Why Design Matters in Imaging

by Kris Kyes

It’s design that can make patients choose one imaging provider over another, according to Morris A. Stein, FAIA, FACHA. At the architecture/engineering firm HKS, Inc, Franklin, Tennessee, Stein is a principal. He presented “Designing the Imaging Experience: Understanding Today’s Requirements for Size, Technology, and Environments” on August 11 in Las Vegas, Nevada, at the 2009 annual meeting of AHRA: The Association for Medical Imaging Management.

Good design, Stein says, must be applied not just to imaging technology and the health care environment, but to the entire imaging encounter, as experienced by staff and by patients and their families.

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Of Competitors and Superheroes

by Curtis Kauffman-Pickelle

An eerie presence had descended on Gotham, and ordinary imaging providers in and around New York were worried. Would their most at-risk patients continue to have access to the technology and early diagnoses that could save their lives, or would the pending imaging-reimbursement cuts decimate their practices, severely restricting funding for much-needed screening exams that have been proven effective in diagnosing early-stage cancers? As they pondered their fate—and that of their referring physicians and patients—these ordinary providers proved that extraordinary things can happen when individual focus is replaced by teamwork. They became superheroes.

In an almost unimaginable scenario, some 13 competing imaging providers in one of the fiercest markets in the country set aside their mistrust of one another to form an emergency coalition intended actually to do something for the profession. In the process, they have gained new respect for one another and from practices around the country. It was also a good business decision: If the proposed cuts in question can be beaten back, these practices will still have a playing field on which to resume their tussle for market share.

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Cracking the Code for Improving Quality

by Cat Vasko

As the entire health care continuum comes under increased scrutiny in terms of both cost and effectiveness, radiologists and administrators alike have fresh cause to contemplate quality in the delivery of imaging services. What are the drivers of quality in radiology, and how can it be quantified, benchmarked, and ensured? As a complex radiology practice reading for a multitude of hospital clients, Franklin & Seidelmann Subspecialty Radiology, Beachwood, Ohio, has refined its approach to ensuring high-quality radiology delivery across an array of subspecialties.

“There’s an underlying assumption that as long as you have a radiologist who’s gone to medical school and is board certified, he or she can read anything. If you have the education, that’s great, but without the experience necessary to create expertise, you’re not as effective.”

—Clay Larsen, senior vice president of marketing, Franklin & Seidelmann

Larsen cites four requirements for ensuring high diagnostic quality: a broad team of properly trained, specialized radiologists; the technology and business processes necessary to route the right study to the right specialist, every time; sufficient study volumes to develop and maintain expertise across a team of radiologists; and an effective quality-assurance (QA) process and feedback loop to ensure continuous quality levels.

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Sunshine Bill Renews Focus on Conflicts of Interest

by Elaine Sanchez

While health care players and politicians have long debated the issue of medical transparency, deeper scrutiny of physician–industry relationships has produced a general consensus on one aspect of the dispute: The climate has changed.

Thomas Hoffman, JD, associate general counsel for the ACR®, says, “Physicians need to look before they leap; also, industry (for its part) needs to be more careful because the government, through the Congress—as well as through federal agencies like the OIG—is looking more closely at relationships and what kind of effect these kinds of payments might have on medical decision making.”

A prime example of the growing interest in physician disclosure is the Physician Payments Sunshine Act, legislation that was reintroduced this year to cast an even more watchful eye on potential conflicts of interest. Cosponsored by Sens Chuck Grassley (R–IA) and Herb Kohl (D–WI), the revised bill would require physicians to disclose payments of $100 or more from pharmaceutical and device manufacturers.

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State of the Technology: Geoffrey Rubin, MD, on 3D Visualization

by Cat Vasko

As CT technology continues to advance and the number of slices in a given exam grows exponentially, how is the role of enterprise visualization software evolving to suit the needs of the modern radiology department? ImagingBiz.com speaks with Geoffrey Rubin, MD, professor of radiology and vice chief of staff at Stanford University Hospitals and Clinics, Stanford, California, on the state of the technology.

ImagingBiz.com: Which enterprise visualization tools have proved most useful in enhancing 3D interpretations of cardiac imaging? How can techniques like bone removal and artery isolation be leveraged for more rapid speed of interpretation, and what are the hazards involved?

Rubin: The tools most useful for cardiac imaging would be multiplanar reformation, curved planar reformation, and volume rendering. There are hazards in using bone removal and arterial-tree isolation; whenever you perform any segmentation tasks, you run the risk of removing structures that you didn’t intend to remove. It’s important to be careful when using these tools.

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Health Care Efficiency: No Miracle Cure

by Cullen Ruff, MD

Health care reform ideas are everywhere these days. As a radiologist, I’m all for controlling costs—but I challenge the assumption that national electronic medical records (EMRs) will magically make providers more informed and automatically decrease unnecessary tests.

It sounds great, but the idea and, at least, its partial implementation are nothing new. We know that most US hospitals have already used electronic records for years in their own systems—yet useful information is ignored every day, costing us all.

An extreme, but genuine, example involves a woman who recently came to a hospital complaining of abdominal pain. Her urinalysis showed blood. The emergency-department physician asked no further questions and reflexively ordered a CT scan, questioning whether there was a kidney stone.

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Beyond the Software: Creating the Optimal Enterprise Imaging Environment

by Cheryl Proval

A familiar face on exhibit floors from Chicago to Vienna and in hospital radiology departments around the world, Robert Cooke, has participated in the commercial development of PACS from its very early days. Currently vice president and general manager, network business, FUJIFILM Medical Systems, Stamford, Connecticut, Cooke has spent the past seven years working on the development of Synapse^TMPACS®. He shares his thoughts on the people and processes that distinguish a successful imaging environment from others, as well as his insight into the source of the next paradigm changes for imaging informatics.

“One of the things I’ve learned through the years is that people are everything. They are the only assets you have to drive success. Certainly, people need to be motivated, to have clear understanding of what their roles need to be, and to have the ability not only to drive change, but to embrace change.”

-Robert Cooke, vice president and general manager, network business, FUJIFILM

ImagingBiz.com: We know that two different organizations can implement the same software and hardware with vastly different levels of success. What are the key questions that a facility should consider before tackling the implementation of a true enterprise imaging environment?

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Daily Exam Volume as a Management Tool

by James A. Kieffer, MBA

Some management techniques take advantage of basic receivables-system information to monitor charge capture and forecast future exam caseloads. The models shown here use real data; a complex hospital-based practice was purposely chosen, with a trend line of January 2008 through August 2009. To understand the power of today’s receivables systems, consider that it took approximately two minutes to write the extraction query for these models, and the compilation took 30 seconds. This covers individual days spanning 19 months. A larger date range would, theoretically, build a more normalized population, but this practice made a significant change in coverage that affected hospital volumes after January 1, 2008.

No strong math background is needed to follow basic statistical techniques. The database extraction was exported to a standard spreadsheet program for modification to produce tables. The receivables-database program can produce statistics; however, in the absence of this feature, the raw data can be exported either to a spreadsheet or to a database program that has statistical functions to produce the same results.

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