Whitney Howell

Healthcare. Politics. Family.

Surviving ACA: A Guide for Rheumatologists

Published on the Dec. 19, 2013 Rheumatology Network website

By Whitney L.J. Howell

Healthcare reform implementation is in full swing. How will it affect rheumatologists? Questions remain, but industry experts say that much of the impact lies with rheumatologists themselves.

The specialty has already faced one healthcare delivery re-design: In the 1990s, health maintenance organizations (HMOs) proved disastrous for providers and facilities. Now, in similarly-designed accountable care organizations (ACO) touted under the Affordable Care Act, providers are assigned to share responsibility and payments for patient care.

For some, ACOs may conjure the ghosts of failed collaborative-care efforts under HMOs. But experts say that rheumatology’s response has been largely positive.

“Rheumatologists are more hopeful now,” said Rod Hochman MD, president and CEO of Providence Health & Services in Seattle. “There are lessons learned from the HMO experience. We know rheumatologists must ensure the healthcare system knows what they do and how they affect change.”

In fact, according to the 2013 Medscape Rheumatologist Compensation Report, 23%  of rheumatologists have participated in ACOs.

Preparing For Success

While positive attitudes will help during this transition, Hochman’s biggest concern is whether rheumatologists can educate their physician-colleagues about the impact of rheumatology services. Succeeding, he said, means demonstrating how rheumatology simultaneously improves patient care and controls costs.

“Rheumatologists must position themselves as musculoskeletal managers,” he said. “They’re uniquely situated to understand what’s needed or not and what therapies are possible, particularly with joint and back pain, before going for surgery.”

It’s crucial for rheumatologists to assume this role because musculoskeletal services often rank among a facility’s top five service lines, accounting for significant expenditures.

For example, rheumatologists can increase collaborations with orthopedists and neurosurgeons to determine whether a patient needs surgery. Or they can partner with primary clinicians to diagnose many causes of joint pain without extensive and expensive imaging studies.

Job Security

With cost control as a bedrock ACO principle, concerns exist within rheumatology that hospital-provider relationships could shrink. Instead of partnering with practices, some providers fear, facilities will opt for a single part-time rheumatologist to treat patients. Some evidence supports this concern – more than 80% rheumatologist providers spend fewer than four hours weekly treating inpatients, according to the Medscape report.

But Hochman believes relatively low numbers and skill-set specificity will protect rheumatologists.

“There will be few rheumatologists nationwide, so there shouldn’t be a big worry about being out of work. The focus should be maximizing abilities and relevance,” he said. “Understanding inflammatory disease is invaluable, so it isn’t a question of not working. It’s of getting reimbursed for work they do.”

Gathering Reimbursement

Recouping adequate payment in ACOs could prove difficult because rheumatologist-managed conditions, including joint pain or knee and hip replacements, face bundling.

“It’s going to be tricky as we go to bundled-episode payments from fee-for-service,” Hochman said. “Under fee-for-service, rheumatology has been predominantly outpatient, so things can’t get worse. They can only get better.”

He recommended that providers closely monitor reimbursement for biologic agents used to treat rheumatoid arthritis and other autoimmune conditions, as well as infusion therapy payments.

The American College of Rheumatology (ACR) is more wary of bundled payments, however. In a Nov. 12 letter to the U.S. Senate Finance Ways & Means Committee, the ACR expressed concern over the potential long-term impact.

“Bundled payments under one label or another will drive providers to identify patients with the best margins,” the ACR wrote. “This will result overall in less value and even worse access for the patients.”

Consequently, Hochman said, providers should discuss with payers how they’ll handle reimbursement and care management in ACOs. Based on Medscape report data, nearly 40% of rheumatologists would drop poorly-reimbursing payers.

Healthcare attorney Stephen M. Harris, a member of the Knapp, Petersen, Clarke firm in Glendale CA,  advised rheumatologists to determine whether participating in a Medicare ACO – which often uses primary services for patient assignment – prevents them from participating in others.

There are two ways to avoid this problem, he said:

  • Bill under a separate federal tax ID number (TIN): Provide some services under professional services or employee leasing agreements with facilities billing under their TIN. Or form a separate group that retains and bills for physicians or lets providers work part-time elsewhere. Physicians could also bill under their Social Security numbers.
  • Code differently: Select codes not categorized with primary care services. For example, code office visits as part of a global procedure fee. Beware, though: This method could limit reimbursement.

Ultimately, Hochman said, rheumatologists must integrate into care management in a way that avoids being seen as part of primary care.

“Rheumatologists will be teachers and managers of patient populations in ACOs,” Hochman said. “If I formed an ACO, I would ensure leadership had a couple of rheumatologists to manage the system and work with primary doctors.”

To read this article at its original location: http://www.rheumatologynetwork.com/articles/surviving-aca-guide-rheumatologists

 

December 20, 2013 Posted by | Healthcare, Politics | , , , , , , , , , , , | Leave a comment

The Year of Ultrasound Brings Implementation and Innovation

Published on the June 24, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

Ultrasound isn’t a new tool, and it’s little secret this imaging method provides invaluable studies without the use of radiation. But now there are enough advancements and technological changes to the modality to capture the industry’s attention all over again.

In fact, the American Institute for Ultrasound in Medicine (AIUM) has dubbed 2013 the “Year of Ultrasound.” The goal: increasingly integrate ultrasound education and use throughout all levels of health professions education and clinical application.

But, why?

Many practitioners in the field point to the warning bells in recent years calling for even more vigilance in restricting radiation exposure in adults and children. These concerns have led to the ALARA — As Low As Reasonably Achievable — principle and the Image Wisely and Image Gently campaigns. However, it’s more than that, said Leann Linam, MD, a pediatric radiologist at Arkansas Children’s Hospital.

“One of the beautiful things about ultrasound imaging is its lack of radiation, but there’s also been a huge push for other specialties to get involved with ultrasound,” she said. “Giving other providers a portable imaging modality that can be done at the bedside is a major reason why this is the Year of Ultrasound.”

According to Michael Blaivas, MD, AIUM’s third vice president and president of

Michael Blaivas, MD, AIUM’s third vice president and president of the Society of Ultrasound in Medical Education

Michael Blaivas, MD, AIUM’s third vice president and president of the Society of Ultrasound in Medical Education

the Society of Ultrasound in Medical Education, the industry is also seeing a rapid expansion in the functionality ultrasound is able to offer throughout the healthcare system.

The Focus on Ultrasound

Ultrasound’s popularity has steadily grown, Blaivas said, making it a commonly used tool in a plethora of specialties and subspecialties over the past few decades. The wider use is a positive step, he said, but the most encouraging development has been the increase in number of medical school – and other health professions – curricula that now offer ultrasound instruction throughout all years of training.

“We’re seeing ultrasound adopted in every specialty now as the standard of care. From A to Z, with the exception of pathology and psychology – it’s being used across the gamut. For many things in the emergency department to standard use for central line placement,” Blaivas said. “There’s also a significant groundswell for use by nurses and physicians assistants.”

