Healthcare reform not slowing scandemic innovations

Oct. 21, 2013

Back in the mid-to-late 1990s, diagnostic imaging equipment and technology companies largely circled their semi-trailers and vans as they anticipated the aftershocks of healthcare reform under the Clinton administration.

As you roamed the expansive exhibit halls of the Radiological Society of North America’s annual scientific assembly during those turbulent years, you noticed that bread-and-butter imaging and information technology capabilities largely overshadowed traditional expectations of innovative bells and whistles. The prevailing undercurrent at that time was to avoid showcasing anything healthcare organizations couldn’t or wouldn’t be able to pay for, courtesy of looming budget restrictions and reimbursement cutbacks.

While you may debate the motivation and logic of manufacturers of diagnostic imaging modalities and IT support products demonstrating product development restraint during such provider fiscal duress, they did not throw up a white flag in an industry fearing red.

Instead, these companies innovated more creatively against the backdrop of forced economic conservatism. Modularity and modest upgrades to existing technology seemed to dominate the showscape. Cash-strapped and regulatory-weary providers could install new “modality-agnostic” and “vendor-neutral” capability extensions and software packages to weather the storm.

Now, nearly two decades later, the healthcare industry may be farther along in the fiscal and operational throes of yet another healthcare reform initiative under the Obama Administration, but the manufacturers of diagnostic imaging and IT equipment and products are not nearly as cautious this time around.

Attribute that in part to the frenetic pace of innovations once the last decade of the 20th century faded into history. Since then, the technological innovations that have emerged have been nothing short of staggering with an emphasis on convergence, flexibility, miniaturization, modularity, multi-functionality, portability and above all, ease of use and simplicity.

We’ve witnessed multi-slice computed tomography (CT) machines where slices surpassed double digits even as upper double-digit slices became the norm for high-end, high-definition heart scanning; extremity and open bore magnetic resonance imaging (MRI) units; digital radiography and computer-aided detection (CAD) and measurement; mobile X-ray devices and modular/portable X-ray rooms; hand-held and wireless ultrasound devices; radiology information systems (RIS) integrated with picture archiving and communications systems (PACS); positron emission tomography linked with CT; ultrasound fused with CT, MR and PET; the emergence of image-guided and adaptive radiotherapy, molecular imaging, elastography, tomosynthesis and proton beam imaging; two-, three- and four-dimensional imaging perspectives; smart phones and tablet computers being used as imaging vehicles; CT and X-ray radiation dose reduction systems, “real-time” imaging and even nanoparticle/nanotechnology capabilities. Most recently, we’ve seen the debut of more quietly running MRIs, long known for their operational noise.

Of course, with the plethora and immensely expanded volume of collected data and images comes the need for more and wider bandwidth for electronic transmission and larger storage and archiving caches.

So what could be next and in the pipeline? That’s what Health Management Technology wanted to learn in advance of the 99th RSNA conference and exhibition at the beginning of next month. We asked key executives at some of the leading diagnostic imaging and RIS/PACS companies to share their insights about ongoing technological advancements and what they might be showcasing shortly. Here’s what they had to say.

Lenny J. Reznik, director, enterprise image and information systems, Agfa HealthCare

With 40 to 60 percent [electronic health record] adoption in the market, we are quickly moving into a post-EHR era where the value of patient data is no longer locked into silos. However, there still seems to exist one significant roadblock to ultimate clinical productivity: Most of the EHRs available today do not complement textual data with relevant clinical images in context. It is said that a picture is worth a thousand words, and in healthcare, medical imaging can save a life and enable the right diagnosis to be made.

As a result, Agfa’s patient-centric, enterprise clinical IT platform ICIS (Imaging Clinical Information System) image-enables the EHR and helps healthcare organizations to develop healthcare information exchanges (HIEs) and engage patients.

Many vendors propose solutions that are essentially an extended radiology PACS or a vendor-neutral archive (VNA). This was a good first step. However, these are really only stopgap solutions and ultimately will not deliver a comprehensive multimedia EHR. PACS are very effective departmental solutions, but they are not enterprise systems able to handle the ever-increasing image data volume expected from different departments and locations from multiple systems. Additionally, today’s VNAs are optimized for storage — not for enterprise imaging workflows, such as department-specific image acquisition, electronic ordering, clinical metadata creation and billing automation. Some VNAs do not fully support DICOM and HIE, and most are not able to function independently of departmental RIS.

ICIS provides integration of multimedia patient imaging records and creates a single, comprehensive, longitudinal imaging patient record by unifying the patient record across regions, facilities, departments and specialties. Its zero-footprint medical imaging viewer, ICIS View, provides secure access to images and data from existing workstations anywhere on the network, using most popular Web browsers — without requiring software application downloads or installations.

