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Advances in Health Technology
Thomas Osborne, MDUCSD Clinical Geriatrics Interprofessional Symposium
October 24, 2015
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Introduction & Disclosures
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Introduction:
Thomas Osborne, MDDirector of Medical InformaticsvRad
Medical School:Dartmouth Medical SchoolRadiology Residency: Harvard Medical School, Mount Auburn HospitalNeuroradiology Fellowship: Harvard Medical School, Massachusetts General Hospital
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I work for Virtual Radiologic (vRad) as:• The Director of Medical Informatics • Neuroradiologist
Disclosures
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Client Markets
Over 350 radiologists reading nearly 6 million annual studies for 2,100+ hospital, health system and radiology group facilities across the U.S. and around the world.
Disclosures: Who is vRad?
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We are the nation’s leading radiology practice – and a recognized leader in evidence-based analytics solutions.
“Analytics for practice comparisons are largely subjective, and in many cases unavailable because of the challenge of comparing disparate data between healthcare facilities. (vRad’s) normalized data set … presents a potential opportunity for radiology to take control of the dialogue around quality as it moves from a fee-for-volume to fee-for-value world.”Ingrid Lund, Practice manager for the Imaging Performance Partnership, ABCO
“Moving up the value chain from a company that only did preliminary reads in 2000, (vRad) has become a center of excellence in the radiology field, rivaling major academic centers in its contribution to the future of radiology.”
vRad
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Medical technology through the lenses of Radiology & beyond
Lecture Outline
Wilhelm Röntgen's first "medical" X-rayof his wife's hand, taken on 22 December 1895 3D volume-rendering of aortic aneurysm
EPOS Educational Exhibit. C. Fraga Piñeiro et al
Race to Build a Real Star Trek Tricorder
Past Present Future
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Radiology Past
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Radiology Past
1895 - Wilhelm Röntgen discovered X-rays
1896 - First clinical radiograph in America @ Dartmouth
1896 – Becquerel discovers radioactivity
1898 - Marie and Pierre Curie discovered polonium and radium
1914-1918 Radiological equipment used in field hospitals during WW I
1918 - George Eastman introduced radiographic film
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Radiology Past
1950s - Clinical use of ultrasound begins
1972 - CT is invented by Hounsfield at EMI Laboratories (Electric and Musical Industries signed the Beatles 1962)
1970s – 1980s MRI developed and used clinically
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Radiology Past
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Radiology PresentAdvances marked by Convergence & Interoperability
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Theme: Convergence & Interoperability
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Interoperability:making systems and organizations work together
Convergence:migrate previously distinct systems into a unified platform
VS
Convergence & Interoperability
Not Interoperability
Also Not Interoperability
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Radiology Teleradiology
1981 - Fuji develops CR technology
+ +
Picture Archiving and Communication System (PACS)
convergence of healthcare, technology and telecommunications
vRad founded 2001
www
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Remote Center
Main Hospital
PACS
Remote Center
Rad &Report
local area network (LAN)
central
Rad &Report
Remote Center
Hospital staff
Off site sta
ff
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vRad Complete – A fully integrated Radiology Service Line
Eliminate the “seam” between on-site and cloud-based radiologists to increase patient access, become more efficient, measure and prove quality – and reduce costs.
