Whitney Palmer

Healthcare. Politics. Family.

Rheumatology-Specific EHRs: What’s Right and What’s Not (Yet)

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


October 30, 2014 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | 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

The Rise of Mobile X-Ray Technology

Published on the Nov. 9, 2012 DiagnosticImaging.com website

By Whitney L.J. Howell

Across the health care industry, mobile X-ray technology is increasing in popularity, and demand for equipment that brings technologists out of fixed X-ray rooms has spiked.

The biggest factor driving the uptick in use, industry experts say, is the need for better bedside imaging, most of which has already moved to digital from computed radiography or analog. Traditionally, obtaining quality images for the sickest patients — those most often located in intensive care units — has been not only time-consuming, but also logistically difficult.

However, based on the findings of a recent report from the health care research firm KLAS, the convenience of taking images at the bedside is now leading to additional advancements in the power management and wireless capabilities of this mobile technology.

“With these new mobile X-ray units, the near-instant access to the images at the patient side has providers asking for more,” wrote Kurt Ising, the report’s author. “Mobility and image quality are key enablers for this trend, while wireless connectivity and battery life are areas where most vendors can improve.”

KLAS analysts also found mobile X-ray vendors have seen a significant rise in the use of their equipment this year, especially in the most acute care settings, such as the emergency department, ICUs, and operating rooms. For example, EDs have augmented their mobile X-ray use by 100 percent in some instances, and ICUs and ORs report up to 89 percent and 60 percent jumps in utilization, respectively.

Increased Use and Its Benefits

Some industry experts credit the usage increase to the expanding variety of mobile, digital X-ray equipment available. And, the push driving that trend is consumer demand for change.

“I think this is one of those situations where there was a way people did things in mobile imaging for so long that people started to believe there was no other way of doing it,” said Helen Titus, X-ray solutions marketing director for Carestream. “Now, radiologists and technologists have challenged vendors to come up with very innovative ways of changing how people do bedside imaging.”

Caresteam, which already has one mobile X-ray product on the market, the DRX-Mobile Retrofit, recently introduced the DRX-Revolution. This wireless, digital X-ray system is the first machine to have a fully collapsible column, the company said. In its completely-retracted state, the machine stands only four feet tall, making maneuverability around the hospital easier, Titus said. With two touchscreen displays — one on the body of the machine and one that hovers over the patient — the DRX-Revolution also lets the technologist make adjustments at any time.

But it isn’t just the call for change to the equipment itself that is fueling the desire for mobile and wireless technology. It’s the main benefit it brings to the patient, the radiologist, and the technologist: time savings.

“This type of technology is as much about the benefit to the radiologists as it is to the clinician,” said Jie Xue, mobile X-ray and fluro general manager for GE Healthcare, manufacturer of the Optima XR220amx. “The immediate feedback of the digital technology allows doctors to see images on the screen instantaneously. They can see images in about 10 seconds and move on to the next patient without delay where before with CR and analog machines, precious minutes would be lost waiting for the image to be retrieved.”

This speed and accuracy can be very help in many situations, such as running a peripherally-inserted central catheter (PICC) line for a patient in the ICU. But the advantages of this technology also extend to the technologists who are responsible for taking the images, he said.

Susan Moody, a radiologic technologist and clinical manager of portable and OR imaging at the University of Rochester Medical Center (URMC), agreed. URMC recently purchased five Carestream DRX-Revolutions. Technologists no longer have to take cassettes to be developed in a dark room and then wait for them to be read by a radiologist, she said. And, with wireless technology, they no longer have to watch out for the various cords that once tethered detectors to the X-ray machine.

“Wireless, digital X-ray technology makes our jobs a lot more efficient and a lot easier,” she said. “There’s less running between patients rooms, and if we get a bad image, we can retake it immediately.”

Mobile, digital technology also reduces the risk that patient images will become mislabeled or misplaced, said Greg Cefalo, digital radiography business manager, with Agfa Healthcare, vendor of the HealthCare DX-D 100. Such technology eliminates much of the likelihood for human error, he said.

“There have been plenty of times where accidents happen. The X-ray cassettes have been dropped and confused,” he said. “With wireless, mobile machines, technologists can go to the patient, pull his or her name off their barcoded wristband, and the machine captures who they are, automatically connects the images, and can send it back to your PACS before you even leave the patient’s room.”

Ultimately, this technology can reduce repeat scans and limit dose exposure, he said.

A third vendor model, the Shimadzu MobileDaRt Evolution Wireless, also promises time-saving benefits. This machine boasts a three-second display time of images taken at the bedside, making it easier for providers to intervene quickly in dire situations.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/digital-x-ray/content/article/113619/2113071

November 9, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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