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Radiology's Playbook for Optimizing Imaging Informatics

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Radiology's Playbook for Optimizing Imaging Informatics YOUR MEDICAL IMAGING CLOUD EXECUTIVE INSIGHTS Radiology's Playbook for Optimizing Imaging Informatics Executive Insights from Weill Cornell Medicine, Memorial Sloan Kettering Cancer Center, and Ambra Health Introduction New regulations like MACRA, MIPS, and PAMA are changing the radiology landscape with an enhanced emphasis on ordering efficiency, turnaround and quality of reads, and patient satisfaction. Keeping your facility in line with new regulations means leveraging informatics to optimize and streamline the flow of medical imaging across radiology and beyond. Health systems and hospitals with inpatient radiology services are facing challenges around reimbursement and looking to better manage radiology utilization and their own fixed costs. In turn, community hospitals and urgent care facilities also have a growing degree of imaging capabilities. In a recent HIMSS webinar event, Keith Hentel, MD MS Executive Vice Chairman, Department of Radiology, Weill Cornell Medicine, and Krishna Juluru, MD Director, Imaging Informatics Memorial Sloan Kettering Cancer Center, discussed imaging informatics in a changing healthcare landscape with Morris Panner, CEO Ambra Health, covering: How to optimize the image order & acquisition process The impact of the latest regulations and how to optimize radiology operations Managing outbound imaging and referral networks This executive brief provides the latest insights in how healthcare leaders are utilizing image management technology and restructuring their broader informatics technology stack to meet change head on. 2 Executive Panel Keith Hentel, MD MS Executive Vice Chairman, Department of Radiology, Weill Cornell Medicine Dr. Keith Hentel is Chief of the Division of Emergency/Musculoskeletal Radiology and is Executive Vice Chairman in the Department of Radiology at New York-Presbyterian Hospital-Weill Cornell Medical Center. He is a 1991 graduate of Cornell University (B.S. in Biology) and earned his M.S. degree in Mechanical Engineering from Yale University in 1993. Dr. Hentel is a graduate of Weill Cornell Medical College and was awarded his M.D. in 1998. Dr. Hentel is an Associate Professor of Clinical Radiology at Weill Cornell Medical College and is an Associate Attending Radiologist at the New York-Presbyterian Hospital/Weill Cornell Campus. Dr. Hentel has been an invited speaker nationally and has published numerous articles and book chapters. Dr. Hentel also serves on many institution-wide committees in the both New York-Presbyterian Hospital and Weill Cornell Medical College. Krishna Juluru, MD Director Imaging Informatics, Memorial Sloan Kettering Cancer Center Dr. Krishna Juluru is the Director of Imaging Informatics at Memorial Sloan Kettering Cancer Center. Dr. Juluru earned his B.S. degree in Applied Physics from Yale University, magna cum laude, and was elected to Phi Beta Kappa. He was awarded his M.D. degree from Johns Hopkins School of Medicine. His internship year in Internal Medicine at Greater Baltimore Medical Center was followed by radiology residency training in Diagnostic Radiology at Johns Hopkins School of Medicine, where he served as Radiology Chief Resident in 2005-2006. Dr. Juluru’s fellowship year combined his interests in informatics and radiology. Dr. Juluru has spoken nationally and internationally on topics related to Advanced Image Processing, optimization of radiology workflow, and technology assessment. He is also actively involved in the development of applications utilizing Radiology for medical education. Morris Panner CEO, Ambra Health As CEO of Ambra Health, a leader in cloud medical imaging, Morris Panner works closely with industry leaders at some of the world’s largest health systems including Stanford Children’s Health and Memorial Hermann. Focused on delivering better care through better technology. Morris is a frequent contributor to business, healthcare, and technology publications. Morris has a BA from Yale University and a JD from Harvard University. 