Whitney Palmer

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In Radiology, Man Versus Machine

Published on the Feb. 11, 2016 DiagnosticImaging.com website

By Whitney L.J. Howell

Call it artificial intelligence. Deep learning. Computer cognition. Whatever its name, it’s the same thing – machines recognizing clinical problems in digital images ahead of the radiologists charged with making the diagnosis.

The artificial intelligence (AI) trend is new, but it’s gaining ground quickly, according to industry experts. The advent of these technologies and radiology’s growing interest in and dependence on them has been discussed at national and international meetings, including the RSNA, HIMSS, and SIIM annual meetings, during the past year. But, there’s still a long way to go.

“We’re just barely scratching the surface of using artificial intelligence in the last few years,” said Eliot Siegel, MD, professor and vice chair of research information systems for the University of Maryland Department of Diagnostic Radiology and Nuclear Medicine. “There’s an emergence of increasing interest in the largest companies in the world, including Google, Microsoft, Apple, and IBM, in actually starting to use these technologies for data extraction and evaluation.”

AI opens the door for radiologists to compare new images with similar, existing ones, said Siegel who also serves as the chief of imaging for the VA Maryland Healthcare System and has spoken about AI use in radiology.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/pacs-and-informatics/radiology-man-versus-machine


February 11, 2016 Posted by | Healthcare, Science | , , , , , , , , , | 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

Mobile Computing in Radiology: the Challenges and Benefits

Published on the Feb. 12, 2013, Diagnostic Imaging website

By Whitney L.J. Howell

Hospitals and physician practices are full of electronic sounds. The whir and clunks of imaging equipment. The quiet hum of patient monitors. The background buzz of computers. In recent years, though, a new sound has become ubiquitous: the ding of the text message or mobile email. Smart device technology has come, full-throttle, to radiology.

More than 80 percent of physicians own and use mobile devices, according to recent surveys, and, a 2011 Jackson & Coker Associates study reported nearly 25 percent of radiologists were already using them clinically. That number has only grown in the past two years, said Jon DeVries, vice president of product solutions at Merge Healthcare.

“At any industry event or session, every single radiologist comes in with some sort of handheld device. Every single one of them is using mobile technology to some extent. It’s a massive trend,” he said. “It’s changing the way people practice. Diagnostics are still done at work stations, but it’s changed how they collaborate, form partnerships, and provide care.”

A Culture Shift

Radiology has always been the early adopter of technology in health care. But, even among this forward-thinking specialty, introducing and incorporating mobile devices into everyday use required a cultural shift. The biggest factor, said Rasu Shrestha, MD, vice president of medical information technology at the University of Pittsburg Medical Center (UPMC), has been provider age.

“One of the key things we’re seeing is an entirely new generation of clinicians that has always been used to technology, and they’re developing a level of comfort and acceptance of mobile devices in the industry,” he said. “Even other clinicians are getting accustomed to this notion of always being ‘on.’”

The ready-made access to colleagues that mobile devices provide has also helped nurture the spirit of collaboration within the specialty. As mobile devices and apps move from being novelties into mature technologies, Shrestha said, radiologists and other clinicians are more easily able to work together as a clinical care teams. Being mobile has gone from being trendy to being a necessity.

“A little more than a year ago, ‘apps’ and ‘mobile’ were buzzwords,” he said. “Now they’re accepted as part of workflow, and they’re well integrated.”

One of the greatest outcomes of increased provider comfort with mobile technology has been improved communication between provider and patient. Providers can now display images on a tablet for patients to see, and viewing the studies on a smaller, more familiar device — rather than a large, clinical screen — can be less intimidating for the patient.

Improving Communication

Perhaps the biggest way smartphone and mobile device technology has touched radiology is through enhanced provider communication, DeVries said. Whether it’s with critical care or emergency patients, mobile technology has streamlined the way radiologists and referring physicians discuss patient care.

“The big area where we see radiologists using smartphones and tablets is in the way they interact with colleagues,” he said. “These devices give them the freedom to get out of the reading room and out onto the floor so they can have face-to-face interactions with co-workers and patients. It’s enabled them to build better relationships.”

Mobile technology can even help you stay connected when you’re away from your hospital or practice. Various apps for the iPhone, Blackberry, or Android let you quickly look at scans so you can discharge patients or initially evaluate a trauma case. These apps aren’t intended to be used for true diagnostic reads, DeVries said, but they do keep the process of patient care flowing.

Herman Oosterwijk, president of Texas-based health care technology training and consulting firm Otech, agreed that mobile devices are the lynchpin of prompt communication and timely patient care. While reaction time to an email might be slow — often more than an hour — responses to text messages are frequently instantaneous.

