Whitney Palmer

Healthcare. Politics. Family.

Wanted: Radiology Resident Leaders

Published on the Nov. 26, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — With challenges looming on nearly every front, radiology needs a new group of strong leaders to navigate the trials and strengthen the profession, industry experts said at this year’s RSNA annual meeting.

Given proper leadership training, current radiology residents are positioned to be the profession’s next generation of leaders. But their training — if not already underway — must begin now if they’re going to fill the current void in the industry, said Richard Gunderman, MD, professor and vice chair of radiology at the University of Indiana.

“There are lots of radiology departments in the United States that lack leadership. Many have titular leaders, but in fact, they’re not being led or they’re being led poorly,” he said. “A lot of capability of the faculty and resident is lying dormant, and people are becoming more disengaged and discouraged than invigorated and encouraged.”

He recommended that faculty engrain in their residents the importance of team work — group accomplishment over individual successes — and embrace a leadership model that encourages others to work to their potential and contribute to either their practice or department.

It’s also paramount, he said, to encourage residents to think creatively so they will be best prepared to tackle future roadblocks.

“The single most important aspect of our residents isn’t their technical skills or their cognitive knowledge base. It’s their imagination,” Gunderman said. “What are we doing to foster the development of imagination in this next generation of radiologists?”

And, that creativity and outside-the-box thinking will be vital to addressing the difficulties the industry already knows are coming. Declining reimbursement, a new payment model, decreasing case volume, and encroaching teleradiology companies are just a few of the changes that threaten to erode the influence radiology departments and practices currently enjoy, said Vijay Rao, MD, chair of radiology at Jefferson Medical College at Thomas Jefferson University.

Surviving these trials requires a cultural shift in priorities that must start with residents, she said. Rather than perpetuate the culture of entitlement that is pervasive in many corners of radiology, faculty and private practitioners should teach residents to focus on quality and putting the patient first.

“We need to cultivate professionalism and eradicate apathy in the profession,” she said. “We must focus on reducing or eliminating inappropriate studies and doing the right thing by the patient.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116427

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December 5, 2012 Posted by | Healthcare | , , , , , , , , , , , , | Leave a comment

How to Make the Most of Your Speech Recognition Software

Published on the Nov. 27, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — If you’re using speech recognition software, you’re likely saving yourself some time with dictation. But, are you sure you’re getting the most out of the technology? Chances are, the answer is no.

The goal of this tool, David Weiss, MD, a radiologist with Carilion Roanoke Memorial Hospital in Roanoke, Va., told a group at this year’s RSNA annual meeting, is to make your work faster and more efficient. There are strategies you can use to optimize what speech recognition (SR) software can do.

He offered these tips for training your SR software to accurately record your dictations with as few errors as possible.

1. Be consistent in your diction. Always use the same phrases to describe a finding or a process. If you must make a correction, fix the entire phrase rather than a single word. SR software doesn’t identify individual words. It works mainly off of context, so it will eventually recognize certain phrases and record them correctly.

2. Speak in a deeper voice. Most SR software is programmed to respond best to a male voice without an accent. If your software is routinely making errors, try lowering the pitch of your voice to see if that will improve performance. Also, wait a few seconds after pressing record. Most microphones have a slight delay, so if you begin speaking immediately, the SR software won’t be able to catch your first syllables.

To view the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116268

December 5, 2012 Posted by | Healthcare | , , , , , , , , , | Leave a comment

The Renaissance of the RIS

Published on the Nov. 27, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — For several years, radiology has largely considered RIS to be a technology that has reached its limits. But the light of development is once again shining on this workhorse tool. And, according to industry experts, even more advancements are coming.

“Today’s RIS doesn’t handle your advanced workflow well,” said Paul Nagy, PhD, director of quality in Johns Hopkins University’s radiology department. “But, there’s a renaissance of functionality coming for the RIS that wasn’t there before. An increasing number of vendors are beginning to develop new RIS systems.”

In the future, he said, your RIS will not only be able to handle advanced work flow, but it will also provide capabilities for peer review, second opinions, discrepancy reporting, and notifications for when patients return for follow-up visits.

The search function in your RIS will also likely improve. Currently, it can take up to 10 seconds for the system to retrieve requested work lists. Commercial vendors are now working to make data retrieval with your RIS even easier, he said.

