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2015: Advances in Health Technology-Osborne


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Advances in Health Technology

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2015: Advances in Health Technology-Osborne

  1. 1. Advances in Health Technology Thomas Osborne, MD UCSD Clinical Geriatrics Interprofessional Symposium October 24, 2015
  2. 2. Page 2 | | 800.737.0610 Introduction & Disclosures
  3. 3. Page 3 | | 800.737.0610 Introduction: Thomas Osborne, MD Director of Medical Informatics vRad Medical School: Dartmouth Medical School Radiology Residency: Harvard Medical School, Mount Auburn Hospital Neuroradiology Fellowship: Harvard Medical School, Massachusetts General Hospital
  4. 4. Page 4 | | 800.737.0610 I work for Virtual Radiologic (vRad) as: • The Director of Medical Informatics • Neuroradiologist Disclosures
  5. 5. Page 5 | | 800.737.0610 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?
  6. 6. Page 6 | | 800.737.0610 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
  7. 7. Page 7 | | 800.737.0610 Medical technology through the lenses of Radiology  & beyond Lecture Outline Wilhelm Röntgen's first "medical" X-ray of 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
  8. 8. Page 8 | | 800.737.0610 Radiology Past
  9. 9. Page 9 | | 800.737.0610 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
  10. 10. Page 10 | | 800.737.0610 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
  11. 11. Page 11 | | 800.737.0610 Radiology Past
  12. 12. Page 12 | | 800.737.0610 Radiology Present Advances marked by Convergence & Interoperability
  13. 13. Page 13 | | 800.737.0610 Theme: Convergence & Interoperability
  14. 14. Page 14 | | 800.737.0610 Interoperability: making systems and organizations work together Convergence: migrate previously distinct systems into a unified platform VS Convergence & Interoperability
  15. 15. Not Interoperability
  16. 16. Also Not Interoperability
  17. 17. Page 17 | | 800.737.0610 Radiology  Teleradiology 1981 - Fuji develops CR technology + + Picture Archiving and Communication System (PACS) convergence of healthcare, technology and telecommunications vRad founded 2001 www
  18. 18. Page 18 | | 800.737.0610 Remote Center Main Hospital PACS Remote Center Rad & Report local area network (LAN) central Rad & Report Remote Center
  19. 19. Page 19 | | 800.737.0610 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
  20. 20. Page 20 | | 800.737.0610
  21. 21. Page 21 | | 800.737.0610 A few examples of leading industry practices Teleradiology Present
  22. 22. Page 22 | | 800.737.0610 Assigner Engine vRad Enterprise Connect – Patented, Rules-Driven Case Assignment 378 378 378 378378 Neuro MSK General Neuro Pediatric ASSIGNMENT RULES 60 23 12 8 3 All Available Radiologists Best Available Radiologists Internet General Subspecialty Facility Preference Current Worklist Depth Remaining Time 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
  23. 23. Page 23 | | 800.737.0610 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
  24. 24. Page 24 | | 800.737.0610 Stroke Protocol Treatment is critical in the first 3 hr after a stroke. The sooner the better: (Time is brain) Clinical History: 78yo facial droop
  25. 25. Page 25 | | 800.737.0610 Stroke Protocol
  26. 26. Page 26 | | 800.737.0610 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 Ivie President/CEO Mercy 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
  27. 27. Page 27 | | 800.737.0610 Treatment is critical in the first “golden hour” after an accident. Clinical History: 88yo fell down stairs Exams:  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
  28. 28. Page 28 | | 800.737.0610 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 neck Body: chest, abdomen and pelvis, thoracic and lumbar spine Lower extremities Upper 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.
  29. 29. Page 29 | | 800.737.0610 Future of Medicine
  30. 30. Page 30 | | 800.737.0610 • 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
  31. 31. 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
  32. 32. Care Professionals Legal Other? Business IT
  33. 33. 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 Information Science Social Science Behavioral Science & Computer Science Care Professionals Business Leadership Management
  34. 34. Page 34 | | 800.737.0610 Corporate Regulatory Critical Document Control Clinical
  35. 35. Page 35 | | 800.737.0610
  36. 36. Page 36 | | 800.737.0610 Search 0:00:00 0:01:26 0:02:53 0:04:19 0:05:46 0:07:12 0:08:38 0:10:05 1 2Pulse (1:05)other (8:41) Results > 8X faster
  37. 37. Page 37 | | 800.737.0610 • Business/Practice • Practice Staff • Clients • Gov/Insurance • Patients Analytics For:
  38. 38. Page 38 | | 800.737.0610 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
  39. 39. Page 39 | | 800.737.0610 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 physician Why? 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
  40. 40. The Future-Is Now Advances mentioned in the prior section will become standard of care practice + Additional early stage trends will accelerate
  41. 41. Future Directions Telemedicine in hospital care
  42. 42. Future Directions Telemedicine pharmacy clinic care
  43. 43. Future Directions Telemedicine at home
  44. 44. Mobile Health Market To Reach $26B By 2017 - InformationWeek
  45. 45. Future Directions Connected Apparel, etc
  46. 46. Accelerators for Future Medical Technology Technology Innovation Insurance/Gov Cost alignment Growing educated & vocal patient population
  47. 47. 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
  48. 48. Thank You