HIMSS 2018 an Exclusive Interview with Denise Hines, Chairwoman, HIMSS North America Board of Directors P

How is AI going to impact workflow in radiology? p. 96

Your Industry Source for Health Care and Equipment Coverage January/February 2018

HIMSS 2018 An exclusive interview with Denise Hines, chairwoman, HIMSS North America Board of Directors p. 50 Top Acquisitions of 2017 p. 16

Also in our Workflow issue ARE YOU READY FOR ECR 2018? • Special interview with Professor Bernd Hamm, ESR president p. 38

GETTING THE EHR TO PLAY NICE WITH DIAGNOSTIC IMAGING • Technological potholes and roadblocks abound on the path to establishing a cohesive, interoperable health IT ecosystem p. 58

INVESTING TODAY TO MEET YOUR IMAGING IT NEEDS OF TOMORROW • Purchasing choices are driven by the need for new and evolving features, such as zero footprint viewers, and tapping into the potential for artificial intelligence technology p. 64

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January/February 2018

EXCLUSIVE Q&As 58 24 The challenges of integrating diagnostic imaging and the EHR The road to electronic health record adoption has not been easy as health Dr. Narendra Kini, CEO, Miami Children’s Health System care organizations faced significant cost and workflow challenges. A hospital's mission is to be a partner in life to children, wherever they are, in wellness and sickness. 64 38 Invest today to meet your imaging IT needs of tomorrow Purchasing choices are driven by the need for new and evolving Professor Bernd Hamm, European Society of Radiology president features, such as zero footprint viewers, and tapping into the Insights on the upcoming meeting, the unique challenges facing potential of artificial intelligence technology. European radiology and predictions for the future. 72 50 Seven signs you need help with population health management Denise Hines, chairwoman, HIMSS North America Board of How do you know if you’re on the right path to value-based care Directors transformation? Should you even be on that path in the first place? Discover the hot topics that will dominate conversations at HIMSS18, the premier event in health IT. 74 The enterprise imaging approach to coordinated care 61 How Southwest Diagnostic Imaging aligned records for 4.5 million Ashley Simmons, director of innovation development at patients across multiple locations and the benefits it has brought to Florida Hospital System the organization. RTLS/RFID is more than asset tracking. Applying these analytics to patients and providers can yield insights for better protocols and 78 improved surgical outcomes. Hype: Helping or hurting health care? Buzz-worthy innovations are exciting, but there's a harmful undercurrent 70 when patients and their loved ones gain false hope in the 'next big thing.' Seana-Lee Hamilton, manager of information privacy and privacy officer at Fraser Health Authority 80 An effective and functioning cybersecurity policy starts with a well- Making blockchain work for health care trained staff. Insights from IBM Watson Health on the potential impact blockchain can have on the health care sector. 76 Dr. Christopher Longhurst, chief information officer, 82 UC San Diego Health Medical VR: When worlds collide for better patient care When it came time for UC Irvine Health to update its electronic A look at the value of virtual reality in medicine and real-world evi- health record, it found a partner in UC San Diego Health that was dence of how it is improving colonoscopy outcomes. willing to try something that had never been done before: collabo- 84 rate with another academic provider to share an already existing Radiology workstations and the bottom line instance of an Epic EHR. With reimbursement down, Reno Diagnostic Centers has increased its focus on operational efficiencies. FEATURES 86 28 The value of a radiology information system in a clinical setting RIS and electronic health record systems with embedded RIS func- The top 10 trends and takeaways from RSNA 2017 tionality are making a comeback. AI is just one part of the emerging radiology toolkit — a kit that is being reinvented alongside the job description of radiologists themselves.

HealthCare Business News I january/february 2018 3

22 76 PUBLISHER DOTmed.com, Inc. PRESIDENT Philip F. Jacobus CHIEF TECHNOLOGY OFFICER Matt Ulman

EDITOR IN CHIEF Gus Iversen 212-742-1200 Ext. 233 [email protected]

EDITORIAL DIRECTOR Glenn J. Kalinoski

EDITORIAL 24 CONTRIBUTING EDITOR Sean Ruck SENIOR REPORTER Lauren Dubinsky STAFF REPORTER John R. Fischer

CONTRIBUTING WRITERS David Bennett COLUMNS & SECTIONS August Calhoun Michael J. Cannavo 8 Daily News Round-Up Shahram Ebadollahi Some of the top current events stories from our Daily Jon Ernstoff Brian Frohna News online Brita Hansen Ronald J. Milbank Roy Smythe 22 Hospital Spotlight Tyler Speakman Miami Children’s Health System Bipin Thomas Thom Wellington

26 IT Matters DESIGN DESIGN DIRECTOR Stephanie Biddle Dr. David Hirschorn, the chief of informatics, imaging DESIGN CONSULTANT Oscar Polanco service line, Northwell Health, on radiology workflow orchestration (part two) SALES SALES DIRECTOR David Blumenthal 212-742-1200 Ext. 224 34 Purchasing Insights [email protected] Considerations for the modern enterprise imaging system: more than a price KEY ACCOUNT Susan Minotillo MANAGERS 212-742-1200 Ext. 261 [email protected] 42 European Radiology News Connie Goon A handful of important current events impacting the 212-742-1200 Ext. 289 European world of radiology, just in time for ECR [email protected]

ACCOUNT MANAGERS Colm Ford 46 Technology Advisor 212-742-1200 Ext. 241 [email protected] Patient-generated data is transforming health care Michael Montes 212-742-1200 Ext. 217 47 Cost Containment Corner [email protected] Health care’s ‘quiet crisis’ Have News For Us? Imaging IT News If you have a press release to share with us or an article 54 you would like to see published, please submit it to: With HIMSS fast approaching, we recap some of the most [email protected] high-impact imaging IT current events Subscriptions For all subscription inquiries please email [email protected] or visit dotmed.com/magazine Innovative Treatment Auctions 57 If you want information about auctioning equipment on Cancer treatments using immune system come with a cost DOTmed.com, please call: 212-742-1200 Ext. 296, or email us at [email protected] HealthCare Business News is published by DOTmed.com, Inc., 88 This Month in Medical History 29 Broadway, Suite 2500, New York, NY 10006 Louis Braille: The world’s knowledge at his fingertips Copyright 2018 DOTmed.com, Inc. All rights reserved.

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DOTmedSM provides the HealthCare Business NewsSM to its registered users free of charge. DOTmedSM makes no warranty, representation or guarantee as to Visit DOTmed.com/news for breaking the accuracy or timeliness of its content. DOTmedSM may suspend or cancel this news daily, to comment on stories in this service at any time and for any reason without liability or obligation to any party. All trade names, trademarks and trade dress contained herein belong to their issue, to participate in surveys and more. respective owners and are used herein with the intent to represent the goods and services of their respective owners. If you think your trade name, trademark or trade dress is not properly represented, please contact DOTmed.com, Inc. Letter from the Editor Health care is no longer all about patients

Apple has just announced the incorpora- — which also means compliant — and useful. As an AI-first company, tion of health records into the iPhone. useful for us is using machine learning and artificial intelligence.” Johns Hopkins Medicine, Cedars-Sinai, Penn As health care shifts toward a wellness paradigm where care Medicine and other providers are among the begins long before admittance to the hospital, it’s easy to see these first to make the beta feature available to their household names as a logical extension of the health conversation. patients, with the goal of making it easy for con- Health care used to be something that had to do with sick patients sumers to see their available medical data from at the hospital, but it’s about the well-being of consumers with lives multiple providers whenever they choose. thoroughly entwined with the digital realm. “By empowering customers to see their overall health, we hope While skeptics will have pause to wonder what these tech giants to help consumers better understand their health and help them lead will be doing with personal health information (Facebook, by the healthier lives,” said Jeff Williams, Apple’s COO. way, has shown a heightened interest in courting pharmaceutical Amazon, meanwhile, is seeking a HIPAA expert to oversee a companies as advertisers), it is easy to see the benefit of having your “new initiative” with a careful eye on health privacy. While the new medical records in your pocket and your prescription available from initiative may be anyone’s guess, the online retailer has already toyed the biggest online retailer in the world. with the idea of adding prescription pharmaceuticals to its massive This has been on my mind a lot lately. If you’re attending HIMSS, umbrella of offerings and has also sought to bring its voice recogni- then I’m sure you’ll hear a lot of people, much smarter and well- tion solution, Alexa, to the medical industry. informed than myself, address these big issues. There is no clearer indication of the tech giants targeting health care Happy new year and enjoy the magazine. than the presence of Google making its RSNA debut last November. Gus Iversen “Our mission in health care is much like our mission as a company,” Editor in Chief Gregory Moore, the vice president of Google Cloud Health and a [email protected] practicing neuroradiologist, told HCB News at the meeting. “To orga- Twitter: @dotmedcom nize health and life sciences information, to make it accessible, secure

Dignity Health, Catholic Health Initiatives agree to merge into giant, new Catholic health system Posted online December 11, 2017 by Thomas Dworetzky

After talking for a year, Catholic Health The new organization will provide care Key strategic and reinvestment opportu- Initiatives and Dignity Health have en- in 28 states. nities for the newly formed system include: tered into a definitive agreement to “We foresee an incredible opportunity to • Expanding community-based care, includ- combine ministries, creating a new, non- expand each organization’s best practices to ing providing outpatient and virtual ser- profit Catholic health system. respond to the evolving health care environ- vices such as telehealth, micro-hospitals This will make for the largest not-for- ment and deliver high-quality, cost-effective and precision medicine; profit hospital system in the nation, ahead care,” Lloyd Dean, president and CEO of • Expanding clinical programs addressing of Ascension, but still smaller than the inte- Dignity Health, added in a statement. specific needs, such as for those with grated delivery system Kaiser Permanente. Lofton and Dean will act as co-CEOs, ac- chronic illness, aimed at helping them re- "We are joining together to create a cording to Crain's Chicago Business Journal, main healthier and functioning in the com- new Catholic health system, one that is po- and divide up responsibilities. Lofton will han- munity for longer; sitioned to accelerate the change from sick dle mission, advocacy, sponsorship and gov- • Continuing to further advances in digital care to well care across the United States,” ernance, system partnerships and information technologies — such as stroke robots and Kevin E. Lofton, CEO of Catholic Health Ini- technology. Dean will deal with operations — Google Glass. tiatives, said in a statement. such as clinical, financial and human resources. Share this story: dotmed.com/news/40673

6 HealthCare Business News I january/february 2018 www.dotmed.com/news HealthCareBusiness Daily News Online Top trending headlines As we went to print: Welcome to our Online 1. Hit with $6.2 billion charge, GE considering major shake-ups News Center — dotmed.com/news/story/41162 featuring our Breaking News Round-up 2. Siemens Healthineers lays out cost-cutting strategy ahead of IPO dotmed.com/news/story/41136 3. Canon to step up payoff of daily news online Toshiba Medical deal debt dotmed.com/news/story/41204 When health care industry news 4. Does health care hold the key to breaks, you’ll read about it first at: IBM's market comeback? dotmed.com/news dotmed.com/news/story/41262 Visit daily and sign up for our 5. Philips to relocate NA headquarters from Andover to Cambridge convenient weekly news digest. dotmed.com/news/story/41106 6. Health Canada approves GE's DaTscan SPECT agent dotmed.com/news/story/41086 in print 7. Donald Trump had a CT scan, here's what we learned Get a free subscription and dotmed.com/news/story/41202 sign up for the digital version 8. ECRI releases its annual Top 10 Hospital C-suite Watch List of HealthCareBusiness News. dotmed.com/news/story/41261 9. Health care groups call on Anthem to rescind outpatient imaging policies dotmed.com/news/story/41264 10. Ultrasound-based technology may be able to treat cancer dotmed.com/news/story/41139 Subscribe to our Magazine and 11. Radiology Partners and three universities establish radiology research center weekly Online News digest now. dotmed.com/news/story/41104 12. MITA and others call for long-term solution to medical device tax dotmed.com/news/story/41121 13. Engineering solution reduces MR production and scanning costs dotmed.com/news/story/41087

How is AI going to impact workflow in radiology? p. 96

Your Industry Source for Health Care and Equipment Coverage January/February 2018 14. Change Healthcare acquires NDSC

HIMSS dotmed.com/news/story/41203 2018 An exclusive interview with Denise Hines, chairwoman, HIMSS North America Board of Directors p. 50 15. NTT Data Services partners with Top Acquisitions of 2017 p. 16

AlsoinourWorkflowissue AI provider Pieces Technologies ARE YOU READY FOR ECR 2018? • Special interview with Professor Bernd Hamm, ESR president p. 38

GETTING THE EHR TO PLAY NICE WITH DIAGNOSTIC IMAGING • Technological potholes and roadblocks abound on the path to establishing a cohesive, interoperable health IT ecosystem p. 58 dotmed.com/news/story/41105 INVESTING TODAY TO MEET YOUR IMAGING IT NEEDS OF TOMORROW • Purchasing choices are driven by the need for new and evolving features, such as zero footprint viewers, and tapping into the potential for artificial intelligence technology p. 64 Visit HCB Daily News online for breaking stories every day.

HealthCare Business News I january/february 2018 7 Daily News Kubtec to supply X-ray technology for 3,500-year-old tomb excavation in Greece Posted online December 12, 2017 by John Fischer

An international research team has and can be operated with complete safety ity, internal structure and the dating of the selected Kubtec to supply X-ray equip- because you are talking about radiation as objects, remains and the tomb at an afford- ment for examining the findings from well as something that can be easily put to- able rate. its excavation of a 3,500-year-old burial gether and above all that, something that is Kubtec plans to work closely with, and site in Pylos, Greece. reasonably priced.” offer support to the team throughout its ex- The Connecticut-based manufacturer The team discovered and began excavat- cavation. will provide the team with its XTEND Por- ing the tomb in the summer of 2015, finding “The challenge falls on us as developers table X-ray system and its high-resolution the remains of a warrior surrounded by met- of technology to develop something while digital detector system to help assess the al objects made of gold, silver and bronze keeping in mind that it needs to be afford- findings from their archaeological dig of the in “one of the most significant displays of able,” Butani told HCB News. “The mate- Griffin Warrior Tomb. prehistoric wealth discovered in mainland rial content of what is being imaged is so “When you’re going out into the field, Greece in the past 65 years,” as described by varied that it is very challenging to develop you need to be able to operate equipment co-leader of the team and archaeologist Dr. technology that is sensitive to that entire in a quickly created lab or in the middle of Sharon Stocker of the University of Cincin- spectrum of material densities. This is going a dig,” Vikram Butani, CEO and founder nati in a statement. to be a system that is going to be able to of Kubtec, told HCB News. “So you need The technology will enable Stocker and support that.” something that offers the highest resolution the rest of the team to assess the authentic- Share this story: dotmed.com/news/40657

New AI solution for chest Innovations in primary X-ray has up to 99 percent diagnostics to boost digital stand-alone accuracy pathology market Posted online December 7, 2017 by Lisa Chamoff Posted online December 29, 2017 by John Fischer

CHICAGO — While artificial intelligence (AI) dominated plenty New business models and increases in the FDA approvals of of conversations at the 2017 RSNA annual meeting, South Ko- whole slide imaging (WSI) scanners for primary diagnostics rean company Lunit was one of a few exhibitors to provide a are expected to boost the growth of digital pathology from live demonstration of its AI solution for image analysis. now until 2021, according to a market report released by The Lunit INSIGHT has a chest X-ray solution that acts as a “sec- Reportbuyer. ond reader” to detect major chest abnormalities, lung nodules or Key drivers behind the global adoption of digital pathology masses, consolidation and pneumothorax. The company says the include a shortage of pathologists and a rise in cancer cases. The solution has 97 percent stand-alone accuracy in nodule detection World Health Organization estimates a 70 percent rise in the num- and 99 percent accuracy for consolidation and pneumothorax. ber of new cases over the next two decades. More than a quarter of lung cancer cases were missed on chest Such solutions are expected to enable physicians to evaluate X-rays, according to the National Lung Screening Trial, and Lunit is second opinions on critical cancer cases quickly and pharmaceuti- looking to decrease the proportion of missed cases. cal companies to remove bias and provide quantifiable results. The solution, which shows the level of abnormality and where the Yet, approval for these devices did not extend to primary di- AI detects it within the image, is accessible via the Google Chrome agnosis until April 2017 when Royal Philips received FDA clear- browser. Radiologists can upload up to 10 X-rays per day for free, in ance for its Philips IntelliSite Pathology Solution. This approval order to become more familiar with the product, though it has not is expected to garner greater adoption of digital pathology in received FDA clearance. Brandon Suh, chief medical officer for Lunit, primary diagnosis with further approval of WSI scanners projected said clinical studies for the regulatory process will start early next year. in the next three to five years, raising competition in the process. Share this story: dotmed.com/news/40609 Share this story: dotmed.com/news/40895

8 HealthCare Business News I january/february 2018 www.dotmed.com/news

Daily News Online > dotmed.com/news Black Book survey: more than 8 in 10 providers lack cybersecurity leadership Posted online December 29, 2017 by John Fischer

Only 11 percent of health care providers target for cyberattacks, with crimes rang- with provable business cases, and that only plan to introduce a cybersecurity officer ing from thefts of information from EHRs to a small portion will go toward cybersecurity. in 2018, with 84 percent lacking reliable complete shutdowns of hospital operations, Other endeavors in this area have re- leadership for combating cyberattacks. endangering the care and lives of patients. ported similar views, with a recent Mimecast Those are the statistics found in a Q4 The chance of such attacks occurring is Limited study conducted by HIMSS Analytics 2017 survey conducted by Black Book Re- high, based on the survey’s findings — with claiming that 78 percent of providers expe- search, paired with 31 percent of payors that 54 percent of respondents admitting to not rienced email-related cyberattacks through- have an established manager for cyberse- conducting risk assessments on a regular ba- out 2017. Experts at the recent RSNA meet- curity programs and 44 percent recruiting sis and 39 percent not carrying out regular ing found that ransomware attacks were on candidates in the new year. penetration testing for firewall efficiency, the rise with the sales market rising by over “It’s a very thrilling time for health care thereby showing an underestimation of se- 2,000 percent in one year. technology,” Douglas Brown, managing part- curity threats. Brown said that expensive costs for cy- ner for Black Book Research, told HCB News. C-suite officers were also interviewed, bersecurity software and insurance, insuf- “It’s crucial that attention to that technology with 92 percent reporting that cybersecurity ficient awareness, process inconsistencies doesn’t come at the expense of hospitals and and the threat of a data breach are not ma- caused by consolidation and the fact that physician practices giving the needed focus to jor talking points with their boards of direc- hospitals are lucrative targets are among the network security, which becomes even more tors. Eighty-nine percent of all respondents crucial factors that contribute to the lack of vulnerable as smart tech advances.” say that budgeted IT funds for 2018 will preparedness among providers. Health care organizations are a notable be primarily focused on business functions Share this story: dotmed.com/news/40892 Hitachi acquires Mitsubishi Nuvolo partners with GE Electric’s particle therapy Healthcare on cloud-based system business enterprise asset management Posted online December 13, 2017 by John Fischer Posted online December 5, 2017 by Gus Iversen

Hitachi Ltd. has acquired Mitsubishi Electric’s particle ther- GE Healthcare has implemented the latest version of Nuvolo apy system business for an undisclosed sum. Clinical EAM for the management of more than 3 million medical The two Japanese companies have signed an agreement to ini- devices in the U.S. and Canada. tiate plans for transferring ownership of the business and integrat- The system, built on ServiceNow and providing online and offline mo- ing it with Hitachi’s own particle therapy division to form one entity. bile functionality, is designed to modernize usability and analytic insight of “As both companies were focusing on globalization, we found asset management while also tightening security and reducing some of the it best to combine resources in order to gain a competitive edge redundancy that can result from using outdated solutions. and add value through product improvement,” Hiroyuki “Henry” According to Tom Stanford, CEO of Nuvolo, an antiquated install base Itami, executive general manager of the particle therapy division, of CMMS and EAM systems — coupled with the continuing trend of health care business unit at Hitachi told HCB News. “Since Hitachi health care consolidation — has made this particular market segment “ripe already had a broad health care portfolio — CT, MR, ultrasound, for disruption” as providers juggle multiple vendors and systems across the particle beam therapy — it made business sense that Hitachi took enterprise with unnecessarily complex asset management tools. the lead in this partnership.” “If you take a step back and look at the last several years, where you once Particle therapy is considered one of the most effective meth- had 6,000 health care providers you now have 3,500 and in a few years ods of treatment for cancer patients, due to its producing fewer you will have 2,500,” Stanford told HCB News, adding that when hospitals side effects, compared to other forms of treatment, such as sur- merge they often wind up with multiple systems of record. “Each [system] gery, as well as its fast recovery time. Over 10 facilities utilizing this has its own corresponding ecosystems so when a vulnerability like WannaCry treatment are expected to be built each year in addition to the 70 emerges you have to figure out which devices are connected and which are current ones worldwide. an exact match to the patch vulnerability that a cyber threat will apply to.” Share this story: dotmed.com/news/40693 Share this story: dotmed.com/news/40590

10 HealthCare Business News I january/february 2018 www.dotmed.com/news Elekta delays order target for Unity MR linac Posted online December 1, 2017 by Thomas Dworetzky

Elekta is shifting its order-taking goals tual agreement. It will now continue “on a tomer focus,” stressed Hausmann, who said for Unity. smaller basis.” the company’s target for the year was an “Recently, we have made two difficult The company also announced a bump in EBITA margin above 20 percent. decisions for the short term, but I’m con- year-over-year earnings before tax, interest The company was lately in the news vinced that they are correct and necessary and write-offs for debt losses for its fiscal Q2, when it announced that the Romanian gov- for the long term. Firstly, we have extended ended in October, of 30 percent, or $60.9 ernment had agreed to install Elekta linear the final stage of the development and test- million, according to the wire service. accelerators for cancer treatment at five ing of Elekta Unity in order to finalize and “During my first six quarters our work facilities throughout the country to replace validate the linac control system, as well as has been characterized by positive change, obsolete cobalt systems. ensure that customers can make use of the increased transparency, openness and cus- Share this story: dotmed.com/news/40529 full potential of high-field functional MR imaging from day one. Unity is a unique and future-proof system as it’s the only technology that combines an advanced linac with the real-time visualization from a high-field Not on our watch! MR,” the company president and CEO Rich- ard Hausmann said in a statement. The delay will be worth it, the company thinks, but it will delay sales. “We are convinced that the new technology will revolutionize radiation therapy and create completely new opportunities for physicians and their patients,” said Haus- mann, explaining that, “with the shift in CE mark and FDA submission, we adjust our target for the first 75 orders accordingly to the first half of calendar year 2020.” The company anticipates CE marking for Unity by mid-2018 instead of 2017. This sent the firm’s shares down in trading, according to Reuters. The program, despite the delay, is “pro- gressing well,” according to Hausmann, AUE enjoys one of who stressed that, “interest from clinicians the lowest DOA rates in the industry!! was very strong when we made the U.S. introduction of Unity at ASTRO in San Di- 1.5 % for the last 12 months! ego. In Europe, University Medical Center Utrecht recently presented results from the When looking for quality systems, parts, service, and repairs, first patient study that demonstrated preci- at better than OEM pricing, look no further than… sion beyond expectations. The system gener- ates excellent imaging quality synchronized with precise beam delivery. We now have 18 customers after we recently added two, one from a leading hospital in Italy and another from a research collaborator in the USA.” The #1 source for all your Ultrasound needs! The company also reported that it had need to redo its 4-year contract in the order www.auetulsa.com • Tel. 1-866-620-2831 backlog with McLaren Health Care, by mu-

HealthCare Business News I january/february 2018 11 Daily News Online > dotmed.com/news Older pacemakers are still safe in MR Posted online December 28, 2017 by Thomas Dworetzky

A new study finds that MR can be safe signals during the MR procedure. After the led to any “significant problems,” according with older “legacy” pacemakers and de- scan, the devices got reset to proper daily to Nazarian. fibrillators. settings. Nine legacy devices were triggered by the The findings are good news for patients The issue is not just about health — the scans, but restarted to backup mode suc- needing a scan and faced with such implant- Centers for Medicare and Medicaid Services cessfully. able heart devices, according to the report (CMS) only covers FDA-determined “MR-con- A single device had to be replaced, which in The New England Journal of Medicine. ditional” scans, co-author Dr. Saman Nazar- had a low battery — but “pacemakers do The study “confirms that pretty much ian, of the University of Pennsylvania Perelman funny things when the battery is low,” ob- anybody who has a pacemaker or implanted School of Medicine, told Reuters. served Halperin. defibrillator can, with very few restrictions, This study follows a similar one that He noted that most heart devices, pace- safely get an MRI scan if they need it,” as revealed that legacy devices were safe, makers and defibrillators passed by the FDA long as settings for the devices are correct which has led Nazarian to suggest that, from 2000 on are better able to handle the for scanning and adequate precautions are given these reports, the agency’s position energy inside an MR, adding, “and we pro- taken, co-author Dr. Henry Halperin, profes- is “hard to understand,” according to the gram them to avoid most any problems that sor of medicine, radiology and biomedical news wire. might happen.” engineering at Johns Hopkins University, told This latest study looked at approximately For patients with an unrated device, Naz- Reuters. 200 of 1,509 pacemaker and defibrillator arian recommended that, “many centers Researchers set these legacy devices to patients who received chest scans using a across the U.S. are capable of performing a standard heart rhythm and blocked other 1.5 Tesla machine. safe imaging despite your device.” settings that could let them react to erratic No scanning, to the chest or elsewhere, Share this story: dotmed.com/news/40894

California Proton Therapy Center re-launches California Protons Posted online December 12, 2017 by John Fischer

California Proton Therapy Center, LLC to improve short- and long-term financial per- tains day-to-day operations, patients of the officially re-launched California Protons, formance,” James J. Loughlin Jr., managing network are still welcome to the center to a cancer treatment center in San Diego, partner at Loughlin Management Partners + seek treatment. on Dec. 7 under new management and Co., told HCB News. “The center is well po- California Protons expects international leadership and with an expanded group sitioned to truly become a regional resource patient volume to grow through the devel- of physicians. that is available to treat patients from all over opment of its first-class concierge program, The relaunch follows a year of hardship the state of California and abroad.” along with the increasing number of proton for the center, which filed for Chapter 11 Changes include a reduction in cost therapy centers in the U.S. bankruptcy protection in March and parted structure and an alignment with a group “We expect that our international patient ways with its management, Scripps Health, of experienced proton physicians, three of volume will grow as we develop a first-class in September. Loughlin Management Part- whom are from the University of California concierge program to support our patients’ ners, a specialist in business and health care at San Diego. Certain functions, such as in- travel and lodging needs while being treated turnaround, is working with the facility on surance authorizations, will be brought in- at the center,” Loughlin said. “As more pro- a transition plan as it welcomes Orix, JP house to decrease delays and enhance the ton treatment centers open throughout the Morgan and Varian as its new owners and efficiency of processes. U.S., the overall awareness of the benefits investors, and Proton Doctors Professional The center also aims to continue building of proton therapy will increase. And as new Corporation (PDPC) as its clinical manager. on its clinical affiliations with its partners, research results support the benefits of pro- “The center has been recapitalized, the including UC San Diego and Rady Children’s ton therapy, demand will increase, which investor group has provided additional finan- Hospital, while forging new partnerships will benefit the California Protons Cancer cial resources to support the center’s future and alliances throughout California. Therapy Center.” growth, and we have taken a number of steps Though Scripps Health no longer main- Share this story: dotmed.com/news/40675

12 HealthCare Business News I january/february 2018 www.dotmed.com/news FDA to require gadolinium retention label warnings Posted online December 20, 2017 by Thomas Dworetzky

In the ongoing discussion over gadolini- It stated that body levels of gadolinium um retention has yet to be established, the um-based contrast agents, the Food and are highest with Omniscan (gadodiamide) agency noted that “we are continuing to as- Drug Administration (FDA) has issued a or OptiMARK (gadoversetamide) com- sess the health effects of gadolinium reten- safety communication. pared with Eovist (gadoxetate disodium), tion in the body and will update the public It will require “a new class warning and Magnevist (gadopentetate dimeglumine) when new information becomes available.” other safety measures for all gadolinium- or MultiHance (gadobenate dimeglumine). The specific label changes for GBCAs based contrast agents (GBCAs) for magnetic Gadolinium levels are lowest when using concerning retention, the FDA stated, are resonance imaging (MRI) concerning gado- Dotarem (gadoterate meglumine), Gadavist in the sections covering adverse reactions, linium remaining in patients’ bodies, including (gadobutrol) and ProHance (gadoteridol) — pregnancy, clinical pharmacology and pa- the brain, for months to years after receiving and levels are similar for these agents. tient instructions. these drugs,” the agency said in a statement. Although the health impact of gadolini- Share this story: dotmed.com/news/40826 No direct link to adverse health impacts has been found in those with normally functioning kidneys, noted the agency, explaining that “we have concluded that the benefit of all approved GBCAs continues to outweigh any potential risks.” That said, the added review and talks with the Medical Imaging Drugs Advisory New and Refurbished Equipment Available! Committee, has led to changes designed to highlight retention issues with MR imaging using GBCA. These include a new Medication Guide for patients to be read prior to getting a GBCA, as well as requiring makers to perform further animal and human studies over its safety. The kidneys usually clear the agents, but trace amounts have been found in the body. For those with a higher risk of retention, such as patients who may need multiple doses, those who are pregnant, children and those with inflammatory conditions, the agency advises care, but stressed, “do not avoid or defer necessary GBCA MR scans.” For those at risk, the FDA pointed out that linear GBCAs “result in more retention and retention for a longer time than macro- cyclic GBCAs,” and to give them accordingly. As a result of its review, stated Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, “we recommend that health care professionals consider the retention characteristics of each agent when choosing a GBCA for patients who may be at higher risk, such as those who may require repeat GBCA MR scans to monitor a chronic condition.”

