures. The ideal of evidence-based practice is to provide clinicians with personalized, actionable information they need to make care decisions that reflect the unique circumstances of each patient. That information should be presented as close to the patient bedside as possible to facilitate in-the-moment decision-making.

McKesson has partnered with Health Outcomes Sciences (HOS), a leader in personalized evidence-based intelligence, to integrate into McKesson Cardiology™ cardiovascular information system (CVIS) several HOS predictive models related to PCI:

• American College of Cardiology (ACC) models to predict the risk of the following complications:
  • Bleeding
  • Mortality
  • Restenosis
• 30-day post procedure readmission tool that identifies at-risk patients

These models pull data from McKesson Cardiology and other electronic systems to create a patient picture that helps clinicians make better decisions and improve patient outcomes and satisfaction at a reduced cost, says Max Reverman, vice president of sales for HOS. In addition, McKesson also sells standalone versions of HOS models for acute kidney injury and appropriate use criteria, as well as the company’s eLUMEN display software, which aggregates information for display in the cath lab.

HOS uses a technology platform called ePRISM to deliver predictive risk models, based on published and peer-reviewed research, to the point of care. ePRISM uses validated multivariable risk models and specific patient information to return a risk score that a physician weighs to determine the best course of action for that patient.

HOS cardiac models are based on research performed by medical research centers affiliated with the ACC. HOS has a business relationship with ACC “to translate the College’s risk models for use in routine clinical settings.” You can read more about the partnership here.

“For a PCI procedure, a doctor can determine whether the patient is uniquely at high risk for bleeding or at high risk for kidney injury,” Reverman explains. “With that information, the cardiologist can tailor their therapeutic choices based on those which are most likely to produce the best outcome. For example, anti-coagulation tailored to the individual; a radial versus a femoral approach or a varied amount of contrast dye.”

HOS clients that have implemented ePRISM have seen significant improvements in quality and outcomes. Examples include a client that reduced its bleeding rate from 5.5% to 1.2% and another that saw both bleed and acute kidney injury rates cut in half, according to company literature.

While the company got its start in the cardiovascular space, ePRISM readily accepts models from other clinical specialties. The ability to create predictive risk models from evidence-based research holds possibilities for many other facets of healthcare, Reverman says. That ability will be even more critical as payers turn their reimbursement focus from volume to value.

Just last month (January), Health and Human Services Secretary Sylvia Mathews Burwell announced ambitious plans to move 30% of all Medicare payments to alternative payment models that stress the quality of care over the volume of care by 2016. Just two years later, that payment goal is 50%.

Also last month, six of the nation’s top 15 health systems and four of largest 25 payers came together to form the Health Care Transformation Task Force, an alliance dedicated to accelerating the transformation of the U.S. healthcare system using value-based business and clinical models. While announcing the alliance, task force members “challenged other providers and payers to join its commitment to put 75 percent of their business into value-based arrangements that focus on the Triple Aim of better health, better care and lower costs by 2020.”

There’s no question that changes in reimbursement methodology are coming, Reverman says. “We help in the transformation from volume to value by focusing on quality outcomes and patient satisfaction. Increasingly, those considerations will be part of the compensation equation,” he says.

And you don’t need a supercomputer or a complex algorithm to realize that evidence-based practices that help improve outcomes are the future of healthcare.

If you would like to schedule a meeting or demo of McKesson Cardiology™ in advance of ACC, please visit www.mckesson.com/acc15.

How can we improve the relationship between computers and radiologists? How can we make use of dark matter (all the information currently not being mined from our images)? How can we combine data sets to calculate critical conditions like malignancy?

The answer to all of these questions is big data. And if it sounds a bit futuristic, that’s because it is.

Dr. Eliot Siegel of the University of Maryland School of Medicine led a webinar at the end of January, hosted by the Society for Imaging Informatics in Medicine. According to a recent HealthImaging article, Siegel both defined big data and discussed the role it could play in radiology. He explained that the National Institute of Standards and Technology defines big data as data that exceeds the capacity or capability of our current or conventional methods and systems.

Big data’s role in radiology begins with saving every clinical course and making its data available for decision support, rather than only using data from specific clinical trials. The idea is to encourage radiologists to rely more frequently on computer-aided diagnosis (CAD). Siegel noted that although a recent survey found that 89 percent of radiologists say they use CAD, only 2 percent say they often change their original interpretation based on its findings.

Second, 100 percent of radiology data would be saved in EMRs. Siegel explained that untagged, unmined images are the equivalent of dark matter — vast amounts of unusable information. He stressed that this must change if enterprise medical imaging is going to play a substantial role in the era of personalized medicine and computer-based decision support.

Third, the resulting large data sets would be used in CAD systems to study patients with similar characteristics and calculate the likelihood of things like malignancy. “Our goal would be to identify molecular pathways for a cancer rather than simply its diagnosis or appearance in one pathology or histology,” he said.

