Published on the Nov. 12, 2014, North Carolina Health news website
New research on the timing of potty training shows problems for pushing children too soon or waiting too long.
By Whitney L.J. Howell
The frustrating journey of toilet training a child is a struggle every parent faces. Starting kids down this path early can be tempting, but a new study from Wake Forest University found that pushing the topic too soon – or too late – can cause physical problems and lead to wetting accidents.
Children who are toilet trained prior to age 2 or after age 3 have significantly more daytime and nighttime accidents than children trained between the two ages, the study showed.
“Toilet training seems like a religious topic,” said study leader Steve Hodges, a pediatric urologist at Wake Forest Baptist Medical Center. “People can get so mad and say they trained their child at age 2 or 1, and [that] everything is fine. But training too early or late is a risk factor, and we want to prevent toileting problems in all kids with maximal effect.”
As long as a child stays in diapers, his or her bladder continues to grow in size. Being able to urinate freely increases the bladder’s fluid capacity and actually helps it learn to function more effectively, he said. Once toilet training is introduced though, that growth stops. So, according to research from the University of Oklahoma Health Sciences Center, children who toilet train earlier will automatically have smaller bladders, potentially setting them up for future toileting problems.
But the real culprit behind wetting accidents, Hodges said, is constipation. Increased fullness in the bowels presses on the bladder, making it harder for children to control the flow of urine. Over longer periods, that same fullness can also stunt the bladder’s growth, further inhibiting capacity. In addition, the muscles used to restrict bowel movements are connected to muscles that control urination; constriction can make it harder for children to learn proper toileting behaviors.
This study is the first research to connect constipation to wetting accidents in younger children.
“Across the board, most voiding complaints in kids are due to incompletely emptying the colon, not anything to do with the bladder,” Hodges said. “There’s nothing inherently bad about pooping rarely as long as everything leaves the colon. It’s when the colon doesn’t empty that we start to see bladder problems, such as daytime wetting and urinary frequency.”
In some cases, constipation occurs when a child resists parents’ efforts to introduce toilet training. Other times, outside influences, such as a new sibling, can stall a child’s progress.
Hodges’ team followed the toileting habits of 112 children aged 3 to 10 for six months. The majority were toilet trained between ages 2 and 3, and parents reported 38 percent had a history of constipation and 45 percent had experienced daytime wetting.
Although anecdotal evidence shows girls can toilet train earlier and easier than boys, Hodges’ research found being male didn’t increase the likelihood of constipation or daytime wetting.
According to the findings, the children who toilet trained before age 2 were more than three times as likely to suffer from constipation than children who trained between ages 2 and 3. Children who trained after age 3 experienced constipation seven times as often. In addition, when compared to other children, kids who trained early and late had daytime wetness nearly four times and five times as often, respectively.
These problems can frequently be overlooked, said Triangle Center for Behavioral Health clinical psychologist Rebecca Dingfelder, because parents aren’t comfortable broaching the subject with their child’s physician. Dingfelder has expertise in working with children who have toilet-training difficulties.
“A lot of problems stem from parents being embarrassed to talk with pediatricians – not about toilet training but about the constipation that might be going on,” she said. “Parents need to discuss with their pediatricians how things are going with pooping, especially if there are problems with wetting the bed or wetting at school.”
It’s important to remember, Dingfelder said, that children develop at their own paces. Currently, the N.C. Department of Health & Human Services – the agency that oversees day-care center licensures in the state – doesn’t require that children be toilet trained by a certain age in day-care or pre-school environments. However, many such facilities maintain a policy that children must be fully trained before progressing to a 3-year-old classroom.
In some cases, she said, that mandate puts unrealistic expectations on the child and family.
“If a child is cognitively and socially ready to move on, and if toileting is the only thing getting in the way, then day-cares need to cooperate with families to see how they can make it work,” she said.
For example, if day-care facilities don’t have a changing table in the older classes, then arrangements could be made for the child to return to the younger class for diaper changes.
Ultimately, Dingfelder said, she hopes Hodges’ research will relieve much of the stress and anxiety parents feel around toilet training their children as soon as possible. Toilet training isn’t a race to the finish line, she said, and parents shouldn’t feel pressure to push their toddlers too soon.
