An Enterprise View of Radiology: vRad CIO’s Top 5 RSNA 2014 Observations

RSNA2014Having just returned from the 100th Radiological Society of North America (RSNA), I continue to be amazed by its scale even after attending for nearly 20 years. The educational sessions offered, the vendors demonstrating their offerings, and the sheer magnitude of the opportunity to network with industry peers continue to impress.

Here are my 5 key takeaways from this year’s visit:

  1. Strong Educational Sessions. Meaningful Use is “Uniquely Gray” … I appreciated the session “Health IT Incentive Programs: Experience from Radiology Practices in Hospitals and Health Systems,” which presented a balanced view of how radiology practices should think about Meaningful Use. Each presenter offered their experiences, which were in stark contrast to the others. After a lively audience debate, the session validated that Meaningful Use for radiology practices isn’t black and white — each needs to consider their unique situation before deciding to move in that direction.
  2. Analytics continue as expected. Natural Language Processing (NLP) On the Rise … vRad continues to invest heavily in analytics solutions both internally, with analytics for operational and clinical insight, and externally by partnering with clients (radiology practices and hospitals alike). While I didn’t find anything new or compelling, I was encouraged to see a number of educational sessions and vendors focused on how NLP is important beyond just coding and billing. The insights that can be gleaned using NLP on a radiology report are endless — now imagine turning NLP lose on more than the current report (actively during dictation – think critical results, prior reports, other clinical documentation). I know Analytics and NLP will continue to be key discussion topics throughout 2015 – and in Chicago next year as well.
  3. The “Bloom is Off the VNA Rose” … I understand the value of integrating more than Radiology/DICOM imaging and appreciate the complete patient record approach. I was part of the Acuo Technologies acquisition by Perceptive Software that provided the first integrated VNA/ECM approach and brought all patient data and content forward, typically presented through the EMR. That said it has been two years now … shouldn’t we expect more? What about data sharing? What about approaching big data through the VNA/ECM solution? I’m pleased with the consolidation occurring within the image/data sharing space (Nuance/Accelerad, Perceptive/GNAX), but where will these larger players take it? What is the strategy? Big Data is only cutting its teeth at this point, but who better than a VNA/ECM/content management player to start thinking about what this means for healthcare? It isn’t just about data storage or retrieval; it should be about what does the data mean, and when can we begin to predict outcomes?
  4. Radiology and Pathology Finally Coming Together? Especially in the oncology space we still don’t have a good solution around how radiology and pathology results can be integrated. I was surprised to hear about how pathology solutions provided by traditional major radiology players are coming together. I was even more surprised to see the infamous PACSMan reference it in his AuntMinnie interview – http://www.auntminnie.com/index.aspx?sec=rca&sub=rsna_2014&pag=dis&ItemID=109569&wf=6302 (~ 4 minute mark. You may have to log in to view).
  5. RSNA Spans the GlobeRSNA has always been a good place to engage the international market, and this year was no different with a noted increase in international participants. As vRad looks to expand its offerings, the international market looks promising with a number of developed and underdeveloped teleradiology markets that could be well served by an international teleradiology player with vRad’s scale.
  6. Teleradiology/Telemedicine Workflow Solutions Appearing … (OK – so I had 6 observations) It was interesting to find new companies either introducing or driving harder toward specific teleradiology/telemedicine workflow solutions. Put the viewer and hardware/infrastructure aside for a moment and think solely about the complexity and requirements of being a national or international telemedicine provider (demand forecasting, capacity scheduling, clinical and operational workflow, financial/invoicing/compensation, reporting, etc.). This is clearly a market that will develop as the telemedicine space grows.

Bottom line: RSNA continues to impress. I was even astonished by innovative offerings from the larger players (especially around pathology).

However, I do continue to be disappointed by the attention given to federal programs/incentives (like Meaningful Use), plus the fact that organizations spend so much time focusing on specific financial models they think are in vogue. Why not listen to your clients and learn how they want to purchase and invest in solutions?

It is obvious healthcare IT still stands to learn more … listening is a good first step. Will go back in 2015 to listen some more.

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“Radiologists are known as – and trained to be – the ‘doctor’s doctor’ for good reason and must remain in that role.”

Doc consulting_smallIn response to a November 24 New York Times article, Dr. Strong submitted the following letter. It outlines his position on radiology’s ability to provide overall patient care and why radiologists are best equipped to be the doctor’s doctor rather than a patient’s.