Finally, Siegel offered the following suggestions for radiologists who want to see this future become reality:

• Look at how you capture your data.
• Consider using formats that are easier for your reports to be mined.
• Consider tagging your studies and making them widely available.

Stay up to date on the latest diagnostic imaging trends by subscribing to the Medical Imaging Talk Blog or following the McKesson Enterprise Medical Imaging LinkedIn showcase page.

Going to HIMSS next month? Visit the Interoperability Showcase, Booth #2084 where McKesson will be presenting, “Evolution of Image Sharing: A Long and Winding Road,” on Monday, April 13 from 3:30-4:00 p.m.

Editor’s Note: This article was written by Evan Godt, Editor of Health Imaging, and is reprinted here with permission.

Early medical image archiving was focused on one main goal: the display of images. No easy feat, especially as storage requirements grew and physicians began to expect images on-the-go through their tablets or phones, but the mission of sharing images remained clear.

Today, however, some are looking ahead at the next generation of archiving and getting beyond the display, to take a deeper dive into image data—and that means more than simply reading imaging reports.

“Today when people are talking about big data and data mining, they are still talking about text,” says Gary J. Wendt, MD, vice chair of informatics, professor of radiology, and enterprise director of medical imaging at the University of Wisconsin-Madison. “They’re not talking about actually mining content out of images. I think that’s probably the next generation, actually processing image data, not just text data.”

Wendt sees a future PACS that doesn’t only find and present images, but automatically performs more complex tasks such as plotting volumetrics of various nodules or describing other characteristics of disease.

“Even in Imaging 3.0, there’s not a lot of automation and aggregation of data,” says Wendt. “There’s been some work on aggregation of text data—digging stuff out of the EMR and past reports—but there’s really not been a lot done with automated image processing.”

Wendt’s comments echo those of Eliot Siegel, MD, with the University of Maryland School of Medicine, who is another champion of bringing big data to medical imaging. In a January webinar hosted by the Society for Imaging Informatics in Medicine, Siegel likened the amount of data embedded within an image to that of dark matter in the universe, which lingers unseen even though we know it’s there.

“There is so much in our images that we just aren’t aware of because the images are untagged and not mineable. All of that information we’re not using is like universal dark matter—it’s vast,” he says. “This must change if medical imaging is going to play a substantial role in this era of big data, medical guidelines, decision support and personalized medicine.”

Siegel says one goal should be identification of molecular pathways for cancer rather than simply its diagnosis or appearance in one pathology. Likewise, Wendt looks forward to the day where he can query the system for a similar cohort of patients — say, patients with brain tumors who are three to six months post-diagnosis, for instance.

“Give me a relevant cohort of priors, not just of the same tumor type, but the same tumor type at the same time post-diagnosis,” says Wendt, adding that this method would allow for better comparisons.

Ultimately, the clinical impact of such next-generation image archiving would come from the creation of more relevant reports. This would be especially beneficial in oncology, where treatments can be modified based on tumor progression, and comparisons to similar cohorts of patients at an oncologist’s fingertips would be useful.

“That’s going to take a whole new type of analytics,” says Wendt. “It’s going to be a whole new world.”

Stay informed with medical imaging and image data updates by subscribing to the Medical Imaging Talk Blog today.

Editor’s Note: This article by Kayt Suke was originally published by Healthcare Informatics and is reprinted here with permission.

As larger healthcare systems continue to grow, often merging with smaller regional and rural hospitals, information technology (IT) leaders are pressed to find innovative ways to deal with interoperability and data sharing across the enterprise. UnityPoint Health, a multi-campus health system in Iowa, needed to integrate a variety of radiologic and medical imaging systems across their rapidly expanding community.

To address the issue, this health system recently transitioned to a completely virtual server environment solution. Todd Holling, the Assistant Director of Clinical Legacy and Business Systems at UnityPoint Health, spoke with Healthcare Informatics about the challenges and opportunities of bringing together disparate systems across a large healthcare system—and how a virtual solution has helped leverage existing IT and medical imaging systems to achieve greater efficiency, improved care and increased cost savings.

Healthcare Informatics: UnityPoint Health has grown rather dramatically over the past few years. With so many different applications from so many different departments and institutions, what are some of the biggest challenges concerning interoperability and data sharing?

Todd Holling: The biggest challenge is that there’s no “one-size-fits-all” way to deal with the problem. There’s never a solution that will be a perfect fit for everyone. UnityPoint Health is very much in a kind of growth mode as we integrate other partners into our system. And as we do that integration, we need to find ways to standardize as much as we can, creating the kind of platform that allows our partners to use our core systems. There are a lot of barriers. Many of our partners have ties to their old systems and may be reluctant to make a change. You have to address the question of how you can convert old data so it can be used by the new systems. What does that timeframe look like? What data moves to the new system? Where does the old data go? How do you retain that old data? There’s a lot to consider.

How do you meet those kinds of challenges?