HealthCare Business News I january/february 2018 13 Daily News Online > dotmed.com/news AI, service-based business models and the cloud will be significant health care trends in 2018 Posted online December 18, 2017 by Lisa Chamoff

There’s no denying that artificial intel- Addressing the emergence of AI, Keith as well as flowing seamlessly right into the ligence (AI) is going to be a key part of Bigelow, the general manager for analytics modalities, the equipment itself.” the health care landscape in 2018, but at GE Healthcare, said that at RSNA 2016, When asked to vote on the one key other emerging trends, including the vendors were excited about the prospect of technology they believe will have the most shift to a product-as-a-service busi- AI, but were not communicating the value profound impact on the health care indus- ness model and the cloud as a core of how it would augment the work of radi- try during 2018, a plurality of respondents storage platform, were highlighted as ologists and improve care. That changed at voted for AI. part of Frost & Sullivan’s 2018 indus- the 2017 annual meeting. Among the eight top predictions, Frost & try predictions. “This year, what we were showing is a Sullivan analyst Kamaljit Behera noted that The consulting firm included these and more humble and mature perspective on over the next year and beyond, a service and other predictions in a webinar. During the artificial intelligence,” Bigelow said. “Hon- not a product business model will become presentation, both an executive and an estly, at least for GE, I think our vision has the norm for drug and device companies, analyst from Frost & Sullivan were joined by matured a bit, where we see artificial intel- opening new revenue streams and contrib- leaders at GE Healthcare, Microsoft and Intel ligence more as an invisible capability, more uting 2 to 3 percent revenue for leading to discuss the health care landscape going like water that starts to flow into the existing companies by 2020. into 2018. workflow applications inside the hospital, Share this story: dotmed.com/news/40744 Siemens launches new teamplay Philips acquires Forcare Cardio dashboard app for Posted online December 7, 2017 by John Fischer

cardiology departments Royal Philips has acquired Forcare in an effort to pro- Posted online December 13, 2017 by Lauren Dubinsky vide more effective, seamlessly integrated informatics solutions for improving clinical workflow, enhancing Siemens Healthineers launched its new teamplay Cardio dash- patient care and optimizing enterprise management. board application within the Digital Ecosystem platform. The purchase will combine the capabilities of Philips’ ad- The application analyzes the data within a cardiology department to vanced clinical informatics solutions with those of Forcare’s provide insight into its performance, resources and status. interoperability platform to strengthen connections among “[Facilities traditionally] need to assign someone to produce the report hospitals and health systems, in order to ensure the efficient and make the data meaningful, but with the dashboard it’s at your finger- delivery of patient information. tips,” Ayse Berdan, global product marketing manager of digital services, “We see the need for better interoperability for hospitals told HCB News. “They can export the data as a PowerPoint or Excel and and health systems, and so do our customers,” Yair Briman, share it with management to analyze this data.” business leader of health care informatics at Philips, told HCB Users can see exam volumes over a certain time period and use the News. “The lack of connectivity between various medical actionable data to create customized reports. That can help the depart- systems, such as imaging systems and information management spot areas that need improving, as well as calculate trends such as ment systems is, in fact, one of the main concerns of hospital staff allocation, room utilization and patient flow. CIOs. We have looked at different interoperability technolo- Teamplay Cardio also provides report turnaround time trends, which gies, and we believe that Forcare’s interoperability platform is is important for business operations. It can spot whether the turnaround the most advanced solution in the industry. We were already times are too long, in order to prevent the department from losing refer- working with them, and we were impressed by the maturity, ring physicians. stability and scalability of their technology, as well as the It could also help a department cut costs in certain areas. If the dash- service and implementation skills.” board reveals that the cardiologists are only using one type of contrast The deal will provide greater scale and reach to Forcare, media, the department can stop ordering other types or negotiate prices with Philips ensuring that employees are able to continue with the vendor. working. Share this story: dotmed.com/news/40677 Share this story: dotmed.com/news/40615

14 HealthCare Business News I january/february 2018 www.dotmed.com/news Anatomage launches Anatomage Cloud for medical image sharing process and distribution Posted online December 27, 2017 by John Fischer

Anatomage Inc., a private manufacturer its XStream HDVR SDK Suite. communication between doctors, and as a of tools for anatomists, has launched Skoff says a simpler and faster process result, enhanced patient treatment.” a new cloud-based service to simplify will enhance communication among phy- Anatomage expects the FDA to approve the distribution and sharing process of sicians, enabling instant review of cases, its Anatomage Cloud 3-D web viewer for medical images. quicker diagnoses and improved care. diagnostic viewing in 2018, with the web Anatomage Cloud enables physicians to “Collaborative treatment planning be- viewer currently available to preview images access images anywhere, on any device with tween doctors is always improved with clear on the web. Received DICOM data can be a web browser-based 3-D DICOM viewer, visualization of the patient images,” he said. downloaded and loaded into any other med- including mobiles. Though designed in re- “Anatomage Cloud will make this process ical imaging software for treatment planning. sponse to the growing number of specialists much faster and easier, so we expect better Share this story: dotmed.com/news/40855 utilizing cone beam CT (CBCT) imaging, the service can be used to share images from any imaging modality that uses DICOM as a standard format, such as MR and PET. “We have noticed that the increased use of 3-D CBCT scanners in dental, medical and even veterinary practices has resulted in more patient 3-D scans and the desire to collaborate with 3-D images,” David Skoff, business development manager of Anatomage, told HCB News. “For instance, an oral surgeon and orthodontist need to view the same patient scan to develop OVER their treatment plan together. The process of sending the scan between offices by CD or USB is slow and cumbersome, but is typical because the file size is large and it requires dedicated viewing software. Anatomage Cloud solves both of these problems because it allows the doctor to send the case quickly and provides viewing capability on any device with a web browser-based 3-D DICOM viewer.” 22YEAR00S OF The universal medical image sharing BEING A PARTNER platform, when used in conjunction with YOU CAN TRUST Anatomage’s Invivo6 workstation software, FOR ALL OF YOUR enables users to rely on no other software RADIOLOGY tools or managing files. It also ensures HIPAA-compliant image transfer and storage EQUIPMENT through its cloud technology, eliminating the NEEDS. need for CDs and USBs. The integration of cloud-based capabilities is a rising trend among medical device manufacturers as providers demand quicker access and more interoperability across the health care continuum. EHR vendor MEDITECH re- 1.888.561.7900 | 1.407.917.5779 amberusa.com cently introduced to its cloud subscription MaaS, as well as Fovia, which announced the addition of its F.A.S.T. Cloud Development to HealthCare Business News I january/february 2018 15 Daily News Online > dotmed.com/news

Top five acquisitions of 2017

Posted online January 3, 2018 by John Fischer

2017 should be remembered as the “Year of the Acquisitions” following the number that took place over the last 12 months, not to mention the size of their importance.

With the future and 2018 on everyone’s mind now, it’s easy to forget the impact that these completed deals will have on the health care industry in the new year and beyond. To avoid this fate, let’s take a look at five of the top acquisitions of 2017:

Bayer to sell Multi-Vendor Service business Consensys’ scalable model to continue its expansion as a company and In an effort to focus more on its radiology business, Bayer announced to absorb existing service needs, including ones already outsourced its decision to sell its Multi-Vendor Service (MVS) operations to Re- back to OEMs. It also certifies Merry X-ray with ISO9001 and ISO13485 silience Capital Partners and North Park Capital Partners (Resilience/ under the International Organization for Standardization. North Park). Consensys customers also benefit, with access to X-ray equip- The MVS business, which provided repairs and maintenance ment distribution, sales of refurbished equipment, certain product primarily for non-Bayer radiology devices, such as MR coils and ul- lines and the inclusion of services offered by Merry X-ray in their trasound transducers, formed an extension of the Medrad MR coil existing contracts. manufacturing business for the repair of multi-vendor coils in 1996. The deal builds upon another acquisition completed in September Operations take place at three depot repair centers in Pittsburgh, of Universal Medical Systems, a supplier of MR and CT imaging and Tulsa, Okla., and Maastricht, the Netherlands, with each maintaining one that holds expertise in robotic CT systems and high-field MR. an ISO 13485 certification. Both these purchases should be noted not just for their multiple The purchase, according to a Bayer spokesperson who spoke assets, however, but as part of an emerging trend, consisting of a with HCB News, supports long-term sustainability for MVS in the greater number of acquisitions and mergers taking place within the third-party radiology device repair sector. Bayer’s choice to sell to third-party service industry and one that is likely to continue in 2018. Resilience/North Park was due to its experience in forming stand- “When you look at the big three manufacturers, GE, Siemens alone companies. and Philips, I think it’s pretty clear they haven’t been growing rapidly Bayer will continue to oversee its service business, providing such because there’s been this uncertainly in the market,” Jim Spearman, support for the devices it produces. the CEO and president of Consensys, told HCB News. "And I think in the third parties, you’re seeing that continue to trickle down, and Merry X-ray acquires Consensys Imaging Service now the industry is worried for digital consolidation.” The acquisition of Consensys Imaging Service marked Merry X-ray Corporation’s transition from a mere distributor of X-ray equipment Alpha Source acquires BC Technical to a one-stop shop for X-ray, MR, ultrasound, CT, mammography Acquiring the latest medical equipment is on every provider’s radar and a variety of other imaging modality needs. year-round. But in balancing pricing, budgets and patient needs, it’s “Now, whether you’re talking about the sale of a digital X-ray also important to preserve what you already have. or the service of an MR, we have one place where we can offer our That’s what made Alpha Source’s acquisition of BC Technical a great customers the service systems of basically one company,” Ted Sloan, asset in 2017, enhancing Alpha’s ability to cater to the marketing needs the president of Merry X-ray, told HCB News. of health care organizations seeking to expand the life of their devices, The purchase, completed in October, provides Merry X-ray with much of which is estimated to be approximately 20 years old.

16 HealthCare Business News I january/february 2018 www.dotmed.com/news “By offering a full [range] of imaging modality services, plus parts year of 2017 started out troubling for both companies, with China and training, we can help customers extend the life of their medical slapping their agreement with a fine of 300,000 yuan ($43,000) equipment,” Rick Lytle, the CEO of Alpha Source and BC Technical, relating to violations over antitrust regulations against Canon. told HCB News. “Further, because of the rapidly consolidating health China furthered frustration through the length of time it spent care marketplace, with systems and hospitals and imaging centers assessing the legality of the deal, delaying Toshiba Medical Systems’ becoming bigger, we’re in a better position, given our nationally name change to Canon Medical Systems to 2018. scaled footprint, to service larger customers, including our OEM and Canon also ran into trouble with the EU in the summer, when asset management partners.” merger commissioners for the 28-member bloc issued a statement The acquisition doubles the size of Alpha Source and enables of objection, alleging that Cannon “breached the EU Merger Regu- expansion of its geographic scope, with field engineers located in lation” by initiating the acquisition before notifying and obtaining major markets nationwide and services for customers across both approval from the Commission. Though the deal was allowed to companies, primarily in field service, sales, marketing, service parts, continue, Canon stock dropped to a two-month low. distribution and supply chains. "We need companies to work with us to ensure fast and predict- It also expands Alpha’s ultrasound and bone densitometry services able merger control, to the benefit of both companies and consumers. to include maintenance, repair and refurbished equipment for CT, MR But we can only do our job well if we can rely on cooperation from the and molecular imaging modalities. companies concerned — they must obtain our approval before they The deal marks the fifth acquisition for Alpha Source in less than implement their transactions, and the information they supply us must three years and reflects a substantial growth projected for the imag- be correct and complete," stated Commissioner Margrethe Vestager, ing service provider market, driven by a desire among health care in charge of competition policy, as reported by HCB News. providers for quality and value-based repair and replacement options The deal, already surrounded in controversy due to the nature of to better manage costs. its structure, seems to have stabilized, with Canon discussing its plans It even got a mention from DOTmed.com president and founder for integration and Toshiba Medical Systems set to officially change Phil Jacobus in his weekly blog, The Jacobus Report. its name to Canon Medical Systems in January 2018. Share this story: dotmed.com/news/40921 Radiology Partners acquires SDI and Peoria facility Radiology Partners, which more than doubled the number of hospitals and health care organizations it serves, expanded its geographic footprint by six states. Serving almost 200 organizations in seven states in December 2016, the hospital-based practice has built up its clientele to nearly 450 in the last 12 months, spread out across 13 states. “Garnering more scale allows us more resources, opportunities to make bigger investments and opportunities to continue to innovate from a clinical standpoint,” Rich Whitney, the CEO of RP, told HCB News in September following the acquisition of Southwest Diag- nostic Imaging, a move which introduced RP to the Arizona market while providing it with a 25 percent increase in scale to serve over 525 radiologists at 400 sites in more than 10 states. RP built upon these numbers further in November when it acquired Specialists in Medical Imaging of Peoria, expanding its reach into Illinois while adding on new sites in Texas, New Mexico, Michi- gan and South Carolina. The acquisition of these two companies as well as other entities provided not just access to new technology and programs but the ability to scale up on a national level.

Canon acquires Toshiba Though technically completed in 2016, Canon’s acquisition of Toshi- ba Medical Systems Corporation was a buzz throughout the industry in 2017 from delays in Toshiba’s name change to EU objections over the deal. It therefore only seems appropriate to mention it in this list. Following the completion of the December 2016 acquisition, the

HealthCare Business News I january/february 2018 17 Daily News Online > dotmed.com/news Large Swiss clinic installs Philips Vereos digital PET/CT system and Ambient Experience solution Posted online December 27, 2017 by Lauren Dubinsky

One of the largest private clinics in Swit- cal Center. Its scan times are up to 10 times engagement in procedures is enhanced.” zerland recently installed Philips’ Vereos faster than conventional PET/CT and it only Philips Ambient Experience designs are digital PET/CT system along with its Am- uses about half the amount of radiation dose. already supporting radiology, cardiology, bient Experience solution. The Ambient Experience solution creates oncology and emergency departments, and The new install has already attracted a relaxing environment for patients while are increasingly being deployed in new areas worldwide medical interest at the Clinique de they undergo the exam. It leverages dynam- such as NICUs and ICUs. To date, more than Genolier, according to Dr. Jean-Pierre Papazy- ic lighting, video and sound to simulate a 1,250 Ambient Experience solutions have an, specialist in nuclear medicine at the clinic. beach scene or display cartoons for children. been installed in hospitals in more than 50 Vereos is the first and only fully digital “It is known that patients can feel that countries. PET/CT system available on the market. Ana- they have lost control over their life because The Clinique de Genolier is among the log PET/CT systems use photomultipliers to of their disease or medical condition,” Wer- first five hospitals in the world to install the detect light, but Vereos uses Philips’ propri- ner Satter, general manager, Philips Experi- Vereos PET/CT. The global PET/CT market etary Digital Photon Counting technology to ence Solutions, told HCB News. “By giving was worth $1.45 billion in 2016 and it’s convert light directly to a digital signal with patients personalized control of the theme expected to skyrocket to $2.1 billion by zero analog noise. that defines the color and intensity of the 2023, according to an Allied Market Re- The system was developed in collaboration ambient lighting as well as the video and search report from November. with the Ohio State University Wexner Medi- sound in the room, their involvement and Share this story: dotmed.com/news/40868 Radiology imaging: A new view or just a different view? Posted online December 1, 2017 by Tom Watson, clinical analyst with MD Buyline

There is no doubt that new hardware and “The speed at which things will happen tient imaging, such as biological results, 3-D software solutions unveiled at the 2017 tends to be overestimated,” Zerhouni contin- image modeling, image fusion of MR, CT RSNA will have a growing impact on the ued. “We have to participate, not just periph- and/or ultrasound with interventional X-ray, future of imaging and radiology. But a erally, but in the core scientific challenges of and even the ability to control the angiogra- somewhat different and intriguing perspective today, which are summarized by the tension phy system with a “floating” virtual control was advanced by Dr. Elias Zerhouni, a keynote between the complexity of biological systems board. This latter innovation was available presenter at the opening of the conference. and the precision medicine needed in the indi- for RSNA attendees to “test fly." Zerhouni is president of Global Research vidual patient population. Imaging innovation The combination of Image-Guided and Development, a member of the executive is, by its very nature, interdisciplinary.” Therapy with Augmented Reality (AR) trans- committee at Sanofi and the former direc- While there are many horizons yet to be ports the test “pilot” into a data-centric and tor of the National Institutes for Health (NIH). explored in biomarkers and related areas, patient-centric world. With the AR headset His presentation, “Imaging Innovation in 21st the principle that resonated with me was the on, and in the midst of a virtual patient pro- Century Biomedicine — Challenges and Op- first, “What will be is already here.” I believe cedure, the physician could, by using hand portunities,” posed the intriguing proposition a “works-in-progress” on display at the Phil- gestures, finger movements and body posi- that “What will be is already here.” ips Healthcare exhibit is a perfect example of tion, bring up and see virtual representa- This statement seems to suggest that the that principle being developed in practice. tions of CT images, MR images, IVUS, lab future is already here, and what we will achieve Dr. Atul Gupta, Philips’ chief medical of- results, ultrasound imaging and hemody- in the coming years is more about how we in- ficer as well as an interventional and diag- namic monitoring parameters, all in a virtual tegrate and utilize information that we can al- nostic radiologist practicing in Philadelphia, floating cockpit within his field of view. The ready acquire than it is about developing totally is a key developer and researcher working result was access to all or many of these pa- new data and technology. But I do not believe with Philips on an Augmented Reality (AR) rameters without having to turn away from Zerhouni is suggesting there will be no further solution. This offers a potential improvement the patient or move to see hardware moni- innovation in technology or advancement in in the workflow and logistics of accessing tors or other traditional display technologies. evolutionary — if not revolutionary — imaging. and integrating the multiple aspects of pa- Share this story: dotmed.com/news/40543

18 HealthCare Business News I january/february 2018 www.dotmed.com/news FDA proposing new fast track for medical device approval and reductions for required safety data Posted online December 15, 2017 by Thomas Dworetzky

The Food and Drug Administration is clearance it must have moderate risk and to apply across the total product life cycle proposing a “fast track” for certain med- be “substantially equivalent” to one that — beyond what Congress has required — ical devices, as well as cuts to the safety already exists. including all device-related applications and data needed for agency approval. Basically, the new alternative to predicates interactions with the medical device indus- It is the agency’s “intention to propose an makes them replaceable by a different ap- try,” Gottlieb wrote in the agency blog post. alternate approach to the traditional 510(k) proach that uses benchmarks of performance The alternative path could save firms mil- clearance process, which will involve the standards and guidance documents. The plan, lions of dollars and save substantial time in use of modern, science-based, consensus according to Reuters, would be voluntary. bringing new products to market. standards and FDA-developed performance “Today, in new draft guidance on the The approach also supports President criteria as the comparator for device review Least Burdensome Provisions, FDA defines Donald Trump’s call to slash regulations and for certain well-understood technologies,” least burdensome to be the ‘minimum has garnered support from makers. FDA commissioner Dr. Scott Gottlieb wrote amount of information necessary to ad- Industry group AdvaMed “commends in the official FDA blog. equately address a regulatory question or FDA’s commitment to promoting patient At present, he pointed out, the agency issue through the most efficient manner at access to medical technologies through in- compares new devices to prior ones, called the right time.’ The new draft guidance also novative regulatory pathways,” its spokes- predicates, that can be as much as 40 years explains FDA’s regulatory approach and de- woman Janet Trunzo told Reuters. old. In order for a new device to gain 510(k) lineates guiding principles that we propose Share this story: dotmed.com/news/40745 CEO set to split Siemens into two separate companies Posted online December 20, 2017 by John Fischer

Company president and CEO Joe Kaeser plans to split Sie- mens into two separate companies, one focused primarily on industrialization and the other on medical technology. The leader of the 170-year-old corporation sat down with the German-based publication, Manager Magazine, to discuss this desire, saying that he sees automation and energy management "for the foreseeable future as an industrial alliance," and hopes to grow a medical technology enterprise that could perhaps surpass the industrial entity within the next few decades. “We want to invest heavily to create a Siemens health care technology that has the potential to be larger in 20 to 30 years than the industrial Siemens,” he said. The news is part of a long list of decisions and ideas taking place ahead of the expected March time frame for Siemens Healthineers’ highly anticipated IPO, an event that has had industry investors buzzing since the company first announced its intention to go public in November 2016. The company is reported to be selling about 25 percent of its listing — about $47.5 billion — making the IPO the largest in Germany since 1996. It recently chose to list its Healthineers business on the Frankfurt Stock Exchange Regulated Market with Deutsche Bank, Goldman Sachs International and J.P. Morgan tapped to coordinate the deal alongside BNP Paribas, BofA Merrill Lynch, Citigroup and UBS Invest- ment Bank, hired as syndicate banks. Share this story: dotmed.com/news/40789 HealthCare Business News I january/february 2018 19 Daily News Online > dotmed.com/news Study finds tomosynthesis is ultimately less expensive than digital mammography Posted online December 12, 2017 by Lauren Dubinsky

Tomosynthesis costs less than digital The study included a total of 46,483 screen- cause it had a lower false positive rate and mammography when diagnosis-related ing episodes that took place between 2012 higher true negative rate. costs are taken into consideration, ac- and 2013 at two hospitals within the Univer- The up-front cost of tomosynthesis was cording to a study presented at the San sity of Pennsylvania Health System. higher than for digital mammography — Antonio Breast Cancer Symposium. If a patient had a prior breast cancer $378.02 versus $286.62 — but there was “This study further supports that screen- diagnosis or reached 90 years of age be- no significant difference in costs within the ing with tomosynthesis is associated with fore the end of the follow-up period, those diagnosis or cancer treatment windows. better screening outcomes and is cost-ef- episodes were excluded. Fifty-three per- “Digital breast tomosynthesis is consid- fective at the population level,” Dr. Emily cent of the women received digital mam- ered the ‘new, better mammogram,’ but Conant, senior author of the study and chief mography exams and 47 percent received there remain gaps in insurance coverage for of breast imaging at Penn Medicine, told tomosynthesis. the imaging modality,” said Conant. “While HCB News. The researchers identified the exams as there have been models evaluating the cost- Conant and her team evaluated actual true positive, true negative, false positive effectiveness of tomosynthesis screening, costs and patient outcomes within a single and false negative by comparing the BI- there have been no analyses looking at ac- health system where both tomosynthesis and RADS score. They found that tomosynthesis tual patient outcomes and actual costs.” digital mammography screening occurred. was a more effective screening method be- Share this story: dotmed.com/news/40672

Philips acquires VitalHealth for an undisclosed amount Posted online December 11, 2017 by Lauren Dubinsky

Royal Philips announced that it acquired 2006, and today it has about 200 employ- have resulted in positive results in the ‘acti- the cloud-based population health man- ees. The company’s products and services vate’ part,” said Kriwet. “VitalHealth has a agement solution vendor VitalHealth are in use in over 100 health care networks particular strength in the ‘navigate’ part of for an undisclosed amount. in the U.S., India, China, Sweden, Germany, our three-pronged approach.” “Although the notion of population Belgium and the Netherlands. In October, Philips announced that the health management has already been there Those products include a portfolio of tele- Colorado-based integrated delivery net- for some time, as a market it is embryonic,” health applications, as well as a care coordi- work HealthONE adopted its Wellcentive Carla Kriwet, chief business leader of con- nation platform that integrates patient infor- informatics platform. Nine other health care nected care and health informatics at Philips, mation across care settings and aggregates organizations, including Banner Health in told HCB News. “The adoption is still in its data from different information systems. Arizona and Rostock University Medical early stages, but there is a true transforma- That will complement Philips’ popula- Center in Germany, have recently selected tion going on in the health care industry as tion health management portfolio, which or renewed relationships with Philips to assist we move toward value-based health care, it acquired from Wellcentive in 2016, and with population health management. and I expect that the adoption will accelerate strengthen Philips’ HealthSuite digital plat- The global population health manage- over the next few years.” form. The combined solution will help health ment market was worth $14.5 billion in The deal with VitalHealth will add ad- care providers better manage high-risk and 2016 and is expected to skyrocket to $60.6 vanced analytics, care coordination, patient high-cost patient populations. billion by 2024, according to a Data Bridge engagement and outcome management so- “Through the acquisition of Wellcen- Market Research report. In this new health lutions to Philips’ existing population health tive and its data analytics, we were already care climate, in which providers are chal- management portfolio. particularly strong in the ‘understand’ part, lenged to provide proactive care, this is be- Mayo Clinic and the Noaber Foundation while our previous organic investments in coming a must-have technology. founded VitalHealth in the Netherlands in telehealth programs and home monitoring Share this story: dotmed.com/news/40653

20 HealthCare Business News I january/february 2018 www.dotmed.com/news Upcoming Events

Arab Health CRASH 2018 HIMSS 2018 Location: Dubai International Convention Location: Vail Marriott at Lionshead Village Location: Venetian – Palazzo – and Exhibition Centre Vail, Colorado Sands Expo Center Dubai Dates: Feb. 25 – March 2 Las Vegas Dates: Jan. 29 – Feb. 1 Years in Existence: 26 Dates: March 5 – 9 Years in existence: 42 Average attendance: 300+ Years in existence: 55 Average attendance: 100,000+ Who should attend: Physicians, anesthe- Average attendance: 45,000+ Who should attend: Radiologists, surgeons, sia assistants, residents, nurse anesthetists Who should attend: C-suite, consultants, C-suite, consultants, government or public and other health care providers. government or public policy professionals, policy professionals, health care finance pro- health care finance professionals, IT profes- fessionals, IT professionals, physicians. ECR sionals, physicians, project managers. Location: Austria Center Integrative Healthcare Vienna, Austria NAPT 2018 Symposium Dates: Feb. 28 – March 4 Location: The Scottsdale Resort Presented by: Beth Israel Medical Center’s Years in existence: 50 at McCormick Ranch Continuum Center for Health and Healing Average attendance: 25,000+ Scottsdale, Arizona Location: New York Hilton Midtown Who should attend: Radiologists, sur- Dates: March 25 – 28 New York City geons, oncologists, Years in existence: 6 Dates: Feb. 22 – 24 technologists. Average attendance: 300+ Years in existence: 14 Who should attend: Physicians, nurses, Who should attend: Doctors, nurses, therapists, proton therapy directors and nutritionists, chiropractors and physical managers. therapists.

