Blockchain Reality Check | Imaging Nudged in Half | Noritsu’s Service Play

“Like desert wanders searching for an oasis, blockchain proponents see opportunity at every turn, only to have hopes dashed by another mirage when a brave enterprise discovers that pilot results don’t match their lofty expectations.”

diginomica.com’s Kurt Marko with some reasons to temper expectations for blockchain’s potential healthcare impact.


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The Imaging Wire


Blockchain Reality Check

In healthcare media it’s a safe bet that a run of ‘next big thing’ articles about an emerging technology will be quickly followed by a hypebuster article. diginomica.com gave healthcare blockchain the opportunity to complete its own hype-to-hypebuster cycle last week, detailing blockchain’s barriers and the technology’s uncertain path towards disrupting healthcare. Here are diginomica.com’s arguments:

  • Sizzle over Substance – Across all industries, blockchain has been heralded as a disruptor but has not delivered significant, business-changing implementations.
  • Healthcare is Different, right? – Healthcare data management and monetization might make better use of blockchain than other industries given healthcare’s need to transfer data and maintain patient privacy. Blockchain might not be able to support both of these needs on its own, but it could serve as the foundation (or part of the foundation) of a healthcare data marketplace that would allow patients to control third-party access to data records.
  • A Hybrid Approach – Given the wide variety of healthcare data formats, a hybrid system that stores data in a conventional or a distributed database but stores hashes of the data in the blockchain could be a solution.
  • Not User Friendly – The patient access benefits of blockchain are undermined by the fact that many older or sick patients are not tech savvy enough to manage the cryptographic keys to their health records.
  • Light on Evidence – Despite big predictions and major interest around healthcare blockchain, there’s still limited specifics about where and how it would be used or whether it would truly be better than conventional methods.



Unnecessary Imaging Nudged in Half

A study from Mount Sinai and the University of Pennsylvania Health System found that adding a default order (aka a “nudge”) to UPenn’s EHR cut unnecessary daily imaging before palliative radiation therapy in half. Here’s how it worked:

  • The Study – Between 2016 and 2018, five Penn Medicine radiation oncology practices performed palliative radiotherapy on 1,019 patients with advanced cancers (1,188 RT sessions), during which time a default EHR imaging order was added to instruct clinicians not to perform daily imaging for palliative radiotherapy.
  • Imaging Halved – UPenn’s five radiation oncology centers used daily imaging before palliative care 68% of the time before implementing the EHR “nudge” and reduced its daily imaging rate to 32% after implementation. Even though palliative RT only requires weekly imaging, clinicians were using daily imaging “almost reflexively” due to the fact that it’s still required for curative RT, making this nudge particularly effective.
  • Potential Impact – Similar nudges could have a major impact, noting that about 250k patients with advanced cancer receive palliative radiation therapy each year and there are surely other providers with similar daily imaging “reflexes.”

As one study author put it, “cutting down on lower value health care is a hard nut to crack,” and this study revealed that an EHR nudge might be a useful way to reduce unnecessary imaging’s role in lower value healthcare.



More AR for IR Evidence

A New York Presbyterian Hospital team developed an augmented reality-based image-guidance technique to support transcatheter procedures for structural heart disease that may provide a number of advantages over standard fluoroscopy (known for low contrast and lack of depth perception). Here’s what they did:

  • Real-Time 3D Positioning – Combining a 3D heart rendering produced from a preoperative CT scan with two fluoroscopic images taken at different angles, the system produces a 3D visual environment and catheter positioning feedback that’s visible in an AR device (in this case a HoloLens) and controllable using voice commands.
  • Results – The team registered 35 pairs of fluoroscopic images and projectional CT images, achieving improvements in registration success rate (100% vs. 85.7-91.4%), registration accuracy (0.42 mm vs. 0.88 average error), and computational time (1.228 seconds vs. 1.413-1.447), while separately placing a catheter an average of 0.298 mm away from their target entry point (under 5 mm is considered safe).
  • IR Benefits – The team claims that the new AR image-guidance system gives interventionalists better visualization and can help them understand complicated cases, while also supporting training.