“It will be Google meets the RIS,” Nagy said. “The ability will be to search quickly — instantly. It’s a great idea of indexing all this patient information and having the data at your fingertips. Such powerful search tools don’t exist in traditional RIS, but it’s coming and will spread throughout the industry.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116292

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Building a New Radiology Reading Room: Lessons Learned

Published on Nov. 27, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — Take a look around your reading room. If it looks the same as it did 10, 15, maybe 20 years ago, it’s time for an update — STAT. Your productivity could be far lower than it should be, and you and your colleagues could be experiencing physical damage.

“There’s never been a more critical need for improving the ergonomics of the radiology reading room,” Eliot Siegel, MD, a diagnostic radiology and nuclear medicine professor and vice chairman of informatics at the University of Maryland, told a group at this year’s RSNA annual meeting. “Volume and complexity is at an all-time high. I can’t overstate how important this is.”

Complaints of repetitive motion disorders, neck strain, and eye fatigue are growing among providers, he said, and many are retiring early on disability because of these ailments. Radiologists at University of Maryland considered these issues when redesigning their reading room after converting to a completely filmless system. The process was long, and they made mistakes. Eventually, however, they identified the best characteristics of reading rooms that minimize stress and maximize productivity.

Here are Siegel’s suggestions:

1. Find the right lighting. Abandon any overhead, fluorescent lighting immediately, and create as close a match as possible between the brightness of your workstation monitors and the ambient light. Without that match, reading time and provider fatigue will increase while accuracy decreases. Also, consider providing your radiologists with individual ambient lighting and task lighting. They will work best in an environment that feels the most comfortable.

2. Give yourself control of your climate. You wouldn’t buy a car without heating or air conditioning you could control at the push of a button. Don’t design a reading room where you don’t have the ability to manage air flow or manipulate the temperature. Work with your colleagues to find an agreed upon temperature, and choose wisely. The wrong temperature will decrease efficiency. For most people, optimal temperature hovers around 78 degrees Fahrenheit, but highest productivity frequently occurs a few degrees below that.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116706

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Splitting With Your PACS Vendor

Published on the Nov. 28, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — In many ways, your relationship with your PACS vendor is like a marriage: good times when the system works well, bad times when it needs maintenance. There’s no doubt, though, that you’re relatively stuck together, and splitting is both painful and hard.

Changing your PACS vendor isn’t a decision to make lightly. You’ll face significant challenges to making the switch, but it can be done, Steven Horii, MD, the director of medical informatics in the University of Pennsylvania radiology department, told a group at this year’s RSNA annual meeting.

Your biggest problem, he said, is the several terabytes of data currently sitting in your existing PACS. All that information must be migrated over to your new system.

“Look at what it will take to transfer your data as far in advance as possible,” he said. “We put DICOM images in there, but the problem is that vendors don’t store our data that way. They use proprietary database tables and reassemble an image into DICOM format when you ask for it. It’s not as simple as going to the archive, putting in a flash drive, and pulling out your data.”

To get the best result, you should begin the migration with at least the past one to two years. That should cover roughly 80 percent to 90 percent of your studies, he said.

With that much stored information, though, there will be mistakes. Patients could have multiple record entries under slightly different names, studies could have been entered with incorrect request numbers, or you could have records for dead-end or orphan studies. It will take time to fix these errors, Horii said, and you will either need to do them manually or with additional software.

The time it takes to migrate your data can also present difficulties. Horii recommended you have a frank conversation with your new vendor about a realistic time frame for how long it will take to make the switch. Many times, new vendors provide time estimates based on having 100 percent to your PACS system. Unless you intend to shut down your practice until your new system is functional, that’s not a feasible option. Determine how much access you can give them each day to accurately pinpoint when your new PACS will be ready to work.

If your new vendor misses that migration deadline, you can encounter problems, especially if your old PACS is running low on storage space. In these cases, Horii said, negotiate a reduction in the migration fee so you are compensated for the added stress and delay.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116754

December 5, 2012 Posted by | Healthcare | , , , , , , , , , | Leave a comment

Focus on CT Effectiveness, Not Its Theoretical Risk

Published on the Nov. 28, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — Every so often, a sudden flurry of articles proclaiming the dangers of radiation dose from CT hits newspapers and magazines, warning patients to resist when their doctors recommend the study. It’s now time for radiologists to start pushing back and having conversations with patients about what CT actually does, industry experts said.

The problem, Michael McNitt-Gray, PhD, a radiological sciences professor at the David Geffen School of Medicine at UCLA, said at this year’s RSNA annual meeting, is that patients — and many providers — don’t understand what CT dose actually means. Consequently, many are vastly overestimating levels of radiation exposure.