Holling: It’s a fine balancing act. But it’s one that can be managed with good communication—where the appropriate stakeholders are involved in those conversations early on, making sure everyone is up to speed. You also must have a systematic process in place to talk through all the issues. Because they can be difficult conversations—and you need to get your current users involved in those discussions so they can convey the benefits of using a standardized system. To let partners know that it’s about coordination of care, sustainability efforts and optimization. Things that ultimately impact clinical care. So, early and often, you need to balance the different priorities of each site, get to a common ground consensus, and then have a collaborative process in place so you can get to a standardized end state where everyone is working on similar platforms.

Are there any issues that get magnified when your organization is in this kind of growth mode?

Holling: Getting buy-in can be an issue. And it’s not a surprise. People at different sites get comfortable with where they’re at—with the systems they have. Certainly, physicians do. And that’s not to say that what they’re using is necessarily the best product. But, they are systems that they know well. So the integration process can be a big culture change. These physicians are coming into a larger institution. They’re coming into a larger neighborhood where they’ll have to connect with more physicians and care team members. The support is going to likely come from a different avenue—in our case, it’s a corporate location and we find local partners to support those systems.

But, again, if you focus on good communication early on, creating good decision documents that can demonstrate what you are doing to the community, you can get there. Get that information into the appropriate hands—and let those doctors start touching the new systems so they can get more comfortable. Do that and they quickly learn that the changes you make won’t be so bad after all. And once they see that, they’ll be part of a much larger network as well as a powerful system that has more tool sets and better support, they will really buy in. They have a real light bulb moment where they realize that their focus was on the wrong aspects of the change—and they will be able to, through this integration, open up a real community of care to help provide the best outcome for every patient, every time.

UnityPoint Health just made the transition to a virtual server environment to help assist with medical imaging data. Why? What are the advantages of such a solution as you are addressing interoperability and data sharing challenges?

Holling: First and foremost, virtualization allows for flexibility. In a traditional physical environment, if you exceed the bandwidth and growth capacity of a server, you have to then purchase another physical server—and keep adding more physical servers as needed. That takes time. It takes more money. It takes the whole lifecycle of a physical device.

Virtualizing allows you to scale out—and not up. That means, if you exceed your capacity virtualization, you already have the existing templates in-house for those virtual servers. You can add additional virtual servers literally within hours. So you can be much more flexible when you are compensating for growth — and all those eventual items that happen as that growth happens.

What kind of support did you receive during the implementation process?

Holling: We partnered a lot with McKesson on the virtualization process. We knew that we needed a solution that wouldn’t just work for today, but one that would work for the next five years. McKesson understood that, too. So we never got a “No, you can’t do this,” or “We’re not comfortable doing this,” when we told them our requirements. Instead, they listened and said, “Yeah, let’s do this together,” and “This is not just good for you, but good for all.” Ultimately, it ensured we had a successful virtual environment implementation.

Was it difficult to get buy-in from key stakeholders and physicians?

Holling: No. As we told the story about why we decided to move to virtualization, and the advantages of doing so, we got buy-in very easily. The fact that we can grow, be flexible and then continue to expand without the constraints of a physical environment spoke to them. Physicians don’t want care interrupted. They don’t want to hear, “We need to wait six months for a new infrastructure to be spun up before you can do that.”

Does this solution change the way that clinicians work in different facilities across the organization?

Holling: It’s hard to quantify how a virtual server impacts a physician behind the screen. But I would say that it has brought changes because our solution means less down time. If there’s an issue with one server, you can switch to another virtual server in real time. That means that physicians can focus on patient care instead of down times and other unforeseeable IT issues. And that’s ultimately what you want. You want the clinicians asking “How can I provide the best care for my patient?” Not “How can I get around this IT problem?”

How does this solution work across different branded software systems or third party applications?

Holling: We used a vendor neutral archive solution called Enterprise Image Repository that allowed us to easily work with third party applications that maybe weren’t native to our standardized McKesson environment. And having a virtualized environment, again, allowed us to be very nimble. We could change the different operating systems to meet more restrictive applications needs in the third party world and with other systems. Virtualization allowed us to do that faster, less expensively and, ultimately, with greater success.

What would you like other growing hospital systems or accountable care organizations (ACOs) to know about this kind of solution?

Holling: Ultimately, we all want to create a standardized environment that is flexible and scalable. You have to mitigate the unknown—because you don’t always know what’s going to happen tomorrow, but you do have to have control of the environment today. So making the investment in the right technology helps you to avoid a lot of pitfalls. Virtualization has allowed us to navigate some pretty difficult waters—with the data tsunami you get when you’re a healthcare system acquiring other facilities as well as partnering with different facilities. It allows your organization to be very dynamic. And helps ensure that your IT dollars are invested not just for now, but for the long term.

If you could offer one piece of advice to an organization considering virtualization, what would it be?

Holling: Do your homework. Think really hard about where you want to be as an organization not just today, but two, three, four and five years from now. The investment you may make today will have repercussions years in the future. Investing in virtualization allows you to consider your needs today—and those tomorrow, too. So don’t think too much about today. Really focus on what you may need later on.