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HealthCare Business News I january/february 2018 21 Hospital Spotlight: Nicklaus Children’s Hospital

Nicklaus Children’s Hospital Location: Miami Year founded: 1950 Number of beds: 289 Number of employees: 4,000 President’s name: Michael Harrington is president and chief operating officer of the hospital. Dr. Narendra Kini is CEO of Miami Children’s Health System, parent organization of Nicklaus Children’s Hospital.

1. Advanced Pediatric Care Pavilion Tower 2. Patient room for older child 3. NICU 4. Life Flight helicopter

22 HealthCare Business News I january/february 2018 www.dotmed.com/news Noteworthy distinctions: Eight Nicklaus Children’s pediatric subspecialties 2 are routinely ranked among the nation’s best by U.S. News & World Report. The hospital also is proud to have consistently achieved Magnet Recognition from the American Nurses Credentialing Center, since 2003. In addition, all three of the hospital’s intensive care units have received Gold Beacon Awards for care excellence from the American Association of Critical-Care Nurses. Nicklaus Children’s is the flagship of one of the region’s few health systems exclusively for children, with a network of 10 Nicklaus outpatient centers, extending from Palm Beach County to southern Miami-Dade County. The hospital is routinely listed by the Ameri- can Hospital Association’s Health Forum among the nation’s “Most Wired” hospitals. In addi- 3 tion, Computerworld routinely recognizes Miami Children’s Health System among the 100 “Best Places to Work in IT.” In 2017, the hospital was ranked third among mid-size organizations. In 2016, the hospital achieved a Stage 7 Award from HIMSS Analytics, reflecting the hospital’s attainment of the highest level on the Electronic Medical Record Adoption Model.

Specialties: • Neurology and neurosurgery • Cardiology and cardiovascular surgery • Hematology/oncology • Neonatology • Pediatric Critical Care Medicine

Recent developments: In the fall of 2016, the hospital opened its new 4 Advanced Pediatric Care Pavilion, a six-story, 213,000-square-foot, high-tech tower that houses the hospital’s critical care services, including three intensive care units as well as the Cancer Center and a neurology-neurosurgery unit. The 189 spacious rooms in the new tower offer an enhanced care environment for the entire family, including space for both parents to remain overnight with the child. The hospital is a leader in IT and telehealth technology and features a Telehealth Command Center that facilitates consults with physicians and patients around the world.

HealthCare Business News I january/february 2018 23 Hospital Spotlight

Q&A with Dr. Narendra Kini CEO, Miami Children’s Health System Lessons from Hurricane Irma and the challenges of pediatric medicine

By Sean Ruck

HealthCare Business News profiled Dr. HCB News: How long have you been There’s a very robust system of response Narendra Kini, the CEO of Miami Chil- with Nicklaus Children’s Hospital, which that’s built into our operation and we call it dren’s Health System, for this issue’s is part of the Miami Children’s Health the Alpha-Bravo Response. Hospital Spotlight. System? Basically, what happens is that the Al- NK: I’ve been CEO for nine years. I joined pha team comes into play where we secure HCB News: What inspired you to get as CEO of the hospital, and as we evolved to the hospital, we ensure our supply chain is involved in health care? a health system, I became CEO of the health adequate for a period of up to 20 days, we NK: I’ve always been interested in the system. have an in-house generator and adequate overall health and welfare of children. I was water supplies. raised in Africa, and health care was a pas- sion of mine since I was a child. Given the opportunity to train in health care, I jumped at it. 'The hospital fared extremely well. We were able to I obtained further training not only in clinical medicine, being a pediatrician and maintain all our services through the storm, ER physician, but also went ahead and got a graduate degree in hospital and health maintained adequate staffing and at no point in time administration. It’s been a very fulfilling life choice to date. were there any issues with patient care. But we’ve

HCB News: Was there any experience always drilled and prepared for this type of event.' or a person who inspired you to pursue this career? NK: There were two major influences. HCB News: How did the hospital Also, the team to care for patients actu- One was my mother, who was a professor hold up during Hurricane Irma? ally stays in the hospital for three to four of biology. I developed an initial interest in NK: The hospital fared extremely well. days and we even allow their families to health science watching my mother prepare We were able to maintain all our services stay. That team mans the care for the first for her lessons, going with her to her labora- through the storm, maintained adequate four days. Should there be a need for fur- tory, looking at some anatomical specimens staffing and at no point in time were ther care, the Alpha team is relieved by the and things of that nature. there any issues with patient care. But Bravo team, which provides care for another The second was a mentor who involved we’ve always drilled and prepared for this three days. me much more in the care of children who type of event. We try to cover one week worth of op- were orphans. I think those two experienc- Disaster drills in Florida are very common erations using an emergency approach. This es really drove my desire to be involved in and mandated because we obviously face was a powerful storm and there were issues health care. weather-related phenomena. across the community.

24 HealthCare Business News I january/february 2018 www.dotmed.com/news We noticed simple things, like pharma- they can check their smartphone to get the NK: We are primarily a safety net hospital cies and groceries were closed, so it was our latest information, which streamlines for ev- and two-thirds of our patients are covered role to be able to supply even prescriptions eryone involved. by Medicaid. So we have a challenge with while local access was unavailable. We man- reimbursement. aged to do a lot of this work in close coor- HCB News: What is your area of ser- Also, pediatric health care in Florida is dination with the state and local agencies. vice? extremely fragmented with many providers NK: Our hospital extends primarily across providing small types of pediatric services HCB News: Were there any lessons five counties in southwest Florida, spanning and adult systems attempting to provide pe- picked up that will help for future pre- an area of approximately 4 million people total. diatric care. paredness? Most of our patients are from that area, al- The third is really an issue of bringing a NK: Yes, we learned some powerful les- though we do serve more than 30 states in the substantive number of providers to Miami sons. It is very important to have commu- U.S. as well as patients from outside of the U.S. and Florida and providing the highest level nications with patients and physicians not of care that’s available nationally. So it’s a only in-house, but if a patient is out of the matter of competing on that level. And we hospital as well. have the challenge of providing the highest We were able to utilize an app to connect 'Pediatric health care level of care for populations who are from a expecting mothers with their physicians. We lower tier economically and educationally. were able to communicate with government in Florida is extremely officials even during the worst of the storm. HCB News: What sets you apart from There was a lesson in the supply chain. fragmented with many other facilities of similar size? While we had adequate water and food, there NK: There are two distinct differences. are always things like emergency medical sup- providers providing One is our vision to be a partner in life to plies and high-risk medications that may need the child wherever they are. That means, to be stocked up after the second or third day. small types of pediatric between the ages of 0 and 19, we intend to Through a partnership with Health Grid, be a partner both in wellness and sickness. we were also able to present information services and adult Our vision is to provide screening, pre- from a classic EMR and present in a very easy vention, treatment and monitoring services. digital manner via an app. The patient can systems attempting to The second quality is that we believe take that home, exhibit it, absorb it and use we are one of the more technologically ad- it how they want. When there’s a disaster like provide pediatric care.' vanced health care systems in the nation. we had, something like this is very welcome. We have invested significantly in technology, The second thing is an application that whether it’s AI, virtual health care or services allows us to notify parents and caregivers HCB News: What challenges does like Health Grid. We’re working to become about what’s going on with their child. We your facility have at the regional and/or the next generation health care provider. don’t have to pick up the phone. Instead, national levels? Share this story: dotmed.com/news/40441

HealthCare Business News I january/february 2018 25 IT Matters Radiology workflow orchestration (part two)

By Sean Ruck Inspiring a Better Healthcare System

In the last issue of HealthCare Busi- “By the time the radiologist came in, According to Hirschorn, machine learn- ness News, Dr. David Hirschorn, chief we’d see the image and very little info on ing is improving as well. The information is of informatics, imaging service line, why the patient was getting examined. So, increasingly being fed into algorithms with at Northwell Health, talked about the with EMR, we’re not just getting access to more accurate results as to the chance of background of radiology workflow that information. We’re having it served up the nodule being cancer, for example, and orchestration and some of the work- on a silver platter,” says Hirschorn. what to do next. The purpose of the radiolo- arounds that radiologists used to make The EMR is providing the background gist is to provide information on diagnosis the most of very limited information. that helps radiologists be a more integral and prognosis, using the best tools to extract Major strides have been made to provide part of better patient outcomes. that information. radiologists with the tools and information “We get the chief complaint, the history “Our experience [with workflow orches- they need to be most effective in their roles. of illness and the problem list,” Hirschorn tration] was that it was definitely worth Fortunately, good radiologists already had a explains. a fair amount of money because of the solid foundation for optimizing their use of The running problem list includes if perceived benefit to load balancing and workflow orchestration. the patient is a diabetic, has cancer and remaining competitive,” Hirschorn says. “Radiologists were always incentivized to other important issues to note. Medica- “I can search the other systems and open communicate clearly,” Hirschorn says. “They tion and allergy information is also helpful, directly from those PACS. All I’m doing is weren’t interacting with the patient, but Hirschorn says. He says it’s also key to pro- retrieving the information and it puts it onto they were interacting with the doctor and viding a working diagnosis. For example, your screen. That’s probably the best solu- poor communication could result in them did the patient come in for a fracture? For tion since I can go in with the current case losing their position.” chest pains? and view priors.” Big teams of radiologists working to- “It’s much better. There are fields I want Working through a system that provides gether have only become more common every time and I can quickly access them a window into other PACS, the data is still in recent years, so developing best practices now. There’s also other information I’d like located in the other PACS, but radiologists for the social aspects of the role would be to know, depending on why the patient was can view it using a system they’re trained on up to the radiologist, or perhaps he or she there,” Hirschorn says. and familiar with. would be able to get guidance by network- If the patient’s information points to a Hirschorn advises hospitals to rethink ing outside of their facility. Communicating certain problem, an effective EMR will pres- their existing workflow if they’re contem- what type of information they needed was ent the radiologist with the other informa- plating a new system. Don’t just look into also a slow evolution, with more usable data tion relevant to the exam they’re reading. your current systems and coalesce into trickling into EMRs over time. “When a radiologist sees certain findings one big system. Think big. Use the tech- Better Care is Coming Together. “There’s definitely room for improve- on the exam, there’s an ACR assist. When nology. What would you do if you could ment. It’s only the beginning,” Hirschorn you see a nodule on the lung, it’ll tell you the do anything? At Change Healthcare, we know that better partners mean better care. And successful says. “Gathering information from the EMR information you should gather and provides “The nature of a workflow orchestrator partnerships are based on collaboration, mutual trust, and common goals. That’s why we has been very transformational for many of the best practice guidelines,” Hirschorn is flexibility. That’s not true of the other sys- believe imaging can be a catalyst for collaboration across a diverse healthcare system, the radiologists I’ve worked with.” says. “Nuance and M*Modal have already tems we’re used to using. PACS and RIS and and our interoperable Imaging, Workflow & Care Solutions support enterprise-wide data For roughly a century, the patient chart started building their systems. The American dictation systems have many strengths, but exchange for a more informed and connected care environment. Great partnerships was the crucial go-to. Doctors and nurses College of Radiology has it. It will walk you flexibility is not their primary strength. Don’t lead to better solutions and better patient outcomes. So let’s team up for the better. relied on that information and, therefore, it through questions. Does the patient have a try to fit the needs of your workflow into the evolved to provide the information doctors history of smoking? But I wonder why I’m orchestrator. A good workflow orchestrator and nurses needed. Since the patient wasn’t being asked. Why doesn’t that information should flex to meet your needs.” HIMSS® MARCH 5-9, 2018 Register for a demo at in front of the radiologist though, neither get pulled from the EMR? Those bridges Share this story: dotmed.com/news/41129 ChangeHealthcare.com/ConnectedEnterprise were the charts. aren’t built yet.” BOOTH 4202 ©2018 Change Healthcare Operations LLC. All rights reserved.

26 HealthCare Business News I january/february 2018 www.dotmed.com/news

7219-10_CHC-PrintAd_8.125x10.75-Feb_vF.indd 1 1/10/18 11:07 AM Inspiring a Better Healthcare System

Better Care is Coming Together.

At Change Healthcare, we know that better partners mean better care. And successful partnerships are based on collaboration, mutual trust, and common goals. That’s why we believe imaging can be a catalyst for collaboration across a diverse healthcare system, and our interoperable Imaging, Workflow & Care Solutions support enterprise-wide data exchange for a more informed and connected care environment. Great partnerships lead to better solutions and better patient outcomes. So let’s team up for the better.

7219-10_CHC-PrintAd_8.125x10.75-Feb_vF.indd 1 1/10/18 11:07 AM RSNA Wrap-up The top 10 trends and takeaways from RSNA 2017

T.J. Webb By the HCB News editorial team

It was an RSNA unlike any other. you looked, but AI is just one part of the 3-D printing braces for the For the first time, radiologists and imag- emerging radiology toolkit — a kit that is mainstream ing stakeholders at McCormick Place wit- being reinvented right alongside the job de- There is an array of potential applications nessed an industry beginning to capitalize scription of radiologists themselves. for 3-D printing in the health care industry, in earnest on concepts that — for so many Here, in no particular order, are the 10 but investing in the necessary technology years — seemed to merely describe lofty and biggest RSNA takeaways, according to the and materials has historically been costly unobtainable goals. five HealthCare Business News reporters enough to keep this technology reserved Yes, artificial intelligence was everywhere who were there. for academic facilities or on the fring-

28 HealthCare Business News I january/february 2018 www.dotmed.com/news es. Through partnerships with Stratasys approach, especially with Google, which had investment? As you may expect, OEMs have and 3D Systems, two global leaders in 3-D a booth at RSNA for the first time. a fairly convincing answer to that question printing, Philips is poised to bring down Representatives from several companies (keep reading). some of those expenses. spoke at an educational session about their Using Philips’ IntelliSpace Portal 10, use of Google Cloud to share images and OEMs seek more consistent providers can now create 3-D models of analyze data. service-oriented relationships patient anatomy, thanks to these new with hospitals partnerships. In the case of Stratasys, the Where’s the investment? For imaging manufacturers, partnerships are models are generated in a Stratasys Direct Amidst the hype surrounding AI at the show, taking the place of conventional sales. Almost Manufacturing facility and sent to the hos- there was some talk about physician pay- every exhibitor at RSNA with a giant booth pital within two days. ment reform, and at least one hospital ex- made similar statements about the impor- “It’s bringing 3-D printing to a lot of in- ecutive asked an important question: How tance of committing to customers along the stitutions that don’t have it on-site,” Mi- are facilities going to pay for this when the workflow continuum as opposed to thinking chael Gaisford, director of marketing for payment landscape is so uncertain? of them as customers on a transactional level. medical solutions at Stratasys, told HCB News at the meeting. A shelf of various 3D models Siemens Healthineers also announced a from a radiology group. 3-D printing partnership. Working alongside (Photo: courtesy Mayo Clinic) Materialise, the OEM is collaborating to allow hospitals to start in-house 3-D printing labs in a more cost-effective way. “By incorporating 3-D technology into syngo.via, we jointly support the entire workflow from patient diagnosis to therapy planning,” said Valentin Ziebandt, head of marketing at the Syngo business line at Siemens Healthineers. “This is a cost-effective way to increase the clinical capabilities of syngo.via and an important step toward achieving personalized care and precision medicine.” One barrier to adoption is that there’s no FDA reimbursement for 3-D printing. Mate- rialise has partnered with RSNA as a member of the 3-D Printing Special Interest Group.

The year of the AI partnership “When you speak to my peers and really “For us, it’s about the collaboration we have It seemed like every other announcement at survey them and say, ‘How many of you in with our customers,” said David Pacitti, presi- RSNA this year was a partnership related to 2018 are going to be going out and writing dent of Siemens Healthcare North America. AI: GE Healthcare announced a partnership big checks for AI?’ not a lot of them are rais- “You go to every booth and you’ll hear compa- with NVIDIA to bring NVIDIA’s AI solutions ing their hands,” said Dr. Rasu Shrestha, nies talk about the bells and whistles they have, to GE’s imaging devices; Nuance and NVID- chief innovation officer at the University of but we really think what sets us apart is that we IA teamed up for the Nuance AI Marketplace Pittsburgh Medical Center. “There’s a lot not only have great technology, but we’re col- for Diagnostic Imaging; and Philips came of interest to play around with it and tinker laborating with our customers in a more mean- together with Nuance to implement AI- with it and see what it’s all about. How do ingful way with a focus on improving outcomes based tools and help radiologists with you pay for it is a really important question.” and reducing overall costs.” interpretation and reporting. Radiology departments are all too accus- The trend toward service-minded re- And after those in the industry expressed tomed to being strapped for cash, so even if lationships is logical in light of the budget worry that Google and Amazon would take these new technologies will usher in a better constraints that facilities are under and may over health care, companies seem to be em- workflow and improved patient outcomes, align nicely with the push for smarter, soft- ploying an “if you can’t beat ‘em, join ‘em” is it realistic to ask them to make that initial ware-based solutions.

HealthCare Business News I january/february 2018 29 RSNA Wrap-up

MACRA/MIPS ain’t going anywhere With all the congressional animosity around the Affordable Care Act, don’t be tempted to think that the merit-based incentive payment system (MIPS) for physicians is going away. The legislation, which passed with bipartisan support in 2015 as part of the Medicare Ac- cess and CHIP Reauthorization Act (MACRA), is still viewed by Congress as part of a vital strategy in controlling health care costs. President Donald Trump has not given any indication that he disagrees with that assessment. However, a three-member RSNA panel — including two radiologists — said it is possible that some elements of the How are facilities supposed to afford AI? program may be slow-walked and shifted to the private sector for administration. “Why should a hospital have to fork over anatomy] looks like, but you can tell that The panel was in agreement that partici- so much money for something that they it’s not really clicking with the surgeon,” pation in accountable care organizations is Hurricane Harvey don’t get the best use out of?” asked Philips Dr. Jesse L. Courtier, pediatric radiologist approaches Texas a key MACRA/MIPS initiative that radiolo- CEO Frans van Houten in an exclusive HCB at UCSF Benioff Children’s Hospital, told gists must embrace — and even lead. ACOs News interview. “Redesigning workflow, an audience at RSNA. “All of the informa- qualify as a payment model that remedies the first-time right, less waste ... that’s what tion we have in a CT is hidden beneath the patient-facing dilemma particular to imaging. we’re trying to bring to the market.” surface of a real, solid organ, so this can be The physicians presented evidence that challenging for them.” the value of radiologists is not in sacrificing Augmented reality — using holograms to improve surgical outcomes A technology that experts think will complement 3-D printing nicely is virtual (or augmented) reality. Virtual reality software can plan the optimal cut planes and segmenta- tions and those results can be transferred electronically for 3-D printing. One such software platform is EchoPixel’s True 3D, which uses medical image datasets to generate 3-D visuals of patient anatomy that can be seen using special glasses. Four cameras track the user’s head movements and they can use a stylus to move and interact with the visuals in real time. True 3-D can also offer intraoperative imaging consultation during complex Where will the radiologist fit in tomorrow's radiology department? procedures. Stanford University Medical Center presented a scientific poster at the Augmented reality tools come in a variety on expensive CT and MR scans. Instead, meeting that found that it’s effective at of different forms, including head-mount- radiologists can make an impact by sup- conveying patient-specific information to ed displays like Google Glass, tablet-based porting primary care physicians with timely the surgical team. devices like Apple’s AR Kit and projection- consults (including on Friday afternoons, “I think we’ve all had this experience based devices. One of the leading options is for example) to keep patients out of the ED where we know in our mind what [the Microsoft’s HoloLens head-mounted display. and the hospital.

30 HealthCare Business News I january/february 2018 www.dotmed.com/news Augmented reality brings 3-D images to life with practical applications.

An emerging identity crisis then it’s hard to see how deep learning al- guide the process rather than having it im- One unfortunate side effect of radiology’s gorithms won’t eventually develop better posed upon us.” evolution is that it can create a rift be- “eyes” than any human. Dr. Roderic Pettigrew, founding direc- tween innovators and the people whose The industry may not arrive there for a tor of the National Institute of Biomedical jobs those innovations impact. Generally long time, but it will likely be an awkward Imaging and Bioengineering at the NIH, speaking, companies exhibiting at RSNA road heading in that direction. and chair of a new Texas A&M program 2017, particularly those engaging in ma- to integrate engineering into medicine, chine learning and artificial intelligence, From reading images to offered several examples of radiologists were most comfortable describing how managing information evolving in their role as biomedical data much efficiency their software can bring C’mon, will the robots really take over? science experts. to health care by automating certain pro- Of course not! “Modern imaging is information science cesses and eliminating human error and Let’s try and stay grounded here folks. and will improve the value proposition of other inconsistencies. Talk that AI will make its way into every facet imaging,” said Pettigrew. “Tomorrow‘s ra- Ask most of them what all this will mean of imaging and will somehow “replace” radiologist will leverage AI.” for the radiologists who will be having tasks diologists is overblown. Instead, AI will serve Dr. Elias Zerhouni, a radiologist, bio- taken from them and you will hear an an- radiologists. medical engineer, former director of the swer like this: These tools will not replace In the opening RSNA session, three radi- National Institutes of Health and now presi- radiologists. They will only serve to support ologists with a bent toward futurism coun- dent of global research and development at their work and perhaps free them up to do seled a capacity crowd of over 4,000 to rein- Sanofi, positions AI as the solution to one of other things. vent themselves through AI technology (aka: the biggest threats to imaging — variation. Clearly, only the most fatalistic radiologist play the hand they’ve been dealt). Future value, he maintained, will be from ra- can realistically imagine being displaced by a “[Radiologists] have to embrace dis- diologists who have common, cloud-based robot within the next decade or so, but if a ruption or be disrupted,” cautioned RSNA reference data correlated at the molecular, radiologist’s main job is to interpret images, President Dr. Richard L. Ehman. “We must cellular and tissue levels.

HealthCare Business News I january/february 2018 31 RSNA Wrap-up

OEMs emphasize X-ray efficiency on the exhibit floor.

In short, radiologists will be fine — provided they can change with the times. 'If we can avoid another X-ray, the patient’s happier OEMs tackle dose concerns with first-time right approach due to fewer exposures and shorter exams.' Decreasing exposure to unnecessary radiation is a challenge radiologists and imaging equipment manufacturers struggle “If we can avoid another X-ray, the think of patients as consumers. with year-round, so although it isn’t a new patient’s happier due to fewer exposures “Being consumer-centric and embrac- concept, it was a topic getting a lot of trac- and shorter exams,” Guillermo Sander, ing patients as consumers means that tion at RSNA. Producing solutions to keep senior marketing manager — Americas at you’re thinking about your patient before, dosage to a minimum, to better monitor its Konica Minolta Healthcare Americas, told during and after their care experience,” administration and — most importantly — HCB News. said Matt Henry, a health care expert with reducing the need for unnecessary repeat With the number of exams and the rate management consultant firm Point B, at an imaging exams. of recalls reduced, patients are less likely to RSNA educational gathering dedicated to For example, Konica Minolta show- experience unnecessary exposure to radia- this subject. cased its new Realism system for process- tion while also getting back out of the hos- This shift in how physicians think about ing bone and soft tissue data of images pital faster and generating fewer expenses their patients is echoed by the way radiolo- separately before piecing them back to- for the health care system. gists are being asked to step out from be- gether. It enables increased sharpness and hind their workstations and engage more contrast to reveal subtle aspects, thereby The new patient experience meaningfully with the people whose images allowing physicians to make a more com- Social media, online reviews and the unri- they are evaluating. plete diagnosis and possibly avoid taking valed retail experience of shopping on Am- Share this story: dotmed.com/news/40608 another image. azon are all factors forcing radiologists to

32 HealthCare Business News I january/february 2018 www.dotmed.com/news

Purchasing Insights Considerations for the modern enterprise imaging system: more than a price

By Tyler Speakman

Purchasing a mod- history of being less than cooperative with AI can develop algorithms that scan an ern imaging sys- other vendors. Vendors who care about your image and separate abnormalities requiring tem is a balance business understand you will have existing review. Minor, more common issues that do between depart- systems in place from competing companies. not indicate larger issues are triaged accord- mental needs and Vendor-neutral archives, or VNAs, for ex- ingly so that clinicians can focus on problem enterprise require- ample, have broken down barriers between areas first. ments. departments and changed how vendors Advancements work with providers and clinicians. Outsourcing both in the technology and approach from As technology advances, hospitals are more vendor partners have a major effect on how Workflow and Imaging Analytics apt to outsource data management services facilities are forced to think about current Current vendor focus has shifted heavily to and hosting due to potential cost or respon- and future solutions. The quality of a system developing applications that directly support sibility reductions, while still maintaining a cannot be judged on cost alone. There are clinical workflows at the hospital. Vendors smaller on-site cache for image storage (i.e. great systems that are expensive and there now focus on “service line” support, mean- speed to download). This is a major consid- are great systems that are not. The very defi- ing applications are developed from a single eration given the current climate we are in nition of “great system” depends entirely on system to support differing clinical practices regarding merger and acquisition activity in how well a vendor’s solutions fit your par- (i.e. radiology, cardiology, specialty). This has the provider space. ticular needs, how well it integrates into and/ evolved from the historic practice of support- Health care systems nationwide are or enhances your workflow and how well it ing separate departments, or service lines, as working to integrate disparate systems to improves your efficiency. wholly different products. an existing infrastructure and scale to meet The common thread connecting provid- Medical images account for the largest new bandwidth needs. On-site data centers ers on this issue is the inherent challenge data source in a patient’s medical record and management teams are generally ex- faced to deliver valuable information in a and, as a result, many vendors are com- pensive, difficult to scale and largely inflex- fast and cost-efficient manner, while also ing up with imaging analytics/deep learn- ible. Cloud-based services, however, provide enabling superior patient care experiences. ing medical imaging solutions to better a different strategy to managing the perils of Here are a few thoughts on achieving extract and analyze the information pre- integrating these systems and allow a focus success in considering system or enterprise sented in images. shift back to patient-impacting issues, such functionality: Imaging analytics will continue to be as clinical practice standardization. integrated in existing systems, and poten- Cost-effectiveness of this balance be- Integration tially become a hallmark of new systems, for tween off-site/on-site balance is still open It’s extremely important to determine spe- point-of-care decision support, second opin- for debate as many vendors make up the cifically how your solution will interface and ion, early detection of a few diseases, work- margin in support fees and/or consultations. integrate with other applications. Modern flow improvements and better outcomes. There are pros and cons to both to be con- systems have multiple touchpoints for in- Predictive analytics, fueled by artificial sidered on a case-by-case basis. tegration, both in and out of the hospital. intelligence (AI), support clinical workflows Outsourcing has also emerged as a top Understand the exact costs and application and reduce the time required to perform case consideration in defense of cyber threats, functionality involved with any integration review. Several vendors are focused on sup- particularly for small- to mid-sized facilities. with your CIS, EMR or imaging modalities. porting mid- to small-size acute care facilities Very few systems maintain adequate infra- Avoid vendors that appear to, or have a that lack bandwidth to review case volume. structure of systems and people to support