In fact, he said, 2013 has been the biggest year for raising awareness of the benefits ultrasound offers – mainly the lack of radiation, lower cost than other modalities, and comparable image quality.

Ultimately, he said, this increased education could one day enable providers to offer more focused diagnoses throughout body systems and could play a significant role in image-guided procedures. Using ultrasound in that fashion could make invasive procedures faster and safer.

Not everyone in the global radiology community is wholly comfortable with non-radiologists performing ultrasounds, however. There is a significant portion of radiologists who oppose the practice altogether, but a small faction support it because they believe it ensures a low-cost, high-quality imaging service will be available to more patients, said Levon Nazarian, MD, a musculoskeletal radiologist at Jefferson University Hospitals and editor-in-chief of the AIUM’s Journal of Ultrasound in Medicine.

“There are radiologists who resent any imaging being done by other specialties. Their main concerns are quality and economics — they don’t like the idea of someone taking over their turf,” he said. “The second, though smaller, camp is filled with people want to see ultrasound better utilized to deliver high-quality imaging and guided interventions to patients. The thought is that it would mean better healthcare for all.”

There is a sticking point, however, he said. The need for ultrasound interpretation in all fields, especially obstetrics and sports medicine, is far greater than the current number of providers can sift through. And many, he added, have little interest or expertise is conducting these studies. The solution, he said, is to open the door for other specialties to offer ultrasound as long as practitioners receive the proper training despite pushback from industry leaders and experts.

In fact, in February 2012, the Royal College of Surgeons in Ireland published a statement in support of allowing properly-trained non-radiologists to perform ultrasounds.

What’s Next for Ultrasound?

Although ultrasound is an increasingly popular modality in the United States, providers still underutilize it, Blaivas said. Elsewhere in the world, however, radiologists are already using ultrasound for more extensive chest and abdominal imaging.

For example, European providers for the past decade have been expanding the use of lung ultrasound in the diagnosis of pneumonia and pulmonary edema. Other radiologists in Asia have begun using ultrasound to image the abdomen, successfully identifying incidences of appendicitis and gastrointestinal reflux. Historically, he said, American providers have opted to use CT in these situations.

“In many cases, ultrasound is far more sensitive and better than chest CT, and it certainly pales in comparison to the cost of CT,” Blaivas said. “Not to mention, it’s portable and can be done at the bedside, giving us greater opportunity to evaluate our most critically-ill patients.”

In fact, he said, the next technological milestone for ultrasound will likely benefit critical and emergency patients the most. Vendors are currently shrinking the machines down to the size of a smartphone, such as the GE VScan. Improved functionality and better image quality will likely follow in subsequent generations.

European radiologists are also beginning to use contrast agents with ultrasound as a way to enhance image quality and improve information gathering, Linam said. Known as microbubbles, these contrast agents are gas-filled and are administered intravenously. They’re highly sensitive and easily reflect ultrasound waves off the body’s soft tissues. Currently, microbubble contrast is only being used as a research method in the United States, she said, but internationally, providers already use it clinically to image blood perfusion in organs and to measure blood flow rate in the heart.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/year-ultrasound-brings-implementation-and-innovation/page/0/1

June 26, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

Duke University team discovers a gene mutation tied to severe myopia

Published in the June 16, 2013 Raleigh News & Observer and Charlotte Observer

By Whitney L.J. Howell

When it comes to reading, teachers re-tell the same stories year after year. One student holds a book inches from his face and requests to sit in the front row. His sister seems perfectly content in a desk toward the back of class and can easily read papers at arm’s length.

It’s not uncommon for children to have varying degrees of eyesight. But is such a big difference normal among siblings?

The reasons why one child inherits a parent’s nearsightedness while another offspring has perfect vision have long been fuzzy. Now, new research out of Duke University is bringing some clarity to this puzzle.

Known clinically as myopia – and frequently blamed on significant time spent reading – nearsightedness is the most common eye disease affecting humans. Nearly 30 percent of American adults have myopia, according to the American Optometric Association. The condition occurs when the

A scene as it would appear to a person with myopia (nearsightedness). ( National Eye Institute/ National Institutes of Health) NATIONAL EYE INSTITUTE / NATIONAL INSTITUTES OF HEALTH

A scene as it would appear to a person with myopia (nearsightedness). ( National Eye Institute/ National Institutes of Health)
NATIONAL EYE INSTITUTE / NATIONAL INSTITUTES OF HEALTH

eye is either oval-shaped (rather than round) or the cornea – the transparent covering over the front of the eye – is too curved. In either case, the eye is unable to properly focus the light coming through the pupil.

The result is blurry vision, meaning a nearsighted person must stand closer to an object that a normal-sighted person in order to see it clearly. For example, a nearsighted person must stand 20 feet away from a street sign to see it as well as a normal-sighted person can at 40 feet.

But, according to research published in the American Journal of Human Genetics, the genetic cause behind myopia could now be a little clearer. Duke researchers found that a newly-identified genetic mutation that affects copper metabolism and oxygen regulation in eye tissue is a culprit in cases of severe myopia.

High-grade myopia is inherited and occurs most commonly in Asian cultures. But it also affects nearly 2 percent of nearsighted Americans, increasing their risks for additional eye problems, such as detached retinas, cataracts and glaucoma.

Several myopia-associated genes have already been discovered, but this one – SCO2 – is particularly important in the study of high-grade disease, said Terri Young, M.D., an ophthalmology, pediatrics, and medicine professor at Duke. When functioning properly, SCO2 helps metabolize copper, an element vital to controlling oxygen levels in eye tissue. A malfunctioning gene can allow oxygen levels to rise too high, increasing stress on the tissue. These high levels can, ultimately, alter the eye’s development and function, she said.

“This is the first time a gene mutation like this has been discovered,” she said. “It’s one found in cases of inherited severe myopia among Caucasians where only one parent carries the gene for the condition and where the nearsightedness isn’t associated with any other health conditions.”

Finding the mutation

To find genetic mutations common among individuals with high-grade myopia, Young and her colleagues within Duke’s Eye Center, Center for Human Genetics, and graduate medical school in Singapore analyzed DNA extracted from the blood and saliva of four individuals all from the same 11-member American family of European ancestry.

Her team used a new sequencing method – next-generation sequencing (NGS) – to produce large, more precise quantities of data. NGS enables researchers to sequence larger numbers of DNA pairs faster than when using the more traditional method, electrophoresis.

“Using next-generation sequencing, we were able to obtain more than 50 times the number of DNA copies than we would have through traditional sequencing,” she said. “It was because we had more copies that we knew what we were seeing with the mutation was real. That’s how we found the gene and discovered that the mutation was only present in people with myopia.”

The team also found three additional SCO2 genes mutations in an additional 140 people.