“Parents these days will say, ‘My kid will read when they read and ride a bike when they ride,’” she said. “We need the same acceptance for toilet training – that it’s OK to start later, and that it’s OK to talk about the stumbling blocks along the way.”
To read the article at its original location: http://www.northcarolinahealthnews.org/2014/11/12/not-too-early-or-too-late-potty-training-timing-needs-to-be-just-right/
Published on the Nov. 5, 2014, North Carolina Health News website
According to its vision statement, the goal of the North Carolina Research Campus in Kannapolis is to become “the world’s epicenter of nutrition and disease research.”
By Whitney L.J. Howell
A small, rural town once known for pillows and sheets is an unlikely backdrop for innovative, groundbreaking nutrition and health research. But that’s just where to find the North Carolina Research Campus and its nearly 20 investigative affiliates.
Nestled in Kannapolis, this 350-acre campus, known as the NCRC, is a bustling, collaborative hub that brings together academic, industry and community partners dedicated to improving human health. It’s integrally involved with creating the city’s new brand: The Healthy Life.
“Nowhere else in the world do you have one campus that houses this many great institutions in one place,” said Lynne Scott Safrit, who leads Castle & Cooke, which oversees the NCRC’s development. “The vision from the beginning was [that] through the close physical proximity of labs, facilities and faculty you’d begin to find scientific discoveries happening in a wholly different way.”
And that’s exactly what’s occurred, Safrit said, as researchers work,
eat and take breaks together daily. In fact, this collaborative spirit led NCRC founder and Dole Food Company chief David H. Murdock to commit – on top of his initial $600 million investment – a $15 million annual endowment to the David H. Murdock Research Institute. The institute houses one of the largest scientific equipment collections worldwide.
Within 30 years, this gift will equal more than $500 million for the NCRC to improve nutrition and fight chronic diseases, Safrit said.
“The Institute will really start to develop its own research mural that hasn’t been possible in the past. By increasing the funding, the hope is that DHMRI will attract a world-class leader from the scientific community,” she said. “We’ll be able to grow the science staff through this funding and bring in additional funding from other sources with similar interests in nutrition and health.”
The local impact
Announced in 2005, the NCRC revitalized Kannapolis after the textile-industry bust crippled the local economy. Recently, city leaders opted to build a new government center in the middle of campus, Safrit said. It will include a large meeting space that, once completed, will host science meetings and other conferences that were never possible before.
The influx of money and job growth has been one of the biggest impacts. By the end of fiscal year 2013, not only had the UNC universities affiliated with the NCRC amassed more than $43 million in grants but those seven academic partners together had also created 151 new local jobs.
Add in other campus collaborators, and that number jumps to nearly 1,000 employment opportunities. According to NCRC statistics, local residents filled approximately half of those jobs.
Classes aren’t held on the campus but it is possible for college and graduate students to apply for internships in five of the groups: the Appalachian State Human Performance Lab, the NCSU Plants for Human Health Institute, the Plant Pathways Elucidation Project (P2EP, a $1.9 million, first-of-its-kind program that brings college students in to study how plants impact human health), the UNC-Chapel Hill Nutrition Research Institute and the Murdock Research Institute.
For example, the MURDOCK Study, an initiative looking at genomic links across major chronic diseases, hired roughly 50 local residents to conduct outreach in schools and churches. Their charge is to ensure the public understands the study’s potential impact. The ultimate goal: using advanced genomic technologies to learn more about disease and improve prevention practices.
The Cabarrus Health Alliance, the county’s public-health agency located on the NCRC campus, is one community organization that has experienced growth as well. Like MURDOCK, it’s added 50 of those 1,000 new jobs.
“It’s unusual for a public-health agency,” said William Pilkington, CHA’s chief executive officer and public-health director. “Most agencies are cutting left and right, but we’re adding employees because we’re working with the research campus partners through the grants we’ve gone after.”
Through investigative relationships with the NCRC, CHA won grants from the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation, the U.S. Department of Health & Human Services and other organizations, he said. Most recently, CHA received a three-year, $3 million-a-year Institute for Research & Poverty RIDGE Center for National Food and Nutrition Assistance Research grant focused on food security and choices, consumption patterns and nutritional and diet-related health outcomes.
