“In America, we have 11 minutes to see a patient, and, you know, you’re going to be empathetic, make eye contact, enter about 100 pieces of data, and never commit malpractice. It’s not possible!”
Beth Israel Deaconess Medical Center chief information officer, John Halamka, lamenting EHRs’ impact on medicine.
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EHR and The Damage Done
Kaiser Health News and Fortune magazine spent three months investigating the state of electronic health records across the US, producing a long list of scary stories in support of their findings that EHRs have fallen far short of what many first envisioned. In fact, the article suggests that EHR companies have been the only clear beneficiaries from the last decade’s digital health boom that saw private hospital adoption rates go from 9% in 2008 to 96% today. The article lists most of the common EHR issues (poor design and implementation, low interoperability, difficult patient access, and physician burnout), but the investigation also revealed thousands of serious injuries and deaths tied to software bugs and user errors that have gone largely unseen due to EHR vendors’ reported “shield of silence.” Kaiser and Fortune weren’t really looking for a bad guy in this article, even noting the good intentions and solid logic behind the US’ initial digital healthcare push and the disappointment among the leaders who made it happen (including Obama). Unfortunately the article doesn’t show any evidence that an EHR hero is on the way to fix this mess any time soon.
NVIDIA’s Clara platform took a key step forward this week with the release of the Clara AI toolkit, transforming Clara from a platform used by (largely expert) imaging AI developers into a platform that has the potential to expand AI development and adoption further across the imaging industry. The Clara AI toolkit is highlighted by its 13 pre-trained classification and segmentation algorithms that healthcare players can use to build, train, and share their own models. Clara AI also launches with an assisted annotation feature (reduces annotation labor during structured dataset creation) and adds new transfer learning capabilities (adapts existing models to fit local variables like demographics and devices), both of which address major AI adoption barriers. Of course AI adoption is the name of the game for NVIDIA, which has arguably done more than any company from the supply-side of radiology tech to drive demand for artificial intelligence (and drive demand for its GPUs). With its new AI toolkit, NVIDIA has a chance to push imaging AI even further along the adoption curve.
Is DM+US Screening Valuable?
A new JAMA Internal Medicine-published study cast some serious doubt on the benefits of supplemental breast ultrasound screening. The study compared same-day mammography plus breast ultrasound screenings (n=6,181, 74.3% with dense breasts) with mammography-only screenings (n=30,062, 35.9% with dense breasts), finding similar sensitivity (78.6% vs. 73.8%) and specificity (94.8% vs. 97.7%) between the two methods. However, the DM+US screening group had over 2-times higher biopsy recommendation rates (57.4 vs. 27.7) and false positive rates (52 vs. 22.2) per 1k screenings, with nearly identical cancer detection rates (5.4 vs. 5.5). These findings are certainly noteworthy given the growing support for breast ultrasound and the rising pressure to supplement mammography for women with dense breasts. Many in breast health will surely maintain their support for supplemental breast ultrasound, but at the very least, this study serves as a call for providers to reevaluate their supplemental screening practices.
AI’s Fear, Hype, Hope, and Reality
Nuance Communications’ Chief Medical Officer, Woojin Kim, MD, took to Radiology Today to add some perspective on the wide range of opinions and emotions swirling around imaging AI and share his take on AI’s present needs and emerging benefits.
Despite radiologists’ long history of adapting to technological innovations, Dr. Kim rightly noted that some radiologists have developed a “fear” of being displaced by machines, exacerbated by ongoing “better/faster than radiologists” news headlines and alarming predictions about the security of the radiology career path. Most Imaging Wire readers should already be well versed about the fear swirling around AI, but the article actually places the industry right at the peak of AI’s “hype” phase, which is bringing increased attention and funding to AI, but risks delayed progress when results don’t match inflated expectations. Kim suggests that those in AI’s respective “fear” and “hype” crowds would adopt a more balanced viewpoint if they fully understood the challenges that still exist in developing and deploying healthcare AI solutions, the current specialization of today’s largely “narrow AI” solutions (modality and application-specific), and the irreplaceable role that radiologists play in healthcare.
Looking forward, Dr. Kim believes that the radiology community would benefit from remaining “focused on the most effective ways to deliver specific and demonstrable clinical, business, and practical value” and provides a list of examples of how imaging AI is already doing this, to the benefit of both radiologists and their patients. This is important, as Kim’s “reality” calls upon the people of radiology to “model how AI will be deployed in the wider health care system” and serve as guides to developers and clinicians in an effort to drive the advancement of AI. There’s a lot of work to do in order to achieve AI’s potential, but the article makes a clear argument that these advancements are necessary.
- New research from the UK finds that DBT has much lower breast biopsy rates than digital mammography, while achieving the same level of cancer detection. The study looked at 30,933 women who underwent FFDM or breast MRI screening, with 1,470 later recalled and screened with DBT in their follow-up exams. The researchers reviewed the DBT and FFDM exams from 827 of the women, finding that DBT would have resulted in far fewer biopsies (298 vs. 571), while detecting all of the same cancers tumors (142).