Need a better way to manage your data? Learn how you can increase efficiency and cost savings, and improve care, with a suite of vendor neutral archive solutions like Conserus™ Image Repository.

The healthcare industry’s ongoing shift to value-based reimbursement is affecting healthcare organizations of all sizes and specialties. How to best transition to value-based care is a challenge for many healthcare leaders, with 37 percent of healthcare CEOs reporting that they are still in the “investigative” stage of transitioning to value-based care.

From improving communication to conducting financial analyses, here’s what industry leaders say about important first steps to take as healthcare organizations implement value-based care initiatives.

Improve Communication

Improving communication among staff, as well as with patients and their caregivers, is a crucial first step, according to Christina Thielst, FACHE healthcare administration consultant. She says that moving toward value-based care requires effective communication to reduce the risk of adverse events and errors, improve patient safety and improve the self-management of patients’ chronic conditions.

“Think about the potential impact of improved communication on readmission and hospital-acquired infection rates on the patient experience,” says Thielst. “But also think about how today’s technologies can facilitate better and more efficient communications – during transitions in care or anytime patients and caregivers have questions or need support.”

Focus on Health-Related Goals

Author and speaker Dave Chase recommends that healthcare leaders get their staff focused on helping individual patients achieve their health goals as organizations adapt to a value-based care environment.

“After all, individuals (a.k.a. patients) make most of the decisions that most significantly influence outcomes for where we spend 80 percent of healthcare dollars – chronic conditions,” says Chase. “If your organization thinks layering on a veneer of ‘patient engagement’ is simply something that’s nice to have, you are positioned to fail in this new environment.”

Develop a Customized Financial Plan

There isn’t a one-size-fits-all payment model that healthcare organizations can follow as they implement value-based care initiatives. Organizations will have to invest in customized analyses to determine a payment model that’s sustainable.

“The devil will be in the details of balancing investment in new capabilities, speed of transition to value-based care (VBC) and managing financial risk,” writes Mitch Morris, M.D., Vice Chair and Global Healthcare Leader at Deloitte. “Organizations can start now by understanding their market position, assessing their capabilities, conducting a financial analysis and aligning around opportunities.”

Consider Going Mobile

Mobile strategies can help health organizations better support patients, particularly those with chronic conditions, says Geeta Nayyar, M.D., M.B.A., former AT&T CMIO & assistant clinical professor at George Washington University.

“Value-based care will require more touch points with patients that the traditional model of healthcare delivery will be hard pressed to deliver on,” says Nayyar. “In addition, start thinking about implementing care transitions and care coordination tools for high risk patient populations. This will become very critical as you prepare for the future, since value-based healthcare is about keeping your patient healthy by preventing critical conditions and educating them in a timely manner.”

Pressure is on healthcare leaders to determine how their organizations will implement value-based care strategies. For the one-third who are still investigating how to proceed, there are goals to work toward beginning now. From improving communication to conducting financial analyses, healthcare leaders can take their first steps toward value-based care initiatives.

Read more “next steps” for value-based care in 2015, along with insights on how to control cost of ownership and deal with regulatory challenges, in the eBook 13 Insights for Conquering Healthcare Challenges in 2015 From the Experts.

The first x-ray ever – of its inventor’s wife’s hand, showing her bones and wedding ring – was in film format, back in 1895. Today, patients share medical images with their physicians via CD, or discs may be sent by courier. However, difficulties with defective discs, different data formats and discs that contain the wrong patient data call for a better solution to data sharing. In order to review and share patient data of all kinds more effectively, achieving interoperability in diagnostic imaging is one goal many healthcare leaders are working towards today, and with good reason.

The Value of Historical Patient Information

There is considerable value to physicians and their patients when patient information is easily accessible. In fact, David Mendelson, M.D., professor of radiology and co-chair of Integrating the Healthcare Enterprise (IHE) International, says that interoperability is critical for the future of healthcare. Transparent, longitudinal medical patient records drive the decisions physicians make.

“The fact is, without historical information, clinicians may order or perform redundant exams, including radiology exams, labs, repeat examinations or other procedures that could be avoided,” says Mendelson. “Interoperability would support organizational efforts to avoid the duplication of costly services and also help ensure quality decision making. If a patient is hazy and forgets to tell you about an allergy, you would see the allergy in the accessed records and be able to prevent a contrast reaction or other severe reaction.”

Mendelson says that health systems should be working toward full, transparent interoperability that includes a consent mechanism for patients – plus security to help ensure that only those who are entitled to the information can access it.

Complying With Uniform Standards Can Be an Obstacle

However, achieving interoperability in diagnostic imaging across the country is going to take a concerted effort, with the largest challenge concerning standardization.

“The biggest impediment in the US is the lack of compliance with a uniform set of standards,” says Mendelson. “In terms of interoperability there needs to be an acceptance of a transport standard and the right security model. In radiology we’re just short of that right now because the vendors haven’t uniformly adopted an exchange standard.”