Consequently, the NCRC-CHA alliance is creating healthier local communities. Not only has the collaboration changed how CHA tailors diabetes information dissemination to include mobile texting and direct, in-hand distribution, but it also provides free healthy cooking classes. The underlying key to success, Pilkington said, is location.
“There’s an advantage to being on campus. People associate us with research,” he said. “If we were located in a typical health department, we’d be begging people to come and try our programs. Right now, we have a cooking class for healthy Halloween treats, and we’re over-subscribed.”
The research effect
NCRC research effects extend throughout North Carolina and beyond, but Kannapolis and its residents feel much of the initial impact, said David Nieman, director of the Appalachian State University Human Performance Lab on campus.
The lab directly touches the community, he said, because researchers share study results with participants so they can learn how stress and different food consumptions affect the body’s performance abilities.
In a recent study, for example, his lab showed bananas are equally as effective as sports drinks at fueling high-intensity workouts. Plus, they’re cheaper, and the fruit adds fiber, potassium and Vitamin C to the body. A single banana also has around 100 calories – less than half the amount in an average, 20-ounce sports drink.
“We think involving residents in research educates the community and provides funding for people,” Neiman said. “They can be proud when they see the results of our research in the media and know they were a subject in that study.”
To date, the lab, which launched in 2009, has brought in $3.5 million in industry funding, and $500,000 of that has been funneled directly into the community through stipend payments to hundreds of research participants, he said.
North Carolina A&T State University’s Center for Excellence in Post-Harvest Technologies has also incorporated local resources into its food-safety and nutrient-preservation research. The lab frequently studies the prevalence of E. coli, listeria and salmonella, bacteria known to cause food poisoning in humans.
Additionally, said lead food scientist Leonard Williams, the lab shares a five-year, $25 million grant with North Carolina State University to collect samples of the leading food-contamination bacterium norovirus from fruits and vegetables.
Most recently, the lab completed a two-year study examining the quality of locally grown produce sold at farmers markets in counties along the I-85 corridor, including Davidson, Mecklenburg, Guilford and Cabarrus counties. The results, Williams said, have been heartening.
“What’s amazing is that our produce sold at farmers markets is extremely safe. There are very low levels or low incidence of food-borne pathogens detected,” Williams said. “That means our farmers are delivering safe, wholesome supplies of fruits and vegetables to consumers.”
These findings will ultimately – and positively – impact their bottom lines and abilities to market their products, he said.
Whether the individual endeavor is economic or research, Safrit said, the NCRC is on track to bring together campus and surrounding area residents to fulfill its mission of improving human health, agriculture and nutrition.
“It’s really a community effort. We’re seeing people buy into the vision that Kannapolis is going to be about science and health,” she said. “Ten years from now, we’re going to be able to say we made a huge difference in the world with what we’ve learned about nutrition and health. We’ll be able to share with our community and state good health, diet and lifestyle choices.”
To read the article at its original location: http://www.northcarolinahealthnews.org/2014/11/05/research-campus-pursues-the-healthy-life/
Published on the Oct. 30, 2014, DiagnosticImaging.com website
By Whitney L.J. Howell
For U.S. healthcare, new payment models are no longer the catchphrases of the day. They’re also not yet realities. But that doesn’t mean health systems aren’t trying them on for size, searching for one that makes the biggest impact in controlling costs, and pumping up patient experiences.
The question is – what has this meant for radiology so far?
Accountable care organizations (ACOs) are at the top of the new payment model list, but there’s no consensus about whether they’re fulfilling patient-satisfaction and cost-savings goals. In fact, out of the 32 original Centers for Medicare & Medicaid Services (CMS) Pioneer ACOs from 2012 that opted to test this system design, only 19 remain active. The rest dropped out of the pilot, citing either too much financial risk or the inability to meet Medicare savings goals.
Although ACOs are being widely tested, radiology hasn’t jumped whole-heartedly into the process. According to the American College of Radiology (ACR), radiology’s participation, to-date, has been fairly minimal.