“Texting and communication between smart devices is incredible,” he said. “People are always listening for that ‘beep’ or ‘ding-dong’ that alerts them that someone wants to tell them something.”

According to DeVries, Merge’s iConnect product offers you this kind of immediate access. The zero-client viewer can be launched through any electronic medical record system and can pull images from any PACS. Carestream’s Vue Motion software also offers similar capabilities, presenting you with patient information quickly to avoid any slow-down in care.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2128049

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

Vendor-Neutral Archives: The Rapid Shift in Image Archiving

Published on the Aug. 24, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When it comes to image storing, PACS still rule the industry. But vendor-neutral archives (VNAs) — products that help you store and share studies across manufacturer systems — are gaining market share fast.

While only 5.4 percent of the nearly 1.5 billion worldwide imaging studies were stored by VNAs in 2011, VNAs are expected to archive more than 30 percent by 2016, according to a May 2012 InMedica report. In fact, a 2012 KLAS report found 27 percent of providers already plan to include VNAs in their image-storing strategies.

“As we’re moving into health care reform, sharing data with other hospitals to coordinate care will be tough if we have to do it across 10 different PACS vendors,” said Chris Tomlinson, executive director of Radiology Associates of The Children’s Hospital of Philadelphia. “By purchasing a VNA, we could segment ownership from the viewers we read things in. It was like getting out of PACS jail, and it’s a great way for radiology to take a lead role within an institution.”

The shift toward VNA implementation has been — and, by most estimates, will continue to be — rapid. And, it’s a move that will impact your purchasing decisions, your image management, and how you shuttle images between institutions. The question, however, is what those impacts will look like.

Making a Purchase

Whether you work in a private practice or a hospital, roughly one-third of image CDs sent from one institution to another are unreadable because the PACS systems are different. This problem has long been understood as a patient-care issue, but it’s also a financial one, said Steve Tolle, senior vice president for solutions management for Merge Healthcare, vendor for the VNA system iConnect.

“Every image CD sent costs about $15 in addition to staff and physician time,” he said. “A hospital can spend between $60,000 and $70,000 annually on courier costs just shuffling CDs between hospitals. That’s a hard savings that can be had with the enterprise and share functionalities of a VNA.”

But you must be careful when selecting a VNA. Examine potential VNA vendors carefully, said Michael Gray, lead consultant at Gray Consulting, because some have modified their marketing efforts to sell PACS systems as VNAs. After you’ve narrowed your vendor choices down, request quotes from each. Remember, if the price tag is high, you can implement a VNA in stages, such as only replacing your tape library, to control costs.

“Identify what’s the most important thing for you to do right now. Do you want to move all your data? Do you want to stick it in a data center?” Gray said. “Have vendors show you creative pricing for putting in part of a VNA. Few real VNA vendors are so busy chasing the $4 million deals that they’re too busy to tell you what you can do for a couple hundred thousand.”

Impacting Image Storage and Management

Most hospital departments operate in separate worlds, making it difficult to share images across institutions. However, expected increases in team-based care and bundled payments will likely make this business and care model unsustainable.

“Interoperability is where we’re going in this world. We’re going to have to share images, so we can’t have these silos of data sitting around,” Holle said. “VNAs offer an entire view of a facility’s diagnostic images, and they provide a solution for all specialists — the cardiologists, the radiologists, the pathologists and others.”

Merge’s iConnect brings together images from any PACS in an institution and offers replicated content management, a feature that supplements back-up recovery by making and storing elsewhere automatic copies of images and data. iConnect also uses a standardized DICOM format that all vendor equipment can access, Tolle said.

Using a VNA will also impact how you interact with your referring physicians, said Merge’s Kurt Hammond, vice president for interoperability solutions. This tool can help you meet growing patient demands.

“Turnaround time is getting really aggressive as physicians expect faster and faster image reads for their patients,” he said. “With a VNA, you’ll save time because there will only be one place to go for images no matter which department they’re coming from.”

According to Shannon Werb, chief operating and strategy officer for Acuo Technologies, employing a VNA also provides you the autonomy to change how you manage your system or distribute your images without contacting the manufacturer.

Acuo’s VNA product, UCP3, is similar to iConnect. However, in addition to DICOM standards, it supports the global authority on international health information technology interoperability Health Level Seven International (HL7) and Integrating the Healthcare Enterprise (IHE) profiles, including Cross-Enterprise Document Sharing (XDS).

VNAs can also save you the time and money you’d expend when migrating imaging data from an old PACS to a new system. Currently, it’s easier to let your PACS vendor transfer the data because it’s time consuming and can be confusing. Often, vendors change DICOM headers, such as CT of the head to CTHead or HeadCT, making it impossible to find some images if they aren’t categorized correctly in the new PACS. The cost for this service is often between $200,000 and $300,000.