Organizations such as IHE and RSNA promote the adoption and use of tools and standards for interoperability. Mendelson says that discussions are underway about the possibility of credentialing to encourage vendors to set uniform standards.

Long-term Preparations Should Begin Now

In the meantime, there are steps that healthcare leaders can take now to better prepare their organizations for the future of interoperability in enterprise medical imaging.

“Imaging leaders should be insisting that the vendors incorporate these image exchange standards (IHE XDS-I),” says Mendelson. “If they do and only purchase products that incorporate them, they’ll be in a much better position to be prepared for interoperability.”

Many healthcare IT vendors are incorporating internet-based standards and working toward interoperability with other health systems. Here at McKesson, we believe that industry standards are critical. Standards allow us to work with our partners to test interfaces in laboratories and provide solutions that can be used in different facilities without going through long and expensive customization processes.

Interoperability in enterprise medical imaging is still a work in progress, particularly when it comes to determining standards. However, interoperability becomes closer to reality as health systems and vendors work together to improve sharing patient information, including radiology images, to support optimal patient care.

Read how the scalable, flexible Conserus^TM Interoperability Solutions suite helps improve image sharing across an enterprise. Going to SIIM, May 28-30 in Washington, DC? Request a live demo of Conserus prior to the show and then visit McKesson booth 413.

Even though value-based care is one of the biggest challenges in healthcare today, a survey of health system CEOs found that 37 percent are still in the investigative stage. However, value-based care is becoming more crucial as fee-for-service reimbursement is dropping; it’s estimated to take up only 34 percent of payments by 2020. Health executives can begin preparations for value-based care by focusing on improving clinical communications – an essential factor impacting value-based care.

Christina Thielst, Fellow of the American College of Healthcare Executives (FACHE), says that effective communication is imperative to value-based care as it can help to reduce the risk of adverse events and medical errors in healthcare settings. In this Q&A, she discusses tactics that executives can consider to help improve communication and ease transitions to value-based care.

Q: What are some current obstacles you see impeding communication between healthcare staff members and with their patients and caregivers?

A:  The greatest obstacle is the estimated 77 million people in the US with low health literacy. The next is the limited amount of truly patient-centered communications. This stands in the way of being able to convey all of the information patients and their caregivers need, in a way they can understand and at the points in time when it is needed most. Instead, too often, communication is delivered within the constraints of the organization, at the times and locations where it is most convenient for staff.

Q: What actions can executives make to foster improvements in communication within organizations—between providers and between patients and their families and providers?

A: Healthcare executives should assure that their organizations are looking at communication mechanisms, processes and flows to identify gaps and barriers and improve performance. They must also consider whether today’s technologies can facilitate more patient-centric communications, since simply adding more staff isn’t a realistic solution given the pressures to contain costs.

What are the first steps for healthcare systems to transition to value-based care? Thielst and others give their opinions on how to initiative a value-based care transition on the Medical Imaging Talk Blog.

Q: Why is improving communication important when it comes to value-based care?

A: Any risk manager knows that communication issues are the top cause of lawsuits, and these can be quite expensive for the healthcare organization. Beyond this, reimbursement (incentives) will increasingly be tied to risk on patient satisfaction and outcome measures. If we don’t get the right information to the right person at the right time and in a format that they can understand and act upon, we may experience increased risks for decompensation and poor outcomes.

In addition, penalties will apply to those facilities with certain poor outcomes, such as hospital-acquired infections and readmissions within 30 days. Patients and their family caregivers are part of the care team and they can significantly contribute to improved outcomes.

Q: What are some emerging technologies you see being valuable that can help?

Texting, secure messaging and social technologies, including the avatars of virtual worlds and social networking. Innovative providers are using:

• Facebook to help teens assess their risk of an asthma attack.
• Social networking for the management and support of those recovering from addiction.
• A virtual discharge advocate to deliver instructions to patients and highlight areas needing more attention from the real discharge advocate.
• Texting to connect with hard-to-reach populations to help improve outcomes and reduce admissions and appointment “no show” rates.

Q: Anything else you’d like to add?

A: The possibilities are endless if healthcare executives take the time to rethink their communication processes and envision new ways to not only communicate but to connect with patients and their family caregivers.

To read additional insight from Thielst and other experts, download the eBook, “13 Insights for Conquering Healthcare Challenges in 2015.”

Nearly two-thirds of Americans own a smartphone, and 62 percent of them have used their phone in the last year to look up information about health conditions. As both patients and physicians rely on mobile devices in their daily lives, they are seeking ways to use their mobile technology in healthcare as well. Both mobile radiology and cardiology have an opportunity to bring value to clinicians and patients even as technology adapts to support real-world applications.

Mobile Radiology and Cardiology Help Speed Care

Mobile imaging supports improvements to patient care. For example, rural hospitals may periodically use the expertise of offsite on-call radiologists. When a patient comes to the emergency department after a car crash, the radiologist’s access of CT scans on a mobile device helps allow for a faster response time. If there’s an intracranial hemorrhage, being able to view the CT scan on a smartphone or iPad can be faster than waiting for a computer to boot up and logins to be inputted. When speed is of the essence, mobile radiology or cardiology can facilitate faster study results and therefore faster care delivery.