“Radiologists are working on being part of integrated care. It’s not due to their lack of trying – it’s more that the payers and the ACOs themselves have had a lot to do in trying to get started,” said Pam Kassing, senior economics advisor in the ACR’s Department of Economics & Health Policy. “They’ve been focusing more on the primary care aspect and what it can offer beneficiaries through a physician base and a central place of care.”
Once that groundwork is in place, she said, more attention will turn toward properly integrating specialties. But, in the meantime, it’s that lack of specialty focus that keeps many radiologists at bay, not wanting to step too far into the new payment model without clearer guidance. They’re cautious, she said, because they’ve yet to see how radiology can benefit from any shared-savings plans.
“It’s unclear whether radiology groups are hesitating or pulling out of the model, but they’re not aggressively moving toward it either,” she said. “How specialists can effectively participate in the program is something that needs to be figured out.”
The ACR, though, is erring on the side of caution and encouraging radiologists to prepare for the ACO payment model through its Imaging 3.0 initiative. Most importantly, Kassing said, radiologists must become more proactive and visible throughout their institutions – sit on committees, get involved in administrative discussions, and take greater roles in team-based care.
The ACO Challenge for Radiology
The idea of sharing savings (and risk) and providing more team-based, patient-centric care is an attractive one to many in the industry. But it also has the potential to place radiology – more than other specialties – in the delicate position of finding the right way to manage and offer its services. And, no matter what radiologists choose, they could experience a negative impact.
According to Steven Seltzer, MD, chair of radiology at Brigham and Women’s Hospital, the ACO model could produce one of two outcomes: referring physicians could see radiologists as unnecessarily rationing diagnostic imaging services or providers could be accused of promoting services without proper consideration of patient needs.
“In the ACO model, if things move all the way to putting the provider organization at risk and they get paid a fixed amount for the entirety of medical services provided, then radiology must do the right thing by the patient – not too little, not too much in providing diagnostic evidence for determining therapy,” he said. “We’re in a fascinating and intimidating transition between two economic models that are paradoxical. In one, the more do you do, the more you get paid. The other gives you a fixed amount, and the less better off you’re going to be.”
In addition, the shift to ACOs could push radiology from a profit center to a cost center, he said. This puts radiology at the center of patient-care decisions that could be tainted by an institution’s bottom-line concerns, such as electing to use cheaper, less-effective alternatives to imaging studies.
With his colleague Thomas Lee, MD, another Brigham and Women’s radiologist, Seltzer wrote in a July issue of the Journal of the American Medical Association the best way for radiologists to maximize their role in this new model is to assume additional responsibilities outside reading rooms. Not only must they be appropriateness-criteria consultants, but they must also give referring physicians feedback on how they use imaging. They should take lead roles in implementing clinical decision support systems and develop image-guided interventions that are less expensive than invasive treatments.
Seltzer acknowledged, however, that for more rural-based providers, reaching those goals in the near future will be difficult. His hope is that smaller, hospital-based departments and community practices will implement the electronic medical records needed to support clinical decision support tools, as well as embrace the call for more consultative services.
There is, though, a more immediate – and frequently discussed – risk to radiology, said John Lohnes, Jr., MD, president of the Wichita Radiological Group in Kansas, an organization associated with a physician-owned ACO. There is the imminent likelihood that radiology will no longer be viewed as a traditional medical specialty.
“The biggest problem I see for radiology within the ACO model is that, more often than not, we’re viewed as a hired service. We have the potential to be further commoditized,” he said. “And, if CMS and others go through with bundled payments, from my perspective, that will lead to even greater commoditization of practices.”
One Practice’s Success Story
Because the onus is on radiology to demonstrate its worth under the new ACO model, Omaha-based, private practice Radiology Consultants of the Midwest took steps to ensure its surrounding medical partners recognized its importance.
“The idea is to make radiologists valuable,” said Patricia A. Helke, MD, Radiology Consultant’s past president. “And, the way you do that is by providing service, so we’ve made a concerted effort to try to provide the best service to our local health system and patients.”
To do this, each of the practice’s 26 providers did as Seltzer suggested. They pivoted from solely being image readers to being more engaged consultants who had greater interaction with referring physicians, as well as patients. An internal committee also launched a three-pronged, hyper-focused initiative that included call reporting, concierge radiology, and traveling interventional radiology to cultivate stronger relationships with referring providers.