3 Executive Summary MULTIPLE PACS REMAIN A BIG BARRIER TO SHARING AND ACCESS. They can create significant physician productivity challenges with accessing imaging. MEASUREMENT AND ANALYTICS INCREASINGLY IMPORTANT. Factors like turnaround times, physician ordering, routing, dose measurement, and capacity management are all becoming critical measures, whether for simply monitoring service levels, efficiency, or ensuring compliance with growing regulations. IMAGE SHARING IS SHIFTING TO REAL-TIME. Multi-day turnaround times are increasingly an anathema in a more integrated fast-moving healthcare system. Organizations are setting their goals on moving towards moving images in real time and getting them to the right person to review without delay. ORGANIZATIONS NEED TO PAY ATTENTION TO PAMA. While there is growing awareness of MACRA and MIPS, providers need to upgrade their technology stack to manage appropriateness of advanced imaging orders. EARLY ACCESS TO IMAGING AND HEALTHCARE DATA SEEN AS CRITICAL. Providing patient portals to enable entry of healthcare history, or upload/download imaging is an important way to engage patients, reduce administration overhead, and reduce time to coordinate care. RESULTS SIMPLY AREN’T ENOUGH ANYMORE. Referring physicians and patients are looking for more than just radiology results, they want the imaging too, which is also an important step towards reducing duplicate imaging downstream. THE CLOUD IS AN IMPORTANT TECHNOLOGY TO IMPROVE IMAGING TURNAROUND TO REFERRERS. Using cloud image management to provide imaging to referrers cuts cycle times from days to minutes or hours and can improve satisfaction. CENTRALIZATION AND UNIFICATION OF DATA IS A PRIORITY. With an increasing diversity of healthcare information, and more distributed data, organizations are using cloud Vendor Neutral Archives to centralize it more effectively and automatically integrate into imaging workflows. 4 Image Ordering and Acquisition Medical imaging is more spread out than ever before across a geographically distributed and diverse referral and patient community. For example, Weill Cornell has a wide range of physicians, some who are affiliated with the institution and some who aren’t. They’re also one of the medical schools and practices that are part of the New York Presbyterian Healthcare Organization and have a sister institution with Columbia Presbyterian, part of the Columbia Medical group, along with also providing regional care in the New York City metro area. The net result is patients frequently coming and going―and a real need to streamline image workflows across a disparate network. At Memorial Sloan Kettering Cancer Center, the patient population is somewhat unique because they are focused on cancer care, and see patients both within the region and globally. Memorial handles coordination of care with Disease Management Teams (DMTs), so for example, an ovarian cancer DMT will be comprised of surgeons, medical and radiation oncologists, and radiologists who work specifically with that patient population. For radiology, DMT members refer to the DMT radiologists who are specific to that area, making specific and precise image routing essential. PACS Remain a Challenge Dr. Hentel noted that a PACS only gets you so far, commenting that, “the same PACS that I have is not the same PACS for a small regional hospital, and it’s not the same PACS we have in our sister institution up at Columbia. PACS are local.” He went on to sum up the operational challenges involved when dealing with multiple PACS observing, “it creates a lot of challenges―maintaining credentials and passwords, knowing where to get the link when you need it, and using another PACS that you just don't feel completely comfortable with. At the very least, it's going to slow down your interpretation.” Attendees at the event echoed Dr. Hentel’s frustrations with nearly 40-percent saying their biggest single frustration is lack of easy image sharing technology between PACS and sites. 5 GREATEST IMAGE MANAGEMENT FRUSTRATIONS Lack of easy image sharing technology 0.37 All of the above 0.25 Overwhelming number of orders 0.2 Inability to image enable EMR/EHR 0.09 Imaging on CDs is frequently lost or unavailable 0.09 0% 5% 10% 15% 20% 25% 30% 35% 40% The Importance of Measurement The saying goes, “you can’t manage what you can’t measure.” It holds true for improving radiology operations to understand the drivers and levers that impact operational performance. Factors like turnaround times, physician ordering, routing, dose measurement, and capacity management are all critical to monitor. At Memorial, Dr. Juluru’s role wearing the informatics hat is ensuring that the right data and measurements are in place, and it’s an area where they’ve made significant investments over the past few years. In terms of where they are with metrics, Dr. Juluru said, “I know to the last hour or so how many scans are being done, what facilities within Memorial those scans are being performed, what body parts are involved, what sub-specialties are involved, and right down to, ‘what is the average number of reads a radiologist is doing?’” In the future, they’re looking to expand measurement by analyzing referral patterns to ensure they are providing strong referring physician and patient service. Dr. Hentel also shared their focus on analytics at Weill Cornell, noting that, “we look at real-time analytics on our equipment, but we also look at ordering patterns, as well, using analytics to see where our orders are coming from, and looking at the supply and demand
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