Meanwhile, PACS are evolving into broad imaging and clinical information systems and expanding beyond their radiology and typical imaging roles as IT solutions that help clinicians improve patient outcomes, while also improving productivity and lowering costs. New systems, with expanded departmental and imaging capabilities, will allow a better ROI for the healthcare providers through better use of IT infrastructure and less administrative overhead.

The expansion of these imaging information systems allows for better focus on productivity for imaging professionals. Productivity is being increased by a truly integrated and seamless user experience that encompasses all aspects of interpreting diagnostic images (HIS/RIS, PACS, 3-D, reporting, specialized clinical applications and more). Clinicians are no longer fumbling between differing applications, and have access to richer clinical data and diagnostic tools.

At RSNA 2013, Agfa HealthCare will launch its next-generation of RIS/PACS, IMPAX Agility, a completely unified imaging-management platform designed to achieve clinical productivity and optimize total cost of ownership. This represents a distinct new approach to IT solutions by delivering a completely unified imaging platform that provides PACS, RIS, reporting advanced image processing and integration of clinical information, all in one sophisticated platform.

Cristine Kao, global marketing director, healthcare information solutions, Carestream Health

Carestream is debuting a new generation of its PACS platform as a work in progress that is designed to deliver access to key image data from links within the report, which merges imaging and reporting to create a more efficient tool for radiologists and referring physicians. It also offers a teleradiology module that gives remote radiologists access to prior exams and reading tools and automatically sends the reports to the requesting facility, all without requiring significant investment by healthcare facilities or radiology/teleradiology groups. 

Radiology images and radiology reports have always been separate systems. Combining the radiologist’s diagnosis with embedded links to key imaging data, such as bookmarks that contain key images — including those with vessel analysis or measurement data — is intended to revolutionize the traditional reporting process.

The new Carestream PACS will also offer an optional Vue Telerad module as a work in progress that is designed to enable efficient off-site reading and reporting by remote radiologists for multiple healthcare facilities. The new module taps into Carestream’s Vue Connect platform, which will enable radiologists to access worklists from unaffiliated healthcare providers, view prior imaging studies and reports, and automatically deliver reports back to each facility. Carestream’s Vue Motion zero-footprint image viewer will be used to transfer the imaging studies. 

Jim Morgan, vice president, medical informatics, FUJIFILM Medical Systems U.S.A. Inc.

Patient engagement in healthcare is a trend that is reaching new heights. Portals and cloud-based imaging give patients control of all aspects of their healthcare record. Features include sharing of data with physicians outside their current network provider, scheduling of exams, payment history, treatment instructions and forms and image viewing. Clinical decision support (CDS) systems have reached a clinical maturity to improve the treatment provided to patients. These systems provide expert recommendations for treatment options that are clinically and financially best for the patient. Integrating these systems into the RIS provides an effective workflow and reduces redundant data entry.

We have built a diagnostic tomosynthesis reading capability into our PACS radiologist workstation that provides diagnostic and screening tools designed for this important area of women’s health. Our Synapse VNA includes a universal viewing capability for DICOM and non-DICOM imaging that completes the patient record by adding imaging from non-traditional areas, such as dermatology, oncology and endoscopy. The viewer is zero download, browser independent and runs on multiple mobile platforms.

Brian Edds, vice president, product strategy, Amcom Software

Amcom wants to improve the speed and accuracy of delivering critical test results from radiologists to ordering physicians. Our product, Amcom Critical Test Results Management (Amcom CTRM), quickly and securely sends test results from radiology to the right physician and other caregivers on their preferred mobile devices. This speeds patient care and reduces valuable time wasted tracking down a patient’s ordering physician. 

For example, a physician orders a CT scan in the emergency department for a patient with a severe headache. The order is entered into the emergency department information system (EDIS) and sent through several integrated systems. These include Amcom CTRM, HIS, RIS and PACS. An automatic alert is sent to all ED physicians at the time the radiologist enters his or her findings. Since the alert includes the full findings, there is no need to waste time tracking down the radiologist. Instead, the ordering physician is able to quickly provide care to the patient. 

Another thing hospitals like about Amcom is how its CTRM works so well with its secure texting application, Mobile Connect, Powered by Amcom. The physicians can get the critical alert in a secure way on their smartphones via this app, acknowledge receipt of it and text with other caregivers. The message is logged in an audit trail. The alerts from Amcom CTRM can include reports, images, annotations, voice clips and handwritten notes to provide the ordering physician all the information needed at his or her fingertips. 

Sending critical test results to ordering physicians with Amcom CTRM is designed to improve care and cut wasted time. The secure delivery helps ensure all patient information is protected. The ability to acknowledge a message via a smartphone provides closed-loop communication that enables physicians and other caregivers to provide the proper treatment for patients as soon as possible. Likewise, a patient with normal test results can be released sooner, and any incidental findings can be noted for followup.