After identifying the SCO2 gene mutation in human eye tissue, researchers explored the gene’s expression in mice to further confirm their findings. They induced nearsightedness in otherwise normal-sighted, newborn mice by putting a translucent contact lens over one eye in each animal. After six weeks, they analyzed the eye tissue to see where SCO2 was most expressed, and in this case, mutated. By attaching a stain to the gene, they found these genes were most expressed in the retina – the tissue where the eye actually sees images – and the white, protective part of the eye called the sclera.

Combining the results from both human and mouse eye tissue analysis highlights the existing connection between low levels of copper in the body and eye disease, she said.

“What we’ve found – and what’s in pre-existing research – suggests that copper deficiencies could set people up to become nearsighted,” Young said. “We didn’t specifically test diets, but it’s possible that mineral- and vitamin-deficient diets could play a role.”

If that’s the case, she said, taking copper supplements could conceivably slow down or stop myopia’s development.

What’s next?

Even though malfunctioning SCO2 has a significant, negative impact on eyesight, it is likely a very rare mutation, Young said. So, rather than test for it alone, her group plans to add it to a panel of studies known myopia-associated genes.

Additional work is also ongoing, exploring the impact an SCO2 mutation could have outside of eye disease. According to Dennis J. Thiele, Ph.D., a pharmacology and cancer biology professor at Duke who wasn’t part of Young’s team, one of the SCO2 mutations is pivotal in a deadly form of cardiomyopathy, a condition that causes the heart muscle to weaken and eventually leads to heart failure.

Because this gene mutation can affect multiple body systems, it’s important for investigators to continue their explorations, said Gary Heiting, a practicing ophthalmologist in Minnesota, as well as the editor of All About Vision, an online eye-education publication. Knowing more about SCO2 will help scientists and doctors better understand how much of eye health is inherited and how much is cause by day-to-day activities.

“This new research is an important step in understanding what causes myopia to develop in some children and not others. But, it is just one step,” Heiting said. “Further research, including research in the areas of genetics, nutrition, reading behaviors, time spent indoors versus outdoors during childhood, and other factors, is needed before we will fully understand what causes myopia and what we can do to effectively reduce the incidence and prevalence of nearsightedness in the future.”

To read the story at its original News & Observer location:  http://www.newsobserver.com/2013/06/16/2959250/duke-university-team-discovers.html#storylink=cpy
To read the story at its Charlotte Observer location: http://www.charlotteobserver.com/2013/06/16/4102306/duke-university-team-discovers.html

 

June 19, 2013 Posted by | Family, Healthcare, Science | , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

4 Tips to EMR Implementation Success

Published on the June 4, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

When it comes to the implementation of new technologies,, radiology is considered a leader among medical specialties. True-to-form, the industry is now on the leading edge of employing electronic medical records (EMRs), as practitioners move to take advantage of federal incentives in the meaningful use program. Despite their tendency to be tech-savvy, radiologists still could use some guidance for successful EMR implementation, a topic of an expert panel at this year’s Society for Imaging Informatics in Medicine (SIIM) annual meeting.

The panel plans to focus on what radiology practices and departments can do survive and facilitate the implementation process. And, according to participants, there are strategies you can employ to stream-line these efforts.

“Because of the need to maintain and work with RIS and PACS systems, there has been a long-standing relationship between radiology and the information technology offices,” said Jim Turnbull, chief information officer for the University of Utah Hospitals and Clinics. “These groups have worked closely together, and there aren’t any surprises anymore. But as we continue to move forward with EMRs, there are still things people should keep in mind.”

1. Get Buy-In: The most important step in properly putting your EMR in place is ensuring your facility’s governance supports the project from the top down. It’s critical to making sure the set-up goes as smoothly as possible.

“You don’t want to be part way into EMR implementation and have people start second-guessing everything and saying that it’s too expensive,” Turnbull said. “It’s a lot more costly to change direction.”

It’s possible to avoid stumbling blocks by working with human resources staff to design a detailed strategic plan, he said.

2. Form a Diversified Team: Even though radiology is one of the most tech-savvy specialties, effective EMR implementation will require several outside partnerships.

The most successful teams include representatives from the emergency department, nursing, pharmacy, IT, labs, and other specialties, according to Julie Riddler, the project manager for implementing the Epic EMR at The Johns Hopkins Hospital. It can also be helpful for project leaders to participate in other hospital committees, such as ambulatory, inpatient, and physician steering teams.

3. Prepare for the Long-Term: As complicated as correctly implementing an EMR can be, it isn’t the end of the process, Turnbull said. There will always been a need for maintenance or a new way to maximize what your system can offer.

“Optimization continues forever,” he said. “The key is establishing a mindset in the office culture that you can’t just plug the EMR in and let it be. This type of system never works that way. The practice or department must be onboard with consistently trying to make things better.”

Conducting a needs assessment prior to implementation can give you an idea of any future changes that might be required.

4. Invest in Personnel Training: Institutional support and identifying your organization’s needs can only take you so far. It’s also important to provide training for all staff and providers who will play a role in implementing and using the EMR.

To reach this goal at The Johns Hopkins Hospital, Riddler facilitated one-on-one and group coaching sessions on using the Epic EMR, as well as offered staff and leadership development curricula around key competencies. She also engaged professionals from other health systems to provide more extensive technical training.

Although other specialties are joining the push to implement EMR solutions, radiology still has the opportunity to maintain its leadership position, Turnbull said, through proper and thorough planning.

“The big challenge will always be making sure you’re putting the networks in place to manage the huge image movement around your organization,” Turnbull said. “But if practices and departments work hard to provide an environment of partnership, then the implementation situation will be workable.”

To read the article at its original location:  http://www.diagnosticimaging.com/pacs-and-informatics/4-tips-emr-implementation-success#sthash.KoKwwoPC.dpuf

June 19, 2013 Posted by | Healthcare | , , , , , , , , , , , | Leave a comment

Women in Radiology: How the Specialty Can Bridge the Gap

Published on the May 22, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

When it comes to women in medicine, the numbers can be confounding. In 2012, women made up nearly 50 percent of medical school applicants, but they accounted for only 34 percent of practicing physicians. And, the statistics for women in radiology drop even lower — roughly 24 percent of all providers are female.

So why are so few female medical school graduates choosing radiology? And, what can be done to change this reality? How can the specialty be more supportive for its female practitioners?

Radiology finds itself in a frustrating cycle, according to Howard Forman, MD, a diagnostic radiology, economics, and public health professor at Yale University School of Medicine. Unless the specialty finds a way to fix these perceived problems, there could be an ultimate impact on patient care.

“If you don’t have women in the specialty, then you don’t have role models for medical students to look to or to aspire to be like. They don’t have those mentors, and that alone creates a bit of a limitation,” said Forman, who led an expert panel discussion on this topic sponsored by the American Roentgen Ray Society in January 2012. “And, if you don’t have women in radiology, then you’re losing the perspective of women in terms of both research and teaching, as well as the perspective of the patient as a woman.”