Mobile Imaging May Support Value-Based Care

Mobile radiology and cardiology can be further used to support value-based care initiatives. Value-based care requires more frequent communication with patients, from educating them about managing conditions to monitoring them to prevent hospital readmissions. Sending a cardiology patient a comparison of their latest ECG and an older study with arrows pointing out differences in plaque buildup could reinforce the patient’s efforts to eat more healthfully.

“For better value-based care transitions consider a mobile and telehealth strategy,” says Geeta Nayyar, M.D. “Start thinking about implementing care transitions and care coordination tools for high risk patient populations. This will become very critical as you prepare for the future, since value-based healthcare is about keeping your patient healthy by preventing critical conditions and educating them in a timely manner.”

Mobile Radiology Must Incorporate Workflow

Studies have found that many mobile devices offer sufficient visual quality for radiology and cardiology images. A recent study compared medical imaging clarity on an iPad® 3 with an LED computer monitor. Participants rated the iPad higher overall than the computer monitors. However, a pilot program of mobile imaging found that few clinicians accessed the medical images when they were separate from workflow.

“[Vendors] focus more on the technological challenge of how to present the image on the mobile device and less about the workflow and what exactly do we try to achieve when we the clinician opens the mobile device,” says Tomer Levy, GM of McKesson Workflow and Infrastructure Solutions, in an article on HealthImaging. “You need immediate interaction with the physician … [and] workflows that could leverage mobility.”

For example, the McKesson Cardiology^TM ECG Mobile is an ECG management app designed for emergency medical cases. It offers push notifications for STAT ECGs, allows users to view the full 10 seconds of a 12-lead ECG and also allows users to view current studies next to previous ECGs, side by side, for improved comparison.

Mobile Benefits Forthcoming

As vendors develop mobile imaging technology, there are a number of possibilities for its usage to support patient care. From facilitating faster access of studies to value-based care educational opportunities, mobile imaging has exciting potential. With a large number of Americans owning smartphones, mobile radiology and cardiology may bring value to both clinicians and their patients.

Read how mobile ECG technology is changing cardiologists’ workflow, enhancing productivity and helping to save lives.

Addressing provider-change fatigue. Determining IT investments. Doing more with less. It’s challenging for healthcare leaders to juggle major decisions and daily management tasks while remaining centered on leadership.

In this interview, Erkan Akyuz, president of Imaging & Workflow Solutions (IWS) at McKesson, shares his perspective on leading healthcare organizations in times of change, including navigating challenges, staying agile to pivot directions when necessary, and utilizing diagnostic imaging.

Q: What would you list as some of the top challenges facing healthcare organizations?

A: Our customers face more challenges than ever due to converging priorities such as massive IT investments, provider-change fatigue, pressures to reduce costs and enhanced care coordination across the continuum.

A recent consultant report noted that with ACA cuts and sequestration and reimbursement changes from value-based payment methodologies, there is a renewed focus on reducing operating costs to achieve financial sustainability. Many hospitals and systems, our customers included, will be focusing on reducing duplication, non-clinical staff, and non-core expenditures; streamlining processes; maximizing group purchasing; eliminating waste; and other activities.

Diagnostic imaging – in both radiology and cardiology – faces key challenges and opportunities related to the evolution toward value-based care. Enterprise diagnostic imaging solutions help enable interoperability and data exchange by removing silos of radiology or cardiology information.

Q: What should healthcare executives know about leading their organizations in a time of change?

A:  Delivering high-quality healthcare in a cost-efficient way is the primary objective of redesigning care models and clinically integrating providers. At IWS, we work to build partnerships with customers, help them manage change effectively and help them through challenges such as consolidation.

In a recent Fast Company article, “The 5 Things That Separate True Leaders from Managers,” Barry S. Saltzman writes, “True growth and change must come from a place of understanding, which is why it’s important whenever possible to explain the reasoning behind your actions to your employees. This includes explaining – as much as you are able – major changes or decisions that are influencing new directives and explaining your own perspective, responsibilities, and experiences. It also includes admitting fault, being willing to ask questions, and not being afraid to pivot in light of new information.”

At IWS we leverage small, cross-functional consultative teams that can speak to a complete solution. We understand the value of having a holistic enterprise view to fit customers’ specific operational, financial and clinical settings.

Q: What are some of the best approaches to addressing these challenges?

A: Personally, I try to avoid the temptations of micro management. My style is to empower people, trust them and measure them by outcomes.

Q: How do healthcare organizations stay current with technology while still supporting care improvements and making cost-effective decisions?

A: Organizations whose strategic plans include population health management will be investing in infrastructure elements such as technology, data warehousing, predictive analytics and care models. These investments will help align their financial and clinical incentives. Processes, people and resources must be deployed to achieve quality outcomes in the most cost-effective setting possible.