This study adds to AR’s momentum in interventional and image-guided areas of radiology, following a number of encouraging studies, papers, and AR product launches that took place over the last year.



Noritsu’s Imaging Service Play

Here’s an interesting story that’s remained largely unnoticed over the last few months. Major photo printing company, Noritsu America Corporation, acquired Atlanta-based radiography products and services company, R & F Imaging in mid-May. Noritsu plans to expand R & F Imaging’s operations nationwide by combining Noritsu’s existing service technician workforce and national footprint with R&F Imaging’s industry and technical knowledge.

  • Although it was unexpected, this isn’t a totally new exercise for Noritsu, as the company similarly leveraged its service unit to expand to a number of adjacent markets over the last 15 years (dental/medical optical devices, cameras and projectors, and security screening systems).
  • Noritsu appears to be targeting geographically distributed hospitals and imaging providers currently supported by regional service companies, suggesting that its national service footprint and ability to provide multi-site support will give it an advantage.
  • R & F Imaging’s leadership will remain onboard (at least for now), helping to guide this expansion.

The Wire

  • A team from the University of Maryland Medical Center added more evidence that concerns of high of out-of-pocket costs cause many patients to decline DBT screening (most states do not mandate DBT coverage). After informing patients at the researchers’ urban breast center about DBT’s benefits and potential out-of-pocket charges, a patient survey found that costs were the main reason for declining DBT (4.68 out of 5) but patients would generally accept DBT screening if there were no extra costs (4.35 out of 5). Other factors that may cause patients to decline DBT (radiation risk, tech anxiety, discomfort, misunderstood benefits) had much lower average scores (1.53 to 1.72 out of 5).
  • Fujifilm Medical Systems U.S.A. relocated its headquarters to Lexington, Massachusetts from Stamford, Connecticut, bringing the management of the company’s various groups and product lines (CT, DR, women’s health, endoscopy, minimally invasive surgery, and medical IT) to the same location for the first time. Fujifilm suggested that combining its various groups will help drive innovation and expand its position in the healthcare industry. The move further builds the Boston area’s role as a healthcare hub, as it is also home to numerous biotech/pharma and AI firms, research and academic centers, and major imaging players (Philips, IBM Watson Health, Hologic, Nuance, Analogic, Samsung Neurologica).
  • Strategic Radiology added Radiology Associates of Tallahassee to its consortium of independent radiology practices, adding the 20-radiologist practice to a group that now includes 28 private practices and over 1,170 radiologists. Radiology Associates of Tallahassee joins Orlando’s Medical Center Radiology Group as the second Strategic Radiology member group in Florida.
  • Siemens Healthineers, University of Missouri System, and University of Missouri Health Care announced an alliance focusing on healthcare delivery, education and workforce development, innovation, and research and collaboration. During the 10-year and $133 million value partnership, Siemens Healthineers will provide the UM System and MU Health Care with equipment (including a 7T MRI), digital health solutions, and educational and training resources, while the UM System will collaborate with Siemens Healthineers on joint innovation research projects and in developing educational programs.
  • The United States Trade Representative added a number of imaging-related items to its list of products that are excluded from the 25% tariffs on Chinese imports including a dental X-ray alignment and positioning apparatus (no. 9022.90.6000), multi-leaf collimators of X-ray radiotherapy systems (no. 9022.90.6000), an overhead tube suspension used to hold and position X-ray generating equipment (no. 9022.90.6000), and a veterinary ultrasound device with black-and-white image quality (no. 9018.12.0000). The tariffs launched last year with the understanding that medical devices can later be removed from the tariffs list when they qualify for exemptions, so this is a decent sign, although plenty of other items have yet to make it through the exemption process.

The Resource Wire

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