Immunization for influenza and pneumococcal pneumonia were incorporated into The Joint Commission "global immunization" core measure January 1, 2012. The authors' hospital chose to adhere strictly to guidelines to avoid overvaccination. An immunization order set was created to aid appropriate ordering practices. In spite of this effort, compliance rates remained below the goal. The objective was to improve compliance with inpatient vaccination core measures to >96%. An educational slide set was created and distributed by the Housestaff Patient Safety and Quality Council (HPSQC). A competition was established among departments. Finally, the HPSQC partnered with quality improvement staff to improve communication and optimize concurrent review processes. The average compliance prior to the HPSQC vaccination initiative was 78% for pneumococcal pneumonia and 84% for influenza; average compliance in the months following the intervention was 96% and 97.5%, respectively. This project yielded significant improvement in compliance with vaccination core measures.
The goal of this work is to provide radiologists an update regarding changes to stage 1 of meaningful use in 2014. These changes were promulgated in the final rulemaking released by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology in September 2012. Under the new rules, radiologists are exempt from meaningful use penalties provided that they are listed as radiologists under the Provider Enrollment, Chain and Ownership System (PECOS). A major caveat is that this exemption can be removed at any time. Additional concerns are discussed in the main text. Additional changes discussed include software editions independent of meaningful use stage (i.e., 2011 edition versus 2014 edition), changes to the definition of certified electronic health record technology (CEHRT), and changes to specific measures and exemptions to those measures. The new changes regarding stage 1 add complexity to an already complex program, but overall make achieving meaningful use a win-win situation for radiologists. There are no penalties for failure and incentive payments for success. The cost of upgrading to CEHRT may be much less than the incentive payments, adding a potential new source of revenue. Additional benefits may be realized if the radiology department can build upon a modern electronic health record to improve their practice and billing patterns. Meaningful use and electronic health records represent an important evolutionary step in US healthcare, and it is imperative that radiologists are active participants in the process.
Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC.
Substantial societal investments in biomedical research are contributing to an explosion in knowledge that the health delivery system is struggling to effectively implement. Managing this complexity requires ingenuity, research and development, and dedicated resources. Many innovative solutions can be found in quality improvement (QI) activities, defined as the "systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare in particular settings." QI shares many similarities with biomedical research, but also differs in several important ways. Inclusion of QI in the peer-reviewed literature is needed to foster its advancement through the dissemination, testing, and refinement of theories, methods, and applications. QI methods and reporting standards are less mature in health care than those of biomedical research. A lack of widespread understanding and consensus regarding the purpose of publishing QI-related material also exists. In this document, guidance is provided in evaluating quality of QI-related material and in determining priority of submitted material for publication.
The purpose of this study was to characterize the performance of the Neuroradiology Second Opinion Consultation Service (NSOCS) at our institution to establish the rate, causes, and implications of requests for repeat imaging.
Over the past century technology has played a decisive role in defining, driving, and reinventing procedures, devices, and pharmaceuticals in healthcare. Cloud computing has been introduced only recently but is already one of the major topics of discussion in research and clinical settings. The provision of extensive, easily accessible, and reconfigurable resources such as virtual systems, platforms, and applications with low service cost has caught the attention of many researchers and clinicians. Healthcare researchers are moving their efforts to the cloud, because they need adequate resources to process, store, exchange, and use large quantities of medical data. This Vision 20/20 paper addresses major questions related to the applicability of advanced cloud computing in medical imaging. The paper also considers security and ethical issues that accompany cloud computing.
Today in the hospital setting, several functions of the radiology information system (RIS), including order entry, patient registration, report repository, and the physician directory, have moved to enterprise electronic medical records. Some observers might conclude that the RIS is going away. In this article, we contend that because of the maturity of the RIS market compared with other areas of the health care enterprise, radiology has a unique opportunity to innovate.
