Dose Tracking Beyond the Enterprise: Pioneers and Challenges
Models for radiation dose tracking beyond a single health care facility or enterprise exist, and the experiences of these early pioneers can help predict what the next generation of cumulative dose estimation will look like, says Gregory Couch, CEO of Radimetrics. As an example, Couch points to a North American regional health authority in which 10 hospitals are leveraging his company’s eXposure software to manage cumulative dose. “It has been a huge benefit to them—they have been able to ensure consistency with their protocols across geographically dispersed hospitals,” he says. As a result, he says, the organization’s sole medical physicist is free to take her work to the next level. “Instead of spending all her time driving from hospital to hospital, she can be more proactive,” he says. “In general, most institutions hire medical imaging physicists to help them attain and maintain accreditation. Our goal is to bring them tools that make them part of the clinical process, enabling them to work proactively.” Proactive Approach Radimetrics’ eXposure software integrates with an organization’s RIS/PACS platforms to aggregate dose information by patient, but gathering that information—a process that has been under way in Vancouver for two years—is just the first step, Couch says. “The first stage, as far as I am concerned, is simple data assessment—understanding what has been done historically. The second stage is analyzing that information.” For instance, Couch says, if the assessment reveals major discrepancies between sites, opportunities for easy improvement will be abundant. That has been the experience at the University of California system, where comparing information across given major medical centers was revealing. “Before, they didn’t really communicate on this topic,” he notes. “There are so many benefits to be achieved simply from communicating and sharing experiences on how protocols have been developed.” Organizations also can leverage the information to better understand the efficacy of their imaging equipment, he adds. “Our sites are very much comparing what they are able to do with their existing equipment and what they can do with the newer CT systems,” he says. “They can show how the new techniques are resulting in a demonstrable reduction in dose, and they are using it to justify additional upgrades and replacements of equipment, and to make better use of the equipment they have.” Beyond that, he says, “The big question is how to incorporate this information into the patient’s record to make sure it is one of the factors considered when assessing the appropriateness of ordering a test.” With sufficient information on historical utilization, facilities can establish appropriateness criteria and measure to ensure that they are meeting those criteria. “In any complex process, it’s standard to measure so you can assure yourself that what you planned to do is what you are actually doing,” he says. “That ability is key to any quality and safety initiative.” Remaining Hurdles One of the biggest obstacles to cumulative dose tracking on a regional level is patient identification, according to Couch. “A growing trend is wanting to provide lifetime dose tracking for patients,” he says, “but in the United States, there is a big barrier to that, which is the lack of a common ID.” In Canada, he notes, there are no national health identifiers, but provinces assign patients a single common ID, “and it’s rare for people to go out of province for treatment. The way I would look at it is in Canada, there are fewer hurdles than in the United States,” Couch says. An even more pressing challenge is incentivizing disparate health care providers to share information. “Obviously, these initiatives benefit the patient, but health care providers need more than that—they need return on investment, and sometimes there is a fear that by sharing information with other providers they will lose patients to them,” he says. “A link to reimbursement would provide some incentive—what remains to be seen is whether that incentive is sufficient.” Couch believes, however, that the tide is beginning to turn. “The reality of the world is that you always have to take economics into account,” he says. “But the pendulum has swung now. We are seeing the beginning of an approach that is patient-centric and accountable.” He observes that at the community hospital level, adoption of dose tracking mechanisms has happened faster than he would have predicted. “They see it as part of their overall quality initiatives,” he says. “One site said, ‘We know if we do the right thing for the patient, the money will follow.’” Cat Vasko is editor of HealthIT Executive Forum.