To the Editor:

As a radiologist who has also worked as an ED physician (residency in internal medicine at Dartmouth-Hitchcock Medical Center with a subsequent radiology residency and a fellowship in musculoskeletal MRI at the University of Arizona, Arizona Health Sciences Center in Tucson), I have first-hand, hands on knowledge of both sides of the issues raised in Gina Kolata’s recent article, “Radiologists Are Reducing the Pain of Uncertainty,” (Nov. 24, 2014).

As a radiologist, I experienced the consequences of trying to get more involved in clinical decision making and patient interaction. Because of my prior training in internal medicine, I made great efforts to bridge the specialties by talking to patients, reviewing histories and lab values, and presenting a diagnosis with associated treatment recommendations.  Despite my best intentions, my interactions confused patients and irritated referring clinicians to no end; had it continued, I would have been universally despised and unable to provide effective and credible care.

The radiologist and the referring physician are separate for a reason: there is simply not enough time in the world to do both jobs well. Most important, though, radiologists simply don’t have all of the information required to help treat and care for a referred patient, as aptly pointed out by Dr. Beaulieu.

Radiologists can’t answer – and shouldn’t answer – the “Now What” question patients undoubtedly ask. Patients should only speak with radiologists once they understand and accept that the radiologist has expertise in interpreting the image only – not in what course of care patients should or can pursue. The scan is a snapshot, a mile marker on a roadmap of the patient’s overall course of care. It is a diagnostic tool – albeit a critical one – but not an end in and of itself (contrary to what some patients think) used by the patient’s physician, not the patient.

Imparting clinical diagnoses and making treatment recommendations are best left to physicians who have access to a patient’s entire medical record and history. These doctors also have a relationship with the patient, know their mindset and understand how they like to receive information. They are current on the most effective therapies and procedures to treat a patient’s specific condition based on objective information a radiologist provides, as well as other clinical information. And, they can speak with the patient face-to-face in the privacy of a hospital or office environment; the radiologist interpreting the patient’s images are most often geographically separated from the facility in which the images were acquired.

Based on experience, I also believe that having one point of contact for a patient is the best way to achieve superior patient-focused care. The likelihood of a radiologist making an erroneous statement that directly conflicts with a previous statement made by a referring clinician increases with every word uttered to the patient by the radiologist.  That’s not a recipe for “reducing pain,” but rather for increasing anxiety – and legal actions.

I accept that the ACR and RSNA would like to work to make radiologists more accessible to patients; however, they cannot forget this basic tenant: Radiologists are known as – and trained to be — the “doctor’s doctor” for good reason and must remain in that role.

If the ACR and RSNA forget this, their initiatives are doomed to fail and will only create more uncertainty, stress and confusion for patients.

Benjamin W. Strong, MD (ABR, ABIM) Chief Medical Officer, vRad

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Varicose veins “more than just a cosmetic problem,” warns DII’s Aaron Shiloh, MD

VV_imageAaron Shiloh, MD, Chief of Interventional Radiology Services at Diagnostic Imaging, Inc. (DII), a vRad’s Alliance Partner, states it is a myth that varicose veins are merely a cosmetic problem.

What Are Varicose Veins?

Normally, the veins in our legs have valves that allow blood to move in one direction from the lower limb toward the heart. These valves open when blood is flowing toward the heart and close to prevent the backward flow of blood.

Varicose veins, which can look like lumpy veins, form in both men and women when these valves weaken and don’t close correctly, which can lead to blood flowing in the wrong direction and impair blood drainage from the legs. Varicose veins symptoms can include pain and swelling, as well as restless leg syndrome or ulcers.

To find out more about who is prone to varicose veins, why it is a progressive disease, and possible treatment for varicose veins, please watch Dr. Shiloh on the web series “Aria’s Medical MythBusters.” The web series explores everyday health and wellness questions, concerns, and old wives’ tales and finds out if they are facts or myths.

Click here to watch Dr Shiloh dispel myths about varicose veins.

 

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ICD-10: It is Time to Commit

Preparing a radiology practice for ICD-10 is challenging. Why? Not only must we educate and prepare our radiologists to provide the level of detail required by ICD-10 coding, but we must also make sure that our referring physicians are prepared to provide the same level of detail when they order a radiologic exam.

Since radiologists are dependent on the referring physician for pertinent information related to an ordered exam, they may be prone to thinking that ICD-10 coding is not their problem. What our radiologist must understand is that the referring physician is equally dependent on them. The treating physician must be able to document and code from our radiologic findings.