With call reporting, each practice provider calls a targeted number of referring physicians monthly to relay clinical findings. Initially, providers concentrated on conveying the most critical results, but over time, they’ve transitioned to calling with less significant findings. According to Helke, most referring physicians have been receptive, leading to closer – and, in some cases, new – relationships.
The concierge service works much like a radiology house call – providers visit referring physicians’ offices on various days to read images. The program is tailored with subspecialty radiologists reading exams in their expertise areas. This move offers several benefits, Helke said. Not only can the radiologists offer more timely feedback, but they also talk face-to-face with the referring physician about appropriate imaging and findings. Additionally, in a step that could increase patient satisfaction, the radiologist gets in-person interaction with patients.
The traveling interventional radiology component works much like the concierge program – interventional radiologists provide their services to local physicians’ offices and hospitals that don’t have full-time interventional radiologists on staff. According to Erik A. Pedersen, MD, Radiology Consultants’ chief information officer, these radiologists have increased their case load by offering their services to referring physicians a few days a week.
Overall, the benefits from this three-pronged initiative have been considerable. To date, Radiology Consultants has seen a 10% increase in referrals. It’s also not uncommon for referring physicians to call with questions about appropriateness or to get second-reads of images their patients have received elsewhere.
“We get lots of phone calls and lots of referring physicians who drop by the department to have us look at cases,” said Pedersen, who is also radiology department chair at Bergan Mercy Medical Center and Boys Town National Research Hospital. “It shows that the relationship is solid, and the physicians trust that what we’re recommending is going to help answer their questions.”
According to Helke, patient approval ratings have skyrocketed to between 90% to 95% because they’re getting their results faster, and they can connect the radiologist’s name with a face. In addition, by compartmentalizing reads and giving providers the latest voice recognition software, the practice has sliced its turn-around time from a day to an hour.
Even though ACOs aren’t the official payment model for the healthcare system, many hospitals and larger health environments are moving in this direction. And, as healthcare goes further down this path, it’s likely, Lohnes said, that the industry’s smaller partners will lag behind the bigger institutions that have already started down the ACO integration path. But overall success is still possible.
“As radiology moves forward as a general entity, we have to be willing to accept risk and learn how to handle that if we’re going to maintain our independence and our standing as physicians,” he said. “By doing so, we’ll be higher on the food chain. That’s where we want to be – that’s our long-term goal.”
Read the article at its original location: http://www.diagnosticimaging.com/practice-management/does-aco-model-commoditize-radiologists?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=31102014#sthash.6BldBTSs.dpuf
Published on the Oct. 30, 2014, Rheumatology Network website
By Whitney L.J. Howell
Not using a rheumatology-focused electronic health record (EHR) yet? There’s no question that, as rheumatologists confront some of the most complex, difficult-to-diagnose conditions in medicine, an EHR well-designed for rheumatology could be great for tracking unpredictable symptoms, monitoring complicated treatment plans, and assessing outcomes.
But does it exist?
According to a study by the market research firm KLAS (Ambulatory EMR by Specialty Study 2012: Finding the Fit,), most specialists including rheumatologists want EHR systems that address their specific needs and requirements. But it says that today’s specialty EHRs fall short, ranking lower in satisfaction (6 vs 7 out of a possible 10) than more generalized tools.
“It is extremely concerning that the average satisfaction in existing EHR implementation is alarmingly low,” said John Bartley, MD, chief medical director for cloud-based EHR vendor iPatientCare. He blames this on a disappointing record among current EHRs for providing specialty-focused, customizable features, for communicating adequately with other providers (labs, pharmacies and other doctors), and for offering satisfactory customer support.
The Benefit of Rheumatology-Focused EHRs
The American College of Rheumatology offers guidance on available rheumatology-template EHRs, and numerous vendors including Cerner, CureMD, 1st Provider’s Choice, and OmniMD do market template-based EHR systems customized for rheumatology.
Some experts say that specialized EHR systems are easier to learn quickly. Other useful features:
Stylus entry: Some systems, including Greenway, let providers circle joints with a stylus – harking back to pen and paper – to indicate problem areas.