That’s why open communication between physician and patient is so critical, said Cynthia McCollough, PhD, biomedical engineering and medical physics professor at the Mayo Clinic in Minneapolis. If providers don’t discuss the significant benefits of CT weighed against its relatively minor, and unverified, radiation risk, patients could forgo studies that might help them avoid a fatal disease.

In fact, McCollough said, her practice sees a substantial number of canceled CT appointments when media reports about radiation risk appear.

“Referring physicians and patients need to know that reducing the use of CT will delay care — our modalities will be clogged, trying to handle the additional volume of studies,” she said. “They won’t know why CT is important if we don’t tell them.”

Education is key to reducing the public’s fear about radiation exposure. And, McCollough recommended having one-on-one conversations when possible and disseminating specialty-specific brochures about the benefits of CT to patients.

It’s also important to reassure patients that radiologists are adhering to the ALARA principle for dosing levels — As Low As Reasonably Achievable. But providers should be wary of swinging the dose pendulum too far. Extremely low doses will negate the test’s efficacy, she said.

For some patients and providers, however, demonstrating low-dose fidelity won’t be enough. In those cases, it can be beneficial to discuss the American College of Radiology (ACR) Appropriateness Criteria that regard CT as an optimal modality for several studies in many disciplines, including neurology, cardiothoracic, vascular, gastroenterology, and urology. In fact, 30 percent to 60 percent of the time, ACR deems CT to be one of the most appropriate for studies, and 10 percent to 40 percent of the time, the ACR considers it the most appropriate study.

It’s also important for patients to understand that multiple CT scans do not increase their cumulative risk of developing cancer, said Robert Dixon, MD, associate professor of vascular interventional radiology at the University of North Carolina at Chapel Hill School of Medicine.

“Repeated CT scans are not at all like chopping down a tree,” he said. “Each axe blow weakens the tree until it topples with the last blow. That doesn’t happen with CT.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116769

December 5, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , | Leave a comment

Patient-centered Care: A Nurse’s Perspective

Published on the Nov. 29, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — You might consider yourself and your practice to be fairly patient-centered. Chances are, though, you’re not. Or, at least according to one nurse who’s worked with breast cancer patients for 15 years, you could be doing more.

“You need to see the world through the eyes of the patient,” Lillie Shockney, RN, nurse director of the Johns Hopkins Breast Center Cancer Survivorship Programs, told a group at this year’s RSNA annual meeting. “You need to understand how patients will see, hear, and feel the results – no matter what the news is.”

Always remember these women are scared, and they’re searching for clues about their condition in anything you do. If they can’t see the monitor you’re using to read their scans, does that mean you’re hiding bad news? If you’re out of the room too long, are you discussing something horrific about her case with your colleagues?

You can help allay these fears or help prepare a patient for bad news, Shockney said. Drop hints about what you see during the procedure. While you might not want to explain everything you’re seeing to the patient at that time, giving clues about anything good can help soothe her. Be careful that you don’t provide any false hope, however.

“I’ve been in the presence of some radiologists who’ve said, ‘You’re going to be fine,’” she said. “They were patronizing the patient, patting her on the shoulder, and I knew from looking at the screen that the next day, she was going to get bad news. Patients really do need to be prepared for that.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116952

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Radiology: Make It About the Patient

Published on the Nov. 29, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — In this health care environment, you’re being asked to do a lot: Control your costs. Reduce your dose. Collaborate with referring physicians and other providers. But the most important thing you can do, according to industry experts, is focus on the patient.

Shifting your emphasis from maximizing your productivity to optimizing your patient’s experience will likely mean changing your practice model or shuffling your priorities, but it’s the right thing to do, said Brent Wagner, MD, a radiologist with West Reading Radiology Associates near Philadelphia, at this year’s RSNA annual meeting.

“As radiologists we might see two or three patients a day,” he said. “Each of those interactions should be perfect. It’s our job to make them perfect.”

To get as close to that perfect as possible, Wagner offered a five-step road map.

First, he said, you must accept that finding a balance between fulfilling your patients’ expectations and maintaining an efficient practice is imperative. Either extreme — focusing solely on the patient or completely on your practice — is an unsustainable model and will drive you out of business.

One feasible option for moving your practice toward patient-centeredness is to utilize the manpower that could already be at your disposal. Rather than taking on added on-call duties, shift this responsibility to your residents. This way, patients have easy access to a radiologist who can answer their questions, and residents gain hands-on experience with provided patient-centered care.