It’s time, he said, to open a conversation and ask the tough questions about why more women don’t choose radiology as their specialty.

The Perceived Problems with Radiology

Historically, industry leaders have pointed to women’s roles within the family and their child care responsibilities as significant factors that routinely suppress the number of women in medicine, including radiology. Practicing physicians often work long hours in high-stress roles, and in many cases women have opted instead to seek a greater work/life balance.

But there are specific reasons why female students and practitioners say they shy away from a radiology career.

Surveys of female medical students — predominantly women of child-bearing years — revealed it’s the assumed long-term radiation risk, rather than their own family responsibilities, that pushes them away. In addition, women reported they believe radiology has too little patient contact, that the specialty is too highly competitive, and that it requires too many years of additional training. A recent study from Western University in Canada also concluded the idea of working in dark reading rooms isn’t attractive to women.

While these issues might steer some women away from radiology, they are largely

M. Elizabeth Oates, MD, president of the American Association for Women Radiologists.

M. Elizabeth Oates, MD, president of the American Association for Women Radiologists.

misconceptions about the field, said Elizabeth Oates, MD, president of the American Association for Women Radiologists.

“We don’t know the full reason why people have this erroneous view of radiology, but probably one of the biggest reasons is that women — and men — aren’t introduced to the field early in their medical school years,” she said. “Students simply aren’t aware of radiology as a field, what it encompasses, and what it is that we do. It’s a pervasive issue.”

But the medical students wary of pursuing radiology aren’t alone. The women who do enter the field often face difficulties, as well, said Julia Fielding, MD, abdominal imaging division chief at the University of North Carolina at Chapel Hill School of Medicine. Fielding also chairs the newly-formed American College of Radiology’s Commission for Women, a group charged with researching and identifying ways to attract and retain more women in the profession.

“A lot of women in radiology feel isolated from their male colleagues,” she said. “But, a lot of the errors men make aren’t errors of commission. Instead, they’re errors of omission — maybe everyone goes out Tuesdays after work for beers, but they don’t even think to ask you.”

The intent, she said, isn’t to actively exclude women. However, many female providers might be uncomfortable joining into a group activity without an explicit invitation. This isolation can have consequences beyond the work social scene. Women are more likely to be passed over for leadership roles or promotion if they aren’t seen as truly being part of the office culture, Fielding said. The result to-date has been a dearth of women as radiology chairs or heads of national associations.

What Radiology Can Do For Practitioners

Much of the responsibility for making radiology more attractive to women rests on department and practice leaders, Oates said.  If changes come from the top down, the specialty’s culture is more likely to change.

The most important thing senior radiologists can do is give female medical students accurate information to dispel the many myths that currently surround the specialty. For example, practitioners are exposed to radiation, but not to the levels many women fear. When conducting studies, providers are protected by lead aprons, lead glasses, thyroid shields, and many other coverings.

It’s also imperative to introduce students to radiology much earlier during their medical school career. A growing number of medical schools are now incorporating radiology into the basic science curriculum of the first two years of training rather than introducing it only as an elective during the fourth year, Oates said.

“The key is to get female students exposed and into the radiology environment early as observers,” she said. “But we have to avoid having students just sit next to a radiologist in a darkened reading room. Perhaps engaging women providers in breast imaging would be a good way to provide role models for female first-year students.”

It could also a positive move, she said, if school administrators helped identify students who might benefit from having a female radiologist as an advisor.

Radiology leaders must also work hard to counteract the belief that radiologist have little-to-no patient contact, Fielding said. In fact, many female patients request women practitioners, particularly with breast imaging. Although radiologists, as a whole, have fewer direct patient interactions, they do work with patients and have significant contact with other doctors.

“I always tell students and younger providers that they might not always have patient contact, but they have contract with their fellow doctors every day,” she said. “Radiologists have enormous patient impact. It’s almost impossible to get out of the hospital without some type of test, and in a lot of cases, it makes a big difference for the patient.”

There are more tangible ways to grow the number of female radiology leaders, as well. Approving and subsidizing additional education courses can be an effective way to foster career growth among women providers, Fielding said. For example, practice or department leaders can support a colleague through an accounting course if she is interested in pursuing a finance management position within the group.

According to Etta Pisano, MD, vice president for medical affairs and dean of the College of Medicine at the Medical University of South Carolina, sometimes the best way for radiology leaders to support women is to simply listen to their wants and needs. Administrators must be accommodating.

“Those of us in leadership positions must be attentive to what employees are saying to us about what they need to be successful and happy at work,” said Pisano, who is also a radiology professor. “Often, we set meetings outside of work-time boundaries, and that’s going to be very hard for anyone with a family. We need to focus on doing work during the work day.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/women-radiology-how-specialty-can-bridge-gap/page/0/2#sthash.RBOTEdrJ.dpuf

For a video perspective on women in radiology: Julia Fielding, MD, on women in radiology

June 19, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Patient Steerage Could Harm Radiologists, Confuse Patients

Published on the April 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

As implementation of the Affordable Care Act continues, all sectors of the healthcare industry are being called upon to increasingly rein in costs. For many insurance providers, patient steerage has proven to be an effective strategy. But the impact on radiology has been largely negative, industry experts said.

Patient steerage in radiology occurs when outside forces — usually insurance providers — actively direct patients or physicians to lower-cost radiology practices. And, this strategy is becoming more prevalent nationwide, said Geraldine McGinty, MD, chair of the American College of Radiology’s (ACR) Commission on Economics.

“Our feeling is that as radiology benefit managers have maxed out on the initial imaging volume savings they can offer to clients, so they’ve started participating in programs to drive patients to facilities where the payers have negotiated lower reimbursement rates,” she said. “Recently, it’s been more aggressive due to increasing involvement of patients as they take on more responsibility for their care through higher-deductible plans.”

In fact, according to an informal survey by the Radiology Business Management Association (RBMA) in September 2012, 65 percent of respondents reported experiencing active patient steerage from either radiology business management (RBM) groups, payers, or both. With active steerage, payers give patients incentives, such as gift cards, for choosing lower-cost providers. In addition, 47 percent confirmed the presence of passive steerage — simply making cost differential data available to patients and providers.

However, patients are also driving a certain level of steerage. A recently-published joint ACR-RBMA paper credits high-deductible insurance plans and patient cost awareness with some patient redirection.

What Payers Are Doing

While not all payers have patient steerage programs, many do. For example, in September 2011, Anthem Blue Cross Blue Shield in Ohio implemented a steerage program for imaging services through which company representatives called patients in attempts to redirect them toward lower-cost providers. Within nine months, more than 3,500 patients had been called and steered to different imagers.

In addition, WellPoint launched a passive steerage campaign with OptiNet, an Internet portal through which referring physician were encouraged to schedule patients with lower-cost imagers. When referrers largely ignored this resource, however, WellPoint enlisted RBM company American Imaging Management (AIM) to call patients directly. According to AIM marketing director Ana Perez, nearly 20 percent of patients chose lower-cost imagers in response to the phone calls.