- The FDA is planning to reorganize the Center for Devices and Radiological Health (CDRH) over the next six months, combining its three main offices (premarket review, postmarket surveillance, compliance) into a new “super office” that will be known as the Office of Product Evaluation and Quality (OPEQ). The FDA believes that the new “super office” structure, staffed with teams that will focus on specific product lines throughout their lifecycle (rather than handing-off products at each phase), will improve product knowledge and overall efficiency.
- Less than two weeks after Philips acquired Carestream’s health IT division, a Reaction Data survey reveals (n=212) that most radiology department professionals have neutral-to-positive opinions about the acquisition. Only 10% of respondents believed the merger would have a negative market impact (49% positive, 41% neutral), although competing imaging players may have different opinions. More importantly to Philips, a decent 56% of respondents who already use either Philips or Carestream PACS/IE solutions were more likely to remain a client following the acquisition (33% neutral, 11% more likely to leave), while 37% of respondents who don’t yet work with the companies are now more likely to do business with them (36% neutral, 27% less likely to buy). However, considering only 49% percent of the respondents were actually aware of the acquisition before contributing to the survey, these early opinions may not be all that well thought out yet.
- A Mass General Hospital research team found that usage (~1%) and public awareness (~16%) of CT colonography remain very low, despite increased CTC insurance coverage and continued increases in optical colonoscopy utilization. The study explored National Health Interview Survey data from 2010 and 2015 (n= 8,965 in 2010, 12,721 in 2015, ages 50-75), finding that CTC utilization fell from 1.2% to 0.9% and awareness declined from 20.5% to 15.9%.
- Major outpatient medical imaging provider, Center for Diagnostic Imaging (CDI – 122 centers, 2,200 employees, 22 states) was acquired by private equity firm, Wellspring Capital Management. Statements in the announcement were clearly focused on the growth opportunities that Wellspring’s funding will provide CDA, suggesting that this acquisition may create even more consolidation pressure in the imaging center segment.
- A team of German researchers found that non-contrast MRI may be effective for monitoring the progression of multiple sclerosis, while reducing scan times and costs and avoiding Gadolinium deposits. Leveraging a new image subtraction pipeline technique that they developed, combined with 3D non-contrast MRI, the researchers monitored 359 MS patients, missing only four out of 1,992 new or enlarged lesions in over 500 follow-up scans.
- Australian patients’ medical imaging costs are set to drop significantly following the Aussie government’s decision to increase Medicare (Australia’s public health care system) rebates for most ultrasound and diagnostic radiology services to about 90% of the total bill. The increased rebates will phase in over a three-year period starting in July 2020, eventually increasing the cost to the Australian government to $200 million.
- Mobile imaging service provider National Mobile X-Ray (NMXR) announced its acquisition of North Carolina-based MMDS Mobile X-Ray, revealing plans to use the deal to expand throughout the southeastern US. Both companies provide onsite imaging services (mobile X-ray, ultrasound, EKG) to skilled nursing facilities, while NMXR appears to have a more advanced operation, leveraging a homegrown platform to partner with independent providers across the US and support clients with locations in multiple regions.
- A new 1,000-physician American Medical Association survey placed its targets on prior authorization (PA) requirements, with 86% of physicians reporting an increase in PA requirements over the last five years and 69% responding that it’s difficult to determine whether a prescription or service (like imaging) requires PA. The paper called for improved PA-related transparency and efficiency, but the group would certainly be open to a reduction in PAs given their operational and revenue impact on healthcare providers.
- PACS and RIS company, Emergent Connect, announced its acquisition of radiology billing and scheduling solutions company, TouchstoneNet. The acquisition should expand Emergent Connect’s end-to-end capabilities in addition to its customer base, although TouchstoneNet’s very low online presence suggests that its business was quite small.
- Johns Hopkins Kimmel Cancer Center researchers identified a PET/CT scan biomarker that may predict whether patients with breast cancer could be treated with standalone HER2-targeted agents and not chemotherapy. The potential precision medicine advancement came as a result of a study that looked at 83 women with stage II or III estrogen receptor (ER)-negative, HER2-positive breast cancer, using radiotracers to detect sugar uptake in cancer cells before and two weeks after HER2-targeted therapy and predicting whether the treatment would be effective without chemo.
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- Bellin Health Titletown Sports Medicine & Orthopedics of Green Bay, Wisconsin (located right next to Lambeau Field) became the latest orthopedic practice to install Carestream’s OnSight 3D Extremity System, specifically highlighting the cone beam CT’s image quality and performance during weight-bearing exams.
- This Focus Ultrasound Foundation blog post from ultrasound pioneer, Narendra Sanghvi, looks back on the modest beginnings and early development of focused ultrasound.
- POCUS Systems is approved as a Veteran Owned Business with the US Government Office of Veterans Business Development, paving the way for partnerships with the federal healthcare delivery systems.
- This Medmo video details how its healthcare marketplace platform and network of participating radiologists help underinsured patients pay as little as possible for their imaging procedures.