Lynda Goodrich, worldwide healthcare industry manager, workstations and thin clients, Hewlett-Packard

Advancements in clinical applications and workflow management tools have transformed PACS into a crucial decision-support system that requires robust performance from integrated workstations. 

Because the amount of image data has grown exponentially over the past few years, users must be able to retrieve and transmit data quickly and accurately. Additionally, increased PACS functionality, increased image size and resolution, larger patient data sets and integrated medical records underscore the need for higher-end workstations.

Selected HP Workstations are FDA-registered 892.2010 Class I devices and deliver proven performance, reliability and expandability needed in PACS. Providing storage and transmission of CT, MRI and PET imaging results, embedded HP Workstations allow data to be imported and exported from external or internal image-archive systems. HP PACS Workstations are also designed to provide efficient heat removal from processors, reduce overall acoustic output levels and support graphics cards that drive multiple high-end and third-party diagnostic monitors. 

James Jay, global vice president, radiology IT, Agfa HealthCare

The healthcare industry continues to experience increases in imaging complexity, diagnostic imaging volume and competition, all while facing reduced reimbursements and increased regulatory requirements. New IT solutions can help medical practitioners increasing patient outcomes, while improving productivity and reducing costs. 

PACS are evolving into broad imaging and clinical information systems and growing beyond radiology and typical imaging roles. Expanded departmental and imaging capabilities will allow a greater ROI on a solution through better use of IT infrastructure and less administrative overhead. These systems are also expanding to focus on productivity of imaging professionals. 

Productivity is being increased by a truly integrated and seamless user experience that encompasses all aspects of interpreting diagnostic images (HIS/RIS, PACS, 3-D, reporting, specialized clinical applications and more). No more fumbling between differing applications. 

The industry also faces increased regulatory and quality requirements. Clinical workflow engines are able to coordinate each of the clinical steps and the collaboration required between all imaging professionals involved in a case. All of the steps that comprise a medical procedure can be broken down into tasks and assigned to roles, according to regulatory and quality requirements.

Finally, to be effective, imaging systems need to be able to integrate into the EMR seamlessly to help provide clinicians a complete, centralized picture of the patient’s health record.

Kevin Yearick, director, network services, Grady Health System

As the science of medicine continues to advance, innovations in technology are evolving to enhance the healthcare industry. Specifically, EMR and PACS are important technologies that are being used more frequently in healthcare. According to a recent report from Kalorama Information, more than 70 percent of physicians have used an EMR, up from only 26 percent in 2006. 

Among those using a regional PACS system are physicians at Grady Health System, one of the nation’s largest public health systems, which includes Grady Hospital, Georgia’s largest hospital and level-one trauma center in metro Atlanta.  

In order to support its healthcare technology systems, Grady Health System needed a high-performance network infrastructure that would improve the speed and quality of patient care. As a result, the organization partnered with Comcast Business, whose Ethernet services provide high-bandwidth communications so that Grady’s 15 remote offices can use EMR, PACS and telemedicine programs for its patients. These programs enable real-time transfer of digital medical records and high-resolution radiology files to leading specialists. This facilitates faster diagnosis, expands access to specialists for patients in remote areas and improves efficiency for medical and administrative staff.

 Through its partnership with Comcast Business, Grady Health System now has access to fast, reliable connectivity between its facilities and a high-performance network infrastructure that enhances the quality of patient care.

Steve Deaton, vice president, Viztek

Viztek is releasing a completely zero-footprint software platform that more seamlessly integrates physician clinic charting with radiology workflow. It includes full Web-based functionality sans client-based software. It works on any operating system, and the platform can host or encompass PACS, specialty viewers and tools, including mammography and orthopedics, practice management, EHR, EMR, billing, radiology scheduling and RIS. The platform is tailored for clinic practices, with on-site radiology services beyond X-ray, and is typical for such exams as MR and CT at orthopedic or ENT clinics, for example, to be ordered by the physician during the patient examination. However, these types of exams require scheduling for a later date, in part because of insurance authorizations. Most EMR systems on the market fall short in allowing for the necessary radiology workflow components beyond X-ray. 

Tom Coppa, senior technical consultant, McKesson

There are four key features and benefits trends to watch.

Managing ongoing costs. This involves reducing escalating, image-management-related expenditures and supporting image data sharing. The McKesson Enterprise Image Repository archives and manages image data on behalf of the systems with which it interfaces in a common, consolidated archive. The McKesson Enterprise Image Repository also simplifies enterprise-wide access to image information with a single point of distribution for image data. 