34 HealthCare Business News I january/february 2018 www.dotmed.com/news in-house management of cybersecurity. The Web-based vs. Web-enabled. Due to the ongoing costs of maintenance, upgrades outsourcing of responsibility and effort has evolving standards of speed and security and storage expansion must be up-front and been well received in the industry, especially over the web, many tele-cardiologists, forthcoming in the contract. Avoid clauses as threats against health care providers rise. referring physicians and physicians at quoting prices at “then applicable rates” Vendors often approach cybersecurity home have found case reviewing over the without some form of an estimate, when- similarly and outsource data management Internet to be an invaluable time saver. ever possible. and hosting to large services (i.e. Google, “Web-enabled” systems imply a stand- About the author: Tyler Speakman joined Amazon). alone application that has been adapted MD Buyline in 2017. Along with health or modified to allow web functionality. care IT, he specializes in capital budget- Purchase Structures “Web-based” systems imply the PACS ing and project management for multiple Capital vs. ASP (Alternate Service Pro- product was built from the ground up to technologies, including nurse call systems, vider) model. A capital purchase typically view and manipulate data over the web OR integration and PACS. Prior to joining gives your facility more control and owner- (i.e., an Internet-based interface). Web- MD Buyline, Speakman worked as a port- ship, but with a higher up-front cost. ASP based systems are growing in popularity folio executive and sourcing executive at models are similar to a lease, which typically as they are explicitly designed with a web Vizient, and as an operations manager for offer hands-free maintenance and cheaper interface in mind and often require little or a Premier Healthcare subsidiary. He also initial costs, but are potentially more expen- no installation for offsite PCs. spent several years as a capital equipment sive in the long run. However, an ASP may Regardless of the financial scope and pa- analyst and has clinical experience as a be a very viable short-term solution if you rameters of your project, all costs must be physical therapy tech. are in transition and need a solution that laid out clearly in the quotation. The cost of Share this story: dotmed.com/news/41206 can be implemented quickly without a long- each component, a breakdown of all profes- term investment. sional service hours, and just as important,

HealthCare Business News I january/february 2018 35 ECR ECR 2018: The world of European radiology will convene once again in beautiful Vienna

The European Congress of Radiology, and concentrating on practice-oriented contribute to the informal discussions while scheduled for Feb. 28 through March 4 contents. For the new project, rooms in a sipping their coffee or tea. in Vienna, has always had something nearby church have been rented, a contem- To make it more widely accessible, the new to offer to its participants, and this porary architectural gem in a cuboid form, ECR will again broadcast nearly every lecture will also be the case in 2018. made of dark chromium steel, hence the via live web streams on ECR Online, a service Possibly the most spectacular of the term, “The Cube.” delegates have used increasingly since its new ECR offerings will be “Interventional The “Coffee & Talk” sessions are another introduction four years ago. Radiology at the Cube.” The program is new format. In a relaxed atmosphere in one The ECR is the annual meeting of the intended to introduce young radiologists of the Austria Center's stylish lounges, short European Society of Radiology, which rep- to the subspecialty of interventional radiol- lectures and discussions will be offered on resents more than 75,500 members world- ogy, and to provide enhanced knowledge topics such as clinical decision support, chal- wide. The ECR is one of the largest medical to radiologists who need it in their every- lenges for department chairs, undergradu- congresses in the world, attracting more day professional life. Lectures and hands-on ate teaching of radiology, radiation protec- than 25,000 participants with 300 compa- workshops will focus on interaction with tion and imaging biobanks. Participants are nies exhibiting. the participants, simulating clinical routine welcomed and encouraged to stop by and Share this story: dotmed.com/news/41207

36 HealthCare Business News I january/february 2018 www.dotmed.com/news www.elsmed.com | [email protected]

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TO HEALTHCARETHE GLOBAL VILLAGE ECR Q&A with Professor Bernd Hamm ESR President

The European Congress of Radiology HCB News: Are there other presenta- something for everyone’s interest. Besides sci- will be held in Vienna from Feb. 28 tions or events you’re particularly ex- ence, there is one topic that plays a major role through March 4. In advance of the an- cited about this year? in all meetings and that is food. I took a close nual event, HealthCare Business News BH: There are many sessions I would love look at the feedback we received from par- reached out to Professor Bernd Hamm, to attend. But, unfortunately, I already know ticipants in recent years and it became clear to from the Charité Hospital in Berlin, Ger- that I will only make it to a fraction of them. me that this is an area where we can do better. many, president of the European Society As this is the case for many of our attendees, At ECR 2018 participants can expect a street of Radiology, the organization behind I strongly recommend to sign up for ECR on- food-style concept with Berlin currywurst and the congress, to learn more. line, where you can watch all sessions either local specialities from our ESR meets countries live or on demand after the congress. — China, Portugal and Switzerland. HCB News: New for this year, the There is another new format at ECR 2018 “My Thesis in Three Minutes” event called “Coffee & Talk,” which I would like to HCB News: What have been the most sounds like a medical version of the ele- recommend. These sessions will be held in a exciting advances in radiology since the vator business pitch (always interesting, relaxed atmosphere in one of the Austria Cen- last Congress? but always challenging). Can you tell us ter’s stylish lounges, where short statements BH: That is a tough one to answer. Radi- a little more about it? and discussions will be offered on topics such ology is a field driven by technical improve- BH: With the “My Thesis in Three Min- as clinical decision support, challenges for de- ment and scientific breakthroughs that we utes” sessions, we provide a new platform partment chairs, undergraduate teaching of can currently witness in almost all areas of for those who would like to give a con- radiology, radiation protection and imaging our discipline. I am pleased that at ECR 2018 cise presentation in a dynamic and enter- biobanks. The goal is to create an open, inter- we can present the latest results from those taining scientific session. Of course, this active forum where participants are welcomed developments to our participants. For exam- can be quite challenging, as participants to stop by and contribute to the informal dis- ple, we will have a new building, called “The have to be well-prepared to present their cussions while sipping their coffee or tea. Cube,” dedicated to interventional radiol- thesis, including the most important re- ogy, where workshops on minimally invasive sults in just three minutes. On the other HCB News: What other top- image-guided therapy will take place. hand, if we think about news on TV, where ics do you think attendees will be dis- ECR 2018 will also focus on artificial in- complex topics are presented in 90 sec- cussing the most? telligence and machine learning. Even if you onds, we realize that this is something BH: This is actually hard to tell as prefer- might think that AI is momentarily undergoing we see every day. Thirty-six percent of ences tend to differ, but I think this is exactly a period of hype, it is nevertheless a technol- our abstract authors applied for this new what our congress motto “Diverse & United” ogy that radiology has to put to its best use. format, so we know that people are ea- reflects. Radiology is such a diverse specialty Furthermore, we will focus on hybrid im- ger to face this challenge and we are very that has something to offer to all of us and aging, which is becoming more important in excited to get their feedback. What I can for future generations of physicians, radiog- daily radiology practice. I am very interested promise right now is that we will see 12 raphers and students. Let me assure you that in integrated diagnostics, which could be ac- interesting and entertaining sessions. ECR 2018’s scientific and educational program complished by the creation of departments will live up to the congress motto and offer of diagnostics, where radiology, pathology

38 HealthCare Business News I january/february 2018 www.dotmed.com/news and genetics join forces. This is highly rele- our daily routine. This, in turn, leaves us with vant to medicine in general and, in my opin- more time for patient care and communica- ion, radiology will play a central role. tion with clinical colleagues, thus making DISCOVER radiology more visible to others. HCB News: The U.S. continues to The best approach to predicting the future struggle with challenges delivering would be to go back 10 years and have a look A Better health care, including rising costs, the at what we were doing back then and where need to improve outcomes, providing we are now. Almost everything we are using Choice access, etc. Is it the same story in Eu- now was already there, not as manifested and rope, or are the challenges unique? by far not everyone was convinced of those FOR PARTS | TUBES | TRAINING EQUIPMENT | DR SOLUTIONS BH: Nowadays all health care systems are approaches back then, while many of them facing problems and challenges. If some are are now generally accepted. It is not much not, then they are just not aware of it yet. different today. We are looking at possible so- Vienna Feb 28–Mar 4 As Europe is comprised of many nations, lutions, which we develop, discuss, discard or EXPO X5 those challenges can be quite different and improve and some of them will possibly define STAND sometimes unique. However, something our daily work 10 years from now. 534 that unifies most of the European systems is the subsidiarity principle, which is one of HCB News: With an aging population the great achievements of the welfare state. in Europe, do you anticipate a shortage One advantage of European health care of radiology services? If so, what steps systems might be that we can learn from are being taken to remedy the problem? others and then adapt or improve our cur- BH: This actually goes hand in hand with rent systems gradually and not be confront- what I have said before. Teleradiology, modern ed with a single choice like yes or no as it is IT solutions and AI will be key in helping us with Obamacare. to cope with the workload, which is not only generated by an aging population, but also by HCB News: Looking ahead, can you a general need for more diagnostic services. offer some predictions about how ra- Nevertheless, the most important thing diology will change over the next five is to spark enthusiasm amongst future gen- to 10 years? erations of students, doctors and radiogra- BH: I am not a fortune-teller, but this is phers. I am confident that we can achieve actually something that I am asked frequently that by promoting the diversity of our dis- by residents and students these days. Radiol- cipline, and having a secure job perspective ogy is amongst the top drivers of innovation will also aid our cause. in medicine, so I can definitely predict a bright future. Radiology, as a specialty, is constantly HCB News: Has the British vote to growing and renewing itself and is also do- leave the EU had any impact on the ESR? Richardson-Certified CT Tubes ing this much faster than other specialties. BH: There is no denying that the British Ready-to-Ship Parts Inventory Moreover, it is such a diverse specialty, hav- vote is affecting Europe and the European community. This is unfortunate, but the ESR ing something to offer for all of us and for Exclusive QA3 Testing future generations as well. The options range and the scientific community are beyond from more refined diagnostic procedures to politics, and we will further strengthen and CT Service Training image-guided minimally invasive treatments. develop international cooperation and relationships. The vote poses no threat to the 24/7 Parts Hotline: One more word on AI: I am convinced 704.739.3597 x3 that it is not a threat, but a tool that we can ESR, but instead, it provides an opportunity use to support our work and to improve to prove that science does not know bor- results. The radiologist’s job has constantly ders. Since the establishment of the ESR and rellhealthcare.com changed in the past and will continue to do through its various activities, we have built a so in the future. For one thing, the amount solid foundation for European radiologists to of data we are dealing with is ever-increas- cooperate and communicate and our motto ing. AI will help us to cope with this work- should be “Let’s be calm and carry on.” load and make optimal use of the data in Share this story: dotmed.com/news/40944

39 HealthCare410144 IMESBusiness 2018 ECR News DOTmed I Ad january 01232018.indd/february 1 1/23/182018 12:23 PM ECR HCB News Special Advertiser Section ECR Exhibitors 2018

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40 HealthCare Business News I january/february 2018 www.dotmed.com/news X-ray imaging components, which include tubes, digital flat-panel mogram, including patient positioning and compression, which are detectors and other image processing solutions, which are key com- widely viewed as the causes of most clinical image deficiencies, and ponents of X-ray imaging systems. With a 65+ year history of suc- associated with delayed detection of breast cancer. cessful innovation, Varex’s components are used in medical imaging Together, VolparaEnterprise and VolparaEnterprise Live! help as well as in industrial and security imaging applications. Global OEM optimize productivity, reduce costs through the reduction of retakes manufacturers of X-ray imaging systems use the company’s X-ray and increase staff effectiveness. sources, digital detectors, connecting devices and imaging software as components in their systems to detect, diagnose and protect. Varex Ziosoft employs approximately 1,900 people located at manufacturing and Expo 1 service center sites in North America, Europe and Asia. Stand #174 Ziosoft is a recognized leader in functional visualization and analysis Volpara Solutions software to benefit physicians, patients and health care specialists. With Expo 1 more than 2,000 systems installed worldwide, Ziosoft’s true vendor- Stand #121 neutral and multi-modality advanced visualization technology platform At ECR, Volpara Solutions will showcase VolparaEnterprise Live!, a is helping patients and clinicians every day, by enabling greater diag- mammography quality control tool that provides real-time, quality nostic confidence, lower dose options and precision in surgical and feedback at the gantry. It calculates the patient positioning score, treatment planning. Our economical and scalable architecture ensures dose and compression pressure for each image before the patient we have a model that is just right for you. leaves the examination room. Designed to help Technologists ac- Ziosoft’s flagship Ziostation2 product provides a vendor-neutral quire consistent, high- quality mammograms, VolparaEnterprise advanced visualization platform across multiple imaging modalities, Live! will be shown for the first time at ECR. in an economical and scalable multi-departmental solution. A full VolparaEnterprise software is the only solution available that pro- suite of regulatory approved 2D, 3D and 4D analytical tools provides vides a comprehensive assessment of image quality on every mam- consistent functionality across the enterprise, without compromise.

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HealthCare Business News I january/february 2018 41 European???? Radiology News

Current events in European radiology

Faced with its own unique regulatory demands, provider challenges and shifting political landscapes, radiology in Europe has its own distinct set of current events. Here are a few of the biggest stories from the last few months. Radiology Census: U.K. has third-lowest number of radiologists per capita out of 31 EU countries By John Fischer

The United Kingdom holds the third- doctors having more scans to report, improv- cent and Scotland, 10 percent. Wales and lowest number of radiologists per capita ing imaging technology means these scans Northern Ireland had the highest of all four out of 31 audited EU countries, accord- are becoming ever more complicated, taking at 13.1 percent and 20 percent, respectively. ing to the Clinical Radiology UK Work- longer to interpret. Cutting-edge radiology, RCR worries that the amount of vacan- force Census 2016 Report issued by The such as life-altering stroke intervention and cies will hinder the ability to keep up with the Royal College of Radiologists (RCR). cardiac imaging, can only keep pace if we evolving complexity of scanning, which is on RCR recorded a rate of 7.5 radiology have enough radiologist doctors to do it.” the rise. For instance, the number of MRs and trainees and consultants combined per The lack of radiologists raises the chance CTs performed increased by over 30 percent 100,000 patients throughout the country, of patients missing out on necessary inter- between 2013 and 2016, three times more compared to the EU average of 12.7 per ventional procedures as well as longer wait- than the rate of growth for the workforce. 100,000 and found that nearly one in 10 ing time for diagnosis of cancer and other The problem is further compounded by posts for British radiology jobs were vacant serious diseases. the fact that a fifth of radiologists through- in 2016 with nearly two-thirds remaining The report indicates that 4, 970 radiolo- out the U.K. are set to retire within the next unfilled for one year or more while the need gists were working full or part time in 2016 five years. In Wales, the rate is 30 percent. for scans continued to grow. with 8.5 percent of posts unfilled. Of that The retiree proportion when compared with “Scans are integral to patient care, and percentage, nearly 61 percent of positions that of new consultants shows only a 1 per- demand for X-rays, MR and CT scans is grow- were vacant for 12 months or longer. cent year-by-year increase in the U.K. radi- ing every year,” Dr. Nicola Strickland, presi- The rate of vacancies was further divided ologist workforce. dent of RCR, said in a statement. “As well as based on regions, with England at 7.4 per- Share this story: dotmed.com/news/39767

42 HealthCare Business News I january/february 2018 www.dotmed.com/news U.K. health system goes fully digital with Carestream X-ray technology By Lauren Dubinsky

Gateshead Health NHS Foundation So far, two of the DRX-Evolution Plus nificant reason for choosing it.” Trust’s radiology department in the U.K. rooms have been installed in the Trust’s main She added that the fully digital environ- recently decided to go fully digital. radiology department. One of the DRX-Rev- ment is also beneficial for patients. The Trust The Trust, also known as QE Gateshead, olution mobile systems is in the ICU and the is now able to provide more timely service is in its final stages of installing three Car- other on general wards. The retrofit kit is for to patients and has been able to achieve lo- estream DRX-Evolution Plus digital X-ray the special care baby unit. cal key performance indicators by reducing rooms, two DRX-Revolution mobile X-ray “Staff have found the new technology wait times. systems and a DRX Mobile retrofit kit. very easy to switch to, and this has been sup- Columbus Regional Health in Indiana in- QE Gateshead was founded in 2005 and ported by our having the same technology in stalled a Carestream DRX-Evolution Plus sys- runs the Queen Elizabeth Hospital, Dunston multiple rooms and as mobile units,” Elaine tem in its updated emergency department. Hill Day Hospital, QE Metro Riverside and Dickson, radiology services lead at the Trust, In March, UnityPoint Health in Wisconsin Bensham Hospital. There are a total of 3,400 said in a statement. “The new equipment installed two systems for its orthopedic and staff members and 580 hospital beds across is also ergonomically superior to previous general radiology patients. all facilities. equipment we used, which was another sig- Share this story: dotmed.com/news/38134

Hologic introduces its GE Healthcare ultrasound 3Dimensions mammo technology developed for rural system to European market Africa gains traction in Europe By Lauren Dubinsky By John Fischer

Hologic Inc. announced that its 3Dimensions mammogra- An ultrasound device designed for expectant mothers in rural phy system is commercially available in Europe. and developing countries is gaining traction as a popular tool in This new tomosynthesis system is equipped with features labor wards and delivery rooms in Europe. that generate higher-quality images and help manage dose. European doctors are adopting and using GE Healthcare’s Vscan “We expect that the European market will be extremely in- Access, a portable ultrasound system originally designed to help ob- terested in the 3Dimensions mammography system because it stetricians and midwives in Africa and Southeast Asia, to monitor the was designed to address key areas, including accuracy, clarity, health of their own maternity care patients and their unborn children. workflow and dose, that we know are of interest to European “With Vscan Access, we found that the very features which make it radiologists,” Jan Verstreken, Hologic’s regional president for ideal for rural Africa also make it suitable for labor and delivery wards in EMEA and Canada, told HCB News. Europe,” Rob Walton, general manager of Primary Care Ultrasound at Its Clarity HD high-resolution 3-D technology can help find GE Healthcare, told HCB News. “For example, the product is designed cancers at an early stage because it allows the radiologists to see to be intuitive [with a touchscreen and preset workflows] to make it subtle lesions and fine calcifications. The technology’s detector easy for new users to learn and quick to use — which is also essential in and imaging algorithm work together to deliver clear imaging busy, fast-paced labor wards. Moreover, Vscan Access is portable, rug- regardless of breast size or density. ged, and operable on a battery to enable midwives to carry it to rural According to studies published in Radiology, Lancet Oncology health centers in developing countries, but this also makes it ideal for and JAMA Oncology, Clarity HD reduces recall rates by up to 40 bedside use and transfer between labor rooms in a hospital.” percent, compared to 2-D mammography alone. Seventy percent of medical equipment designed for use in devel- The system’s Intelligent 2-D imaging technology works in oped nations does not work in developing countries, according to the conjunction with Clarity HD to improve clarity, contrast and detail World Health Organization. The same, though, cannot be said for the while lowering dose. It also enables the radiologist to instantly reverse of this fact, an assessment that is further strengthened by the move from suspicious areas detected on the 2-D image to the European adoption of Vscan Access. point of interest on the 3-D slice. Share this story: dotmed.com/news/38819 Share this story: dotmed.com/news/39070

HealthCare Business News I january/february 2018 43 European Radiology News New European project aims to protect patients and clinicians from low-dose radiation exposure By Lauren Dubinsky

The European Institute for Biomedical tional objectives — to improve organ dose diation protection, including radiologists, Imaging Research launched a four-year estimation and registration, evaluate and nuclear medicine physicians, radiotherapists, project in June to protect patients and understand the cardiovascular effects of ra- radiographers and medical physicists. health care professionals from low-dose diotherapy for breast cancer and pediatric “Usually, these highly specialized profes- radiation exposure. cancer risks from CT exams and to develop sionals carefully follow scientific advances, The MEDIRAD project, which is being recommendations to protect patients, staff and I am confident they will pick the rec- funded by the Euratom research and train- and the general public. ommendations up,” said Guy Frija, clinical ing program, comprises a consortium of 33 “We will also organize two dissemina- coordinator of the project and professor at partners from 14 European countries. tion seminars to present the MEDIRAD rec- the Universite Paris Descartes. Although vendors have made improve- ommendations to the medical and research MEDIRAD expects the European Com- ments to their diagnostic and treatment communities and competent authorities, mission to consider making regulatory technologies, the use of ionizing radiation in and we will facilitate consensus building,” changes based on the recommendations. medicine is steadily increasing. MEDIRAD is Elisabeth Cardis, scientific coordinator of the The Euratom research and training program working to curb that, as well as the resultant project, told HCB News. is also expected to fund new research pro- health risks. The recommendations will be developed grams. The project involves three major opera- for all stakeholders involved in medical ra- Share this story: dotmed.com/news/39834

European Society of Radiology Philips to shutter Dunlee calls for diagnostics to be better parts facility in Illinois, move represented in value-based care operations to Germany By John Fischer By Gus Iversen

The European Society of Radiology (ESR) has released a concept Dunlee, the CT and X-ray components company acquired paper on value-based radiology (VBR), arguing for greater inclu- by Philips in 2001, will no longer be conducting operations sion of diagnostics for radiology and other medical areas in value- from its facility in Aurora, Ill., according to a statement based health care (VBH). provided by a Philips spokesperson to HealthCare Busi- The paper argues that the VBH model disregards the diagnostic ness News. process when evaluating quality of care for patients, and that diagnosis Citing a significant decline in the replacement parts market, should be the first outcome assessed in regard to this matter. The find- those operations — consisting of generator, tubes and com- ings in the paper were compiled by ESR and its Value-Based Imaging ponents manufacturing — will be moved to an existing Philips Working Group (VBI WG). location in Hamburg, Germany. “Patients benefit from a timely and accurate diagnosis, which is the The move will affect approximately 200 employees at the basis for any treatment decision,” Professor Lorenzo Derchi, the first existing Aurora site and was expected to be complete before vice-president of ESR and the chair of the VBI WG, told HCB News. “By the end of last year. changing the incentives in the diagnostic process from volume-based The following is the statement Philips provided in its entirety: toward value-based aspects, radiology departments will focus more on As part of Philips’ ongoing strategic review of our Diagnos- what effect their work has and what matters most to patients, rather tic Imaging competitive market, the company has taken the than on the number of exams and reports they produce.” decision to transfer operations from our Generators, Tubes The paper’s publication comes at a time in which health care and and Components (GTC) facility in Aurora, Illinois, in the United radiology trends are shifting from volume- to value-based systems that States, to an existing Philips site in Hamburg, Germany. focus more on quality of care and patient safety as well as reimbursement Share this story: dotmed.com/news/37956 systems instead of the number of services carried out. Share this story: dotmed.com/news/39672

44 HealthCare Business News I january/february 2018 www.dotmed.com/news The following are just some of the products and services on display at ECR 2018. To view these products online or to share the article with colleagues, visit dotmed.com and NEW enter the code DM41208 in the search window or enter the address www.dotmed.com/ ECR news/41208 in your browser. PRODUCTPRODUCT SHOWCASE Varex Imaging SHOWCASE Nexus DR Software Expo 2 Stand #209 Nexus DR is advanced, digital X-ray image acquisition software designed to quickly and easily automate patient workflow and obtain higher quality images using less dose. Inte- grated with Varex 14x17 wireless cassette-sized detectors, Nexus DR provides a cost-effective and trouble-free solution that includes advanced image processing algorithms for optimal image quality and excellent reliability. Nexus DR is an efficient solution designed to provide fast and accurate diagnostic images with minimal user interaction.

Varex Imaging Cardinal CT Tube Expo 2 Stand #209 The Cardinal (Computed Tomography) CT tube is being designed into new OEM equipment and is optimized for use in mid-tier range CT scanners. It also is a direct replacement for the Stargate/ CTR-2150 tube used in Philips Brilliance 6(r) and 16 CT scanners. With an X-axis toggling focal spot, a 5MHU anode and a 0.5 second gantry speed, the Cardinal has high heat capacity, excellent image quality and throughput allowing for quicker imaging. The tube also has a 12-month full replacement warranty.

ContextVision VolarViewTM Expo 1 Stand #107 ContextVision’s world-leading image enhancement technology is now available also for the handheld ultrasound market segment. VolarViewTM is designed for efficient implementation on all types of handheld devices such as smartphone and tablet-based systems. The increased availability of handheld

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HealthCare Business News I january/february 2018 45 Technology Advisor Patient-generated data is transforming health care By Bipin Thomas

The importance of data in delivering effi- Applications of patient-generated data cient, effective health care has long been The entire health care ecosystem has been evolving with IoT-based tech- obvious, and has never been greater. nology platforms. IoT enables consumer-centric care from an integrated The increased focus on value-based care set of services from the providers, payers, medical device manufacturers is shifting financial incentives to a model in and life sciences companies. All these entities in the health care value which providers are compensated based on chain are shifting from a product-centric view to a patient view. The how their patients fare, rather than by the patient is in the middle of it all, no longer the product. IoT plays a pivotal number of tests, visits or procedures per- role in bringing patient data and the care team together to improve formed. This means that providers, patients and everyone in-be- patient engagement across the continuum of care. tween are more eager than ever to measure patient outcomes in As patient-generated data use increases, three areas in particular order to determine what works and who gets paid. offer a growing evidence base for value in improving health out- In striving to improve outcomes and reduce costs, health care pro- comes, reducing cost and expanding access to care. viders have long struggled with several nagging problems — most no- 1. Chronic-disease management and home care tably, their interactions with their patients are sporadic, giving them little Continuous data streams from patients’ devices to optimally manage insight into the daily decisions and activities that have a huge impact on narrow sets of known health issues, such as diabetes, measuring patient health. Providers could be much more effective in supporting potentially concerning deviations from normal parameters. their patients’ health if it was easy, or even automatic, for information 2. Short-term care planning and feedback to flow between patients, providers and caregivers. For- Event-specific data for a finite time period, or epoch of care, to cus- tunately, new technology is making that increasingly possible. tomize care and support compliance to treatment regimens through Where data about consumers have been critical to the transfor- education, feedback, reminders and monitoring. mation in retail, in health care the key is patient-generated data, 3. Population-based evidence creation defined as health-related data created, recorded, gathered or inferred High volumes of data to better understand how certain determinants by or from patients or their designees to help address a health con- of health affect patient populations and inform treatment guidelines. cern. It includes patient-reported outcomes, medical-device data and wearables data, in addition to the application of consumer-generated The way forward data in a health care setting. The use of patient-generated data presents an opportunity for cost savings, health outcome improvements and patient engagement Internet-of-Things (IoT) technologies by partnering with patients in many aspects of their health. The IoT has the potential to reinvent the health care industry. It has the challenges for health care organizations are substantial but sur- potential to transform traditional paper-based health care treatment mountable. As health care evolves toward outcome-focused care, through access to real-time patient data and remote patient monitor- patient-generated data can allow providers to deliver care tailored ing. The emergence of this digital health care (mobile health, wireless to individual patients, transforming the way care is delivered from health, connected health, etc.) technology has delivered solutions to sporadic, minimal interactions over large spans of time to a more tackle the increasing need for better diagnostics and more personalized patient-centered and ongoing relationship between patients and therapeutic tools. The IoT plays a significant role in a broad range of their providers, allowing patients to not only live longer, but thrive. health care applications, from managing chronic diseases to preventing About the author: Bipin Thomas is a renowned thought leader on disease, but it also works as a fitness and wellness tracker for athletes. consumer-centric health care transformation. Thomas is a board The health care industry has been overhauled by the digitalization member of HealthCare Business News magazine. Thomas is a senior of data and the incredible deployment of IoT technologies and apps executive at Flex, where he is leading business innovation by deploy- to enable access to data anywhere and at any time. The new breed ing cross-industry solutions with intelligent products and connecting of patient data is increasingly generated by IoT technologies and key industry stakeholders. Thomas is a former senior executive at associated business processes that offer the ability to track activities, Accenture and UST Global, where he implemented strategic digital identify choices, evaluate outcomes and act in circumstances that initiatives across the care continuum. were previously effectively beyond reach and influence. Share this story: dotmed.com/news/41209