Other payers, such as UnitedHealthcare, also provide radiologist cost information, but they do not actively contact patients. Still other payers successfully steer patients by classifying certain providers as out-of-network in a patient’s insurance plan.

The Impact of Patient Steerage

The increasingly prevalence of patient steerage can potentially impact practices and departments on a variety of levels, McGinty said. According to the ACR-RBMA paper, she said, radiologists should be aware of the three main ways patient steerage can affect everyday practice.

1. Daily operations: When payers redirect patients, providers can lose any time they’ve already spent in the pre-authorization process. They can also experience productivity dips , and if they don’t know patients have been steered elsewhere, they  could face vacant or missed appointment slots. Imagers could  also be asked to answer patient and provider questions about any steerage and why it occurred. Overall, up to 82 percent of RBMA survey respondents indicated steerage decreased their patient volume. However, some respondents — about 14 percent — actually saw volume increases due to patient steerage.

“The big item will be the loss of business, and virtually every practice is looking at a decrease in volumes,” said David Levin, MD, a radiologist with the Center for Research on Utilization of Imaging Services at Thomas Jefferson University. “It’s not like in the early 2000s when volumes were growing like crazy and it wasn’t a problem if we lost a little business because insurance steered our patients elsewhere. No one feels that way anymore.”

2. Legal issues: When payers actively steer patients to lower-cost imaging centers and away from a referring physician’s initial suggestion, they open themselves up to potential medical liability if findings, such as a lung cancer, are missed. In addition, legal action can also be launched against the chosen imager, the imager’s corporation, and the RBM. It’s also possible, especially with active steerage, that these activities violate the federal anti-kickback law that forbids any payments or solicitations that influence patient health decisions.

According to the ACR-RBMA paper, radiologists could also assert payer-directed steerage impedes their legal right to practice, defames their professional reputations by listing them as lower-tiered providers, or violates any existing contracts they have with facilities to receive a certain amount of referrals.

3. Provider relationships: Any payer-directed steerage can disturb existing healthcare relationships, McGinty said. Referring physicians often have a small cadre of imaging providers, chosen for their levels of quality and service, to whom they send patients. Redirecting patients to different imagers can damage long-term provider partnerships and can impose on referrers the additional cost of transferring all patient records to a new imager. Any instances of incomplete reads prompt the need for a second radiological opinion. And, the radiologists providing the second read do not receive reimbursement.

Impact on Patients

While survey data exists to support the negative effect steerage has on providers, the verdict is out on how much payer redirection influences patient care.

The ACR’s biggest concern, McGinty said, is that steerage can confuse patients.

“Patients build relationships with their physicians over time, and they value their doctor’s advice and guidance,” she said. “We don’t want to see those relationships disrupted or see patients’ confidence shaken when it’s suggested they see an imager their doctor didn’t recommend.”

It’s also paramount, she said, to make it clear to patients that payer recommendations are only cost-based suggestions. Many patients are unaware they have a choice to simply pay a higher fee for seeing the imaging provider chosen by their referring physician.

Payer steerage also increases the risk that patients will be sent to a facility without ACR accreditation. But that risk is small, Levin said, adding that ACR accreditation ensures a certain level of service quality.

“I don’t think steerage will impact patient care that much. People will get scans if they need them even if insurance companies steer patients to places they think are more affordable,” he said. “It’s not as if there’s a huge variation in quality so that if you go to my hospital you’ll get a great scan, but if you go to the hospital down the street, you’ll get a lousy one.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/patient-steerage-could-harm-radiologists-confuse-patients

April 25, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Duke researchers create polymer coating to keep bacteria, barnacles at bay

Published in the April 15, 2013, Raleigh News & Observer and the April 14, 2013, Charlotte Observer

By Whitney L.J. Howell

Swatting at pesky insects or air-borne particles – it’s a common, everyday activity for nearly all living creatures. It’s a way to keep clean and get rid of anything that might cause future problems.

But what about machines and vehicles that can’t take a swing at annoying parasites, particularly ones submerged in water?

Continual biofouling – the accumulation of microorganisms, plants, algae, or animals on wet surfaces – has been a long-term problem for the global shipping industry. Now researchers at Duke University’s Pratt School of Engineering have developed a strategy that could enable ships to rid themselves of creatures and substances that hitch a ride on their hulls.

Coating ships in a new material that shakes itself on command can eliminate several problems associated with keeping ships clean, said Xuanhe Zhao, a Duke mechanical engineering researcher.

“If you’ve ever seen a horse or cow shake its skin or tail to get rid of flies, that’s analogous to shaking off something that’s bugging the ship,” he said. “We’ve introduced a new mechanism that can deform, and that deformation can literally detach the biofouling materials adhering to the surface.”

Why slough the ships?

Apart from being unsightly, barnacles and other biofouling substances can inhibit a ship’s ability to function. Even a small amount can cause difficulties, said Gabriel López, a Duke biomedical and mechanical engineering professor. He is also the director of Research Triangle Materials Research Science and Engineering Center.

“Even a small layer of slime can significantly increase drag, and

This extremely enlarged image shows a covering of green microorganisms being lifted off the metal to which it is attached. The metal was coated with a polymer developed at Duke University's Pratt School of Engineering. When an electric current goes through the polymer, the coating becomes bumpy, forming patterns that can detach the biofouling. COURTESY OF XUANHE ZHAO

This extremely enlarged image shows a covering of green microorganisms being lifted off the metal to which it is attached. The metal was coated with a polymer developed at Duke University’s Pratt School of Engineering. When an electric current goes through the polymer, the coating becomes bumpy, forming patterns that can detach the biofouling.
COURTESY OF XUANHE ZHAO

as drag on the ship goes up, the fuel consumption goes up, as well,” he said. “Pollution goes up, and more greenhouse gases are produced.”

Leaving biofouling materials stuck to ships can also have another environmental impact. For ships sailing worldwide, there is a risk invasive species will be transferred from their native habitat to ones where they can be damaging. For example, nutrient-hoarding zebra mussels from Russia were brought via ship hull to the Great Lakes in the late 1990s. Within 10 years, these invaders had wreaked havoc on the region’s fishing industry and levied more than $3 billion in damages.

Ridding ships of biofouling materials is also of military import, López said. The more barnacles and bacteria a ship carries, the noisier the vessel is, making it easier to detect.

How it works

Traditionally, the shipping industry used less-than-optimal means to protect vessels. For more than 40 years, global maritime companies coated their roughly 30,000 ships with paint containing tributyltin, an inexpensive, effective – and poisonous – barnacle- and algae-killer. An international treaty banned its use in 2007.

Another protection method has been a polymer coating that reduces biofouling substances’ ability to adhere to the boat. It’s a temporary fix, though, because bacteria and barnacles eventually adapt to the polymer and attach themselves anyway, Zhao said.

