A CIO at the Table
By Cheryl Proval

Most radiology practices have not invited their CIOs onto the executive committee, but a recent survey¹ from the Center for CIO Leadership suggests that it may be time to set another place at the table. A practice benefits not only from hiring a well-qualified CIO, but also from empowering that person to be a member of the core executive committee charged with analyzing, automating, innovating, and growing the business.

"How does a CIO have influence over the business? I used to think it was about being asked, or where I reported . . . influence is more about building relationships-having the right conversations, at the right times, with the right people, and grounding those conversations in the realities of the business."

—Fortune 500 CIO

Overall, the survey, which includes the input of 175 CIOs representing a cross section of industries, indicates that CIOs have made significant progress in the past year in the eyes of senior management, which increasingly recognizes the transformative power of IT and the contributions of the CIO.

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Grow Your Multisite Business With a Single Sign-on Solution
By Cat Vasko

Six months ago, Jesse Salen, vice president of sales and technology for Online Radiology Medical Group (ORMG), Riverside, Calif, found himself in a situation familiar to many radiology practices: upgrade ORMG's RIS/PACS platform or face dissolution. ORMG had been in operation for nearly a decade, but the practice's single-database PACS wasn't sufficient to meet its needs. With an increasing number of radiologists reading from home, a single sign-on solution had gone from being a fantasy to a necessity.

"It's not like we're in a controlled environment, like a hospital," Salen says. "We have no control over what our customers send us. In order to operate efficiently, we have to be able to adapt to whatever the customers need."

Add to that the complicated infrastructure created by a staff of more than 30 radiologists, and you've got a daunting problem. It's an issue faced increasingly by practices that want to expand their businesses in the era after implementation of the Deficit Reduction Act. How can you support efficient, distributed reading over a wide geographic spread?

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My PET/CT Experience: Adding a New Modality to PACS
By David Brown, CIIP

It was a Tuesday afternoon when I received the call. The new PET/CT scanner was installed, and acceptance testing was about to begin, but my medical physicist informed me that PACS was not listed as a destination. The installation team had not configured the scanner to communicate with PACS. Not too concerned, I asked to speak with the modality vendor's field service engineer (FSE), who was working on-site. A sinking feeling set in as I learned that he was new to the company, and that he did not know how to set up DICOM.

The first question posed by the FSE was whether we had purchased the required licenses for the DICOM services that I was requesting. Confidently, I replied, "Yes." My purchasing agent had called me during the contracting phase to ask what requirements needed to be included for PACS. I provided my typical list: DICOM Modality Image Store, DICOM Print, Modality Worklist, Storage Commitment, and Modality Performed Procedure Step. Unfortunately, there was no Integrating the Healthcare Enterprise (IHE) specification available during the procurement phase, so IHE-compliance statements were not included in the purchasing contract.

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Solved: A Consistent and Simple DR/CR Interface
By George Wiley

Hospitals trying to send both CR and DR images to PACS, especially for the same patient, have encountered multiple problems in the past. CR and DR images acquired for the same diagnostic study, but through differing devices, might have been presented with a different look and feel because of the technologies with which they were acquired, delaying interpretation. The images might also have had differing exposure, contrast, and resolution, sometimes annoying and distracting technologists and radiologists.

More troublesome than the image problems themselves might have been the workflow delays that resulted when PACS administrators were forced to reconcile CR and DR images for the same patient into a single patient case. Technologists could also find themselves using different workstations and software tools, or creating an extra step by sending CR and DR images to a centralized workstation for quality assurance (QA) on those same datasets before they could even be sent to PACS.

Workflow delays in the radiology department were a problem that Russell E. McWey, MD, remembers well. At the Virginia Hospital Center (VHC) in Arlington, Va, technologists used to queue at a QA workstation waiting to process images, he says.

"There was a traffic jam. If you had five technologists QA-ing at the same station, it either went down or logjammed."

—Russell E. McWey, MD

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How I Do It: Imaging Pulmonary Hypertension in Pediatric Patients Using CT Angiography
By Jeffrey Hellinger, MD

Pulmonary hypertension is a complex process affecting pulmonary and cardiac functions. It is defined as a pulmonary pressure of more than 30 mm Hg. Its etiologies can be categorized as preload, pulmonary, or afterload pathologies. Preload abnormalities include any processes that may lead to increased pulmonary blood flow, such as left-to-right shunts.

Over time, increased flow leads to vasoconstriction and/or cellular proliferation, increasing pulmonary resistance and pressure. Pulmonary etiologies include any intrinsic lung diseases that lead to loss of cellular function and secondary regional changes in pulmonary blood flow and resistance. Afterload processes include cardiovascular diseases that increase left-sided systemic pressures. Progressive elevated systemic pressures lead to increased pulmonary resistance and pressure.

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Intersociety Conference: Adopt Structured Reports Now

Aside from referrers' clear-cut preference for structured reports, radiologists have added cause to adopt the use of structured reporting. At its annual meeting last summer, the 2007 Intersociety Conference urged the adoption of structured reports, according to an article by N. Reed Dunnick, MD, and Curtis P. Langlotz, MD, in the May 2008 issue of the Journal of the American College of Radiology.

Because the reports are organized into sections that are consistent and that use standardized language, they are more easily mined for key information that is increasingly necessary to document quality metrics linked to pay-for-performance programs, the authors wrote. While there are a few structured reporting systems for radiology on the market, radiologists can make progress toward satisfying referrers' preference for structured reports by using the standard macros available in most speech-recognition programs. The conference participants also supported the continued use of free text, which enables radiologists to expand on findings.