Targeted popups: A recent study from Roudebush VA Medical Center in Indianapolis found that these alerts often target pharmacists, not physicians. Physicians get confused and ignore them, potentially jeopardizing patient safety. A specialty-specific EHR could reduce this problem by offering only popups relevant to the user, the report said.
Pre-populated templates: Along with condition-specific decision support, prespecified options make it easier to complete face-to-face patient assessments. And drop-down menus that offer diagnosis variables may improve on keying the information in manually. (Experts say that’s true only if the user doesn’t need to click more than three times on a list.)
“One would think that having drop-down menu options based on those pre-coded by other rheumatologists might make charting super easy and fast,” said Rebecca Muntean MD, a rheumatologist at Providence Health & Services in Washington. “At the time same, it might lose the individualistic nuances that each patient with the same disease might have.”
Many industry leaders stressed the importance of having rheumatologists participate in EHR design and coding for their specialized systems. For example, Modernizing Medicine’s new product, EMA-Rheumatology, asks condition-specific questions based on content written by a panel of rheumatologists.
What Rheumatology EHRs Still Need
Other specialty features that knowledgeable sources say would be especially useful in rheumatology:
1. Collecting patient-reported health assessments and disease activity information,
2. Fields to capture therapy attempts that were unsuccessful, and
3. Enhanced access to laboratory and diagnostic imaging reports
But the key missing ingredient, perhaps, is a way to make it worth rheumatologists’ investment of the time and attention to customize and then use a specialized system.
According to Vandana Ahluwalia MD, rheumatology chief at William Osler Health System in Ontario, Canada, getting providers to adopt a rheumatology EHR has been a stumbling block.
“We surveyed our rheumatologists to see if they were actually using our new EHR system and how they felt about it. We assumed they were expert or super users,” she said. “The majority said they weren’t using it.”
The hang-up? Implementing the EHR correctly demanded a large investment of time and energy to program the system. Most rheumatologists in the practice weren’t willing to shift their focus away from active patient care.
Ultimately, Ahluwalia predicted, implementing rheumatology EHRs will help create more consistent patient-care delivery across the specialty.
“It’s really important that we enter data in a standardized way so we can start to reduce the variation of care delivery,” she said. “We must create a way in which we all do the same things and do it according to set criteria or guidelines that deliver the best possible care that we can.”
To read the story at its original location: http://www.rheumatologynetwork.com/rheumatic-diseases/rheumatology-specific-ehrs-whats-right-and-whats-not-yet#sthash.ESY9AdAe.dpuf
Published on the Oct. 9, 2014, DiagnosticImaging.com website
By Whitney L.J. Howell
When it comes to having an imaging study, patients can identify most of the team members. They recognize the radiologist, the technologist, and the nurses involved. But the one team member they might not know exists – the medical physicist – is the one who often plays the biggest role in keeping them safe.
In the United States, there are approximately 8,000 medical physicists working in hospitals and clinics. However, even in 2014, not every state requires that a medical physicist be part of a diagnostic imaging management team. Currently, according to the American Association of Physicists in Medicine (AAPM), 19 states offer neither licensure nor registration for this profession.
“A lot of people don’t know what medical physicists do. We’re very behind the scenes,” said Jessica Clements, medical physics director and radiation safety officer for Texas Health Presbyterian Hospital in Dallas. “Radiation is all over the hospital, so we play an important role because of the widespread use of medical imaging and radiation.”
And, while the medical physicist job affects the technical intricacies of diagnostic imaging services, much of what these individuals do also has both a direct and indirect impact on patient care and satisfaction, she said.
Who Are Medical Physicists?
At the core, medical physicists apply physics to providing clinical services in diagnostic, nuclear, therapeutic, and mental health physics. They’re in charge of managing the technological components of radiology, radiation oncology, and nuclear medicine.
In fact, they’re solely responsible for making sure the equipment used to provide imaging studies is calibrated and being used correctly.
“It’s necessary for every radiology department or practice to have a medical physicist examine their equipment annually, at least, for accreditation purposes,” said Richard Morin, PhD, professor of medical physics at Mayo Clinic. “Now-a-days, that accreditation is important because otherwise, it means the facility might not be paid for services rendered by Medicare.”