In addition, don’t ignore the low-hanging fruit. Look around for opportunities that can push you toward focusing more on your patient. For example, Wagner said, if your practice is associated with a hospital emergency department, take steps to streamline your read process so you’re getting the report to the emergency physician before the patient returns to his or her room.

You also have ready-made opportunities with patients, said Volney Van Dalsem, MD, a radiologist with the Stanford Medicine Imaging Center in Palo Alto, Calif. Take the time for face-to-face contact, no matter how brief it is.

“We make a point to try and meet every patient. To say hello and thank them for coming to our facility,” he said. “We introduce ourselves and give them information about when their report will be available.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2117006

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Threats to Radiology and the 20 Ways to Beat Them Back

Published on the Dec. 3, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — It’s a common topic of conversation in radiology today: The profession is under attack from several fronts. This lament is most certainly true, but there are several ways to conquer these problems, industry experts said at this year’s RSNA annual meeting.

But before you know how to fix the situation, said Jonathan Berlin, MD, associate professor of radiology at Northwestern University Feinburg School of Medicine, you have to understand the forces working against you.

The Threats

1. Declining reimbursement: This issue is no surprise. Since 2006, Medicare reimbursement as slowly dwindled. Until recently, the drops only affected the technical component, but this year, CMS retained the multiple procedure payment reduction (MPPR) to the professional component. It will eliminate 25 percent of the payment you receive for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice, during the same session, on the same day. Add bundled payments, combined codes, and the new accountable care organization model, Berlin said, and CMS is whittling away your reimbursement.

2. Bad job market: Ask any radiology resident, and he or she will tell you there are simply no jobs available in the field. Confusion around reimbursement and the radiologist’s role in health care has prompted many practices and departments to freeze any hiring efforts. Less job opportunity is already equating to fewer medical students pursuing radiology as a specialty, and existing resident morale is at an all-time low, he said.

3. Commoditization: In recent years, rather than focus on all the work associated with diagnostic imaging — the pre-, intra-, and post-service — radiology has placed the greatest emphasis in image interpretation. And hospitals and referring physicians have followed suit, giving the profession the reputation for being a commodity rather than an integral specialty. Many facilities now outsource their image reading to the lowest bidder, and many insurance companies now steer patients to facilities that offer services at the lowest cost.

4. Teleradiology companies: Although shifting night reads initially seemed like a good idea, corporate teleradiology companies are now expanding beyond nighthawk work. Many are now stealing hospital contracts away from local radiology practices, promising to offer high-quality care at reduced cost.

5. Medically-inappropriate imaging: CMS and other health care agencies now estimate that 35 percent of all imaging studies conducted are unnecessary and don’t contribute to diagnosis. A major reason for this is self-referral, non-radiologists who purchase scanning equipment in order to perform studies without sending a patient to an outside radiology practice. In many cases, the physicians are practicing defensive medicine, but they lack the proper skills to correctly interpret studies.

While these challenges are significant, said Vijay Rao, MD, chair of radiology at Jefferson Medical College at Thomas Jefferson University, there are many strategies at your disposal to reverse these trends.

1. “Take back the night”: Don’t outsource to teleradiology companies, and don’t work for them. Instead, find a way to bring night reads back into your practice.

2. Consolidate: If your practice is too small to handle night reads alone, consider merging with a larger group or multiple groups. This move can also increase your ability to offer subspecialty services. Mega-groups, she said, will likely be very common in the future of radiology.

3. Affiliate: Free-standing practices are vulnerable under the new models of care. Contract with a hospital or a larger multi-specialty group. You could even consider becoming a hospital employee. Any of these decisions would help protect your revenue.

4. Build bridges: Work on your relationships with hospital administration and become more active in hospital management structure and culture. Currently, most of these relationships are strained, Rao said, but you can nurture them by serving on committees, getting involved with quality and safety measures, or participating in strategic planning or marketing efforts. Jumping into the hospital culture will show that radiologists add value.

5. Manage your department: Don’t be afraid to take on more responsibility for your department’s management; Hospital administration is generally amenable to letting you do this, and you could get paid for it. Create financial targets and propose getting a portion of the savings if you meet the goal. The more you show administrators you’re a team player and can help control costs, the less likely you are to lose out to a teleradiology company, she said.

6. Control image utilization, even if it hurts: Do everything you can to make hospital leadership understand the importance of order entry and decision support systems. It might take money out of your pocket, but it’s the right thing to do for patients, Rao said. As with department management, work on an arrangement where your department and the hospital split the cost savings from reduced imaging equally.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2117464

December 5, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

   

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