Cholinergic innervation is extensive throughout the central and peripheral nervous systems. Among its many roles, the neurotransmitter acetylcholine (ACh) contributes to the regulation of motor function, locomotion, and exploration. Cholinergic deficits and replacement strategies have been investigated in neurodegenerative disorders, particularly in cases of Alzheimers disease (AD). Focus has been on blocking acetylcholinesterase (AChE) and enhancing ACh synthesis to improve cholinergic neurotransmission. As a first step in evaluating the physiological effects of enhanced cholinergic function through the upregulation of the vesicular acetylcholine transporter (VAChT), we used the hypercholinergic B6eGFPChAT congenic mouse model that has been shown to contain multiple VAChT gene copies. Analysis of biochemical and behavioral paradigms suggest that modest increases in VAChT expression can have a significant effect on spontaneous locomotion, reaction to novel stimuli, and the adaptation to novel environments. These observations support the potential of VAChT as a therapeutic target to enhance cholinergic tone, thereby decreasing spontaneous hyperactivity and increasing exploration in novel environments.
The utility of a simple, low-cost detection platform for label-free electrochemical characterization of acetylcholinesterase (AChE) inhibition is demonstrated as a potential tool for screening of small-molecule therapeutic agents for Alzheimers disease (AD). Technique validation was performed against the standard Ellmans colorimetric assay using the clinically established cholinesterase inhibitor (ChEI), Donepezil (Aricept(®)). Electrochemical measurements were obtained by differential pulse voltammetry (DPV) performed using a portable potentiostat system for detection of the enzymatic product, thiocholine (TCh), by direct oxidation on unmodified gold screen-printed electrodes. The IC50 profiles for Donepezil measured in vitro were found to be comparable between both colorimetric and electrochemical detection methods for the analysis of purified human erythrocyte-derived AChE (28±7 nM by DPV; 26±8 nM by Ellmans method). The selectivity of this unmodified electrode system was compared to a range of biological sulfur-containing compounds including cysteine, homocysteine, glutathione and methionine as well as ascorbic acid. Preliminary studies also demonstrated the potential applicability of this electrochemical technique for the analysis of Donepezil in crude cholinesterase samples from anterior cortex homogenates of C57BL/6J mice.
The adequate and repeatable performance of the image display system is a key element of information technology platforms in a modern radiology department. However, despite the wide availability of high-end computing platforms and advanced color and gray-scale monitors, the quality and properties of the final displayed medical image may often be inadequate for diagnostic purposes if the displays are not configured and maintained properly. In this article-an expanded version of the Radiological Society of North America educational module "Image Display"-the authors discuss fundamentals of image display hardware, quality control and quality assurance processes for optimal image interpretation settings, and parameters of the viewing environment that influence reader performance. Radiologists, medical physicists, and other allied professionals should strive to understand the role of display technology and proper usage for a quality radiology practice. The display settings and display quality control and quality assurance processes described in this article can help ensure high standards of perceived image quality and image interpretation accuracy.
This report summarizes the performance of the Imaging Informatics Professional (IIP) examination from 2009 to 2011 (six exam administrations). Results show that the IIP exam is a reliable measuring instrument that is functioning well to consistently classify candidates as passing or failing. An analysis of the section scores revealed that content in the Image Management, Systems Management, and Clinical Engineering sections of the exam were somewhat more difficult than the content in the other sections. The authors discuss how future candidates may use this information to help hone their study strategies. By all indications, the IIP examination appears to be statistically functioning as a high-quality certification measuring instrument.
The aims of this study were to analyze reporting of critical findings among neuroradiologists in a university setting and to revise a list of critical findings reflecting an academic clinical practice as part of a practice quality improvement project.
Post-processing of volumetric data sets lands in a fuzzy boundary between the technologist and the radiologist. Is this the role of the technologist as part of image preparation? Or is it the beginning of the diagnostic process by the radiologist? Technology advances in real-time server side rendering platforms is challenging the traditional role of expensive dedicated advanced visualizations workstations with dedicated personnel. Will this also challenge the role of a dedicated 3D post-processing technologist?