Keep in mind that for outpatient coding (Medicare Part B), the diagnosis code is assigned based on positive findings in the radiology report. When the finding is not definitive or negative, the code is assigned based on the diagnosis provided on the order (the indication). If the information provided in the indication and/or the finding sections of the final report are unspecific, assigning a diagnosis code for the procedure will be difficult or
impossible in ICD-10 coding.

Greater specificity will be needed in radiology reports to assign ICD-10 coding
to the findings. Details such as specific anatomical location, the severity or
acuity of the condition, the context, and the story of the patient’s condition
must be included in the radiology report.

It is time for radiologists to commit to ICD-10 and ICD-10 coding and embrace training opportunities that will help them prepare for this inevitable change.

Sharon Roeder, CPC

Manager of Payer Coding and Compliance
ICD-10 and ICD-10 coding vRad expert

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Breast Cancer Awareness Month is here. We have much to be thankful for.

The mortality rate from breast cancer continues to decline as we discover more and better improved methods of detection and treatment.

We also have much to celebrate; we continue to raise awareness and much needed funds both through individual drives and the National Institute of Health. And we are making great strides in elucidating not just the causes of breast cancer but the cures.

But until there are no breast cancer deaths, only survivors, until the face of this disease is wiped from our lives completely, we will continue to find ways to beat this disease with
everything we have.

I encourage you to wear a pink pin this month in solidarity with our mothers, sisters, daughters, and friends. We need to show we care with this tiny but very important act. Be a part of the cure.

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Examining Breasts: A Teaching Moment on the Mammographic Signs of Breast Cancer

Earlier this month, I gave my fourth annual national CME WebEx lecture on Breast Imaging and Intervention through the University of Arizona. I have always enjoyed teaching and part of my current responsibilities includes teaching radiology residents.

I consider it a success when at least one resident in each class decides to go
into breast imaging as a specialty. It makes me feel like I have done my job
well. This year’s lecture was a bread-and-butter one. It is a back-to-basics
lecture on the mammographic signs of breast cancer. There are so many
additional wonderful tools for helping us find and treat breast cancer; however
the single best screening tool still remains mammography.

We may have dressed up the modality by making it digital or making it three
dimensional, but it is still the basic two views of both breasts that serve us
the best. While it is not perfect, it is about 90 percent sensitive or accurate
in finding breast cancer. We need to continue to educate those around us to its
continued and timed earned value in our fight against breast cancer.

You can find a recording of this year’s talk about mammography and the mammographic
signs of malignancy on vRad’s site by clicking here.

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vRad supports move to make it easier for doctors licensed in one state to treat patients in other states…potential positive effect for teleradiology and improved patient care.

In response to a June 29 New York Times article, Dr. Strong submitted the following letter. In it, he notes the positive benefit of removing complexity that affects underserved health facilities and their patient communities.

To the Editor:

As the chief medical officer of vRad, the nation’s largest telemedicine practice, I am encouraged by the move to create an interstate licensing compact that reflects the impact of technology on our practice of medicine. (Medical Boards Draft Plan to Ease Path to Out-of-State and Online Treatment, Robert Pear, June 29, 2014)

Our 450 US board certified radiologists will collectively read over 7 million client studies this year – diagnosing via a patented cloud-based network to provide critical clinical care to patients in over 2,000 healthcare facilities in all 50 states (plus Puerto Rico and the District of Columbia).  On average, each of our radiologists has 14 state licenses and credentials to read for 175 different facilities. I am personally licensed in all 50 states and read for over 900 facilities.

The complexity of current state licensure processes means time and money for our practice – and that means delays in getting doctors up and running quickly for patient care.  Once hired, it takes an average of 4 months (as many as 9 months, depending on the state) for a radiologist to be fully operational because of the current state licensing model.  Processes vary by state (paper-based vs. online), as well as required information.  For example, to be licensed in certain states, our physician-applicants must appear in-person solely to present a photo ID – and sometimes their original medical school diploma.  That’s onerous for our practice and a disservice to underserved healthcare facilities and their patients.

While the bar for certification must be high in any interstate compact, the consolidation and simplification of investigatory and certification processes would be welcome to reduce the time required for licensing board and credentialing committee approval, lower processing costs, provide greater mobility for physicians – and ultimately, deliver exceptional patient care by matching patient to physician as quickly and as efficiently as possible.  At 3AM in an emergency room when an ED physician is waiting to have an image read to determine if a patient is having a stroke, does it really matter if the radiologist is reading and diagnosing from the basement of the hospital, an in-state office or a home office equipped with state-of-the art diagnostic tools across the country? Seconds count. With today’s cloud-based tools, geography should no longer be a barrier to excellent clinical care.