46 HealthCareBusiness news I october 2017 www.dotmed.com/news Cost Containment Corner Health care’s ‘quiet crisis’

By Brita Hansen

Value-based care is revealing a “quiet ancies can occur. Preventing these issues right channel, at the right time in workflow. crisis” in health care today: the lack of requires the ability to easily access and see In this manner, dynamic clinical pro- capability enabling clinical teams to con- clinical processes and data. It also requires cess improvement solutions can save time trol, improve and standardize clinical accounting for the individuals, technology and resources by ensuring EHR workflows processes in near real time. and tools that support these processes and and order sets are regularly updated when Without timely process control and stan- influence outcomes. changes are made to medical evidence and dardization systems and tools, clinical teams best practices. are challenged in the delivery of consistent, Integrating enterprise high-quality and reliable care. As a result, clinical process control and Continuous improvements outcomes and financial performance suffer. improvement solutions Enterprise clinical process control and im- Health systems allocate significant re- Increasingly, health systems are leverag- provement solutions are powerful tools for sources to standardization initiatives. But ing enterprise clinical process control and maintaining standardized care. they are doing so by committing expensive improvement software to assist in the One good example is how this type of staff resources to “one-off,” time-consum- analysis, evaluation and management of technology helped reduce the sepsis rate ing processes of aggregating data housed in clinical processes to fix what is broken at one Florida hospital. The facility initially the electronic health record. Clinical leaders and ensure appropriate standardization. standardized all clinical content around the have no real mechanism for instant insights By aggregating data related to EHR com- early detection of sepsis, then continuously into the impact of individual process inter- ponents, such as order sets, that support measured clinician adherence to standard- ventions on clinical practice patterns, leaving clinical processes, organizations are better ized workflows and the correlation between them in the dark as to which areas within able to evaluate all care delivery practices care delivery and outcomes. This enabled the workflow require additional, or alter- and determine where breakdowns leading real-time data collection and analysis, which nate, intervention. to unnecessary variation occur. led to the determination that an enhanced Without those granular insights, it is also Enterprise clinical process control and im- sepsis order set was needed to guide clini- unlikely that any improvements resulting provement software allow those teams and/ cians in the accurate ordering of IV fluids. from the initial initiative will be scalable or or individuals specifically tasked with identi- Once the new order set was in place and sustainable, hindering efforts to replicate any fying and implementing workflow enhance- workflows standardized, the hospital real- successful actions. ment and process improvement to do so on ized a 50 percent increase in sepsis bundle their own, without the need to get in line for compliance in just one week. EHRs’ role in standardization IT support or a report from the informatics By integrating clinical process control EHR systems are a strategic asset for their team. This reduces the resources required and improvement systems that provide real- ability to influence and, in some cases, drive to fix and/or improve a clinical process, and time insight into critical data, health systems standardized, high-value care. Yet EHR work- enables it to happen in a timelier manner. will realize benefits including enhanced care flows and content often fail to align with To drive enhanced outcomes, enter- and reduced costs while achieving, and ex- clinical workflows, thereby hindering the po- prise clinical process control and improve- ceeding, quality benchmarks and improving tential to achieve and maintain standardized ment platforms must be able to measure, care outcomes. care. For example, when health care systems evaluate and manage the entire life cycle of About the author: Dr. undertake process improvement initiatives, standardized care delivery in near real time. Brita Hansen is chief it is common to identify multiple conflicting, Continuous monitoring and control by clini- medical officer of outdated or dormant order sets, which con- cians as they deliver care ensures that the LogicStream Health, tribute to unnecessary care variations. right content supporting current best-prac- a leader in clinical To overcome the challenges created by tice standards is built into the EHR. Clinical process improvement these care variations, providers must adopt teams with the capability at their fingertips solutions. She is also a a holistic approach that includes analyzing to systematically apply technology that helps practicing hospitalist all workflow components with the potential them control and improve their processes and an assistant professor of medicine at the to influence clinical processes, while elimi- ensures the right information is sent to the University of Minnesota School of Medicine. nating areas within the EHR where discrep- right person, in the right format, through the Share this story: dotmed.com/news/40763

HealthCare Business News I january/february 2018 47 HIMSS High profile speakers will take the stage at HIMSS18 in Vegas

There will be no shortage of promi- topic: “It Takes a Community — Delivering Wednesday, March 7; and 9:30 a.m. to 4 nent keynote speakers appearing at 21st Century Coordinated Care for Those In p.m. on Thursday, March 8. HIMSS18. and Out of Uniform.” The HIMSS18 Career Fair is scheduled The event is set for March 5-9 at the Vene- Immediately following their address, for Wednesday, March 7, from 9 a.m. to 3 tian-Palazzo Sands Expo Center in Las Vegas. from 9:30 to 10:15 a.m., Keller Rinaudo, p.m. at Wynn Las Vegas. Attendees will have Eric Schmidt, the executive chairman the founder and CEO of Zipline, will cover the opportunity to post their resumes and of Alphabet Inc., the parent company of “Innovative Leadership, Robotic Technology connect with the top employers in health Google, will get things started on Monday, and the Future of Healthcare.” IT. The Career Fair is a centralized location March 5, from 5 to 6:30 p.m. His topic will be The final keynote speaker, addressing for recruiters, job seekers, consultants and “Technology for a Healthier Future: Modern- HIMSS18 on Friday, March 9, from 1:15 to others who contribute to the development ization, Machine Learning and Moonshots.” 2:30 p.m., will be basketball legend and of the health IT workforce. Attendees will Two speakers will address conference at- entrepreneur Earvin “Magic” Johnson. be able to meet one on one with recruiters. tendees on Friday, March 9, from 8:30 to His topic: “Perspectives on Leadership and The free resume review will take place from 9:30 a.m. They are: David Shulkin, M.D., Healthcare Advocacy.” 9 to 11 a.m. and between 1 and 3 p.m. Advice Secretary of the U.S. Department of Vet- All keynote sessions will be held in the and recommended improvements will be pro- erans Affairs; and Vice Admiral Raquel Palazzo Ballroom. vided by professional resume experts. Space C. Bono, director, Defense Health Agency Also, the exhibit hall hours will be: 9:30 is limited and advance registration is required. (DHA), Defense Health Headquarters. Their a.m. to 6 p.m. on Tuesday, March 6, and Share this story: dotmed.com/news/41210

48 HealthCare Business News I january/february 2018 www.dotmed.com/news Nihon Kohden rated #1 by

in Patient Monitoring or Telemetry for more than 10 consecutive years

System Applications Performance Training

System Service Reliability Response Time

Installation / Service Implementation Repair Quality

Different Thinking for us.nihonkohden.com Better Healthcare.®

MMLB 188 [A] - CO-1534 MD Buyline is a registered trademark of MD Buyline. Different Thinking for Better Healthcare is a registered trademark of Nihon Kohden. HIMSS Q&A with Denise Hines Chairwoman, HIMSS North America Board of Directors

By Sean Ruck

HealthCare Business News recently DH: There’s potential for a number of On the regional side, states, provinces spoke with Denise Hines, DHA, PMP, uses. Patients can use virtual reality for and regions are taking a more aggres- FHIMSS, chairwoman, HIMSS North physical therapy, and surgical procedures sive approach to accommodate and un- America Board of Directors, in advance are also being planned and practiced us- derstand the role health IT can play in of the HIMSS Annual Conference & ing VR. improving health. Exhibition for a sense of what to expect during this year’s event as well as some updates on what the society has been working on over the past year 'There’s plenty to talk about how information and its plans for the future.

HCB News: What are a few of the and technology can positively address the topics that you expect to dominate conversations among attendees at impending economic crisis facing health care in HIMSS18? DH: Cybersecurity is definitely at the top nations around the world. HIMSS18 will offer over of the list, followed by artificial intelligence, precision medicine, interoperability and in- 500 educational sessions, most of which are vestment in new technology and startups. Emerging technologies, such as virtual re- applicable to attendees from around the world.' ality (VR) and blockchain, will be popular as well. And, of course, there’s plenty to talk about how information and technol- HCB News: Recapping 2017, what The government’s focus on information ogy can positively address the impending were some of the landmark events for and technology increased. For example, economic crisis facing health care in nations HIMSS or for health IT? in the U.S., the VA is exploring a new EHR around the world. HIMSS18 will offer over DH: For health IT in general, I think system and the FDA is exploring new ways 500 educational sessions, most of which it was the introduction and focus on to bring safe medical devices to market. In are applicable to attendees from around newer technology, with interoperability 2017, many providers continued to work the world. Our approach is to host an event being better recognized as an important on meaningful use and care measures, and that equips professionals globally with the function for health care. In the U.S., leg- increasingly focused on better understand- education, networking and access to sup- islation was enacted, The Creating High- ing the user’s experience. pliers and consultants to meet their needs. Quality Results and Outcomes Necessary For HIMSS17, recognizing the contribu- to Improve Chronic (CHRONIC) Care Act tions of women in health IT and bringing HCB News: Going back to VR for of 2017, that promoted the use of tele- millennials into our field were two big ar- a moment, how is that expected to health in ways we hadn’t seen before. eas of focus. HIMSS18 expands that focus. move into health care?

50 HealthCare Business News I january/february 2018 www.dotmed.com/news HCB News: In a HIMSS survey from last year, two-thirds of respondents reported a “significant” cybersecurity 'Health care will be much more personalized by incident. In what ways is HIMSS responding to the uptick in hackers tar- incorporating digitized medicine. We’ll have a geting health care? DH: HIMSS hosted a hackathon to ad- better ability to develop the treatment path for a dress cybersecurity threats and supported numerous readiness initiatives that in- particular disease in a particular person. cluded collateral, tip sheets, webinars and leaders of various types coming together to There will also be more work done talk through best practices. In 2017, HIMSS got in touch with our full membership and regarding population health.' worked in partnership with related federal agencies to talk through education, strategy and prevention. Our cybersecurity is shaping the foundation of a worldwide where interoperability can be useful, call to action includes strategies and a tool ecosystem where information and technol- having our systems implemented and ex- kit. We worked in partnership with orga- ogy-driven innovation powers the transfor- tracting data and getting that to provid- nizations that set standards for technical mation of health. ers. Bringing together the whole commu- security measures, and provided feedback To actually implement and integrate in- nity of providers for one patient is where and access to those types of measures for novation into patient care, HIMSS advises health care is headed. health care providers. global leaders, executives, government en- We’ll see new technology integrated tities and others of best practices in health into our day-to-day health interactions. HCB News: What are some of the information and technology to improve And then, we’ll have the ability to make presentations or events taking place patient care by having the right informa- sure everyone is included in health care. It at HIMSS18 that you’re most excited tion at the right time to make the right won’t be just the large health systems, but about? decisions. We create the opportunities to the personal care home run by a mom and DH: I’m looking forward to the Magic discuss technology, to allow innovators to dad taking care of several people in the Johnson session and all of the keynote talk to clinicians, executives and providers community, too. speakers. And, I can’t really describe how using systems every day, and to connect Health care will be much more person- phenomenal the networking is. All of the dots on workflow. alized by incorporating digitized medicine. the networking events will be wonder- We’ll have a better ability to develop the ful. All my vendors will be there. All my HCB News: Turning the focus more treatment path for a particular disease in a colleagues will be there. New people will to your role, what are some of your particular person. There will also be more be there. goals as HIMSS chair? work done regarding population health. DH: I would like to encourage more We’ll see that a zip code might be predis- HCB News: There is a noticeable gap minorities and women to pick a career in posed to certain diseases due to pollution between the cutting-edge solutions health care technology. As part of that, in the water, for example, and use that to showcased at HIMSS and the day-to- we are promoting HIMSS’ vision of bet- identify issues like Flint, Mich., experienced. day health IT reality of most facilities. ter health through information and tech- Information will be created to see how we What role does HIMSS play in making nology in school systems and colleges. can prevent population health crises in the these innovations an actual compo- Many times, young people don’t know next five to 10 years. Work will be done nent of patient care? about careers in our field. HIMSS is here bringing in our federal agencies and get- DH: While I represent the board of to change that. ting them the information they need to HIMSS North America, HIMSS as an orga- accomplish their jobs. There will also be the nization focuses on innovation, thought HCB News: Thinking about the next challenge to increase clinical information in leadership and community building glob- five to 10 years, what will be some of order to prevent outbreaks. ally. I see innovation at the core of HIMSS’ the biggest changes in health IT? Share this story: dotmed.com/news/40907 global quest to transform health. HIMSS DH: I think we’re starting to see

HealthCare Business News I january/february 2018 51 HIMSS

HCB News Special Advertiser Section HIMSS Exhibitors 2018

CarePassport DOTmed.com and HealthCare Business News Booth #269 Booth #2477 A next generation patient engagement app designed to enable pa- DOTmed.com is the world’s leading public medical equipment, parts tients to take control of their medical records by allowing patients to and service marketplace. We publish HealthCare Business News mag- aggregate, store, share and manage all their medical data including azine, which features our popular IT Matters column every month radiology images, lab results, dental, vitals, medications and more plus other IT-related articles, and we cover breaking industry news at no cost to the patient. CarePassport brings patient data together with HCB Daily News online. DOTmed.com receives over 1.5 million in one single, secure health portal, and allows patients to create a page views per month. We host over 700,000 user listings on any secure medical wallet with key information including demograph- given day, welcome more than 22,000 unique visitors a day and have ics, insurance, emergency contacts and important health info for over 270,000 registered users. emergencies, such as blood type, allergies and medications. The app enables users to engage more proactively and meaningfully with their health care providers. Nihon Kohden America, Inc. The solution’s back end is designed to run as a stand-alone so- Booth #10925 lution or seamlessly integrates with existing EMR systems to help Founded in Japan in 1951, Nihon Kohden is the leading manufac- streamline administrative routine tasks including scheduling appoint- turer, developer and distributor of medical electronic equipment, ments, registration, patient reminders and enables health care facili- with subsidiaries in the U.S., Europe and Asia. The company’s prod- ties to securely deliver medical images and clinical results to patients. ucts are now used in more than 120 countries, and it is the largest Stop by booth #269 and see how CarePassport can help you elevate supplier of electroencephalography products worldwide. A pioneer the patient experience and improve health care outcomes. in transformational health care technology, Nihon Kohden has envi- sioned, designed and produced revolutionary devices such as pulse oximeters, arrhythmia analysis, low-invasive blood volume monitor- Change Healthcare ing and wireless patient monitoring. In the U.S., the company is a Booth #4202 trusted source for patient monitoring, sleep assessment, neurology Change Healthcare is inspiring a better health care system. We’re a and cardiology instrumentation solutions. key catalyst of a value-based health care system, working alongside our customers and partners to accelerate the journey toward improved lives and healthier communities. We are a health care technol- Terso Solutions, Inc. ogy solutions company that uniquely champions the improvement of Booth #10654 all the points before, after and in-between care episodes. Our holistic Terso Solutions is the leading provider of automated inventory man- suite of solutions encompasses imaging, workflow, infrastructure, agement solutions for tracking assets in health care and life science analytics, capacity management, homecare/hospice and consulting. to achieve supply chain automation, real-time data and improved We combine these with deep industry expertise to help our custom- workflows. Terso’s line of RAIN RFID solutions include cabinets, refrig- ers and partners create a stronger, increasingly collaborative and erators, freezers (-20ºC to -86ºC), mobile solutions and smart rooms. more efficient health care system that enables better patient care, Terso’s RFID sensors are being used to manage inventory throughout choice and outcomes at scale. the supply chain in a growing array of applications including consign- ment inventory tracking, Kanban systems, field audits, cold chain distribution, chemical tracking, quality control solutions, regulatory compliance and tissue and implant management.

52 HealthCare Business News I january/february 2018 www.dotmed.com/news The following are just some of the products and services on display at HIMSS18. To view these products online or to share the article with colleagues, visit dotmed.com and NEWHIMSS enter the code DM41211 in the search window or enter the address www.dotmed.com/ PRODUCT SHOWCASE news/41211 in your browser. PRODUCT NK-HiQ™ Wireless Patient aireeg® WEE-1200 Monitoring System Nihon Kohden America, Inc. Nihon Kohden America, Inc. Booth #10925 Booth #10925 SHOWCASEExperience the new standard for qual- The face of wireless patient moni- ity in wireless EEG data collection with toring is changing forever with the the aireeg® WEE-1200, a premier NK-HiQ™ Wireless Patient Monitor- diagnostic platform featuring Nihon ing System, a breakthrough data ac- Kohden’s signature amplifier and sig- quisition and management platform nal processing technology in a mobile- that meets patients where they are, ready, patient-friendly system. anywhere Wi-Fi is enabled in the hospital setting. The NK-HiQ™ Wireless Patient Monitoring System allows patient data to flow safely, seamlessly and securely from admission to dis- TS057 RFID Ultra Low charge, enabling the right care, at the Temperature Freezer right time, in the right setting. Terso Solutions, Inc. Booth #10654 Terso Solutions provides RAIN RFID technology for automating inventory management in health care and life science. Terso’s line of enclosures are used to control inventory in a range of applications including supply rooms, research labs, surgical centers, dental offices, pharmacies and stockrooms. Terso’s 13-cubic-foot, TS057 ultra-low temperature freezer reaches -86 degrees Celsius and is ideal for ensuring integrity of implants, tissue, biologics and high-value inventory. Generate policy compliance while reducing waste and increasing merchandise diversity with the freezer’s variance alerting and remote temperature monitoring. The freezer communicates with Jetstream, Terso’s IoT platform, to capture and send product usage information in real time to the end user inventory management, EHR, EHS or BI systems.

Change Healthcare Conserus Workflow Intelligence Booth #4202 Orchestrate and automate workflows across your health system with Conserus Workflow Intelligence™. This vendor-neutral rules engine facilitates interpretation and quality workflows based on your business rules. It helps you manage process Change Healthcare and measure results so you can improve McKesson Radiology areas like turnaround times and produc- Booth #4202 tivity. Its automated alerts and escalations McKesson Radiology™ is a web-based PACS with a flexible and scalable architecture to help bridge communication gaps so you

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HealthCare Business News I january/february 2018 53 Imaging IT News

Current events in the imaging IT market sector

With HIMSS fast approaching, here are some of the most high-impact imaging IT stories that helped shape the industry landscape over the last several months.

ACR’s Data Science Institute to develop structured AI framework for radiology practices By John Fischer

The American College of Radiology ing doctors ‘what do you need, what do you through an AI registry. (ACR) Data Science Institute (DSI) is set need in your practices?’” Allen says that the development of AI use to introduce a framework, strategy and Development will take place in stages cases will provide many standards of refer- focus for turning artificial intelligence with the first step involving the construc- ence and resources that will assist more than from a concept into an everyday prac- tion of the open source standard framework just radiologists. tice in radiology. which will be available to medical organiza- “ACR DSI use cases will be more than just ACR DSI will develop AI use cases for ra- tions, institutions and developers for build- the good idea for an AI algorithm, but also diology using an open source framework ing radiology uses cases around AI. Specific a framework for data elements for annota- to determine standards for training, test- AI use cases will be based on standards that tion, AI authoring, algorithm testing, training, validating, integrating and monitoring are necessary for meeting the needs of the ing and validation, data elements for clinical AI algorithms in clinical practice, creating a specialty. integration into transcription software or standardized platform to build such cases for A standardized pathway for validating elsewhere, and data elements for registry optimizing radiology practices and improv- and certifying algorithms will be created to input to monitor algorithm performance in ing patient care. ensure their effectiveness and patient safety, clinical practice,” he said. “We believe these “A lot of developers are creating algo- and to assist in expediting FDA regulatory tools will be useful to developers and FDA rithms right now, and I think some of those review processes. Plans also include the de- and government regulators, and we have re- will find utility in clinical practice and some velopment of radiology workflow interoper- ceived positive feedback from both groups.” may not,” Bibb Allen, chief medical officer ability standards and pathways for incorpo- The organization hopes to have proof of of the ACR DSI, told HCB News. “I think rating AI algorithms into clinical workflow, concept use cases available in the first half what developers are missing is structured as well as ongoing postmarket assessment of this year. use cases for AI algorithms in regard to ask- of algorithm performance and effectiveness Share this story: dotmed.com/news/40389

54 HealthCare Business News I january/february 2018 www.dotmed.com/news FDA approves sale of SyMRI IMAGE software for GE Healthcare MR scanners By John Fischer

SyntheticMR’s software, SyMRI IMAGE, is need for patients to return for further scans. ing neurological conditions. now available in GE Healthcare’s MR scan- Approval for the software was based on Hurtig says that SyMRI IMAGE has the ners, following FDA approval. the results of the MAGiC study in the Ameri- potential to become a common tool for as- The product is licensed to GE Healthcare can Journal of Neuroradiology, the first to sessing neurological conditions. under the brand name MAGiC (MAGnetic compare synthetic and conventional MR “We are convinced that our way of quan- resonance image Compilation) and is designed imaging in the assessment of neurological tifying brain tissue will revolutionize the MR to ensure shorter scan times while offering in- conditions. software market, and that our solution will sights to determine diagnostic decisions. Seven neuroradiologists, blinded for the become the standard method for following “The synthetic MR imaging quality is study, read through 1,526 imaging case-con- up on patients with neurodegenerative brain diagnostically non-inferior to conventional trol pairs from 109 subjects with neuroimag- disorders,” he said. imaging, with the added value of reduced ing indications, acquired through synthetic SyntheticMR previously partnered exam times,” Jonas Hurtig, a spokesperson and conventional brain MR scans. Clinical with Siemens Healthineers to make SyMRI for SyntheticMR, told HCB News. “We have MR imaging studies found 46 healthy and 63 software packages compatible with its MR a unique value proposition and do not face pathologic cases. Participants were between scanners, starting in 2017. any direct competition in the marketplace.” the ages of 19 and 89. The study found that The software is CE-marked. It is approved SyMRI IMAGE can reconstruct a variety the quality of synthetic MR imaging showed for use in Singapore, Australia and New Zea- of image contrasts from one scan, thereby similarities to that of conventional proton land under Philips, and in Japan under Sectra reducing overall scanning time, saving pro- density, Short-TI Inversion Recovery (STIR) and and Philips. viders significant costs and eliminating the T1- and T2-weighted contrast views regard- Share this story: dotmed.com/news/39004

Zebra Medical offers AI access Fujifilm wins 10-year, $768 for a dollar per imaging scan million contract with VA, By Lauren Dubinsky Department of Defense

Zebra Medical Vision is offering a new artificial intelligence By Lauren Dubinsky suite that gives health care providers access to its current and Fujifilm Medical Systems U.S.A. has earned a 10-year con- future algorithms for one dollar per scan. tract with the U.S. Department of Defense and Department This is part of the company’s goal to make advanced health care of Veterans Affairs worth $768 million. tools more affordable for the world’s population. A five-year base period and five-year renewal option are cov- “Health care providers have been asking for a way to try AI and ered under the Digital Imaging Network-PACS IV contract. deep learning technologies within radiology, to understand the value U.S. government health care providers are now able to pur- it can provide,” Elad Benjamin, co-founder and CEO of Zebra Medi- chase and implement technologies from the company’s Synapse cal, told HCB News. “They are unsure how the technology works and enterprise imaging portfolio. That includes Synapse 5 PACS, Syn- look for an affordable way to ‘dip their toes.’” apse Mobility Enterprise Web Viewer, Synapse 3D, Synapse CV and As the demand for imaging services has surpassed the number Synapse VNA. of physicians available to perform those tasks over the past two de- Fujifilm introduced its Synapse 5 PACS enterprise imaging solu- cades, it has put tremendous pressure on providers and radiologists tion. It's different from the previous version in that it's a server-side to do more without compromising care. platform rather than a workstation image rendering platform. Zebra Medical believes that adopting new technology that en- The DoD and VA are in the midst of a project called the MHS hances radiologists’ capabilities is the solution. For example, its Deep Genesis that will replace their current EHR system. Fujifilm’s tech- Learning engine automatically analyzes imaging data, which helps nology will play an important role in this transition. the radiologist generate faster and more accurate reports. Share this story: dotmed.com/news/38823 Share this story: dotmed.com/news/39951

HealthCare Business News I january/february 2018 55 Imaging IT News Experts stress workflow orchestration and protocol standardization at SIIM meeting in New York By Lisa Chamoff and John R. Fischer

While artificial intelligence was the main complex, Hirschorn said. PACS and RIS systems, but that is not those buzzword at the SIIM-NYMIIS Regional “Radiology has to be able to respond and systems’ core competency, Hirschorn said. Ra- Meeting in Manhattan, there was also get the scan done, get the reading commu- diologists can also use the EMR, or purchase a less sexy, but still important, focus on nicated in a timely fashion, document it, and an independent workflow orchestrator. making sure imaging departments are prove that it got done every time, not just “At least it’s in the business of doing it,” well organized with workflow orches- most of the time,” Hirschorn told the radi- Hirschorn said. “That’s its job.” tration and protocol standardization, ologists and those in the health care industry Ann Scherzinger, a professor at the Uni- and a look at enterprise imaging. gathered at the Marriott Marquis in Times versity of Colorado and a conference co-chair, Dr. David Hirschorn, chief of informat- Square for the meeting. “It needs a workflow spoke about the importance of protocol stan- ics for the imaging service line at Northwell engine that’s going to be able to track that, be dardization, particularly when it comes to pro- Health in New York, and the conference co- a watchdog, and be sure that that happens.” viding lower-cost, quality care to patients. chair, extolled the virtues of a workflow or- A workflow orchestrator can also help “A prerequisite to actually integrating chestrator and its role in maximizing through- keep track of radiologists’ schedules and these services into service lines is to standard- put and developing subspecialty expertise. make sure exams are read in a timely fash- ize the services somehow,” Scherzinger said. This kind of organization is important for ion, even when someone is out sick or on “So it wouldn’t matter which institution the facilities looking to become accredited stroke vacation, Hirschorn said. They can also en- patient was sent to within our many hospitals. centers and honor service agreements, and sure that exams are labeled with consistent They would get [the] same service and the is critical in the era of consolidation, with names and descriptions. same value.” radiology groups growing bigger and more Workflow organization is available with Share this story: dotmed.com/news/39030

FINAO Solutions processing Sectra launches vendor-neutral over 1 million radiology access to machine learning on studies with Intelerad PACS enterprise imaging platform By John Fischer By John Fischer

FINAO Solutions is processing in excess of 1 million ra- The Sectra enterprise imaging platform will be available with in- diology studies per year through the use of its hosted tegrated vendor-neutral access for machine learning capabilities. Intelerad solutions, produced by Canadian manufacturer The new feature will provide users with access to machine-learning ap- Intelerad Medical Systems Incorporated. plications developed by Sectra and virtually any other application, regardless The Alabama-based provider of turnkey imaging technology of the vendor, offering a unified entry point to a best-of-breed portfolio. has distributed the PACS technology to different practices through- “A user can right-click their way directly into an external application out the U.S., many of which use it for a variety of purposes. without additional logins and the results can be sent back to the worksta- “Intelerad is a PACS,” Gene Cathey, the CEO of FINAO Solu- tion for inclusion in the report without launching, searching or sending data tions, told HCB News. “But we have people who use it as a full to an external application or to a web service,” Dr. Torbjörn Kronander, CEO PACS system. In other words, we do the archiving and long-term and president of Sectra AB, told HCB News. “Sectra’s own applications will, storage of their studies. It’s also used as a teleradiology solution.” when possible, use the same interface for our applications and machine Intelerad solutions can connect radiologists to various reposi- learning tools. Ahead, we also see strong opportunities in applying machine tories within an imaging ecosystem, creating efficient workflows learning to improve workflow itself, being able to triage and separate cases and improving quality by ensuring access to patient information needing urgent attention from those likely to be benign.” needed at the time of interpretation. The technology also allows Specific capabilities added include imaging analysis, diagnostic ser- radiologists to read all of their studies from the same viewer and vices and computer-aided detection (CAD) systems with the interface same voice recognition system instead of having to log in and log eliminating the need for users to log into separate applications or manu- out of different viewers and different systems. ally connect over DICOM when using these tools. Share this story: dotmed.com/news/39938 Share this story: dotmed.com/news/40192

56 HealthCare Business News I january/february 2018 www.dotmed.com/news Innovative Treatment Cancer treatments using immune system come with a cost By Thom Wellington To many fighting cancer, palliative care tack our bodies. The practical application Unique selling proposition is considered the ending point — just of this practice is just beginning to emerge. Novartis, the drug manufacturer of the gene dealing with pain management until Immuno-oncology molecules are designed to therapy formulation for leukemia treatment life ends. help identify cancer cells and destroy them. called Kymriah, has also developed a unique Recent developments outside of normal marketing program to move the focus off the Gene therapy cancer treatment have emerged with both therapy’s high price tag. The treatment price, Gene replacement therapy sounds invasive promise and staggering treatment pricing. reported to be $475,000 for a one-time and significantly complex to most patients. While chemotherapy is still considered a treatment, is at the top of the oncology list In actuality, gene replacement is a simple mainstay in fighting cancer, it has its draw- for most expensive therapy formulations. No- concept: insert a copy of a specific gene backs in the form of adverse side effects. vartis’ unique selling proposition being devel- into targeted cells. The process introduces As more cancer cells grow in the patient’s oped is to only charge insurance companies genetic material into targeted cells to either body, they take over useful cell space. Che- and CMS for reimbursement of the sky-high produce a protein or to overcompensate for motherapy drugs are designed to interfere price tag if the patient goes into remission abnormal genes. The process is intended to with the cancer cell’s ability to divide and within one month of receiving the treatment. place a normal gene to replace an abnormal reproduce. Unfortunately, chemotherapy Novartis calls the plan “outcomes-based pric- gene, or to provide restoration of a malfunc- can also interfere with healthy cells, further ing” and is waiting for CMS approval. weakening the patient’s immune system. To tioning protein. many, the treatments mean dealing with the Researchers have found that a gene can- Clinical trial success pain and hoping things improve. not just be inserted into a cell and cause a Marie Miceli, an active real estate administra- Recent approvals from the Food and Drug desired reaction. The gene has to be deliv- tive professional in St. Louis, received the gift of Administration (FDA) have created controlled ered by a carrier called a vector, which also is a lifetime by being offered a chance to partici- chaos with pharmaceutical development genetically engineered to perform the trans- pate in an early clinical trial as a last-resort effort companies being purchased at sky-high port. In addition, modified viruses become in her fight against non-Hodgkin’s lymphoma. multiples and drug treatment costs reaching the vector since they can infect the cells. In Previous chemo and bone-marrow transplant stratospheric heights. Kite Pharma, the devel- this case, the viruses have been modified so treatments were ineffective. In 2015, after the oper of an FDA-approved treatment which that they cannot cause a disease in humans. failed treatments, doctors told Miceli to get her genetically alters a patient’s cells to actually The process starts with a patient’s cells be- life in order. Nothing else could be done. Par- attack cancer, fits both scenarios. The innova- ing removed and joined with a vector in the ticipating in the trial was considered a last grab tive treatment for aggressive non-Hodgkin’s laboratory. The modified vector-containing at hope, but innovative treatment focused on lymphoma has seen strong positive results in cells are then either injected or given intrave- re-programming the patient’s own cells worked all trials, and the company was recently pur- nously into targeted tissue in the body. The when conventional cancer treatment failed. chased by Gilead Sciences for $11.9 billion. In goal is to deliver the new gene into the cells As successful cancer fighting progress con- addition, the treatment known as CAR T-cell that will fight the cancer. tinues with cell re-programming, the price tag therapy and branded as Yescarta has an eye- A gene therapy developed by Novartis will begin to drop to more reasonable levels. opening treatment price of $373,000. called Kymriah uses the patient’s own T cells Hope comes with a price, but for those ex- to fight cancer. The one-time treatment is periencing complete Immuno-oncology the first therapy based on gene transfer ap- remission from inno- Innovative cancer treatment is quickly devel- proved by the FDA. The FDA approval is only vation, it’s worth it. oping. Immuno-oncology holds the promise for patients up to 25 years old who have About the author: of treating certain forms of cancer, such as acute lymphoblastic leukemia either relaps- Thom Wellington is prostate cancer and melanoma, by leverag- ing or refractory. According to The Washing- the CEO and a stock- ing the power of the human immune system. ton Post, “the therapy’s approval signals a holder in Infection The human immune system is our built-in new chapter in treating cancer by mobilizing Control University. natural defense mechanism which eliminates the body’s own immune system and by using Share this story: dotmed.com/news/41212 foreign substances, cells and tissues that at- modified genes to fight disease.”