This new solution, however, starts with an environmentally safe silicon rubber polymer coating on the ship’s hull. Running voltage through the flat polymer turns it into a capacitor – a passive structure that stores energy – and generates an electric field, he said. This cleaning strategy then relies on electrostriction, a property of electrical nonconductors that allows them to change shape when exposed to electricity, to slough away the offending substances.

“There are patterned channels – air channels – beneath the polymer, and if you blow air into the channels, it will increase the hydrostatic pressure and buckle up the polymer surface,” Zhao said. “We basically form a wrinkle on the surface of the polymer, and the biofouling substances simply detach.”

Although this strategy must be tested on the large scale, it does offer two advantages other cleaning solutions have lacked, Zhao said. The silicon rubber polymer could potentially last for years, and this method eliminates the need to dry dock a ship for cleaning. An electric current can be sent to the polymer anytime, anywhere, and the ship will slough off biofouling material.

Challenges, future uses

To date, Zhao and López have only tested this self-sloughing mechanism with areas only a few centimeters wide. But, according to Jan Genzer, a chemical and biomolecular engineer at North Carolina State, larger experiments are needed to prove it’s a valid cleaning solution.

“It’s a very clever, very different way to think about this problem – like trying to stand on a trampoline while it’s being shaken,” said Genzer, who created a different cleaning solution. “The real question is, though, can it be applied to a ship? How will the research translate to application? Will the discovery need to be modified?”

In his discovery, Genzer and his colleagues created a dense layer of molecules capable of repelling biofouling organisms by repeatedly hitting a stretched piece of rubber with reactive oxygen and allowing the rubber to rebound. The result, he said, was a roughness that helped prevent barnacle and algae accumulation.

Even though the self-sloughing mechanism has only been applied to shipping so far, both Zhao and Genzer agree that there are additional uses for this technology. Representatives from the food industry, lubrication companies, and medical device manufacturers have all expressed interest in this development, Zhao said.

“Any time you have synthetic material in contact with some sort of water that might have bacteria or other microorganisms in it, you will form this biofouling layer,” he said. “So, it’s a very pervasive problem.”

Ultimately, Genzer said, concentrating on strategies to remove biofouling materials rather than trying to create ones that prevent accumulation from even beginning will be a productive plan. Organisms adapt to survive when faced with foul-resistant substance, and that can do more harm than good to an ecosystem.

“People are now realizing foul-resistant coatings are more realistic. They allow deposits to settle, but they can be cleaned by shaking or running the ship at particular speeds,” Genzer said. “You can’t outsmart Mother Nature. She’s been around for millions of years, and she’s developed ways for organisms to survive in different conditions. If we can get surfaces clean, we should be happy, and leave it at that.”

To read the story at its original Raleigh News & Observer location: http://www.newsobserver.com/2013/04/14/2816390/duke-university-researchers-create.html
To read the story at its original Charlotte Observer location: http://www.charlotteobserver.com/2013/04/14/3974504/duke-university-researchers-create.html

April 15, 2013 Posted by | Science | , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Enterprise Imaging: Beyond Cloud-based Image Sharing

Published on the April 8, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Zero-footprint viewers. Vendor-neutral archives. Image mobility. Individually, they are helpful tools to radiology and becoming more ubiquitous. But together, they help create a cohesive enterprise imaging strategy.

Enterprise imaging (EI) isn’t a particularly new idea, but to date, it has been largely misunderstood, industry experts say. It’s more than simply implementing new technology. And, achieving the full benefits EI can provide will require both sophisticated software and provider engagement.

“Enterprise imaging is a hot topic, but there’s a big misconception around what we mean by it,” said Paul Chang, MD, University of Chicago School of Medicine’s enterprise imaging medical director. “Enterprise imaging is a much broader, more complex problem when you take the enterprise perspective rather than the silo perspective.”

What is EI?

Put simply, the goal of an EI strategy is to ensure the correct image is delivered to the right place at the appropriate time. It has the potential to fundamentally change how facilities, providers, and patients interact with diagnostic images. Reaching that goal, however, requires a great deal of collaboration, Chang said.

According to a 2012 KLAS report, many facilities are already moving in that direction. Of the 134 providers surveyed, most reported being in early EI stages. To create a fully integrated EI system, Chang said, these facilities and others must address five factors that affect how the healthcare system currently views and uses diagnostic images.

1. Archive architecture. For many providers, EI simply means implementing a vendor neutral archive (VNA), an archive-neutral vendor, or using a zero-footprint viewer, all methods for easily sharing images within the facility and off-site. However, the archive is only one part of a successful EI strategy, albeit an important component. It’s important, Chang said, to free radiology departments and practices from being tethered to one PACS, but identifying and employing an effective VNA is largely an IT responsibility.

“VNAs and zero-footprint viewers are just the middle wear that links commodity storage to the application layer,” he said. “We’ll do it, and we’ll go to the cloud. But it’s all buzzwords and plumbing. That’s designing the car. Now radiologists have to learn how to drive it.”

2. Multiple creators and consumers. Radiologists are no longer the only specialty that produces and uses diagnostic images. Today, cardiology, gastroenterology, pathology, and several other departments rely on imaging to provide proper patient care, so facilities must have a streamlined way to distribute scans throughout the health system.

“To do this right, you do need the architecture of a VNA or archive-neutral vendor, but there’s a bigger concept behind enterprise imaging,” Chang said. “This view is the realization of the modern enterprise that it must deal with both consumers and producers of images simultaneously throughout the hospital — not just radiology.”

 3. Ubiquitous electronic health records (EHR). The concept of an EHR isn’t new to radiology, an industry that has used PACS and RIS for many years. But now, meaningful use requirements are calling upon the specialty to interface seamlessly with patients’ records through an entire health system. Consequently, according to KLAS imaging research director Ben Brown, all new systems must be interoperable. It will be up to a facility’s IT department, Brown said, to create an infrastructure that manages and stores PACS, maintain a patient index to ensure proper patient identification, and determine how long images are stored.

4. The enterprise concept. Years ago, when radiologists discussed “the enterprise,” the term referred to anyone outside the department who still worked within the hospital’s firewall. But as health systems have expanded and more specialties have become image producers and consumers, the definition of “enterprise” has expanded, Chang said. Radiology groups have consolidated, many facilities within the same system are separated by hundreds of miles, and providers are now required to read scans for multiple hospitals.

The logistics of moving images from one facility to another aren’t difficult — the real challenge comes in coordinating the workflow needed to properly use transferred scans. According to Rasu Shrestha, MD, MBA, a University of Pittsburg Medical Center radiologist, however, the potential exists, for EI to have a significant positive impact on work  flow management.

“[EI] allows for a patient-centric approach to care versus an image- or application-centric approach,” he wrote in a 2012 Applied Radiology article. “It allows for the possibility of true collaboration among care teams, which would bring the value of imagers back into the spotlight.”

5. Tying it all together. The real challenge behind effective EI, Chang said, is to fuse the needed technology with the proper workflow perspectives. But it can be helpful, he said, to consider that EI is less about imaging and more about radiology’s need to re-invent itself as healthcare enters a new chapter of value-based purchasing.