Benjamin W. Strong, MD (ABR, ABIM)
Chief Medical Officer, vRad

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Are You Innovating Your Radiology Practice? Find out on May 22

Many forces in the U.S. healthcare market—from declining reimbursements and volumes to value-based accountable healthcare models—are pushing radiology into a corner.

But these challenges are being embraced by some as an opportunity to innovate for continued growth – and to become an indispensable partner to referring physicians, hospital administrators and the patients they collectively serve. Innovation allows radiology the ability to be seen as a strategic partner vs. a cost center to be managed by their hospital and physician clients.

Our latest webinar — “Innovating Radiology: Is it in You?” — is designed for radiology administrators and leaders that want to hear how innovation can address seismic shifts, drive continued growth, and foster alignment with referring physicians, hospital administrators and the patients they collectively serve.

Attendees will also:
• Learn why innovation is vital to radiology’s long-term growth prospects and how it builds a culture of engaged innovators.
• Hear “Lessons Learned” from the nation’s largest radiology group as it defined and designed a strategy based on analytics, collaboration and communication for better alignment with its healthcare partners.
• Discover new growth opportunities for radiology, such as direct-to-patient remote diagnostic services, and extension to other global telemedicine platforms and models.
Register here for our May 22 Webinar at 10:00 AM ET.

Our speakers include:
• Nadim M. Daher, Principal Analyst from Medical Imaging and Imaging Informatics, Frost & Sullivan
• Raymond Montecalvo, MD, one of vRad’s Medical Directors
• Michael Ge,  Executive President & CTO of E-Techco Information Technologies Co., Ltd.
(E-Techco), a leader in consumer telehealth solutions in China.

vRad recently partnered with  E-Techco to offer E-Techco customers 24/7 access to subspecialty radiology for second opinions. This innovative partnership, for the first time, allows for Direct-to-Patient remote radiology services in China from US-trained radiologists.

Hope you can attend and learn about the latest developments to innovate the practice of radiology.

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Sylvia Mathews Burwell on Building a Better Model of Care: Data, Analytics and Transparency on Capitol Hill

Sylvia Mathews Burwell said it is "important" to base decisions on data to ensure you "get the largest impact you can."

During her confirmation hearing last week for HHS Secretary, Sylvia Mathews Burwell said it is “important” to base decisions on data to ensure you “get the largest impact you can.” Listen to her philosophy around data and its importance (go to 57:38 in the video).

Data is the cornerstone of “managing what you measure.” Starting with normalized data, vRad was able to measure what we do and then make informed decisions to better
manage our radiology practice. We had to because it was necessary for us to build – as Sylvia Mathews Burwell noted — a “successful model that can scale.”

Data lead to insight – radiology requires insight into the practice of medicine so that leaders and managers can make informed decisions and take actions that deliver the best care and drive the best value for their patients, ultimately at an overall lower cost.

vRad and our clients must shine the spotlight on imaging use, analyze the data, and partner on operational decisions to improve efficiency and value to patients and hospital
administrators. If we don’t, someone else will do it for us. And it just might build a model that does not benefit radiology and its benefits to overall patient care.

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Thinking of Sending Your Teleradiology Provider Packing? Think Again.

Is your practice considering taking back night-time reading to meet new hospital demands or to improve your bottom line? Think it will help your economics?

Well, think again. Or better yet, “analyze the data” first – and then think.

Why? Not all radiology shifts are created equal when it comes to reimbursements, RVUs or volumes.

Hospital expectations of all physician groups, including radiology, are shifting quickly as new market realities of healthcare reform come to fruition. Many times, groups overlook the underlying economic realities of what it means to “take back the night” from a teleradiology provider.

Our new whitepaper “Rethink the Night: An Evidence-Based Discussion on Teleradiology
Partnerships
” looks at this issue in detail. It can help your practice to:

  • Build an operating plan to drive and manage growth in the new “Wild West” healthcare market.
  • Understand how economic realities and hospital service-level requirements affect your practice’s value and performance. (And make no mistake—they do.)
  • Make data-driven decisions about coverage and service-level commitments, which will allow your practice to become indispensable and better aligned with your hospitals and their patients.

So before you send your teleradiology provider packing, look at the data. You will be surprised by what you find.

We were… and it made our practice better.

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