Online social networking is an immature, but rapidly evolving industry of web-based technologies that allow individuals to develop online relationships. News stories populate the headlines about various websites which can facilitate patient and doctor interaction. There remain questions about protecting patient confidentiality and defining etiquette in order to preserve the doctor/patient relationship and protect physicians. How much social networking-based communication or other forms of E-communication is effective? What are the potential benefits and pitfalls of this form of communication? Physicians are exploring how social networking might provide a forum for interacting with their patients, and advance collaborative patient care. Several organizations and institutions have set forth policies to address these questions and more. Though still in its infancy, this form of media has the power to revolutionize the way physicians interact with their patients and fellow health care workers. In the end, physicians must ask what value is added by engaging patients or other health care providers in a social networking format. Social networks may flourish in health care as a means of distributing information to patients or serve mainly as support groups among patients. Physicians must tread a narrow path to bring value to interactions in these networks while limiting their exposure to unwanted liability.
Both outcomes researchers and informaticians are concerned with information and data. As such, some of the central challenges to conducting successful comparative effectiveness research can be addressed with informatics solutions.
The current array of PACS products and 3D visualization tools presents a wide range of options for applying advanced visualization methods in clinical radiology. The emergence of server-based rendering techniques creates new opportunities for raising the level of clinical image review. However, best-of-breed implementations of core PACS technology, volumetric image navigation, and application-specific 3D packages will, in general, be supplied by different vendors. Integration issues should be carefully considered before deploying such systems. This work presents a classification scheme describing five tiers of PACS modularity and integration with advanced visualization tools, with the goals of characterizing current options for such integration, providing an approach for evaluating such systems, and discussing possible future architectures. These five levels of increasing PACS modularity begin with what was until recently the dominant model for integrating advanced visualization into the clinical radiologists workflow, consisting of a dedicated stand-alone post-processing workstation in the reading room. Introduction of context-sharing, thin clients using server-based rendering, archive integration, and user-level application hosting at successive levels of the hierarchy lead to a modularized imaging architecture, which promotes user interface integration, resource efficiency, system performance, supportability, and flexibility. These technical factors and system metrics are discussed in the context of the proposed five-level classification scheme.
Radiology departments today are faced with many challenges to improve operational efficiency, performance, and quality. Many organizations rely on antiquated, paper-based methods to review their historical performance and understand their operations. With increased workloads, geographically dispersed image acquisition and reading sites, and rapidly changing technologies, this approach is increasingly untenable. A Web-based dashboard was constructed to automate the extraction, processing, and display of indicators and thereby provide useful and current data for twice-monthly departmental operational meetings. The feasibility of extracting specific metrics from clinical information systems was evaluated as part of a longer-term effort to build a radiology business intelligence architecture. Operational data were extracted from clinical information systems and stored in a centralized data warehouse. Higher-level analytics were performed on the centralized data, a process that generated indicators in a dynamic Web-based graphical environment that proved valuable in discussion and root cause analysis. Results aggregated over a 24-month period since implementation suggest that this operational business intelligence reporting system has provided significant data for driving more effective management decisions to improve productivity, performance, and quality of service in the department.
The American Board of Imaging Informatics (ABII) was founded in 2005 by the Society of Imaging Informatics in Medicine (SIIM) and the American Registry of Radiologic Technologists (ARRT). ABIIs mission is to enhance patient care, professionalism, and competence in imaging informatics. This is accomplished primarily through the development and administration of a certification examination. The creation of the exam has been an exercise in open community involvement with SIIM providing access to the PACS community and ARRT providing skilled psychometric support to ensure a balanced and comprehensive examination. The process to generate the exam required several years and the efforts of dozens of subject matter experts active who volunteered to submit and validate questions for the examination. This article describes the organizational and statistical processes used to generate test items, assemble test forms, set performance standards, and validate test scores.