HealthCare Business News I january/february 2018 57 Workflow Roadblocks The triumphs and pitfalls of integrating diagnostic imaging and the EHR

By Lauren Dubinsky

Fujifilm's Synapse Mobility Enterprise Web Viewer.

The road to electronic health record take the images,” says Mitali Maheshwari, tem. “But some might argue that the best (EHR) adoption has been anything but health care information technology analyst approach might be to have the best work- smooth as health care organizations at MD Buyline. “They store their images in station from vendor A combined with the grappled with significant cost and their particular systems and those systems best network from vendor B combined with workflow challenges. cannot talk with each other.” the best storage from vendor C.” But, according to The Office of the Na- Health care organizations are now work- That customized approach to imaging IT tional Coordinator for Health Information ing on making all of the patient records and is sometimes called “deconstructed PACS,” Technology, 96 percent possessed a certified images within each department available on and although it does put more control in the EHR technology in 2015. demand. Some progress has been made with hands of the facility, it lacks the cut-and-dry Still, most experts agree that the work is the introduction of the vendor neutral archive simplicity of a single vendor contract. The far from complete as technological potholes (VNA), which stores images in a standard for- question providers need to ask themselves and roadblocks continue to get in the way of mat so they can be accessed by different sys- is whether those added complications can establishing a cohesive, interoperable health tems, but it does give rise to important new yield a smoother experience in the era of IT ecosystem across the enterprise. As silos questions for hospital decision-makers. enterprise imaging where that data needs to come down, one of the most daunting tasks “PACS has traditionally been provided play friendly with the health record. has been integrating diagnostic imaging into by a vendor [that offers] the network, work- the EHR. stations, storage and other components in Enterprise imaging as the “Each facility has its own PACS and each one package,” says Dr. Eliot Siegel, chief ultimate goal department such as cardiology, dermatol- of radiology and nuclear medicine for the In recent years, the concept of enterprise- ogy and oncology has its own devices that Veterans Affairs Maryland Healthcare Sys- wide imaging has gained a lot of traction,

58 HealthCare Business News I january/february 2018 www.dotmed.com/news but not without causing some confusion as So how can a facility make sure its big of the hospitals that want to share images to what the term really meant. In May 2016, jump into enterprise imaging enhances val- with each other need to be on the LifeIM- The Healthcare Information and Manage- ue-based care as opposed to delaying diag- AGE network. To date, 1,400 hospitals in the ment Systems Society (HIMSS) partnered nosis, causing unnecessary duplicate exams U.S. are on the network, yet there are 5,564 with The Society for Imaging Informatics in and furthering the pinch on its bottom line? registered hospitals in the nation, according Medicine (SIIM) to define enterprise imaging It requires a great deal of homework and to the American Hospital Association. as “a set of strategies, initiatives and work- choosing the right partnerships to meet spe- In May, Fujifilm Medical Systems’ Synapse flows implemented across a health care en- cific needs. Mobility Enterprise Web Viewer was granted terprise to consistently capture, index, man- authority to operate on networks in the U.S. age, distribute, view, exchange and analyze What’s on the market? Department of Defense. This solution allows all clinical imaging and multimedia content LifeIMAGE’s enterprise-grade electronic providers to view all patient imaging data via within the EHR.” medical image sharing platform is leveraged the EHR or a web browser. Getting images where they need to be by some of the nation’s largest health care It utilizes the latest server-side rendering has given rise to many innovative solutions systems, including UCLA Health, Stanford technology so providers don’t have to down- to a problem that virtually every hospital and Hospital and Clinics and NYU Langone Med- load any patient data locally. According to imaging center has struggled with. Unlike ical Center. Bill Lacy, vice president of medical informat- conventional PACS providers, which arose in “What we do is provide access to imag- ics at Fujifilm, having a server-side solution an era when digital X-rays were mainly the ing and related medical information regard- reduces the likelihood of workstation-related business of the imaging department alone, less of where the image was taken, on what challenges. companies like LifeIMAGE have emerged kind of machine or where it is stored and Microsoft desktop software requires an- with a singular focus on improving image then we get it where it needs to be for di- nual operating system and browser-related and information accessibility. agnosis and treatment,” explains Michela. updates. If a facility didn’t have the right “What provides value is the interoper- In addition to moving images around a viewing technology to interoperate and ability of the different technology com- hospital, the platform also enables image adapt with the new EHR versions, then that ponents that allow the acquisition of the sharing between different hospitals. For ex- can cause problems and delays in workflow. unique piece of medical information to a ample, an academic medical center can send “Trying to keep up with the desktop vari- specific patient to actually make a difference images to about 54 of its major referral sites. ability is what has been really driving a lot in a diagnosis or treatment plan,” says Matt One drawback to the platform is that all of the enterprise viewer activity,” says Lacy. Michela, CEO of LifeIMAGE. His company conducted a survey in 2016 including 100 members of the College of Nuance PowerScribe 360 Healthcare Information Management Execu- tives (CHIME) that found enterprise imaging strategies are key priorities for hospital chief information officers (CIOs) with more than 58 percent of facilities having implemented an enterprise imaging strategy to help manage, store and exchange medical image data. Unfortunately, most of the respondents described poor returns on these initiatives. While interoperability is perfectly in line with value-based care, more than half of the organizations surveyed reported they were not yet able to move imaging data between systems and applications due to unsolved technical issues. One-third of the CIOs who responded to the LifeIMAGE survey reported that their facility might be losing revenue because of image data interoperability challenges.

HealthCare Business News I january/february 2018 59 Workflow Roadblocks

“As of late, [the focus has been on] making patients access to their own EHR. The RSNA ing to better define standards that will help sure the enterprise viewers had no desktop Image Share project, which was launched accomplish this interoperability. Once those requirements.” in 2016, allows patients to store images in are defined, the committee plans to pro- The voice recognition software company the cloud, which can be used as a way to mote a national infrastructure with common Nuance Communications offers a cloud- transfer images between hospitals. standards and policies. based image sharing platform called Power- The program is open to the vendors of “Our goal as part of CommonWell is to Share. To date, 4,500 facilities are connected reporting systems, radiology information get out of the proprietary nature and get on the platform and about 200,000 studies systems and PACS that want their solutions into industry standard,” says Abels. “I think are shared every month. to connect to image sharing networks. In we all share a mutual goal of standard-based exchange, but it’s just a matter of how to get from where we’re at to where we want 'The biggest challenge we have in medical imaging to be.” Who’s in charge here? is that there is no unified patient EHR.' Imaging has historically been under the control of radiology, but now that it’s entering the greater hospital enterprise, will that con- “Some of the large health systems spend January 2017, Agfa Healthcare, Ambra tinue to be the case? At some health care half a billion dollars on their EHR so there Health, GE Healthcare, Lexmark Health- organizations, imaging has become the core is an expectation that the enterprise users care, LifeIMAGE, Mach7 Technologies and responsibility of the IT department. are going to be working in that system, but Novarad became the first to successfully “To the hospital CIO who thinks of imag- the patient information is not necessarily complete the program. ing ultimately as part of the EHR, it would there,” says Karen Holzberger, vice presi- Regarding PACS vendors, one of the seem most logical to have the people whose dent and general manager for diagnostics biggest challenges is lack of standardiza- core expertise is IT, storage and backup to at Nuance. “[We’re thinking] strategically tion. For example, Cerner has defined its have responsibility for that,” says Siegel. Un- about how to move that information into own set of application program interfac- fortunately, he adds, there is a precedent for those enterprise systems without having to es (APIs) for third-party companies, and radiology departments, which may operate build different systems.” other vendors have defined their own at all hours of the day and night, to be more At the 2017 Radiological Society of North unique APIs. responsive to technical issues than conven- America meeting, Nuance announced a “If a patient presents at one hospital then tional hospital IT staff. partnership with NVIDIA to bring its deep goes to another hospital, [the idea is to] ex- Eighty-six percent of the CIOs who took learning platform to the PowerShare net- change images like they can lab values,” part in the LifeIMAGE survey reported that work. Working together, the companies hope to spur the development and deployment of imaging AI models into the existing radiology workflow for faster detection of key clinical findings. 'If a patient presents at one hospital then goes to

Interoperability challenges from another hospital, [the idea is to] exchange images the enterprise perspective “The biggest challenge we have in medi- like they can lab values.' cal imaging is that there is no unified patient EHR,” says Veterans Affairs Maryland Healthcare System’s Siegel. “There is not an says Erik Abels, senior solution leader for their IT department owns enterprise imag- easy way to automatically have image data clinical and diagnostic imaging at Cerner. ing either exclusively or as a shared initiative transferred from one facility to another with- “That isn’t prevalent today, and I think one with their radiology departments. In addi- out human intervention that confirms that of the biggest reasons is because the stan- tion, almost half of them believe that a suc- a particular patient is the same patient at dards aren’t well-suited for it.” cessful enterprise image strategy requires another facility.” Cerner participates in a committee within shared responsibility. One potential solution may be to give CommonWell Health Alliance that is work- Share this story: dotmed.com/news/41213

60 HealthCare Business News I january/february 2018 www.dotmed.com/news RTLS/RFID Q&A with Ashley Simmons Director of innovation development at Florida Hospital System Using RTLS/RFID data to improve surgical outcomes

For Florida Hospital System, asset in partners and really think about innovat- care should look like, how quickly they tracking means much more than fig- ing, creating a care environment for the should be getting up and walking after uring out where the portable ultra- future.’ We had some visioning sessions their surgery and what that means for sound is being stashed. It means us- with partners and asked, ‘What can we their recovery, when they should be going ing location data to generate better do differently to drive more effective, ef- home. That gave us a great use case to outcomes by understanding the time ficient care and improve outcomes in the track whether or not outcomes are differ- frame between operations and reha- care setting?’ ent for patients who aren’t doing what he bilitation. It means looking at the way One of those partners was AeroScout feels they should be doing. nurses are interacting with surgical pa- (acquired by Stanley Healthcare). They felt So we began tracking (wearable track- tients to establish better protocols and a there was more that we can do with RTLS/ ing via ultrasound exciters in the ceiling) more efficient workflow. RFID in this stage versus just the typical those patients and the nurses caring for It also means having a stronger grasp tracking of a pump or a wheelchair. That’s those patients — what were the interac- on patient satisfaction — which is increas- when we really started to dive into what tions, how long was it taking to get from ingly important to a provider’s bottom this information could tell us. It could give surgery to the unit and once they were on line. But, according to Ashley Simmons, us real-time insight on not just things but, the unit, how long before they were physi- the hospital system’s director of innova- more importantly, people. The more data cally getting up and walking as he recom- tion development, for all the benefits these and information you can gather, the more mended they do? He thought it should insights bring, there is still plenty of un- you can proactively manage the future. happen within four and six hours. We were tapped potential when it comes to making That was our goal. How can that data able to track if that was really happening. these kinds of solutions worth the invest- provide us insightful analytics on how we ment for hospital executives. approach things, processes, workflow and HCB News: What did you find out? teams, going forward? AS: We actually found some really cool HCB News: When people think of stuff. We found that the surgeon was RTLS and RFID in health care, they usu- HCB News: Can you give an ex- spot on in terms of length of stay related ally think of tracking down a device ample of one way in which RTLS/RFID to patients who got up within four hours when it’s needed. How did you and analytics have enabled you to improve of getting to the unit. There was an abso- your colleagues get started in expos- efficiency? lute correlation with their length of stay ing the analytical insights hidden be- AS: One of the things we immediate- and how quickly they got up and started neath the surface? ly did in the surgical unit was track the walking around post-surgery … and from Ashley Simmons: Initially, it was part nurses and the patients to see what was a clinical outcomes perspective of getting of a larger plan about six years ago with happening in that transition out of the out of the hospital sooner — which most our Florida Hospital Celebration Health fa- OR into recovery. We had a specific use patients want to do. cility. When we looked at building a new case around one of our engaged surgeons Overall the outcome quality for the tower onto the hospital the leadership at who was very efficient in his process with patient was higher. We started to find the time said, ‘Let’s do this right. Let’s bring his patients. He knew exactly what their some predictors of the experience of

HealthCare Business News I january/february 2018 61 RTLS/RFID

With the aid of tracking devices, Florida Hospital is verifying that surgery patients are regaining mobility at the optimal rate after their procedures.

the patient related to their nurse/clinical HCB News: Has Florida Hospital out if you’re ready. It’s a good readiness time. Through the data we were able to explored using similar analytics to im- assessment. At first we weren’t ready. It find some very interesting relationships prove workflow in other departments? took us years to be ready. But it was failure between how often a nurse entered the AS: We’re now also using this at one of from a learning perspective, where we had room on the day shift versus the night our new NICU units and scaled it to all of to rethink things and approach them the shift, how long they spent with the pa- our emergency room facilities across our right way. tient … things which, at the end of the Orlando system to primarily track staff du- Also, this has not been a very scalable day, could predict how happy that patient ress and safety. model because it is very costly. Ultrasound was with us. exciters and cabling are extremely expen- So we found a sweet spot in terms HCB News: What advice would you sive and to put an ROI behind that is diffi- of engagement of the nurse with the give to a hospital hoping to get start- cult to do. We’ve been working with Stan- patient on different shifts as to how we ed with unlocking deeper meaning ley to develop and engineer more efficient would create the right experience for from its RTLS/RFID data? ways to deploy this type of technology. that patient to be happy with us on the AS: Start with equipment. You learn a It’s hard to prioritize this over something satisfaction survey. This helped us to do lot about your processes (or lack thereof), else. Is it clinically critical? It is an additive some interesting work around the expe- operational gaps and your infrastructure. for process improvement, so it’s sometimes rience for the patient in terms of what It gives you a safe way to figure out if you hard to justify over other capital needs. they wanted, how to set expectations, have the right Wi-Fi, cabling and building how we educate the nursing team on infrastructure. That is the killer. HCB News: At HIMSS 2016 you how to interact with those patients de- If you don’t have the right processes gave a presentation on your successes pending on the hour of day so the pa- to scale to staff and patient tracking, it with RTLS/RFID. Have there been any tient would leave ultimately satisfied and will be a complete disaster. Starting with major milestones or achievements taken care of as best as possible. pumps and wheelchairs is a way to find since then?

62 HealthCare Business News I january/february 2018 www.dotmed.com/news AS: From a scale perspective, what application/approval process — why do HCB News: Looking further ahead, we’ve been doing is figuring out how you need it, here’s what it’s going to cost, is there a level of RTLS/RFID insight to maintain and manage things because here’s what it will take, here’s the value/ that we’re not yet tapping into? we’re so large. We scaled to do tem- cost for doing it. AS: People who have never done temperature checks (clinical refrigerators and The last two years we’ve had a major perature tracking are still buying it, so the coolers) and asset tracking across differ- organizational shift. Our IT infrastructure business is still viable. But in terms of in- ent campuses. That required a lot of man- that leads this project got merged with our novation and taking it to a different level, power and facilitation of monitoring alerts, Central Florida group, so that has slowed it’s stuck. Until it gets leapfrogged and able replacing batteries and making sure medi- our acceleration. to return a value that is easily and quickly cal devices are getting preventive mainte- achievable — not a five-year ROI — that’s nance. HCB News: What kind of conversa- when we’ll see movement forward. We had a team that all they did was tions do you expect to hear at HIMSS I think the engineers get stuck in their walk around and check the temperatures 2018 regarding RTLS/RFID? minds over how it can really work. They in the refrigerators, but now we have a AS: I’ve talked to Stanley about this. I tell me that the size of the tags and the monitor that can alert us when a refrig- think someone is going to blow this up in battery life having to be so long explains erator gets unplugged so we don’t lose some way because it’s not sustainable to why it’s so costly. But how can I have an $10,000 worth of drugs. Starting in 2012, go forward where it is. It’s too costly and Apple Watch that can track me in a five- when we started tracking staff and pa- it’s never going to be prioritized over other mile run, but you can’t track me in a build- tients, we’ve been continually trying to clinical capital needs. I think someone is ing? I think there’s a need for rethinking standardize processes. going to leapfrog it and figure out a way to the technology for tracking and wayfind- Now, we have a process for teams allow for efficient tracking and movement ing in health care. and departments that want to do staff of people and items throughout a facility Share this story: dotmed.com/news/41214 and patient tracking. They go through an at a lower price.

A patient is taken to the OR.

HealthCare Business News I january/february 2018 63 Workstation Efficiency Investing today to meet your imaging IT needs of tomorrow

By John R. Fischer

Andrew Mazzella Rasu Shrestha Laurie Lafleur

Eitan Aschner Harold Welch

Steve Deaton David Hale

64 HealthCare Business News I january/february 2018 www.dotmed.com/news InteleViewer is equipped with a flexible interface and tools that enable radiologists, including subspecialists, to customize their reading and reporting workflows.

Five years ago, Radiologic Associates, an imaging group serving the Hudson Valley region of New York state, was focused on ensuring that its dedicated workstations had the correct staff for each type of report or imaging scan that was being reviewed. But fast-forward to today and the issue is resolved. “We’ve really moved ourselves into more teleradiology,” Andrew Mazzella, CEO of Radiologic Associates, told HealthCare Business News. “Now our radiologists — whether it is PET/CT, 3-D-tomosynthesis, MR or CT — can read scans from any of our workstations.” This is but one example that reflects the many changes taking place in the imaging IT landscape, with practices and providers driven by the need for the new and evolving features, such as zero footprint viewers, and tapping into the potential for artificial intelligence technology. For Mazzella, the Clinical Collaboration Platform from Car- estream is what has made all the difference. The image management platform provides enterprise imaging and vendor-neutral archiving capabilities to the group’s 28 radiologists, which he says has paved the way for greater productivity. Getting medical images out of their silos and transferring them more seamlessly throughout the care system has been an ongoing struggle, and Carestream is not the only company working to resolve the problem. Enterprise imaging solutions promise interoperability, scalability and a more seamless workflow, but does that mean an enterprise solution is a one-stop replacement for the conventional components that have historically gone in PACS?

HealthCare Business News I january/february 2018 65 Workstation Efficiency

Clinical Collaboration Platform.

This question is further complicated The Exa platform is comprised of a variety by the addition of new features and ca- of modules including pabilities that previously did not exist, and a PACS, RIS, EHR and storage standards and security require- specialty viewers across ments that may not have previously been a shared database, each a concern, all of which together can create of which can be utilized confusion, uncertainty and a state of mis- alone or together to create a complete information around the most important enterprise imaging question of all: What is the best imaging radiology environment. solution for my facility?

It starts with knowing what you need In today’s imaging IT field, few things are as desirable as interoperability. Hospital departments are being asked to engage more completely across the enterprise — and allowing data to be shared and disseminated among different physicians in and out of ers for reading and interpreting scans and These capabilities enable providers like a given facility is precisely what enterprise reports off phones and tablets rather than Mazzella to work on operational budgets imaging aims to do. at big, heavy workstations, and the cloud, and improve workflow by increasing the This desire is further augmented by which centralizes access to — and allows frequency and speeds in which they can ac- technologies, such as zero footprint view- for storage of — large volumes of data. cess and read scans and make diagnoses.

66 HealthCare Business News I january/february 2018 www.dotmed.com/news What should providers be asking themselves? The first question that a provider or practice should ask is “What Getting medical images out of their are my goals,” says Eitan Aschner, Carestream product line manager for Healthcare Information Solutions in the U.S. and silos and transferring them more Canada. “What are you actually trying to achieve in terms of this new system?” seamlessly throughout the care The answer to that question will depend on a range of factors, including: future endeavors; size of the facility; cost of the system has been an ongoing struggle. solution; and who is involved in the decision. In an era where interoperability is king, the burden of imaging IT decision-making has been partially lifted from the radiology department’s shoul- ders and is shared among all department heads and hospital They also tie in other goals important to many practices, including decision-makers. the ability to scale up in growth and workflow consistency in tasks “What they should ask is, ‘How can the system or solution I’m such as finding and adding in priors for diagnosis evaluation. looking for benefit outside of our specific department?’ ” says Rasu Shrestha, chief innovation officer at the University of Pitts- Harold Welch, vice president of technical solutions worldwide at burgh Medical Center (UPMC) and executive vice president at UPMC Novarad. “How can this benefit us as a whole?” Enterprises, says combing through his hospital’s PACS systems for That conversation should be had with one eye on the future. patient priors in the past was exhausting and time-consuming. Instead of figuring out what kind of technology will improve work- Now, since the implementation of GE Healthcare’s Centricity flow efficiency and patient outcomes right now, planning ahead Solutions for Enterprise Imaging — which includes a RIS-IC, PACS, means leaving room for the integration of complementary tools universal viewer and clinical archive — the improvements to work- and solutions, such as artificial intelligence, for example. flow at UPMC have been significant. “Previously, we would have to search across multiple different vaults, as we call them. Hospitals that have different PACS systems that may or may not have had those patient’s studies,” he says. “To- day, with one click, we’re able to have true enterprise view across the long regional care record of the patient, regardless of which hospital system or which health system the patient’s studies actually reside in.” But experts warn that no solution is perfect, and although a product may have impressive capabilities, there are still limitations to enterprise imaging technology and misconceptions regarding the capabilities of these evolving tools. For instance, though zero footprint viewers may enhance the technological capabilities of radiologists, they are not changing the day-to-day tasks of radiologists. They are merely improving the speed at which these tasks are carried out by decreasing installations and eliminating complex software deployment for potentially tens of thousands of PCs in large enterprises. It should also be noted that periphery workflow tools do not have excellent zero footprint technologies and require desktop applications. Also, not every facility is suited for a particular solution. In the case of zero footprint offerings, one consideration is that they may not provide high performance efficiency in certain locations where poor bandwidth may result in more delays. “You need a system that’s able to adapt to those different envi- ronments,” says Laurie Lafleur, director of product marketing at Intelerad Medical Systems. “Maybe a hybrid solution to do some local caching or local processing to remove the burden from the network infrastructure.”

HealthCare Business News I january/february 2018 67 Workstation Efficiency

Centricity Universal Viewer (product image).