Ability to scale. This enables easier deployment on multiple devices and in multiple locations and offers scaling to meet growing business demands, which is how and why McKesson’s radiology solutions contribute to a lower cost of ownership and a faster adoption of the technology. Our radiology solutions are created to suit various user needs, from a complex radiologist reporting cockpit to clinical reference viewers and workflows. The solutions are optimized for network performance that may result in faster launch time and faster time to load the first image and scale to meet the growing demands of the business.

Workflow management. This calls for collecting, combining and analyzing data in powerful, actionable ways, which helps improve quality and expedite communications. The McKesson Qualitative Intelligence and Communication System bridges communication gaps by providing a comprehensive view of healthcare workflow and correspondence. The system reaches across various healthcare departments and IT boundaries using a sophisticated, configurable rules engine. The clinical workflow in each solution orchestrates multiple productivity spaces, helping to expedite communication and improve quality and efficiencies while supporting efforts to improve patient care. 

Patient-centric data sharing. This allows physicians to access reports and images from a variety of mobile devices, simplifying workflow and making it more intuitive. McKesson Enterprise Image Clinical Reference Viewer is a zero‐footprint, browser‐agnostic viewer designed to reduce training, increase end‐user satisfaction and enable fast adoption by referring physicians.

Gene Saragnese, executive vice president & CEO, imaging systems, Philips Healthcare

This year at RSNA, Philips will unveil several new product innovations designed to transform imaging for clinicians and patients. Two of these products are AlluraClarity and EPIQ.

Philips’ AlluraClarity live image guidance system received 510(k) FDA clearance in July 2013. The system uses the ClarityIQ technology to provide high-quality imaging for a comprehensive range of clinical procedures and to achieve excellent visibility at low X-ray dose levels for patients of all sizes. AlluraClarity’s low X-ray dose settings are a radical new development in the healthcare industry that will help clinicians better manage their patients’ and their own exposure to X-ray radiation.

EPIQ is a first-of-its-kind ultrasound system that represents a totally new approach to creating high resolution with extraordinary detail images, along with incomparable levels of information. EPIQ is built on Philips proprietary nSIGHT Imaging architecture, which introduces a never-before-used imaging architecture to form ultrasound images.

James Hamilton, manager, healthcare marketing, Canon Healthcare Solutions Division

Canon is promoting two key trends. Canon’s CXDI-701 Wireless digital detector is designed to enhance existing wireless workflows and assist the healthcare industry with providing quality patient care that is efficient, streamlined and convenient through accelerated exams and productive workflows. The CXDI-701 Wireless offers enhanced charging capabilities with Onboard Charging, allowing the battery to charge directly in the system. This latest digital detector is light and easy to maneuver, too, weighing only 7.5 pounds.

The CXDI-701 Wireless also features a rubber seal for liquid intrusion protection; auto detection imaging (i.e., no generator communication or special integration necessary), image rotation and impact detection; a detector status indicator; easing grid restriction (i.e., expanded available grid protocols for detectors); and the ability to send 12-bit and 16-bit images.

Canon’s Enhanced Workflow Package, which is specifically designed for the RadPRO 40kw Digital Mobile X-ray System,  provides digital mobile freedom in that it reduces needless travel time for technicians and enables them to complete their routine imaging tasks directly from the bedside.  Patent-pending hardware allows end users to customize their workflow routine, seamlessly switch between acquisition and desktop environments, access third-party software applications, query PACS for prior studies and perform image verification and close patient studies.

Bryan Mock, MRI products manager, GE Healthcare

An MR scanner can generate noise in excess of 110 decibels, enough to rival a rock concert. There is a good reason why this happens. “An MRI scanner is like a huge version of a speaker in your home,” says engineer Bryan Mock, who manages GE Healthcare’s MRI products. “They both have magnets inside and a coil of wire that carries electric current,” Mock says.

The current that flows through the coil inside the speaker creates a magnetic field that moves a magnet attached to a flexible membrane that generates sound. The MR scanner uses changes in the current to generate a magnetic field to image the body. MRI manufacturers traditionally minimized the noise by muffling it with foam or rubber. “But that’s just covering it up,” Mock says.

Two years ago, a team of engineers at GE Healthcare in Waukesha decided to snuff out the noise at the source. They developed a combination of hardware and software called Silent Scan that brings MR scanner noise near background sound levels around 77 decibels.

The technology works by minimizing changes in the current during the imaging process. Smoother current means fewer vibrations and less noise. “How we change the magnetic field is really the breakthrough of the Silent Scan technology,” Mock explains. He says that the software is changing the current “a tiny amount for every bit of information that we need.” New, “extremely stable” hardware helps to reduce the vibrations even further and eliminate bad images and image artifacts. “You need both pieces to work correctly for the machine to be quieter and give good images,” Mock says.

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