More organizations are creating and joining accountable care organizations (ACOs) and clinically integrated networks. This expansion will require investments in infrastructure to support new systems and processes of care – the most significant of which will be for information technology to provide real-time access to relevant data in a timely manner.

Read advice from other industry experts when you download the eBook 13 Insights for Conquering Healthcare Challenges in 2015 from the Experts.

Curious about the health system in the UK? David Howard of Change Healthcare, argues that cross-site reporting is key to unlocking transformation within the NHS, but warns this is dependent upon the right technological infrastructure. This article was originally posted to the Building Better Healthcare website and is reprinted here with permission.

Sustainable NHS transformation will depend on unlocking quality and efficiency gains through the cross-site reporting of diagnostic imaging.

The cross-site reporting of diagnostic images, through which organisations can share resources and maximise capacity, is contingent upon developing the right technological infrastructure to support collaboration

It’s widely accepted that collaboration is fundamental to the sustainability and transformation of NHS services.

This is particularly the case in radiology, where a paucity of radiologists and divergent geographical challenges means that cross-site collaboration and reporting has become essential.

The drivers are well understood. As NHS organisations struggle to recruit radiologists and subspecialists are often remote from where imaging is taking place, trusts are increasingly using other professions to augment their radiology resources or outsourcing to the private sector at significant additional cost. The approach is not sustainable. The only way to unlock transformation is to enable cross-site reporting. The question is how.

The cross-site reporting of diagnostic images, through which organisations can share resources and maximise capacity, is contingent upon developing the right technological infrastructure to support collaboration.

Certainly, as care pathways move patients through a variety of provider settings, maintaining the old approach of storing diagnostic images in silos at the institution level will not drive the service improvements the NHS desperately needs.

However, despite common consensus on the need for change, progress has been slow, stifled by a common misconception that organisations need to rip out existing PACS and RIS and replace them with expensive new solutions.

The reality is very different. Believe it or not, NHS trusts have tangible, realistic and affordable options that can move them towards more-collaborative models of working.

Pathways to progress

As care pathways move patients through a variety of provider settings, maintaining the old approach of storing diagnostic images in silos at the institution level will not drive the service improvements the NHS desperately needs

There are various routes trusts can consider to facilitate cross-enterprise collaboration, with choice ultimately dependent on an organisation’s digital maturity.

One option is for everyone to be on the same system. A good example of this is NIMIS in Ireland, where the country’s much-acclaimed Radiology QI programme is underpinned by an enterprise imaging solution that gifts clinicians, anywhere, access to all the diagnostic studies carried out in a region. Cross-site reporting, and indeed collaborative resourcing, is an inherent capability in the solution.

A second option, suitable for disparate digital infrastructures where there are multiple PACS and RIS vendors in place across a region, is to join those systems together with a technology such as XTS and use a ‘vendor neutral’ archive to house the data. This approach, which has proved particularly successful in Canada, provides full access to images wherever you are and can, therefore, sustain cross-site reporting.

Finally, a third option – best-suited to more-mature digital environments – is to embed some logic into the first two approaches with the addition of an intelligent workflow layer that uses information gleaned from imaging data to drive work to the most appropriate radiologists. This approach – a truly-holistic enterprise imaging solution – enables cross-site reporting, task prioritisation/assignment and resource optimisation.

Alternative view

An alternative approach was proposed by the Royal College of Radiologists (RCR) in 2016, which argues that the NHS Network Teleradiology Platform (NTP) could lay the foundation for more-collaborative working across clinical networks.

The RCR recommendation advocates the introduction of a cloud-based teleradiology solution that mimics local PACS and provides reporting radiologists with another platform for reporting. While the NTP would certainly enable greater sharing of expertise across specialties and could help facilitate efficient out-of-hours reporting using shared resources, the approach could prove challenging and costly to deploy.

Fundamentally, the RCR model invites trusts to buy a second system – a National PACS that sits on top of their existing, local PACS/RIS. In the process, it introduces an additional platform that takes reporting radiologists outside of their familiar environment.

The approach requires radiologists to use two systems, meaning two different user interfaces, multiple logins and separate IT environments. This, in turn, leads to additional training requirements, additional information governance and, naturally, additional cost.

These factors will increase, rather than remove, barriers to use and will undoubtedly prove counter-productive in the quest for collaboration.

Moreover, the approach is unlikely to facilitate MDTs or unlock the service transformation gains that effective cross-site reporting can deliver.

The best enterprise imaging solutions do not require trusts to ditch their existing systems – but they do allow institutions to maximise the technology investments they have already made

With regional NTPs able to connect with trusts’ existing IT systems, the RCR-backed approach means organisations would not need to replace their PACS/RIS solutions.

However, the solution undermines institutions that have already developed enterprise imaging capabilities – resembling an unnecessary plaster to stick on top of existing solutions. Moreover, the approach is highly radiology-centered. True enterprise imaging strategies cover the gamut beyond radiology, enabling all the investment in technology and infrastructure to be leveraged by other departments across an enterprise, rather than just the radiologist.