To view remainder of story at original location: 


August 31, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Taking Medical Image Sharing to the Cloud

Published on the Jan. 19, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When the CT images came through to Children’s Hospital of Boston, the attached physician’s note indicated the patient had an epidural hematoma. The diagnosis was accurate, but doctors had grossly underestimated the severity.

“When our radiologists looked at the images, they decided the epidural hematoma was much larger than the referring physicians thought,” said Richard Robertson, MD, Children’s Hospital’s radiologist-in-chief. “Rather than wasting time admitting the patient to the emergency department, we routed the child directly to the operating room.”

Providing the best care hinged on viewing the scans prior to the patient’s arrival, Robertson said, and he credited cloud image sharing with having that ability. It’s that early access to imaging studies that gives doctors a jump start in treating patients with urgent needs.

As a significant shift in practice, online image transfer eliminates the possibility that an image-containing CD will be lost when patients visit a new provider or clinical setting. If a patient forgets the CD or if it is misplaced, you face having to either postpone service or repeat scans — and that’s expensive. According to a 2008 McKinsey Global Institute report on diagnostic services, duplicated studies accounted for $26.5 billion in unnecessary healthcare costs.

But data exchange via the cloud isn’t a new idea. Financial advisory firm Merrill Lynch estimated in 2008 that cloud computing was already a $95 million industry. As a $56.5 million-subset, cloud-based image sharing is also quickly gaining popularity, and business intelligence firm GlobalData anticipates it will grow by an additional 27 percent before 2018. At the November 2011 RSNA meeting in Chicago, several vendors unveiled cloud-based systems as the technology gains ground in the imaging field.

How It Works

In most ways, the cloud is synonymous with the Internet. However, images sent via a cloud image sharing solution can only be viewed within that system rather than being freely and publicly available.

In most cases, cloud image sharing strategies closely resemble your PACS, said Florent Saint-Chair, the general manager for eMix, the cloud image sharing solution for San Diego-based vendor DR Systems. The cloud platform hovers above the PACS like a membrane, allowing you to both receive outside images and send your images to other providers .

“Cloud image sharing is a very cost-effective solution because it doesn’t require monetary investment in a lot of hardware,” Saint-Clair said of the cloud solution that has about 350 hospital customers. “It’s an excellent way to go for groups or hospitals that don’t want to solely own an image sharing solution.”

Sharing images is a one-step process for hospitals or clinics that are part of the same cloud network. For unaffiliated hospitals, it’s almost as easy, Saint-Clair said. After confirming the identities of each provider, cloud image sharing can proceed over a virtual private network (VPN). As part of this connection, the provider receiving the image uses a password sent via email to log into the cloud server and see the studies.

According to Hamid Tabatabaie, CEO of Massachusetts-based vendor lifeIMAGE, cloud image sharing can also free up space in your PACS. Instead of downloading the image into your system, you can read the image within the cloud sharing platform and delete it when you no longer need it.

Cloud image sharing solutions are really the custodian of images that are shared between providers,” he said. “It’s quickly becoming an accepted way to handle data.”

To read the remainder of the article: http://www.diagnosticimaging.com/informatics-pacs/content/article/113619/2020231

January 23, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Try Kiosks to Improve Check-In Speed, Accuracy

Published in May 10, 2011, DiagnosticImaging.com

By Whitney L.J. Howell

For years, you’ve seen them in airports, movie theaters, and banks. Now, an increasing number of you are seeing kiosks pop up in your practices. While many groups have experienced work flow improvements, not everyone has seen all the promised benefits.

Kiosks – stand-alone, table-top, and tablet versions – have been touted as a way to streamline patient registration, especially during peak hours, increase the accuracy of recorded patient data, collect co-pays or outstanding balances in a timelier manner, and better utilize front-office staff. The added bonus is the impact on patients, according to some in the industry.

“Kiosks are intended to be cost effective for your business, but they also give patients a level of engagement and empowerment,” said Paul Merrild, senior vice president of solutions management at Merge Healthcare. “They feel a level of control over their health information.”

Patients can update their contact information, scan their insurance cards and driver’s license, sign consent forms for tests, and pay co-pays or balances at the kiosk, depending on how your office uses the technology. Many prefer the active involvement, said Jeanne Hanford, applications specialist at Radiology Ltd. In Tucson, Ariz., but others shy away, potentially preventing you from making any staff changes.

To read the remainder of the story online: http://www.diagnosticimaging.com/practice-management/content/article/113619/1858609

May 12, 2011 Posted by | Healthcare | , , , , , , , , , , , , | Leave a comment


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