• Single platform• Unified worklist• Customized workflows• Data-driven operating
plan designed to help optimize your radiology service line
Proven Clinical Leadership
Operational Infrastructure with
Patented Workflows
Integrated QA
Custom Structured Reporting
Patent-Pending Analytics
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A few examples of leading industry practices
Teleradiology Present
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Assigner Engine
vRad Enterprise Connect – Patented, Rules-Driven Case Assignment
378 378 378 378378
Neuro
MSK
General
Neuro
Pediatric
ASSIGNMENTRULES
60 23 12 8 3
All AvailableRadiologists
Best AvailableRadiologists
Internet
General
Subspecialty FacilityPreference
Current Worklist
Depth
RemainingTime
MSK
Breast
Cardiac
Neuro
Nuclear
General
General
Cardiac
• Repeat every 30 seconds for entire practice• Apply rules to each case• Assign additional radiologists as needed
1
2
3
License & Credential
Assignment Rules
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The vRad Operations Center immediately calls
attending physician
Attending physician is located and connected
to the reading radiologist
vRad radiologist clicks “Critical Finding” and
resumes clinical work
Critical Findings Protocol
Features:
1. Details of verbal communication are documented on the radiology report and in the Operations Center records
2. Communication response time reports available to clients
3. Disruption to radiologist and attending physician clinical work is minimized
Benefits:• Expedited time to accurate diagnosis
• Improved patient care
• Documented results
• Reports satisfy ACR and Joint Commission Requirements
Critical Findings Snapshot
Current average statistics:• Critical finding relay time: 11 minutes
(Radiologist call request > physician located > conference call completed)
• Annual critical finding calls: 150,000+
• Daily critical finding calls: 400+
vRad’s strict process and robust support deliver rapid communications and reportable documentation
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Stroke ProtocolTreatment is critical in the first 3 hr after a stroke.The sooner the better: (Time is brain)
Clinical History: 78yo facial droop
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Stroke Protocol
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Stroke Protocol
“Physicians need immediate responses to make critical decisions. Without both subspecialty radiologists working remotely and onsite interventional neuroradiologists, this [stroke service line] offering would not be possible”
Brian IviePresident/CEOMercy San Juan Medical Center
Stroke cases designated with our highest prioritization and fastest turnaround time target of under 20 minutes
Designating the order as Stroke Protocol in the vRad OMS:• Immediately assigns the order to all credentialed radiologists who are online at the
time of the study
• Escalates the order to the very top of the radiologists’ worklists with a requirement that it be read as the next study
• Generates a call to your facility with positive findings (and negative findings if requested)
Trusted Partner:• vRad is the trusted partner of stroke centers nationwide
• Current average turnaround time: Under 9.5 minutes
• Top vRad neuroradiologists deliver the very same clinical quality at night as your patients realize by day
• Over 35,000 stroke studies per year
“According to the American Stroke Association, stroke is the fourth leading cause of death in the United States, with approximately 795,000 Americans each year suffering a new stroke or recurrent stroke.”
American Stroke Association
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Treatment is critical in the first “golden hour” after an accident.
Clinical History: 88yo fell down stairsExams:
CT Head CT Cervical Spine CT Face CT Abd/Pel CT Thoracic Spine CT Lumber Spine CT Left Shoulder CT Knee CT Foot
Trauma Protocol
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Trauma Protocol
Patent-pending workflows designed specifically to increase the speed of high-quality radiology reports for trauma patients – up to 40% faster.1
Unique Solution – Studies Read by Multiple Radiologists • Patent-pending technology automatically “unbundles” trauma cases, assigning each
body region to the appropriate radiologist to read concurrently:
Neuro: head, face, orbits, cervical spine, and neckBody: chest, abdomen and pelvis, thoracic and lumbar spineLower extremitiesUpper extremities
• Cases automatically prioritized at the top of our radiologists’ worklists, required to be read next
• Radiologists automatically notified which colleagues are reading the other body regions for the same patient, enabling real-time collaboration
“The average time from when our imaging department receives the order to when the ED receives the final reports from vRad dropped by almost 20 minutes since implementing vRad’s trauma protocol. That’s a big improvement and our emergency physicians have definitely noticed.”
Shawn Snider MS, RT(R)(M)Administrative Director, Radiology Services, CoxHealth
Rapid Communications – Reports Sent and Critical Findings Called• Radiology reports for each body region sent as soon as they are completed allowing
treatment to begin as quickly as possible
• Critical finding calls made to any designated number, priority placed on Head/Cervical Spine studies
• Calls can be configured to include both positive and negative findings
Current Average Stats for Trauma Studies
4 minutes: "Eyes on the Images” – Radiologist begins reading
<12 minutes: Turnaround time
1Turnaround time statistic compares cases designated as trauma protocol following launch of the vRad Trauma Protocol to comparable cases for the 12-month period prior to launch.