The way forward

The best enterprise imaging solutions do not require trusts to ditch their existing systems – but they do allow institutions to maximise the technology investments they have already made.

The most-effective are ‘standards-based’ and able to connect any PACS/RIS available with the NHS.

Standards-based connectivity provides a basis for cross-site collaboration and reporting that, with the right technology, can be enhanced with tools that support the intelligent management of workflow in radiology. The smartest tools include flexible workflow rules engines that integrate with heterogeneous system environments to consolidate interpretation and quality tasks. Moreover, they replace silos of information with enterprise visibility that enables organisations to collaborate, optimise resources and maximise IT investment.

However, the enterprise approach is not just about productivity and efficiency gains – it’s a recognised means of driving quality.

Holistic enterprise imaging systems not only promote peer review, their resource optimisation and prioritisation tools free up specialty radiologists to focus on their specialisms – improving quality and, in some cases, re-motivating disenchanted HCPs.

Picture perfect

There’s little doubt that cross-site reporting can play a significant role in driving service optimisation and transforming patient care.

Evidence shows that where organisations have a greater visibility and consolidation of information – and the infrastructure to enable collaboration – meaningful gains in quality, efficiency and patient outcomes can be realised.

The most-progressive organisations will be those that recognise the need and the opportunity – and engage a trusted transformation partner to deliver an imaging strategy that enables a shared vision

Certainly, if STPs are to meet their goals in an under-resourced NHS, the health of providers’ radiology services will be a critical factor. Collaboration will be key. To achieve it – and to improve workflow and align demand with capacity – an enterprise imaging strategy is essential.

The most-progressive organisations will be those that recognise the need and the opportunity – and engage a trusted transformation partner to deliver an imaging strategy that enables a shared vision.

Can you picture perfect? We can. You could too.

For more information about Change Healthcare imaging solutions in the UK, contact us.

The post Unlocking Efficiency Gains Through Cross-Site Reporting of Diagnostic Imaging in the UK appeared first on Medical Imaging Talk Blog: Covering News & Advancements - Change Healthcare.

It’s an exciting time to be in radiology. Advances in enterprise imaging, artificial intelligence, data and analytics have the potential to transform patient care. With the right infrastructure, imaging scans and datasets can be accessed on any device at any time. In addition, health systems face the ongoing challenge of finding greater efficiencies while delivering top-quality care, as reimbursements decline and costs rise.

Let’s take this opportunity to look at how all of these factors are transforming our profession and what it takes to thrive in this rapidly evolving environment. To help guide hospitals, radiologists, and health IT leaders, Change Healthcare is proud to announce our latest interactive eBook: Enterprise Imaging Inspirations: How to Explore, Invent and Transform Diagnostic Imaging.

This eBook draws on our organization’s experience and the expertise of leaders in the healthcare industry to guide health systems to the next stage of imaging transformation. It explores the current state of the art in enterprise imaging, AI, and cybersecurity. Then we take a look at the near future of the industry, to see the inventions on the horizon that will continue to change healthcare for the better. In the final section, we collect reports from leading health systems that have fully transformed their imaging operations and lowered costs, streamlined workflows, and improved quality of care.

Read Enterprise Imaging Inspirations: How to Explore, Invent and Transform Diagnostic Imaging to discover:

• The eight crucial elements of an enterprise imaging partner
• How artificial intelligence is impacting radiology decision making
• How to create a secure enterprise imaging solution
• How to improve care collaboration with viewer technology
• How smart analytics turns big data into actionable insights
• How to increase throughput in your radiology department
• How industry-leading health systems transformed their imaging departments

Along the way, the eBook presents advice from leaders in the health industry, including Randy Olson, Senior Data Scientist at University of Pennsylvania; Oliver Christie, Artificial Intelligence Consultant at XPRIZE and Garry Choy, MD, MBA, Chief Medical Officer at Health Informatics & Technology Venture.

“Enterprise imaging viewers will save lives and save the healthcare providers from administrative burden. Technology that aims to bring the right data to the healthcare practitioner at the right time will improve outcomes and allow for patients to benefit from faster, more appropriate and higher quality clinical decision making. Furthermore, gone are the days of trying to find the images and sifting through administrative processes to see the original raw (imaging) data. Via enterprise image viewers and similar tech that improves data access and availability, healthcare providers can get what they need, faster, and in better ways, thereby reducing administrative burden.” – Garry Choy

It takes inspiration, exploration and innovation to spark a diagnostic imaging transformation. Enterprise Imaging Inspirations can help your organization begin the journey to the future of diagnostic imaging.

Read and interact with Enterprise Imaging Inspirations: How to Explore, Invent and Transform Diagnostic Imaging to get started.

The post Enterprise Imaging Inspirations: How to Explore, Invent and Transform Diagnostic Imaging [eBook] appeared first on Medical Imaging Talk Blog: Covering News & Advancements - Change Healthcare.