There remains, however, the challenge of creating those macros, and the conference participants urged the creation of best-practices structured reports using a standard radiology lexicon across all reports for examinations, interventions, and radiation oncology. The conference suggested that professional societies take the lead in developing these best-practices reports, enlisting subspecialists and referring physicians to develop the report templates. The reports could then be adapted for local conditions.

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Four Essential Archive Practices for Good PACS Management
By Joseph L. Marion, MBA

For PACS, archiving is an important part of the acronym, and equally important to effective system management. PACS calls for changes in the way patient information is handled, and the life-cycle management of images gains greater significance as imaging becomes more integrated with the electronic medical record. My experience of more than 20 years in PACS application and implementation has taught some lessons worth sharing.

Redundancy Matters
For years, radiology has maintained a file room for the storage of film, with no redundancy. This has probably been due to the realities of the prohibitive media cost and storage space needed to duplicate film. Some would argue that PACS, in and of itself, provides a level of redundancy; in a sense, that is true. As images are acquired, they are stored in a short-term cache for immediate accessibility. The short-term cache is then written to the long-term archive for permanent storage, so there is redundancy. One needs, however, to be aware of the PACS event that triggers repetition to the long-term archive. In many PACS, images are written to archive as soon as the study is validated. In others, images may not be written to the archive until the study is read. If this is the case, there is a risk of image loss in the event of a catastrophic failure of the short-term cache.

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PUBLISHER
Curtis Kauffman-Pickelle

EDITOR
Cheryl Proval

VP CLIENT SERVICES
Steve Smith

ADVERTISING DIRECTOR
Sharon Fitzgerald
sfitzgerald@imagingbiz.com

PRODUCTION COORDINATOR
Megan Runyon

TECHNICAL EDITOR
Kris Kyes

WEB MASTER
Bob Stephens

CONTRIBUTING WRITERS
Cat Vasko
David Brown, CIIP
George Wiley
Joseph L. Marion, MBA

Health Care Security Week Marred by a Series of Lapses
Now in its fifth year, the Health Information Privacy and Security Week, April 13-19, was marked by a startling series of security lapses when WellPoint exposed 130,000 patient records on the Internet, computer tapes containing the personal information of 2.1 million patients were stolen from the University of Miami, and 53 employees (including 14 physicians) purloined a look at Britney Spears' medical record at UCLA Medical Center in Los Angeles.

[Read more]

NHIN Will Integrate Google and Microsoft PHRs
First came the announcement that Google and Microsoft would launch Web-based personal health record repositories; then, federal officials announced that the Nationwide Health Information Network would be integrated with the databases of the two private informatics giants, as would the electronic health networks operated by the Department of Defense and the Department of Veterans Affairs. A few weeks later, an article in the New England Journal of Medicine raised serious questions about the ramifications of personal health information in the hands of public companies.

[Google Plan] | [NHIN Plan]

Consolidation Ahead for Health Care IT Companies
The soft market for auction-rate securities is hurting health care IT companies, warned Arlington, Va-based Friedman, Billings, Ramsey & Co. These companies have used the securities to fuel growth, and some, like Eclipsys, have a high exposure to the securities, whose rates are reset frequently at auctions.

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Allscripts and Misys to Merge
A planned merger between Chicago-based Allscripts and Misys Healthcare, Raleigh, NC, will create a combined customer base of an estimated 700 hospitals and more than 150,000 physicians in the United States. The deal will give London-based Misys PLC a majority stake in the new company, and Misys Healthcare will become a wholly owned subsidiary of Allscripts.

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PACSGEAR Launches Enhanced Multimedia Burner
PACSGEAR Inc, Pleasanton, Calif, has upgraded its MediaWriter with the Epson Discproducer, a high-volume robotic CD/DVD burner. MediaWriter D200 has two CD/DVD drives and a capacity of 100 discs, offering health care providers a fully automated DICOM distribution solution.

[More Information]

Megagroups Adopt Software to Monitor Payor Contracts
Harvard Vanguard Medical Associates, Newton, Mass, and WellSpan Medical Group, York, Pa, have purchased Phynance by Medical Present Value, Austin, Tex, a Web-based application designed to evaluate payor contract performance, verify reimbursement, and assess the financial implications of contract proposals. The software is designed to simplify contract evaluation by defining more than 50 variables and maintaining a database of client-specific contract terms and fee schedules.

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May

SIIM 2008 Annual Meeting
Sponsored by the Society for Imaging Informatics in Medicine

May 15–18
Seattle

Educational sessions are designed for the imaging informatics needs of physicians, researchers, administrators, and imaging informatics professionals, and the program includes educational and scientific sessions, debates, and hands-on experience in the SIIM Learning Lab.

[Register]

June

HIMSS Summit 08
Sponsored by the Health Information Management Systems Society

June 9–10
Renaissance Hotel, Washington, DC

Billed as the premier senior IT leadership program in North America, the summit takes place during National Health IT Week. The event is designed to address the high-level policy issues of this election year and their practical implications. Program tracks include: Ambulatory-enterprise Cooperation, Consumerism and HIT, Financial Health of Hospitals & Physician Practices, and Strategic Relationships: The C-suite.

[Register]

July

Beyond Strategies: Best Practices for Excellence in Outpatient Imaging

July 23–25
JW Marriott Pennsylvania Avenue, Washington, DC

Top-notch keynote speakers and seminar leaders will present a variety of topics on trends in health care consumerism, merger-and-acquisition strategy, and marketing/demand management. Keynote speakers include Mark McClellan, MD; election analyst Charlie Cook; and futurist Jeff Goldsmith.

[Register]