“The concept of enterprise imaging is a proxy or code word for having to re-engineer a more useful, comprehensive workflow solution for a more complex enterprise,” he said. “It’s better not to talk about enterprise imaging but talk about re-engineering ourselves so we can continue to add value.”

How can you plan?

It’s no longer a question of whether EI is right for your practice or department. Radiology’s move toward EI is clear, and it’s up to you to determine how you will navigate these new waters. There are many moving parts with this imaging strategy, Chang said, but you can outline your course of action by remembering one question: “What is the role of radiology or the radiologist in this decision?”

For example, as the end-user, you can — and should —tell your IT department what you need out of a VNA, but don’t expect to be included in any purchasing decisions. The facility’s chief financial officer and chief information officer will make that determination, he said.

You will, however, have a greater role — alongside cardiologists and other providers — in determining how the VNA architecture will support your needs and workflow. In addition, you must make it clear to your hospital administrators and IT department that any EI system must offer interoperability for the strategy to succeed, said Robert Barr, MD, president of Mecklenburg Radiology Associates in Charlotte, N.C.

Through interoperability, he said, his practice — which has been using EI for several years — is able to quickly migrate images between all subspecialties, streamlining patient care and facilitating greater access to patient records.

Your biggest role, however, will be in providing evidence that supports the true value you bring to your facility. Your worth is no longer tied solely to the number of interpretations you produce daily, Chang said. You must now demonstrate your impact on patient outcomes, population management, and down-stream resource utilization and cost control.

“In the fee-for-service environment, we could be selfish and insular in our thinking. We floated everyone else’s boat,” he said. “But now we’re a cost center, and every CT you order better be worth it. Justify it, and demonstrate its positive impact.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/enterprise-imaging-beyond-cloud-based-image-sharing/page/0/1

April 10, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , | Leave a comment

Radiology Data Registries: Know How to Comply

Published on the March 14, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

The number of radiology practices and departments looking to benchmark themselves against their peers through data registries is growing. But many still need guidance on what these databases are and how they can correctly participate.

For years, your practice or department has likely followed its own protocol for diagnostic scans, using what you felt were best practices for radiation doses, for example. According to industry experts, data registries are pathways to double-check yourself and ensure what you’re doing provides the best care to your patients.

“These registries are effective in the promotion of quality improvement changes and changes in high-quality health,” said Cynthia Moran, assistant executive director of government relations, economics, and health policy at the American College of Radiology (ACR). “The use of registries is so that people can see where they are in the performance metric.”

Although the ACR Dose Index Registry has received the most attention recently, seven additional registries exist — CT colonography, general radiology improvement, IV contrast extravasation, mammography, oncologic PET, night coverage, and quality improvement for CT scans in children. Together, these registries comprise the ACR National Radiology Data Registry (NRDR).

By providing data to a registry, you’re contributing to the body of information that will be used to craft future best practices guidelines. According to Moran, these registries also make it easy for you to compare yourself to your peers.

“If you provide data to a group or registry, you periodically get a report to see where you stand respective to your other colleagues,” she said. “If your numbers are far off from the performance of others, you can create a process to see what’s wrong and how you can do better for your patients.”

While data registries are most often lauded for improving the quality of care available to patients,  they do make a more direct impact on radiology practices, said Judy Burleson, ACR’s director of quality and safety metrics.

“When quality improvement and quality reporting programs are used in combination with reimbursement mechanics, it enables payers — private or Medicare — to pay for services for their beneficiaries based on quality rather than fee-for service,” she said. “When you integrate a quality program within payment structures, you’re inserting and element of value there.”

Ensuring Compliance

To participate in any registry within the NRDR, your practice must complete a participation agreement. Not only does this document outline the specific registry or registries in which you want to enroll — it isn’t required that you participate in all registries — but it also mandates that you have the proper privacy protocols in place to protect the patient data you collect and submit.

There are also other rules you must follow, Burleson said.

“To be in compliance with a clinical data registry like the ACR registries or specialty society registries, practices just need to submit specific data elements in the format that’s required,” she said. “This could be problematic for some sites that must figure out the best way to get this data and from where to find it.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/articles/radiology-data-registries-know-how-comply-0

March 18, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Taking the Pulse of Mobile Health

Published in the March 13, 2013 Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

It’s no secret the healthcare industry is going digital. Electronic health records, health information exchanges, and Web-based patient portals are becoming ubiquitous features in nearly all clinical environments. But the fastest, most widely adopted digital push, according to healthcare industry experts, has undoubtedly been in mobile health.

Frequently referred to as mHealth, this phenomenon is the practice of medicine and public health through mobile devices. And, in the great scheme of healthcare developments, mHealth is relatively new. However, it’s already proving to have a large and growing impact.

Consulting firm PricewaterhouseCoopers predicts that by 2017, mHealth will post revenues of $23 billion, with $6.5 billion coming from North America. It’s anticipated that, by that time, nearly two-thirds of the market will be dedicated to remote monitoring of chronic disease.

Although most insurance plans still don’t reimburse physicians for mHealth activities, the healthcare industry is already seeing the cost savings associated with these tools. According to a 2012 Benton Foundation study, mHealth improved medical productivity by $11.2 billion just in 2011. Those gains are expected to reach $305.1 billion by 2022.

The proliferation of mHealth, however, isn’t simply about boosting a health system’s bottom line. Ultimately, it’s about the industry’s end user – the patient.

“One of the big issues facing the healthcare system that isn’t often discussed is the sense of patient empowerment and involvement in their own healthcare,” said Jay Yadav, President and CEO of CardioMEMS, a medical device company specializing in wireless sensing and communication technology. “We all know that if you feel pushed along in an assembly line, your behavior will be quite different than if you’re engaged and have some charge over your care.”

The ultimate goal, he said, is to give patients a sense of ownership over the care they receive, while giving providers effective tools and good data that will enhance the care they provide.

Provider Enthusiasm
Providers aren’t being shy about adopting mobile technologies. According to the 2nd Annual Health Information and Management Systems Society (HIMSS) Mobile Technology Survey, 93 percent of providers use mobile technology in their daily activities, and more than 60 percent use third-party apps.

But while on-the-go providers are naturally attracted to mHealth technology, the real driving force behind this mobile care trend is patients themselves. In fact, according to a Deloitte study, the number of mobile device users who downloaded at least one mHealth app doubled between 2011 and 2012.

A 2009 Brookings Institution study found that roughly 75 percent of patients nationwide want email appointment reminders, want to schedule appointments online, and want email contact with their doctors. Another 67 percent would prefer to see their diagnostic test results via email, and 57 percent would use a home monitoring device, such as one that transmits blood pressure readings.

Patients are also accessing information on their own. According to the 2012 Pew Research Center Internet & American Life Project, more than 30 percent of patients use their cell phones to research health information. And, GlobalData reports, more than 70 percent of health and wellness mobile apps target patients.