The size of an imaging facility, hospital at Konica Minolta HealthCare Americas, nance will be required for a solution, how or health system will also play a significant Inc., told HCB News regarding his compa- long are they feasibly hoping to use their role in finding the right imaging IT solu- ny’s imaging IT technology. “I think a lot of system and what return on investment tion to meet its needs. While a smaller fa- legacy vendors out there have not updated they hope to gain are all essential to prop- cility might have the disadvantage of an their platforms’ core technology in years, erly crunching the numbers. extremely tight budget, limited size and and they often do not even support any comparative simplicity are advantages that standard for exporting data such as prior Shifting markets and make its needs easier to be met at a price radiology reports. We’re playing friendly considerations for tomorrow’s point that won’t break the bank for such just by overly accommodating people that imaging department a facility. are nowhere close to meeting standards The question of whether an enterprise im- Bigger facilities, conversely, tend to such as HL7 or DICOM.” aging system is a solution for all needs and have more complex systems, particularly those with sites that are regionally diverse. Providers like this might see greater advantages in zero footprint solutions as a way Manufacturers and experts assert that AI will most to minimize troubleshooting at individual workstations — especially those that are likely function as an assistant to the radiologist, acquiring other providers and practices, reflecting an ongoing trend of consolidation. who may evolve into something of a data With many organizations working together to develop and integrate new intelligence manager. standards for interoperability, a standards- based solution is best. “We’re seeing a lot of the more innova- All of these considerations take their a replacement of other modalities contin- tive vendors play friendly because they can toll on the bottom line, but experts agree ues to set off debates on the present and more easily adjust their products to support that cost is a more dynamic issue than the future state of imaging IT technologies. datasets that may not be entirely compliant number on the sticker. Factors such as the Although the introduction of en- with standards such as HL7 or DICOM,” scalability that the organization wishes to terprise imaging, coupled with the Steve Deaton, president of Healthcare IT achieve, what innovations and mainte- abundance of PACS systems already in-

68 HealthCare Business News I january/february 2018 www.dotmed.com/news stalled, has taken some of the air out and extremely important, but it’s not tomor- charge of software and image manage- of the conventional PACS/RIS market, row morning that all of these applications ment solutions is that these IT groups are a 2016 Transparency Market Research are going to suddenly become FDA-regulat- overloaded and all they can do is function report found those markets will grow ed for approval,” says Hale. in maintenance mode,” says Konica Mi- from $2.2 billion in 2015 to $3.9 billion Intelerad’s Lafleur agrees that by exciting nolta’s Deaton. “They don’t have time to by 2024 at a compound annual growth the imagination, AI can sometimes generate investigate what efficiencies could be lever- rate of 7 percent, and the Asia Pacific more of a fuss than may be warranted. aged, or if they can reduce the number of region is leading the way. “I think one of the things that is forgot- products and consolidate with one or two One possible reason for this is that de- ten with the focus on future tech, such as vendors. IT departments need the time to veloping a RIS requires time and money as AI, is the other technologies that can boost explore what is needed clinically so provid- well as a large base to sell to in order to workflow intelligence,” she says, referenc- ers can do more with less.” justify the investment for one. ing workflow intelligence solutions like In- As the industry increasingly warms up “Outside the U.S., it’s still very much a telerad’s SmartLayouts and InteleOne XE to the notion of enterprise imaging, these joint RIS/PACS market. RIS and EMRs tend products. kinds of growing pains are likely to con- to have a lot of geographic dependencies Meanwhile, as radiology sheds its silo tinue. Debating the right way to bring im- such as billing, how things are processed, and joins the enterprise, hospital IT depart- aging IT into the modern era is the only one payor versus multiple payors. The lead ments have taken on much more responsi- way to make the right investments, and EMR in any given country tends to be a lo- bility within the imaging department. While the conclusions will be unique to the indi- cal EMR player. That also means, though, skilled for such a task, the result can have vidual needs of the providers having those that their main geographic scope is that some negative aspects. discussions. country, so creating a big enough busi- “What’s happened with IT now in Share this story: dotmed.com/news/41215 ness to also be able to invest in building a RIS in addition to an EMR is challenging. The scale of the U.S. is obviously different and that gives you enough revenue and income to be able to invest in periphery areas around the core EMR, like RIS,” said David Hale, leader of enterprise imaging, cardiology IT, high acuity care and peri- natal software businesses globally at GE Healthcare. A topic on the rise in discussions of imaging IT and the capabilities of emerging technology is artificial intelligence. Anyone who attended the RSNA annual meeting last November can attest that AI has stimulated interest and fear as well as excitement over the changes it will bring to workflow in day-to-day tasks, but cau- tion over whether or not it will become a replacement for radiologists. Manufacturers and experts assert that AI will most likely function as an assistant to the radiologist, who may evolve into something of a data intelligence manager. Still, AI applications are subject to the same approval processes as present-day technology. “From what I hear, at least from a lot of our customers, is it’s academically interesting

HealthCare Business News I january/february 2018 69 Cybersecurity Q&A with Seana-Lee Hamilton Manager of information privacy and privacy officer at Fraser Health Authority

HealthCare Business News recently From another literacy-level view, one of from Iatric Systems to show us a clear picture spoke to Seana-Lee Hamilton, manager the biggest areas we can’t control is phish- of how patient data is being accessed, so we of information privacy and privacy of- ing, and this is how many ransomware can properly address any issues. ficer at Fraser Health Authority, regard- attacks and other items are originating. ing the importance of training staff to Employees must understand how phish- HCB News: What cybersecurity strat- understand cybersecurity policies and ing works and how their actions affect the egies has your health care organization risk mitigation. network. A basic understanding starts with been focusing on in the last year? emphasizing that the service desk will never SH: The past year, which has been a ma- HCB News: What are the major cy- ask you for your user ID and password. jor reality check for the health care industry, bersecurity threats that health care or- Health care is different and more vulnera- has made us honestly assess our vulnerabili- ganizations face right now? ble to cyber events because of the advanced ties so we understand our risks. After this SH: The most significant threat to cyber- technical tools utilized, including diagnos- assessment, we created an action plan and security and patient privacy is literacy of us- tic and imaging tools, as well as biomedical timeline for fixing risks or any other identi- ers, making sure they understand the need equipment. For instance, our medical imag- fied issues. We have also worked on making for safeguarding patient data and protecting equipment, our CT scanners and our MRI sure we are adequately staffed from cyber- ing the hospital’s network. BYOD and staff machines are all very advanced, technical security and privacy perspectives. properly using the hospital’s network are units, and the technology involved affords a We also conducted a cybersecurity audit among the greatest issues facing cybersecu- vulnerability, and thereby, must be strategi- and are now looking at creating a cyberse- rity professionals in hospitals today. Whether cally checked. curity response team. This team would look it’s employees accessing their Facebook page Health care organizations must have poli- at incidents to determine if they are cyber in or checking their personal web mail, or plug- cies and assessments in place for patches nature, and who needs to respond, with the ging in their own USB memory stick, they’re and security upgrades for clinical informa- ultimate goal of containing any breaches. introducing network threats and making tion systems and EHRs. Security and privacy Through this team, we would also evaluate the hospital, its staff and their patients sig- professionals must look at these systems and how privacy comes into play in our cyber nificantly more vulnerable to the ugliness of ensure all necessary security upgrades are response, and how to determine if a breach a cyber event. BYOD initiatives need to be complete. occurred. Our assessments show how our rolled out utilizing best practices in technol- These systems also introduce the insider response plan must go even deeper to in- ogy, user terms of use and corporate policy. threat to protecting patient data. Hospitals clude questions such as who do we key up Hospital policies have allowed these sort of must know who is accessing patient data from our media people, how do we involve things, and now we need to review policies and why. Auditing patient data access is the the quality care office, what is the role of ad- and probably create new ones that will both only way to truly understand how patient ministration and other key factors. It is quite allow people some privileges when they’re data is being accessed, providing an opportu- an undertaking, and why we are evaluating working, but seal contain or entirely close nity to better protect that data. To get a true the need for a cyber response team. off vulnerabilities that come with a BYOD look at this data, technology must be imple- We know it’s not a matter of if a breach environment. mented. We use Security Audit Manager happens, but when, and we must be orga-

70 HealthCare Business News I january/february 2018 www.dotmed.com/news nized and understand how we will address view will be essential in developing a strate- SH: I believe the future of cybersecurity these things when they do happen. It must gic plan. Strategic reviews need to happen and patient privacy in health care will be be an organizational plan, not just privacy separately, looking from a security perspec- more comprehensive in terms of every or- or just security. We know personal health tive, then vulnerability and state of the net- ganization having a strategic plan they put information is the most valuable informa- work assessments. into place and review annually. In conjunction on the black market, meaning privacy should always be involved, but we also must consider what role we play in touching the data forensically. We want the right people Our patients truly deserve to be confident that their touching and analyzing the data. sensitive health information is safeguarded against HCB News: Have you encountered any challenges in implementing those unauthorized collection, use, disclosure and disposal, strategies? If so, how did you overcome them? only being accessed on a need-to-know basis. SH: To be honest, the answer is no. May- be it’s because of the times we’re living in or the numerous incidents happening to organi- These assessments need to address tion with these plans, I think we will see ex- zations of all sizes and types accompanied by patches and how servers are updated, co- panded and enhanced auditing, both from backlash and other issues. Our organization ordination of equipment pulse checks, how a patient privacy and security perspective, leaders are understanding that time is ben- are we handling vendors and their access which will provide clear pictures of who is eficial for both being prepared and in terms to the network and patient data. We must accessing patient records, as well as how of responding. We have received total buy-in determine how we are auditing who is in that data is being secured. from everyone in the organization, including the network and how they’re getting in. Ad- In the future, I see health care organiza- the administration and the board. This is a ditionally, we have to determine our internal tions hiring highly credentialed privacy and great development, as the trust demanded literacy level, and ask if our people are aware security individuals, taking the necessary from patients must come from the top down. of what phishing attacks are, are they aware steps to maintain these professionals through Our board and executives are buying in, and of what they’re doing when they’re plug- establishing departments in various areas of wanting to know more as they’re seeing the ging in their BYOD device. practice. These areas of practice, including backlash and the effect on the organization’s Organizations must understand you technology, cybersecurity and patient privacy, reputation in the media. The time is right, and can have security without privacy, but you will be increasingly accountable to the CEO the support is incredible, as we continue our can’t have privacy without security. Privacy and CFO, showing the expanded priority readiness assessment and establishing our and every privacy legislation is based on placed on the need for privacy and security. cybersecurity task force and response teams. a framework and those frameworks have In my 16 years of work in privacy, I’ve Social media has really helped these ef- safeguards involved that are both physical never seen an impetus like what we are cur- forts, showing the severity of these attacks and technical to protect personal informa- rently in, with privacy and security becom- happening worldwide. This has led employees tion and sensitive health information from ing more predominant in all organizations, from across the enterprise to ask what are we unauthorized collection, use, disclosure specifically health care. Patients trust us to doing and working from security and privacy and disposal. care for their ailments and sickness, but perspectives. It is an advantage to have an The biggest piece of advice is to move they now trust us to keep their data secure. entire organization care about what we are forward. We must go beyond talking and This trust is paramount and the responsi- doing to secure our network and protect the planning and put these policies and plans bilities are incredible. But our patients truly privacy of the patient data entrusted to us. into action. But policies must be continually deserve to be confident that their sensitive assessed in a way where you walk through health information is safeguarded against HCB News: What advice would you use cases of potential attacks and how to unauthorized collection, use, disclosure and give to another health care organization involve various organization areas. disposal, only being accessed on a need-to- as they begin to focus on cybersecurity? know basis. The future of cybersecurity and SH: I advise organizations to start with HCB News: What do you think the patient privacy will hinge on understanding a strategic review to understand where the future of health care cybersecurity will and protecting this trust. vulnerabilities and risks exist. A strategic re- look like? Share this story: dotmed.com/news/41216

HealthCare Business News I january/february 2018 71 Value-Based Care 7 signs you need help with population health management

By August Calhoun

ter leverage the data in your EHR and other connected health care information technology (HIT) solutions. They tend to be more longitudinal and are designed for care collaboration between providers and patients.

You might be missing key diagnostic data According to a review published in the Journal of General Internal Medicine, “doctors in the U.S. are failing to follow up on results of up to 62 percent of laboratory tests and up to 35 percent of radiology tests.” As a result, they are missing critical diagnoses, including cancer, and causing delays in treatments for many conditions. Those are enormous care gaps. Incidental findings, previously undiag- nosed medical conditions discovered unin- tentionally during diagnostic testing or treatment for an unrelated medical condition, are Attend almost any health care industry are the disease management/care manage- a challenge for both laboratory diagnostics event, or read health care social media ment opportunities that most impact your and diagnostic imaging. The challenge is and news headlines, and you will see organization? even bigger for tests performed on patients a lot of messaging around population Before you purchase software, before in the emergency room. Incidental findings health and value-based care. you start new community-based initiatives, have a high prevalence in the emergency The volume of information can be over- look at your existing technology, workflow, room setting. A 2011 study found that in- whelming, so how do you know if you’re care pathways and resource investments and cidental findings were documented in 33.4 on the right path to value-based care trans- determine what you need to optimize these percent of 682 CT scans performed in the formation, or if you should even be on the to best care for your population. ED on discharged patients. Of these, only 9.8 path? Here are seven signs that might in- Design a roadmap that plots how your percent were reported to patients, accord- dicate you could use some help with your organization will transition from a delivery ing to discharge paperwork. The impact on value-based care or population health man- model of volume-based care to one that readmission rates and malpractice claims is agement strategy. allows for better risk contracting, reduced certainly substantial. costs and healthier, happier patients and em- You don’t know where to start ployees. Don’t be afraid to bring in outside You aren’t getting the ROI As a world-class health care leader, you want consultants for advice. you expected to own the change from sick care to lifetime Your health system purchased population wellness, but where do you start? The evo- You have an EHR to manage health management technology or has de- lution from quality of care to quality of life your population, and you think cided to use their electronic health record requires serious strategy and a deep dive that is enough (EHR) solution for value-based care, yet you into data to understand your population, You may want to consider population health aren’t getting the return on investment (ROI) your capabilities and your resources. What or value-based diagnostic solutions that bet- you intended. As a wise colleague of mine

72 HealthCare Business News I january/february 2018 www.dotmed.com/news once said in a recent webinar, “Sometimes and avoid costly penalties while demon- It is possible to communicate with every software alone is not the answer when it strating value to your community? A rec- patient in your care community. comes to value-based care transformation.” ommended practice includes implementing Population health management and val- Successful transformation may require targeted, customized patient outreach cam- ue-based care transformation can be daunt- change — change in workflow, change paigns aligned with quality and care initia- ing, so don’t go it alone. Together, we can be in clinical practice or change in workforce tives that best support your population and victorious over disease before it takes hold. structure. It is extremely challenging to get individual patient compliance. We can help you proactively engage with stakeholders in health care provider organi- your population to create a community of zations to change. Identify a trusted partner You don’t have enough staff wellness. Let’s lead the evolution from qual- who knows your business and can help you or time to engage with ity of care to quality of life, together. leverage your existing and future invest- every single patient About the author: ments for maximum impact. Your team takes the best care of your pa- August Calhoun, tients while they are in your health system or Ph.D., is senior vice You have a patient leakage health care facility, but what happens once president of North problem these patients leave? It makes sense to focus America Services at Are some of your patients seeking services on your high-risk patients, but make sure Siemens Healthineers. outside of your health system, or being re- you aren’t forgetting about those who may He is responsible for ferred out of network by health care provid- have rising risks to their health. Preventing all Services business ers? Then you may have a leakage problem, illness and sustaining patient health and re- lines in the U.S., including Customer Services which can impact your reimbursement and covery “takes a village” — caregivers, pa- (preventive maintenance and repair for im- likely contribute to care gaps (when you tients and family members — but it can also aging and laboratory diagnostic equipment, don’t have access to complete patient data). require a lot of staff time and resources. and education and training), Enterprise One way to better manage and reduce leak- Consider an automated patient engage- Services (advisory services, multi-vendor age to outside competitors is by focusing on ment solution with targeted campaigns to management, asset management and other patient convenience from the perspective of communicate with every single patient in enterprise services offerings) and Digital Ser- the patient experience. your care community. The right patient en- vices (workflow, data and analytics software • Don’t just verbally suggest or give a paper gagement solutions should be able to: and services). Calhoun is based at the U.S. order for a specialist, primary care physician • Uncover gaps in care, including missed ap- Services headquarters in Cary, N.C. or diagnostic test. Schedule the appoint- pointments, screening tests, rising risk due ment for the patient or simplify their access to diagnostic results, etc. Before joining Siemens Healthineers in 2016, by sending them a link to resources that • Communicate discharge plans and re- Calhoun was senior vice president and gen- they need (and happen to be within your minders to promote patient compliance eral manager of Provider Solutions at Truven health system). A referrals management and reduce readmission. Health Analytics, a cloud-based health care solution takes the burden off the patient. • Send links for scheduling follow-up ap- data and analytics firm in Ann Arbor, Mich. • Patient engagement can also help reduce pointments. In this role, he oversaw global sales, market- leakage. Regular communication and pro- • Improve staff efficiency by automating, ing, services, consulting, operations and active outreach keeps patients engaged identifying and grouping patient contacts. product management, providing products and helps your patients see you as a valued • Send information about potential diagnos- and services that leveraged data and analyt- resource for promoting wellness. tic screenings to groups of patients that ics to guide business leaders and clinicians. meet the criteria. Prior to his tenure at Truven, Calhoun spent Your readmission rates are • Allow patients to add supportive family six years with Dell, Inc., most recently as vice affecting your bottom line members to receive these communications president and general manager of the com- Are readmission rates bringing your reim- and reminders. pany’s Healthcare and Life Sciences Industry. bursement down? The leading cause could • Allow patients to choose their desired He began his health care career at IBM and be a lack of patient compliance and follow- means of communications — phone, text held leadership positions in IBM Global Ser- up, or a gap in care due to incidental find- and/or email. vices, Business Consulting Services and sales, ings. Create a strategy to reduce readmission • Help optimize appropriate diagnostic test eventually rising to the position of executive rates and emergency room “bouncebacks” utilization, but also simplify the scheduling director of IBM’s Pharmaceutical Industry. due to noncompliance and care gaps. Pa- process for patients by identifying imaging Share this story: dotmed.com/news/41217 tient compliance and follow-up may be the locations with available appointment slots key. How do you maximize reimbursement close to their home or office.

HealthCare Business News I january/february 2018 73 Care Coordination An enterprise imaging approach to coordinated care Multisite radiology group unifies medical data and imaging files for improved clinical workflow, streamlined billing and a longitudinal patient record

By David Bennett and Brian Frohna

SDI's Valley Radiologists

Fragmented patient information con- Despite intense efforts and significant To align records for 4.5 million patients tinues to be a significant barrier to investments to implement EHRs, duplicate across its multiple hospitals, imaging centers tackling rising health care costs and and incomplete records continue to plague and radiology practice locations, and to pro- improving the quality, safety and ef- providers. Patient data matching functional- vide on-demand access to scads of imaging ficiency of care. ities within EHRs often lack the complexities exams, Phoenix-based Southwest Diagnostic As data proliferates, a longitudinal view to unify information from disparate and ex- Imaging (SDI) — one of the nation’s largest of an individual’s medical record sets the ternal systems. The resulting number of du- radiology specialty corporations — looked to foundation for enhanced care coordination, plicate and disjointed records lead to patient implement an enterprise-wide solution that informed clinical decision-making and im- safety errors, skewed reporting and analyt- would consolidate patient data and imaging proved patient experiences. ics, administrative burdens and lost revenue. files into a single record.

74 HealthCare Business News I january/february 2018 www.dotmed.com/news Defining the challenge Social Security number, birth date or address seamless health information exchange and Integrating patient records with medical im- only compounds the potential for creating a longitudinal view of a patient’s medical aging is a challenge for many of today’s ra- duplicates. This can lead to diagnosis errors, imaging history regardless of where the diology practices. Lack of real-time access to redundant medical tests, gaps in treatment exam was performed. X-rays, MRIs and other imaging files caused and billing inaccuracies. Patient identity management has made by siloed health care data across various sys- a big difference in the efficiency and effec- tems and settings leads to suboptimal out- The solution tiveness of SDI’s clinicians and staff, and has comes and avoidable costs of care. Managing and sharing patient information reduced wait times for patients and their Providing diagnostic imaging services to across multiple systems and sites of care re- families. the entire Phoenix metropolitan area, SDI quires a holistic approach, free of data silos Automation and data standardization is comprised of three radiology practices and disjointed records that hinder patient care provided by the EMPI have streamlined — Valley Radiologists, Scottsdale Medical and optimal clinical workflows. As health in- workflow and productivity, affording down- Imaging and East Valley Diagnostic Imag- formation exchange proliferates, organizations stream benefits to SDI’s operational and -fi ing. Annually, SDI performs 900,000 outpa- must be able to quickly reconcile the exorbitant nancial outcomes. The enterprise implemen- tient exams and interprets 2.6 million exams amount of patient data within the network. tation allows radiologists, technicians and across its 35 full-service imaging centers and To give their providers an enterprise view other staff members to provide improved 12 regional hospitals. of any given patient, and enable greater patient services via portals and online billing tools, delivery of electronic reports and electronic image linking with added ease and security. Automation and data standardization provided by Prior to implementing the EMPI technology, radiologists at SDI had a limited view the EMPI have streamlined workflow and productivity. of their patients' historic data, which led to continuous disruptions throughout each phase of the workflow, and delayed turn- Like many growing health care institu- clinical and operational efficiency, SDI imple- around time of reports. Since the patient tions, SDI struggled to reconcile and ex- mented a vendor-agnostic enterprise master matching implementation in January 2017, change patient data and imaging files from patient index (EMPI) to facilitate medical re- the number of addendums has reduced by multiple systems and locations. For years, ra- cord reconciliation and link imaging files to 75 percent on average. That means clinicians diologists spent much of their day perform- the same individual in real time. The patient spend less time performing repeated docu- ing addendums because information at the matching technology enabled integration mentation tasks and more time assessing, point of care was missing or incomplete. At and clean-up of more than 5.2 million re- treating and engaging with patients. times, radiologists could not access patient cords within 18 source systems across SDI’s studies from hospitals just 150 yards away. 35 imaging centers, 12 regional hospitals When radiologists received newly ac- and third-party sources, and prevented the quired patient imaging studies, previous creation of 100,000 duplicate records in the medical histories, X-rays, laboratory and test first six months. results were not readily available, hindering Additionally, SDI was able to: the ability to accurately interpret radiologic • Move its patient master file out of the examinations. billing system and institute a stand-alone From a revenue and operational stand- network for cross-platform patient iden- David Bennett Brian Frohna point, duplicate and disconnected records tification. About the authors: David Bennett is vice at SDI put a strain on billing, which faced • Provide an automated, centralized inter- president of partnerships and alliances for inefficiencies processing claims, collections face to integrate, resolve and unify patient NextGate, a global health care leader in and payments. records across all clinical and financial sys- identity management. Dr. Brian Frohna is Duplicate patient records frequently oc- tems. a Phoenix-based, board-certified radiolo- cur as a result of complex spellings or mul- • Bring accuracy and consistency to the com- gist specializing in diagnostic radiology tiple name variations, data entry errors and plex patient data environment by creating and neuroradiology and chief technology a lack of standardized admissions processes. a single source of truth for every individual. officer of SDI. A typo or absence of a single digit in one’s • Establish SDI as a fully integrated entity for Share this story: dotmed.com/news/41218

HealthCare Business News I january/february 2018 75 EHR Collaboration Q&A with Dr. Christopher Longhurst Chief information officer, UC San Diego Health Because one EHR is better than two

When it came time for UC Irvine Health share an already existing instance of arrangements like these could have on the to update its electronic health record an Epic EHR. future of smaller hospitals and population (EHR), the medical center found a HealthCare Business News spoke to Dr. health, in general. partner in UC San Diego Health that Christopher Longhurst, chief information was willing to try something that had officer with UC San Diego Health, to find HCB News: How did the idea to share never been done before: collaborate out how the unconventional partnership has a single EHR across the two academic with another academic provider to benefited his care system and what impact facilities arise?

76 HealthCare Business News I january/february 2018 www.dotmed.com/news Christopher Longhurst: I really credit We hosted a data center that was state data across multiple platforms. That is an un- Chuck Podesta, the CIO at UC Irvine. He of the art when it was built, but it was quite solved problem and always takes more time arrived about four years ago. There was in- antiquated and needed a significant invest- and effort than people anticipate. So the terest in switching EHR vendors, but when ment. Epic had started offering private cloud opportunity to have multiple health systems they priced out the cost of moving to Epic hosting, but the cost of conversion was sig- on a single integrated platform is a big win. on their own, it was formidable. nificant. It was because of our collaboration From a population wellness standpoint, it allows the possibility to extend our care across a larger continuum. Our CEO’s co- There is a program called Leveraged Scale for Value operation is paramount to allowing that to happen. For example, there are best practic- that has allowed us to procure vendors together as es both sites have been developing for years that we can now easily share — ranging well as work together to aggregate our data from from admission to cancer protocols. We’re getting the best of both worlds. an analytics standpoint. The implementation was faster than normal, according to Epic, with UC Irvine So, Chuck thought, “Hey, we’ve got the with UC Irvine that we could shift from on- coming online in just 17 months. In general, health system partners in the other UCs, and premise hosting to cloud hosting. By target- academic medical centers average about a there’s really no reason we couldn’t share.” So ing that investment to cloud hosting, we two-year period. Chuck was able to get this they went through a process of looking at what were able to benefit both institutions. done in 17 months, so that helped hold the would make the most sense from a partnership Back in the ‘80s or ‘90s, IT systems ran expense down. Doing this in 17 months also standpoint and discovered that UC San Diego about 2.5 percent of the operating cost of a required a lot of governance input. would be committed to collaborating with an hospital, but HIMSS data has shown that as equal and shared governance philosophy. you automate clinical workflow, and the cost HCB News: Is it possible that these of software and the cost of the labor to keep benefits could be leveraged on a larger HCB News: What was already in the software up to date, a highly automated scale one day, perhaps across more Uni- place to allow the hospitals to do this? hospital system now runs 4 to 6 percent. versity of California academic hospitals? CL: Five UC hospitals — San Diego, Ir- It is an improvement in quality, value and CL: There are no current plans to do so, vine, Los Angeles, Davis and San Francisco patient convenience, but it’s contributing to but there’s clearly more opportunity sur- — are all part of the same University of Cali- the increasing cost of health care. The irony, rounding affiliated hospitals. The smaller fornia system. Even though the hospitals are of course, nothing scales better than infor- hospitals — especially safety net and critical financially independent with their own tax ID numbers, we have committed increasingly in recent years to collaborate for the greater good. The smaller hospitals, especially safety net and There is a program called Leveraged Scale for Value that has allowed us to procure ven- critical hospitals, are struggling with IT because dors together as well as work together to aggregate our data from an analytics stand- they can’t afford the same costs the larger point. That was part of what led to this initiative to share an EHR. Initially it was UC San medical centers can. Diego and UC Irvine, and also now across the clinics at UC Riverside. mation technology. You see that in the large hospitals — are struggling with IT because systems — Kaiser, Sutter and HCA. They’re they can’t afford the same costs the larger HCB News: From a productivity and not spending that high a percentage. medical centers can. I think that's where economic standpoint, what advantages we'll see some opportunity. For example, has UCSD taken from the shared EHR? HCB News: How does the shared EHR UC Davis is now hosting Marshall Medical CL: From the UC San Diego side, this has al- impact patients and the way the hospi- Center in Placerville, Calif. They just went lowed us to do things that we would not have tals address population health? live in November. otherwise been able to afford on our own. CL: The challenge is always to aggregate Share this story: dotmed.com/news/41219

HealthCare Business News I january/february 2018 77 Research & Investment Hype: Helping or hurting health care?