Considerable debate within the medical community has focused on the optimal location of information technology (IT) support groups on the organizational chart. The challenge has been to marry local accountability and physician acceptance of IT with the benefits gained by the economies of scale achieved by centralized knowledge and system best practices. In the picture archiving and communication systems (PACS) industry, a slight shift has recently occurred toward centralized control. Radiology departments, however, have begun to realize that no physicians in any other discipline are as dependent on IT as radiologists are on their PACS. The potential strengths and weaknesses of centralized control of the PACS is the topic of discussion for this months Point/Counterpoint.
The American College of Radiology (ACR) Appropriateness Criteria was compiled as a set of evidence-based guidelines to aid both radiologists and referring physicians in making efficient use of imaging resources. In our study, only 60% of residents knew how to obtain a copy of the ACR Appropriateness Criteria, and 90% were unaware of its contents. The overall mean score in a Medical Decision Support Competency Quiz was less than 60%. We propose that there is a clear need for the formal implementation of the ACR Appropriateness Criteria within our radiology training programs. Residents should be better familiarized with its contents so as to improve medical decision support to clinicians, technologists, and radiologists alike.
Information technology teams in health care are tasked with maintaining a variety of information systems with complex support requirements. In radiology, this includes picture archive and communication systems, radiology information systems, speech recognition systems, and other ancillary systems. Hospital information technology (IT) departments are required to provide 24 x 7 support for these mission-critical systems that directly support patient care in emergency and other critical care departments. The practical know-how to keep these systems operational and diagnose problems promptly is difficult to maintain around the clock. Specific details on infrequent failure modes or advanced troubleshooting strategies may reside with only a few senior staff members. Our goal was to reduce diagnosis and recovery times for issues with our mission-critical systems. We created a knowledge base for building and quickly disseminating technical expertise to our entire support staff. We used an open source, wiki-based, collaborative authoring system internally within our IT department to improve our ability to deliver a high level of service to our customers. In this paper, we describe our evaluation of the wiki and the ways in which we used it to organize our support knowledge. We found the wiki to be an effective tool for knowledge management and for improving our ability to provide mission-critical support for health care IT systems.
Clinical and contextual information associated with images may influence how radiologists draw diagnostic inferences, highlighting the need to control multiple sources of bias in the methodologic design of investigations involving radiologic interpretation. In the past, manual control methods to mask review films presented in practice have been used to reduce potential interpretive bias associated with differences between viewing images for patient care and reviewing images for the purposes of research, education, and quality improvement. These manual precedents from the film era raise the question whether similar methods to reduce bias can be implemented in the modern digital environment.
The Certification for Imaging Informatics Professionals (CIIP) program is sponsored by the Society of Imaging Informatics in Medicine and the American Registry of Radiologic Technologists through the American Board of Imaging Informatics. In 2005, a survey was conducted of radiologists, technologists, information technology specialists, corporate information officers, and radiology administrators to identify the competencies and skill set that would define a successful PACS administrator. The CIIP examination was created in 2007 in response to the need for an objective way to test for such competencies, and there have been 767 professionals who have been certified through this program to date. The validity of the psychometric integrity of the examination has been previously established. In order to further understand the impact and future direction of the CIIP certification on diplomats, a survey was conducted in 2010. This paper will discuss the results of the survey.
The digital imaging and communications in medicine (DICOM) 3.0 standard was first officially ratified by the national electrical manufacturers association in 1993. The success of the DICOM open standard cannot be overstated in its ability to enable an explosion of innovation in the best of breed picture archiving and communication systems (PACS) industry. At the heart of the success of allowing interoperability between disparate systems have been three fundamental DICOM operations: C-MOVE, C-FIND, and C-STORE. DICOM C-MOVE oversees the transfer of DICOM Objects between two systems using C-STORE. DICOM C-FIND negotiates the ability to discover DICOM objects on another node. This paper will discuss the efforts within the DICOM standard to adapt this core functionality to Internet standards. These newer DICOM standards look to address the next generation of PACS challenges including highly distributed mobile acquisition systems and viewing platforms.
Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064-1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.
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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.
Video X seems to be unrelated to Abstract Y...
In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.