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Future of Medicine
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• Clinical & corporate efficiency Integrated systems, specialties & technology
• Move to system of payment for quality/outcomes
• Improving healthcare accessibility & participation
• Growing importance of deep analytics & AI
Future of Medicine Trends
Connected Systems• Improved clinical care:
– Improved knowledge delivery to physicians and patients– Reducing medical errors– Improved workflow and treatment analysis– Foster innovation
• Improved business health:– Reduce waste, reduce cost, increase efficiency– Break down silos b/t isolated business units, teams & systems– Eliminate redundant systems create unified operating system– Government/payor compliance
Care Professionals
Legal
Other?
Business
IT
Social Science includes:•communication•anthropology•economics•political science•Psychology•Sociology•History•law•linguistics
Information:•analysis/research•collection•classification•manipulation•storage•retrieval•movement•dissemination
Behavioral Science includes:•psychology•psychobiology•cognitive science
methodical processes:•feasibility•structure•expression•mechanization For information:•acquisition•representation•processing•storage•communication•access
Business:•executive•finance•marketing•sales•IT•HR, Etc
Leadership:• vision•strategy•direction/decision•alignment•coalition/collaboration•empowerment•energizes
Management:•organization•agendas•timetables•resource allocation•structure•rules and processes•roles and responsibilities•corrective actions
InformationScience
Social Science
Behavioral Science
&
ComputerScience
Care Professionals
BusinessLeadership
Management
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Corporate
Regulatory
Critical Document
ControlClinical
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Search
1 20:00:00
0:01:26
0:02:52
0:04:19
0:05:45
0:07:12
0:08:38
0:10:04
Pulse (1:05)other (8:41)
Results
> 8X faster
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• Business/Practice
• Practice Staff
• Clients
• Gov/Insurance
• Patients
Analytics For:
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1. Powerful, user-friendly analytical tools: Get custom information and insight unavailable in your existing systems – delivered right to your inbox.• Teleradiology Metrics ReportSM • GPISM (Global Practice Information) Report with 24/7 cross-practice
metrics (including facility, modality and physician-specific benchmarks)
• Hospital Insight ReportSM
2. vCoderSM patent-pending data normalization: The industry’s first data normalization tool used on inputs for any hospital or radiology group delivering a single and consistent retrospective view across our clients’ facilities.
3. National and peer group benchmarking with RPCSM (Radiology Patient Care) Indices: Compare your data with the first findings-based national and peer group benchmarking metrics. Our indices are at the aggregate level, adhering to industry confidentiality requirements – while providing critical comparisons and relevant context for your decision making.
4. Expert collaboration, consulting and transformation: Our Advisory Solutions radiology experts provide actionable insight from your data with recommendations tailored to your organization to optimize your practice and your radiology service line.
You can’t get paid for quality if you can’t prove it. And you can’t prove it if you don’t measure it …
Transforming our clinical data repository into actionable insight
vRad Analytics
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Natural Language Processing technology provides quantitative measures of qualitative clinical and operational information currently locked within your reports – all with automated and consistent output.
Example GPI Report Components: What Can Be Measured?
Evaluate your percent positive findings by referring physicianWhy? Are your referring physicians ordering appropriately based on practice and peer group benchmarks? vRad’s GPI Reports give you the ability to provide fact-based insight to your physician partners – making your practice an indispensable partner. Use consistent metrics to identify best practices – and areas of opportunity to improve quality and cost.
Looks for key words that indicate positive findings
The Future-Is Now
Advances mentioned in the prior section will become standard of care practice+
Additional early stage trends will accelerate
Future Directions
Telemedicine in hospital care
Future Directions
Telemedicine pharmacy clinic care
Future Directions
Telemedicine at home
Online virtual doctor visits MDLIVE, American Well, TeleDoc, Google Helpouts, and Dr on Demand
Mobile Health Market To Reach $26B By 2017 - InformationWeek
Future DirectionsConnected Apparel, etc
BeBop Launches Wearable Smart Sensors, Coming to Cycling Clothing Near You
Accelerators for Future Medical Technology
TechnologyInnovation
Insurance/GovCost alignment
Growing educated & vocalpatient population
Conclusion• This is about medicine utilizing technology,
not the other way around• Principles of medicine unchanged• These are just tools• Must be directed by healthcare professionals