By Roy Smythe

With new medical miracles being laud- requires decades of work and significant health care innovation spectrum. We saw ed by health care providers on a regular investment to develop viable solutions. Ar- this same scenario play out with all the buzz basis, it’s hard to differentiate between tificial intelligence (AI), machine learning, around gene therapy 20 years ago. On one realistic benefits and overblown hype. predictive analytics and natural language hand, there will always be products or tech- Promising research does not always processing have great potential to help us nologies that promise far beyond what they’ll equate to applicable clinical use in the near solve some of the biggest challenges we’ve ever be able to deliver, leaving patients and future. When the potential clinical effective- faced in health care over the past 500 years. investors at a loss. On the other, we have com- ness of a research endeavor is exaggerated, it But there is huge risk when we talk up shiny panies that might not seem that miraculous, may stymie the flow of financial, medical and new technology and move too quickly to but deliver on improvements and, more impor- regulatory support. Hyped-up claims can be the health care delivery market, while the tantly, actually work. The middle ground may a death sentence to once-promising work. solutions themselves don’t deliver on their be somewhere that both gathers the interest If claims such as these do not pan out, promise. If clinicians, providers and inves- of patients and investors and provides modest, those who invest in and fund medical re- tors are not seeing results they may retrench. yet successful, results. As with many aspects of search may be wary of supporting future Admittedly, however, it’s also a fine line we life and business, finding the middle ground, if ventures, and the hype ends in head-scratch- walk, because when we don’t move quickly one actually even exists, can be tricky. ing as to why millions were invested in a no- enough — waiting longer than necessary AI, for instance, has much potential, but show. More critically, hype can lead to heart- to bring potentially beneficial products and we need to be careful of the hype around breaking situations for people waiting on the solutions forward — more patients lose out. it as it cannot do everything. AI will help us “next big thing” with the potential to save fix problems that have stumped the health their lives, or the life of a loved one. Finding the middle ground care industry for centuries, but we need to Medical advances cannot be made with- It’s difficult to achieve the proper balance be- be realistic regarding where we are now in out research and trial and error, which often tween the two extremes of such a dynamic order to most effectively meet that future

78 HealthCare Business News I january/february 2018 www.dotmed.com/news goal. Yes, it can help with superior pattern cal applications, or using at-home genetic must remember “Moore’s Law” will not recognition and processing capabilities and testing kits that can help provide a clearer likely apply to the development of all new has the capacity to help solve problems we picture of a person’s ancestry. However, we biomedical and technological solutions to can’t imagine today, but it will never com- need to be careful here as well. treat human disease. There’s no guarantee pletely replace the need for the human pro- On the extreme end, we have the hype that we will double our progress each year. vider of care, the nurse or physician. Com- and controversy of eugenics and “designer Research and clinical trials will continue to panies need to be mindful of making claims babies,” but in the near term we will be take years of development to reach efficacy like this, as AI will be much more focused using our growing understanding of the and even longer to be approved for wide- on augmenting what care providers are genetic basis of the predisposition of dis- spread treatment. When hype overshadows already doing, scaling existing expertise to ease and disease treatment effectiveness to reality, the greatest harm can fall on patients. larger numbers of patients while improving provide more accurate prognoses and more We don’t need to slow down the in- efficiency and effectiveness of interventions. effective tailored therapies. Health care lead- novation engine by any means, just make Twenty years ago, the promise of gene ers should be excited about the future and sure that we are realistic about how soon therapy was dominated by hype, while all be optimistic about what is to come, but the vehicle that uses that engine can take the time saddled with a number of very vex- have reasonable expectations — finding the us to the next place in health care, and how ing problems that needed to be solved be- middle ground once again between dream- long it will take us to fore the approach was clinically useful, but ing big and being realistic regarding what get there. the field has made huge strides since that consumers and patients can expect. About the author: time and is now becoming clinically useful. In Excessive hype from investigators or Roy Smythe is the other fields such as human genomics, we’ve those populating the boardrooms of cor- chief medical officer, gone from knowing only a few useful things porations and health care institutions can Strategy & Partner- about disease predisposition to advance- put life-saving treatments at risk, or certainly ships, at Philips. ments like centralizing and organizing ge- delay their development. In our technologi- nomic data for increasing numbers of clinical age, researchers, investors and patients Share this story: dotmed.com/news/41220

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HealthCare Business News I january/february 2018 79 Industry Innovation Making blockchain work for health care By Shahram Ebadollahi

As we look forward in 2018 to the next Many of the intrinsic properties of block- information is a major component — is wave of technological advances that chain technology — such as transparency, growing at an astonishing 54 percent com- will impact health care, it’s hard to ig- security and authenticity — are well-suited pound annual growth rate. So, while the nore the word on every health care to help address some of health care’s most reality of “big” data finally benefiting our technologist’s tongue — blockchain. pressing challenges with respect to the data health care system is upon us, the fact is that Like “big data” before it and “the cloud” exchange process. Here, we will explore “long,” or longitudinal, data is not. In other before that, the term is grabbing the atten- three key benefits that blockchain can bring words, the different pieces of patient data tion of most health care audiences as a criti- to health care. lack fluidity and are sitting in silos, unable to cal peak in the wave of the future for mak- be easily shared and collectively interpreted ing health data more fluid and valuable for a Patient consent and health for the patient’s benefit. For example, a pa- variety of health care stakeholders. data access tient could go to one facility for imaging and While the implications of blockchain as As we all know, health data is exploding another for blood work, yet none of the re- they relate to the meteoric rise of Bitcoin with the growth of EHRs, wearables, ad- sults are shared or available to one another, prices are well known, its potential impact vanced imaging capabilities and genomics which results in tremendous waste. to propel innovation within the health care research. According to IDC’s Data Age 2025 Giving patients the opportunity to share industry is only just beginning to reveal itself. report, hypercritical data — of which health their data securely, for research purposes or

80 HealthCare Business News I january/february 2018 www.dotmed.com/news across their health care providers, creates op- rules. An example is the general area of pay- sites with principal investigators (doctors) to portunities for major advancements in health ments in health care and related issues such conduct a portion of that trial. After recruit- care. With blockchain, the massive amount as preauthorization and bundle-based pay- ing trial participants, the investigators must of siloed patient data being generated and ment methods. conduct the protocol by collecting enor- captured every day could be shared across a For example, in bundle payments, mous amounts of data on multiple subjects group of individuals and institutions. Using tracking the various services provided, — often daily — to test the treatment. This the blockchain framework in this way could their costs, their associated outcomes and process, as many physicians already know, be a critical enabler for making a truly fluid mapping them to the specifications of the can be ripe for introducing errors and/or health information system possible — allow- bundle are critical for timely adjudication duplicate records — something that can be ing patients (or consumers) to be the true of the bundle. Blockchain could play a key potentially very damaging for the trial drug’s owner of the data and in charge of providing role because it creates visibility and an au- final submission to regulators. consent for the exchange and use of it by dit trail on what has happened, by whom With blockchain as the backbone for various entities. and to what outcome. tracking all of this information, you don’t have to wait three to four months to collect, process and review all of the research. The secure, decentralized framework blockchain Blockchain could play a key role because it creates provides allows you to have instant and clear visibility into the data, seriously reducing er- visibility and an audit trail on what has happened, rors and duplication. This has the potential to speed the time and potentially lower the by whom and to what outcome. cost of bringing new treatments and diagnostic capabilities to market. These are just a small handful of the many potential benefits for applying block- To date, the top-down model for data At IBM Watson Health, we’ve been chain within our health care system. The sharing among institutions hasn’t worked working and experimenting with various bottom line is that blockchain shouldn’t and has encountered many challenges in blockchain-based smart contract implemen- be a scary word that the general medical adoption, not necessarily from a techno- tations that help with capturing all kinds of community only associates with the world logical standpoint, but with ownership important patient information like medica- of cryptocurrency. It is, in my opinion, a very and reluctance to share the data by vari- tion adherence, tracking benefits eligibility viable technology that will open the door ous entities. or capturing patient outcomes for enabling wider for better health care delivery, enable Creating the capabilities to access data value-based care models. Smart contracts organizations to better work together and based on an owner’s consent, and aggregat- enable automation of business processes ultimately improve patient care. ing it into a truly longitudinal view of the pa- that transcend organizational boundaries in About the author: Dr. tient, may be able to unlock many possibili- a secure and decentralized manner, and en- Shahram Ebadol- ties for a new set of services. This is already a able a better network, when multiple people lahi, Ph.D., MBA, is reality in certain parts of the world — most and factors are contributing, yet all must be the vice president, notably Estonia. In addition, certain regions tracked appropriately. Innovations and the like Europe with General Data Protection chief science officer, Regulation (GDPR) are advancing new ways Clinical trial results IBM Watson Health of properly regulating models of consent for Another area where there are numerous col- Group. As the head consumers. laborators, contributing factors and a lot of of Innovations, he oversees development, accompanying paperwork is during clinical solutions and strategic partnerships for the Payment and claims trials. As pharmaceutical companies advance IBM Watson Health business unit. He has While it’s important to recognize that block- treatment candidates to later stage clinical global responsibility for the innovation and chain will not be a solution to all problems trials, they must prepare a dossier for review technical strategy for IBM Watson Health in health care, it holds tremendous promise by federal regulators, like the Food and Drug and the global health informatics research in when there are many transactions with a Administration. IBM Research. multitude of involved entities, where each Once a pharma company comes up Share this story: dotmed.com/news/41221 transaction or interface between entities with the treatment-testing protocol, it, or a must abide by certain policy or predefined contract research organization, must recruit

HealthCare Business News I january/february 2018 81 Virtual Reality When worlds collide for improved patient care

By Jon Ernstoff, M.D.

Virtual reality, or colonoscopy and the preparation involved. To help make sure patients have ab- VR, is a fascinating But, unfortunately, the climate in health care sorbed key takeaways, the tour concludes technology that does not always allow for this. with patients taking an interactive quiz to can take you into a Unlike many other medical procedures, test their knowledge. three-dimensional colonoscopies are heavily dependent on pa- Before the use of this VR application, the world of imagina- tient compliance often for days prior to the typical approach was for a nurse to commu- tion. procedure. This is key to a successful screen- nicate the information verbally to our patients For years, this ing where optimal visibility of polyps and often with the use of a take-home pamphlet computer technology has stimulated the lesions is necessary. for prepping instructions, leaving little interac- senses to create an illusion of reality. Its pri- On the day of the colonoscopy, it is not tion between patient and instructor. Given the mary focus was in the entertainment world. until we actually perform the procedure that often-sensitive nature of the discussion, we Recently, it has found a growing niche in we can determine how well the patient actu- find that patients are often too embarrassed health care with more applications targeting ally understood and followed the directions to ask detailed questions, and we therefore new aspects of the industry ranging from for the bowel preparation. And, after any do not truly know how much information has education to exciting clinical applications. unsuccessful procedure, we as professionals been conveyed to the patient. This is typically Medical VR technologies are exploring are left wondering how to improve the pa- the one and only encounter the patient will new therapeutic areas and helping to accel- tient's understanding of the process to help have prior to their colonoscopy erate recovery in post-stroke patients as well us better help them. Medical VR is shooting colonoscopy edu- as aiding those in the military suffering from cation into the 21st century and provides an post traumatic stress disorder, or PTSD. This Medical VR: Helping me help you additional “wow” factor that truly engages is an exciting interaction of new technology Studies have shown that supplementing patients’ interest. This opens a door into a in the health care environment. the traditional physician-patient interaction new world where the patient can actually As a practicing gastroenterologist, medi- with more engaging visual aids such as il- visualize the inside of the body and the co- cal VR caught my attention as a potential lustrations for colonoscopy procedures will lon, which holds patients’ attention. It has means for better educating my patients. improve patient education regarding bowel also prompted a much more meaningful dia- preparation. logue between the patients and myself. This Every GI’s challenge: Going several steps further, beyond mere sharing of information has made patients The colonoscopy illustrations or videos, medical VR is now feel more like a partner in their health care For GIs, performing colonoscopies for the changing the educational potential for my pa- with a shared responsibility in the success of prevention and detection of colorectal can- tients with a new VR experience called Colon the procedure and its outcome. cer, the second-leading cause of cancer Crossing. This is an eight-minute guided tour We are closely evaluating how significant deaths in the U.S., is one of the primary fo- that places patients directly inside the colon this educational tool will be in improving pa- cuses of our field. For the 15 million colo- and shows them a “clean,” or well-prepped, tient preparation, but we already see that it noscopies performed in the U.S. annually, up colon. This simulation allows patients to visu- is providing a much better understanding of to one-third of patients who have the pro- alize what polyps and cancer look like dur- the value and importance of the procedure. cedure performed will have an inadequate ing the colonoscopy. By also going through About the author: Jon Ernstoff is a practic- bowel preparation or incomplete emptying a “dirty,” or poorly prepped, colon, the tool ing gastroenterologist and the chief of of the bowel prior to the screening. This is helps illustrate how easily cancer and polyps gastroenterology at Midstate Medical Center frequently due to a lack of understanding can be missed due to lack of visibility. in Meriden, Conn. He holds appointments of the importance of the prep, and in some The software also instructs patients in the as assistant clinical professor of medicine cases, an actual fear of bowel preparation at-home bowel preparation, including what at Yale School of Medicine and Quinnipiac itself. Ideally, every patient would meet with to eat and drink during the days before the School of Medicine. the endoscopist to review the nature of the procedure. Share this story: dotmed.com/news/41222

82 HealthCare Business News I january/february 2018 www.dotmed.com/news

Imaging Profitability Reno Diagnostic Centers focuses on efficiency amid decreasing reimbursements Implementing high-tech radiology workstations delivers greater productivity and throughput with an impressive ROI

By Ronald J. Milbank

It has been said that every company is In any organization there are dozens of date technology and focusing on efficient a technology company, no matter what opportunities to invest in technology to im- scheduling for all modalities has generated product or service it provides. prove overall performance and shorten the a dramatic counterbalance to continuing Leaders of hospitals, radiology depart- exam cycle. In radiology these include activi- drops in reimbursement. ments and imaging services providers need ties such as patient scheduling and sending A critical question is how many additional to look at their businesses as IT companies reports to the referring physicians. But one of exams can be processed by using updated that deliver radiology services. the highest returns on investment is making technology and procedures to reduce delays The implementation of technology to en- the radiologist as efficient as possible, which in radiologists’ workflow. Important factors sure quality, reduce regulatory administrative requires innovative workstation design. that can boost overall profitability include burdens, manage the education of employ- minimizing the time radiologists spend: ees and increase overall facility/employee Impressive productivity gains opening and closing exams; loading prior efficiency is not only in your best interest, but Reno Diagnostic Centers has been in opera- exams for comparison; taking their hands off is imperative to your survival. Topping this tion for 33 years. We had three of our most the microphone, mouse, keyboard or auxil- list of mission-critical tasks is ensuring your productive years during the last five years. iary keypad device; reviewing and signing radiology services are as efficient as possible We went from seeing 185 to 200 patients reports; physically adjusting their position to to offset continuing annual reductions in re- a day to between 280 and 300 patients a maintain a physical comfort level that reduc- imbursements from government and private day with the addition of one modality. Mak- es fatigue; and relocating between modality- providers for imaging services. ing radiologists more productive with up-to- centric reading workstations.

84 HealthCare Business News I january/february 2018 www.dotmed.com/news mouse and keyboard or auxiliary controller. This reduces hand fatigue and hand movement. • Ensure dual network ports (1GB/10GB) as appropriate for the underlying network infrastructure.

Maximizing the patient schedule In the face of continued deceases in reimbursement, imaging providers must fully utilize all modalities. When a patient cancels their appointment the day of the scheduled exam, our staff contacts other patients who are on an “early appointment requested” list to see if they are willing to fill the slot. Then we move patients into the schedule Reno Diagnostic reading workstation. to ensure each appointment is booked. This process minimizes the costs of having staff Redesigning the workstations at our • Understand how EMR, HIS, RIS and PACS with no patient to scan, which represents facility improves productivity and reduces systems are programmed. Are they pro- full cost with no revenue. Some facilities fatigue. It also eliminates delays of a few grammed to take advantage of multicore book patient appointments, and if the pa- seconds to a dozen seconds or more that (8-16 core) processors, or are you better off tient cancels, they do not try to fill it. Striving can occur every few minutes when the ra- with a four-core processor? Ask your solu- every day for maximum utilization is essential diologist is reading a single exam. The new tion provider. Select the fastest possible to ensure the lowest cost per exam possible. workstations allow radiologists to read 90 processor with the fewest number of cores Making our patients feel welcome and percent of exams without taking their hands to exploit the software that is running. valued is very important. We have stream- off the mouse and the microphone. That • Find the right diagnostic monitor and the lined our procedures to ensure we process creates substantive savings. right graphics card for your radiologists’ and image each patient quickly and effi- Let’s use five cents per second as an aver- workstations. Use 4k/5k monitors where ciently. Our patients respect and appreciate age radiologist’s cost ($400,000 annually). diagnostic monitors are not absolutely that we value their time as much as we do How many seconds a day do you need to required by law or recommended by the our own. save to pay for a $27,000 to $40,000 work- American College of Radiology (ACR) It’s time for imaging services providers station? Moreover, how many more exams guidelines. Use 6MP and 8MP monitors to stop worrying about their IT budgets and do you have to read to recover your worksta- wherever possible. Seek monitor vendors start investing in technology that can in- tion investment? This is a calculation that all that specify high-performance, off-the- crease profitability and throughput in radiol- administrators must face, but the bottom shelf, third-party graphics cards. ogy services. Well-designed and implement- line is you can easily save multiple seconds • Workstations that can be used for all mo- ed technology allows health care providers per minute and save multiple minutes per dalities reduce cost, and increased use of to achieve greater efficiency, which benefits hour if you implement the right technology these workstations lowers overall ROI time both patients and providers. at the radiologist’s workstation. frames and increases exam throughput. About the author: Saving just two minutes per hour of a • Consider M.2 interface NVMe (Non-Vola- Ronald J. Milbank is radiologist’s time over 2,080 work hours per tile Memory) over spinning hard drives or director of informa- year provides an additional 69.3 hours of 3.5”/2.5” solid-state drives (SSDs). tion technology for reading. The efficiency gain creates a sub- • Consider gaming keyboards, mice and Reno Diagnostic stantial increase in throughput for both ra- auxiliary controllers from the same manu- Centers in Reno, diologists and the practice. As a result, we facturer. A unified device controller soft- Nevada. He is also achieved an ROI of 25 months on technol- ware can manage all the devices (mouse one of the owners of ogy that we will use for five years. button and shortcut key programming) R&C Consulting, providing national infor- What technology solutions can ensure to reduce conflicts and increase reliability. mation systems and operational excellence the greatest productivity for radiologists? • Explore tabletop microphones or headsets advisory services. Here are a few suggestions: to allow both hands to be placed on the Share this story: dotmed.com/news/41226

HealthCare Business News I january/february 2018 85 The RIS Market The value of a radiology information system in a clinical setting

By Michael J. Cannavo

For the past few decades, radiology in- facilities to obtain best-of-breed solutions and software both in the cloud is yet anoth- formation systems (RIS) have lived in versus an all-in-one solution. er, especially since most IT (information tech- PACS’ shadow. Today, RIS and electronic health record nology) departments are overcommitted to In the early days of PACS, the 1990s (EHR) systems with embedded RIS function- supporting the existing clinical information and early 2000s, RIS was PACS’ partner. ality are making a comeback. Lower prices systems they have now. Most importantly, You almost never heard of someone buying for an integrated RIS and the high price that though, is MACRA (Medicare Access and a PACS without a RIS. Then, for a host of vendors often quote to integrate disparate CHIP Reauthorization Act of 2015) and its reasons, RIS growth slowed (despite what systems is one reason, while having “one paths for participation that involve quality companies that sell market reports stated to throat to choke” is often cited as a primary improvement programs that RIS can address. the contrary). The reasons were many and driver for choosing an integrated RIS. The The Merit-based Incentive Payment System ranged from cost justification to the use of use of cloud-based solutions that employ (MIPS) and the Alternative Payment Mod- standards-based integration that allowed VM (virtual machine) hosting the hardware els (APMs) pathways require participants

86 HealthCare Business News I january/february 2018 www.dotmed.com/news to use certified EHR technology to develop they are checked in until they are checked between a facility that is making money and programs that involve quality (50 percent), out, can be key to insuring that patients are one that is losing it, often through no fault outcomes (25 percent) and cost contain- processed in a timely fashion. So often, staff of its own. It’s a simple question of knowing ment (10 percent). Under MIPS, a provid- members misjudge how long a patient has versus not knowing that makes the differ- er’s base rate of Medicare Part B payments actually been waiting to get in to the exam ence here. would be adjusted based on a composite room and have their procedure done. A RIS PACS and RIS are often tied together be- performance score. Providers would receive takes the guesswork out of that by using cause a PACS only deals with the images, positive, negative or neutral adjustments. In 2019, the maximum payment adjustment amount starts at 4 percent upward or down- ward. It then incrementally increases to 9 Patient wait times may be shown in green if 10 percent in 2022 and onward .That said, the financial incentive to use RIS and EHR tech- minutes or less, in yellow if between 10 and nology is probably the biggest single factor for RIS’ resurgence. While a RIS alone cannot 25 minutes and red for anything over 25 minutes. meet all of the MACRA requirements like electronic prescribing and creating a patient pre-defined color changes based on the time not the reports or the historical patient data. portal, although some do have this feature, the patient has been waiting. Patient wait If the prior reports and images are both avail- it can help with many of the needs of a facil- times may be shown in green if 10 minutes able, as well as other pertinent patient in- ity to improve quality, especially if the facility or less, in yellow if between 10 and 25 min- formation (patient history, lab results, etc.), has an electronic medical record (EMR) in utes and red for anything over 25 minutes. then technically a radiologist is only required place already. This insures the patients will be taken back to be on-site for interventional procedures A RIS typically addresses the multiple for their study in a timely fashion, or at least like biopsies and catheterizations. This al- functional areas, although there can be few- notified if there is a delay that will impact the lows a facility to use remote reading services er or more modules than discussed. These timeliness of the study. Insurance verifica- from teleradiology service providers (TSPs) include patient registration and scheduling; tion also lets the patients know exactly how to either augment a site’s reading capacity, patient list management; modality interface much financial responsibility they will have or just provide coverage for vacations and using worklists (typically to a PACS via an for a study and avoids surprises weeks or other events where a radiologist may not HL-7 interface); document scanning; dic- months down the road. be present. tation and transcription, including custom Having information that can be trans- The use of RIS goes back to the late report creation and speech recognition (al- ferred to the patients’ primary care physi- 1970s when Massachusetts General Hos- though this typically is done using a third- cians quickly and electronically, as well as pital’s MUMPS programming language was party vendor like Nuance or M*Modal); having it available to them in secure patient the standard for many clinical systems. It auto-routing of results to the primary care portals, is yet another benefit, as is a sched- has since evolved to become an invaluable physicians and others via email or fax; pa- uling and registration module that allows tool in radiology’s armament. A RIS is of- tient tracking; and many others. Some RIS them to choose their appointments by time ten the key to providing the highest quality providers also offer billing and ICD-10 verifi- and date that is most convenient to them. service to patients, valuable information to cation as well as data dashboards, real-time To the clinicians using the system the clinicians and others, and most important- data analytics, integrated mammography benefits shown are numerous. Reports ly, generating revenue in a system where tracking and reporting and more. that show no abnormalities (also called value-based care has become the name of It’s interesting to see how RIS is being normals) can be dictated and signed off on the game. used, not just for MACRA-related reimburse- in a matter of seconds, saving the clinician About the author: ment, but also to improve overall quality and several minutes per case. This can translate Michael J. Cannavo functionality at an imaging center or radiol- to hours of time savings daily and allow has 30 years of experi- ogy department. The more automated a de- them to complete more studies in the same ence in the evaluation, partment can become, the less dependence time allotment. design and imple- it has on people to determine what is and is Data dashboards and data analytics are mentation of PACS not going on within the site. This is especially invaluable to the facility determining not and associated clinical true when dealing with things that improve just resource utilization, but also referral pat- systems including RIS. patient satisfaction. Patient tracking, which terns, payer profiles, accounts receivable and Share this story: dotmed.com/news/41230 keeps track of the patients from the time so much more. This can make the difference

HealthCare Business News I january/february 2018 87 This Month in Medical History Louis Braille: The world’s knowledge at his fingertips

Some have the good fortune to ease into greatness without be read without the use of a light. His system used embossed dots to experiencing adversity, but it’s those who strive and suc- represent sounds, since the majority of the soldiers serving under him ceed to overcome challenge that often offer the greatest couldn’t read standard writing even with a light. While the military inspiration. wasn’t impressed with Barbier’s system, Braille was. At that time, Louis Braille belongs to the latter group and his hardship and the blind students could only read text by tracing raised letters with their solution he created has helped to illuminate the darkness some have fingers, which was incredibly slow and challenging, resulting in few to live with every day. actually learning to read in that way. Braille was born in Coupvray, France, on Jan. 4, 1809. He was the Braille took Barbier’s idea and spent all his free time, working son of a harness maker night and day over the and his father’s vocation course of three years, to tragically played a role in refine it, puncturing pa- the accident that would per to create the needed befall Braille at an early texture. By 1824, he age. It was at the age of had his writing system. 3 that he suffered an eye Braille’s system used six injury while playing in his dots, arranged in a va- father’s shop with an awl riety of ways, to create (a sharp tool his father letters and then contrac- used to make holes in tions of words in order to the leather saddles and make reading by touch harnesses). Even though faster. He also adapted his parents sought the his system to create mu- best care available at sical notation. that time, both his eyes By 1826, Braille had became infected due to become a teacher at the the injury and by the age school where he devel- of 5, Braille had totally oped his print form for the PAGE lost his vision. blind. Three years later, he In 1914, there was published a paper on the little a blind person could do to gain an education except depend system and in 1837, he published a three-volume Braille version of a on their hearing and memory. Although they realized their son history book that was in wide use at the time. would be at a distinct disadvantage, Braille’s parents still wanted Braille’s code expanded far beyond his native France and the him to have the opportunity to get an education. He was enrolled French language. Today, it has been adapted for use in nearly every in the village school and worked hard, listening to instruction. He language currently used. But Braille wouldn’t live to see the entire also showed himself to be a talented musician, learning to play the breadth of use for the system named after him. By his early 40s, he organ, a talent he would enjoy throughout his life. At the age of was gravely ill with tuberculosis, succumbing to the disease on Jan. 6, 10, Braille was awarded a scholarship from the National Institute 1852, just days after turning 43. A century after his passing, his body for Blind Youth in Paris. was moved from its initial resting place and interred in the Pantheon. While he was at the National Institute for Blind Youth, he at- His hands, however, those incredible tools that once punctured a tended a demonstration by Charles Barbier, a retired artillery of- series of raised dots into paper to bring the written language to mil- ficer, where he explained and shared a system he had created to lions, remained in the village of his birth. pass messages among the battlefield troops at night, which could Share this story: dotmed.com/news/40520

88 HealthCare Business News I january/february 2018 www.dotmed.com/news Medical Museum: Pre-19th Century Instruments General Surgery

Each month, we visit Dr. Blaufox’s Museum of Historical Medical Artifacts to take a look back at the medical equipment that cleared the way for what patients encounter in doctors’ offices and operating rooms of today. Some equipment may be recognizable, while other featured inventions have since become obsolete or have had their usefulness discredited.

The picture and description appear courtesy of Dr. M. Donald Blaufox, M.D., Ph.D., from his website: www.mohma.org.

Estimated Date: 1775 Name: Etui Manufacturer: unknown

Description: This is a 3.5“x 1.5“x .5” tapered silver case heavily embossed with a floral design. It appears to have been used for personal as well as medical applications. The case contains a 2.75” silver handle, with two 2 ⅛” steel blades that screw into the handle. One is marked “guest,” with a tortoise handled lancet also marked guest. Additionally, the set contains a needle, scoop, folding rule, scissor, caliper, a pencil in a silver case, forceps and file along with an ivory notepad.

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Dr. Michael Recht, Lewis Marx Professor For example, is there a pneumothorax or in certain use cases is eliminating radiogra- and chair of the Department of Radi- not a pneumothorax? Is there a nodule or is phy,” he says. “If we can do a CT or an MR ology at NYU Langone Health, spoke there not a nodule? at a much lower price, or much lower radia- with HealthCare Business News about “The problem is,” explains Recht, “when tion, or much faster than we currently do, why he believes artificial intelligence is we look at an image, we don’t look at a spe- we might not need X-ray anymore because poised to have a dramatic impact on the cific question.” we know we get far more information on entire workflow of radiologists, from In order for machine learning to evaluate these cross-sectional modalities than we do scheduling an examination to the exam an image from the ground up, the way a on radiography, so we’re very excited.” protocol to how an image is interpreted radiologist does, would require general AI, Recht believes that innovations with and how that interpretation is commu- and that level of sophistication may still be a undersampling and image reconstruction nicated to the patient. good ways down the road. could also lead to more simplified imaging “There are a number of articles that For Recht and his colleagues, one particu- machines, like an MR that does not require show pattern recognition algorithms doing larly interesting and promising area of artifi- all the magnetic homogeneity that currently as well as, and in some cases better than, cial intelligence is with image reconstruction, defines the technology. radiologists on specific tasks,” says Recht. particularly for MR and CT. “I can picture a future where all of He and a few colleagues recently highlighted “With MR, the huge advantage with these AI tools present information to us some of that research in an article published machine learning reconstruction, and we in a much more efficient manner, putting last year in the Journal of the American Col- have some early results to show, that you the images in order and presenting them lege of Radiology. can undersample images and significantly in a better way and using pattern recog- Ultimately, he believes these innovations speed up your acquisitions,” says Recht, nition algorithms so that our productivity will usher in a brand new way of manag- who believes these algorithms could in- as radiologists could be significantly in- ing a radiology department, understand- crease the speed of an MR scan by four to creased and we could read more and be ing which patients will be no-shows, how to six times the current speed. much more integrated into the clinical care schedule so you can account for no-shows “We’re talking about potentially using teams, working with the referring physi- and add-ons and most efficiently utilize your MR in far more cases than we do now, and cians and understanding the information, equipment. MR becoming less expensive than it is now,” understanding what you do in terms of They will also change the way images he says. what imaging should be done, what fol- themselves are interpreted, but there is still With CT, undersampling means signifi- low-up should be done,” says Recht. “It’s plenty of progress that needs to be made on cantly reducing the radiation dose to the pa- really changing our role a little bit and get- that front. One challenge is that all of these tient and potentially disrupting the way we ting us much more integrated than a lot of emerging algorithms are what Recht calls think about imaging altogether. radiologists are today.“ narrow AI. They answer a specific question. “One of the things we’ve talked about Share this story: dotmed.com/news/41231

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