These check-ups are particularly important for mammography facilities, he said. Those that aren’t inspected yearly could not only lose their accreditation, but they could also lose their certification, accrue fines, or face imprisonment.
But medical physicists’ impact goes further than checking machines. On a daily basis, they take steps to improve patient care.
Creating Quality Care
The AAPM identifies three fundamental roles a medical physicist plays, whether they work in a neuroradiology department or a musculoskeletal clinic. They teach, they participate in research, and, most importantly, they are active in clinical care.
According to Clements, it’s their responsibilities with the imaging machines that are the most important. Measuring the radiation dose of all modalities and examining the image quality directly affects patient safety.
“It might seem like a small function, but that one piece touches hundreds of patients – a CT scanner may be used on 100 patients a day,” she said. “Making sure the dose and protocols are optimized and the image quality is good has a huge impact.”
Medical physicists also play a vital role in selecting equipment, Morin said. Frequently, practices bring a medical physicist in as a consultant to guide them through purchasing decisions. It’s a tactic that helps practices make the wisest decisions with their funds available for capital expenditures.
“When a practice decides to buy new equipment, they want someone to translate for them what they hear from vendors into what they need to know before spending the millions of dollars that equipment will cost,” he said. “As a third party, a medical physicist can assist the practice in knowing whether a vendor is saying something that may be partially correct but that won’t work the same way for that particular practice.”
As the radiation safety officer for a facility or practice, medical physicists are also responsible for educating patients and other providers about how pervasively radiation can affect the body. For instance, if an unknown pregnancy is discovered during a study, the medical physicist would counsel the radiologist or referring physician on the best way to address the subject with the patient.
But, Clements said, there are also instances where medical physicists talk with patients one-on-one. Patients undergoing treatment for thyroid cancer often have a post-surgery, follow-up procedure where they receive injections of radioiodine. By collecting in any leftover thyroid tissue, the radioisotope identifies any remaining cancer in the body. However, only 5% of the radioiodine collects in the thyroid tissue, leaving the patients bodily fluids radioactive for three days and restricting them to complete isolation.
“This is where the medical physicist steps in. We connect to them and talk with them about their home life to make sure they understand what they can and cannot do safely,” Clements said. “Not only does it protect them and the people they live with, but it protects the general public, as well.”
Being a Team Player
Although a medical physicist’s role is fundamental to patient safety, these professionals can’t do the job alone. They must partner with radiologists and technologists to ensure imaging protocols are designed properly, Clements said. They work together like a check-and-balance – the radiologist or technologist will tell the medical physicist if a certain action isn’t possible with a particular scanner.
If they don’t collaborate, she said, there’s a danger of over-exposing a patient or using too little radiation to secure a good image, making a duplicate image necessary.
“Protocol management takes all three members of the team,” she said. “The radiologist has to say what image he or she wants, the technologist acquires it, and the medical physicist is the go-between, helping them optimize imaging dose and quality.”
There’s also a growing push, Morin said, to increase the medical physicist role with information technology (IT) departments. Although IT professionals control the movement of an image from equipment to reading station, it’s the medical physicist who understands how the image is acquired. A 2009 study published in the Journal of Applied Clinical Medical Physics reported medical physicist involvement is particularly important with intensity-modulated therapy, image-guided radiation therapy, 4-D radiation therapy, electronic medical records, and paperless clinics.
“Data integrity from one step to the next must be preserved. The data is used often and must be available in real time at the treatment machines,” the authors wrote. “The medical physicist understands the workflow and the data transactions, and must, therefore, be involved in all IT decisions that affect patient care.”
Basically, Morin said, radiology practices should think of the medical physicist as the quarterback of image management – the player who brings together the skill sets of all other individuals involved in radiology patient care.
“The idea is team work, and often the medical physicist is the person who can assemble the team and provide the direction so a practice can be assured that things will go well,” he said. “Their presence makes it possible, that if patients have any questions about the amount of radiation, for facilities to say that they have someone watching out for and over their patients.”
Read the article at its original location here: http://www.diagnosticimaging.com/practice-management/medical-physicists-and-quality-care-radiology?cid=tw
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.
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.”
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
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