Consequently, according to Jonathan Dreyer, Director of Mobile Solutions at Nuance, the mHealth industry will play into those patient preferences through 2013. For example, more apps and mHealth technologies could use “gamification” – the use of interactive games that teach health information – as a way to reach patients.

“Patients simply want more responsibility over their own health, so we’re likely to see more patient-focused apps, such as health games, fitness and nutrition apps, and wellness tools,” he said. “In all likelihood, 2013 will likely see a great focus on making this technology more accessible and easier for patients to use.”

Payers are already on-board, as well. The Deloitte study reported that many encourage their customers to use mHealth technologies to monitor chronic conditions and share information with their providers. They also support using mHealth as a means to report and share information about facility and provider care quality.

Regulatory Hesitancy
Although mHealth is popular, it isn’t devoid of challenges. Mobile and smartphone technologies can be easy to use, but they have proven difficult to regulate because working with these types of developments is uncharted territory. The Food and Drug Administration (FDA) has grappled with how to ensure mHealth tools are both safe and beneficial.

So far, the agency has ventured timidly into mHealth regulation. In 2011, it published draft guidelines, focusing specifically on how effective mobile devices are in reading diagnostic scans. Its next step came in February 2012, when the agency acknowledged in the Federal Register that patients now have access to medical screening and diagnostic mobile apps. Official regulatory guidelines are still pending, but industry experts anticipate the FDA will claim regulatory authority over these types of apps.

One member of Congress is also trying to help the FDA augment and fine-tune its mHealth capabilities. Michael Honda, D-Calif., introduced the Healthcare Innovation and Marketplace Technologies Act in December 2012. If passed, this legislation would create a wireless health technology office within the agency, launch a support program in the Department of Health and Human Services to help mHealth developers ensure their technologies meet current privacy standards, and establish a tax incentive program for providers to deduct the cost of many health information technology systems. The bill has been referred to the Subcommittee on Health, but, to date, no vote is scheduled.

As of press time, lawmakers on the House of Representatives’ Energy and Commerce committee will conduct a three-day series of hearings in mid-March to better understand how the FDA should regulate mHealth apps on smartphones and tablets. According to the Washington Post, they plan to focus specifically on how regulation may affect patients, providers and developers looking to capitalize on this growing market.

What’s Out There?
The market, however, isn’t waiting for the FDA to craft its rules. Patients and providers alike already have unfettered access to mHealth tools that augment healthcare delivery.

So far, these tools are mostly remote monitoring technologies that help patients keep track of their own chronic conditions, such as congestive heart failure, pulmonary disease or diabetes, and digitally send information to their providers. Their intent is to improve patient outcomes, but a May 2012 Brookings Institution report revealed they could also save the healthcare industry nearly $197 billion in U.S. healthcare spending over the next 25 years.

For example, more than 24 million Americans live with diabetes, and more than 11 million of them use home glucose monitors, such as the GlucoPhone. This device, manufactured by HealthPia, reminds them to test their levels, keeps track of the results, and sends the information directly to caregivers.

Some chronic conditions, however, require a more intensive level of monitoring, said CardioMEMS’ Yadav. To provide that level of data collection and care, CardioMEMS has developed a two-part sensor – a wireless implantable sensor and an external monitor – to keep tabs on a patient’s heart function and eliminate the need for repeat heart catheterizations.

“This technology gives doctors the same kind of cardiac catheter information without actually having to do the procedure,” he said. “It gives doctor’s precise information tied to the patient’s heart disease from inside the body, and they can interpret it.”

In addition, providers have instant, real-time access to this patient data. Through a desktop graphical user interface, doctors and nurses can see how a patient is doing. That information – their blood pressure, heart rate and cardiac output – then feeds directly into the facility’s EHR.

mHealth solutions are also being used to combat substance abuse. Researchers at the University of Massachusetts Medical School developed iHeal, a remote-monitoring device that senses the changes in skin temperature and nervous system activities linked to drug cravings. This data, along with self-reported stress levels, helps providers offer text, video and audio interventions when needed.

These tools are also demonstrating that they can directly impact the day-to-day function of the health system. If a patient near New Hampshire’s Portsmouth Regional Hospital needs medical attention, he or she can text “ER” to a specific number to receive the estimated ED wait time.

Effect on Providers
The benefits of mHealth don’t stop with patients. They extend to healthcare providers of all types, as well, directly impacting the quality of care.

It has been documented that physicians using mobile devices read medical test results more quickly, have better data management and record-keeping skills, and make fewer medication errors at discharge.

These tools also help nurses avoid errors. A 2011 Nurse Educator study reported 16 percent of surveyed nurses said a hand-held device helped them avoid at least one clinical error, and 6 percent credited the tools with helping them to avoid making multiple mistakes.

To meet these provider needs, AT&T launched its mHealth platform, said Geeta Nayyar, MD, the company’s Chief Medical Information Officer.

“At a high level, there are so many connection points in healthcare that are lacking,” she said. “Patients see a primary care doctor, or a specialist, or they go to the emergency room, but there isn’t a streamlined way to communicate between those positions or facilities.”

Consequently, she said, providers often miss out on pertinent data that could impact the care they provide. By using mHealth platforms, physicians can better track their patients with chronic conditions. Patients receive access to an online log where they remotely input information related to their condition, such as diabetes or heart disease, and providers can access and review the data. This way, doctors can contact patients if anything seems amiss.

“This system gives patients just-in-time care when they need it so they don’t end up in the emergency room, or having to see a doctor who doesn’t know them,” Nayyar said. “Basically, it avoids potentially negative patient and quality outcomes.”

What Next?
mHealth’s recent growth has been explosive, and there’s no sign that it’s slowing down. Developers, health systems, providers, patients and regulatory agencies are already finding new ways to leverage the technologies and maximize their beneficial impact.

According to the Deloitte study findings, healthcare’s future will have a high level of digital integration. Not only will patients use self-monitoring sensors, but they will also have access to social health networks for information and support. Providers will have big data-smart dashboards to centralize patient records and minimize errors, as well as to digitally share patient information with colleagues. And, health systems will likely rely first – or solely – on mobile technologies to customize care.

Regardless of what mHealth tools health systems choose, it will become increasingly important that all stakeholders – providers, insurers, and pharmaceutical and medical device companies – work together to ensure privacy, security and efficacy as the industry forges ahead. According to Jon DeVries, Vice President of Product Solutions and the iConnect suite at Merge Healthcare, this is a trend that has irreversibly changed healthcare.

“Smartphones and mobile technologies have become a major driver in communications and will be a major driver in how we provide healthcare in the future,” DeVries said. “Our devices are here to stay, and as much as we like it or don’t like it, these mobile applications are making inroads that our health systems will have to find a way to work with. We have to listen to what the marketplace is telling us.”

 To read the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2013/Taking_the_Pulse_of_Mobile_Health

March 18, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

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