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 facility management focus page provides information, videos, podcasts, and the latest news about workflow optimization, artificial intelligence, technology, radiology-radiologic technologist relationships, productivity, legislation, and reimbursement.

Earlier this month, on April 5, the Office of the National Coordinator enacted its information-blocking rules designed to facilitate sharing of health data and images with patients. However, a recent survey conducted by interoperability company Life Image revealed that most facilities are not yet in compliance, opening themselves up to penalties of up to $1 million.

Compliance, however, is critical to improved patient care, particularly during the lingering pandemic. 

 spoke with Life Image President and CEO Matthew Michela about the role these rules play in healthcare and strategies facilities can use to come into compliance. 

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

Matthew Michela, President and CEO of Life Image, discusses ONC information-blocking rules and strategies practices can take to ensure compliance.

The Reading Room: Information-Blocking and Interoperability Compliance

Artificial intelligence has been a mainstay of the Radiological Society of North America (RSNA) annual meeting for nearly a decade. Each year brings new developments, reveals new capabilities and algorithms, and furthers the conversation about how these tools can help radiologists provide care.

This year, the conversation began to turn to what steps could come next for AI. Conversations about deployment, consolidation, and U.S. Food & Drug Administration clearance are now the norm as the technology becomes less of a novelty and more of a mainstay.

 speaks with Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, about her reaction to what this year’s conference offered about these tools and what she sees on the horizon in 2021.

RSNA

Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, discusses, during RSNA 2020, what new developments the annual meeting provided about these technologies, sessions to access, and what to expect in the coming year.

The Reading Room: Artificial Intelligence: What RSNA 2020 Offered, and What 2021 Could Bring

Work has been ongoing for years to decrease the presence and impact of disparities throughout healthcare, including in radiology. But, problems still exist, and there are new challenges on the horizon that could make it more difficult for radiologists to make it easier for patients to get the imaging services they need.

During this year's Radiological Society of North America (RSNA) annual meeting, Richard Heller, M.D., associate chief medical officer and national director of pediatric radiology with Radiology Partners, and Lucy Spalluto, M.D., associate professor of radiology and radiological sciences at Vanderbilt University School of Medicine, participated in a session dedicated to addressing the continued existence of health disparities. 

 about the underlying factors that result in healthcare disparities, as well as the challenges providers and facilities face to improving access to care.

Rich Heller, M.D., with Radiology Partners, and Lucy Spalluto, M.D., with Vanderbilt University School of Medicine, discuss the highlights of their RSNA 2020 session on health disparities, focusing on the underlying factors and challenges radiologists face to providing greater access to care.

RSNA 2020: Addressing Healthcare Disparities and Access to Care

This is Episode 2 of The Reading Room, the Diagnostic Imaging podcast. To subscribe, click 

According to Matthew Michela, president and chief executive officer of medical image exchange company Life Image, the continued spread of COVID-19 has revealed to many radiology departments the importance of digital image exchange. Those that have not viewed it as a critical priority are nervous about the impact of handling physical media over the long term.

Michela, a 30-year healthcare industry veteran, joins 

 to discuss how data can improve our understanding of COVID-19, what we have learned from the pandemic, and what best practices facilities can implement to bolster their interoperability and accessibility. 

Matthew Michela, president and chief executive officer of Life Image, discusses the role of data interoperability and accessibility during the pandemic. 

The Reading Room: Data Interoperability's Role in the Pandemic

Rogue MDs is a group of health care professionals who enlighten and entertain by discussing issues relevant to today’s health care landscape.

In early December, President Barack Obama’s throat had already been sore for several weeks. His unscheduled visit to Walter Reed National Military Medical Center quickly made breaking news, and White House staffers “were kept up to speed” on the President’s condition, according to 

. After an ear, nose, and throat specialist conducted a fiber optic exam, which revealed soft tissue swelling in the posterior throat, a CT scan was ordered.

The CT scan was normal; President Obama was experiencing acid reflux.

So let’s talk about quality of care and appropriate use of imaging.

In this episode, our “Rogue MDs” discuss “Obamascan” and its implications for how imaging is used.  

Meet this episode’s Rogue MDs:[[{"type":"media","view_mode":"media_crop","fid":"34494","attributes":{"alt":"Saurabh Jha, MD, MS","class":"media-image media-image-right","id":"media_crop_4216929555348","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3669","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 134px; width: 100px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Saurabh Jha, MD, MS","typeof":"foaf:Image"}}]]

Saurabh Jha, MD, MS, is an academic radiologist who believes there are no solutions, only trade-offs. Follow him on Twitter @RogueRad

Stephen Hunt, MD, PhD is an interventional radiologist who believes that innovation can solve anything. Follow him on Twitter @MD_Rogue

Disclaimer:
The opinions expressed are those of the speakers and are not the opinions of their employers or spouses, particularly not their spouses.

[PODCAST] Obama's sore throat and CT scan and what it means for imaging utilization. 

Fifth Column: Obamascan

The radiology department at Hackensack University Medical Center has always been committed to patient safety and quality of care. But now they have a unique distinction to prove it.

The Bergen County, NJ, facility was recently recognized by the American College of Radiology as one of the first two 

This distinction, also awarded to the Mount Desert Island Hospital in Bar Harbor, Maine, shows the medical center went above and beyond accreditation, proving high quality in areas such as personnel, equipment specifications, outcomes measurement and quality control systems, safety policies, utilization reviews, facility management and patient outcomes. The center was also evaluated in service, availability of imaging and radiologists, and image interpretation and quality.

[[{"type":"media","view_mode":"media_crop","fid":"14193","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9222787725802","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"708","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px;","title":"Harry Agress Jr., MD, FACR","typeof":"foaf:Image"}}]]“By being so stringent and so specific, it not only speaks to the elements of patient safety and care, but it also goes to the point that we take this job very, very seriously,” said Harry Agress Jr., MD, FACR, chairman emeritus of the Department of Radiology at Hackensack University Medical Center, speaking in a podcast interview with 

. “This says we feel a great deal of responsibility for that.”

Agress and Jason Kreitner, MHA, RT, (R)(T), FACHE, administrator of clinical services at Hackensack, convened a multidisciplinary team to review the ACR standards set in the application. Together, that team tackled each area to ensure they met the requirements, he said. It turned out the medical center was already following most of the standards, and a few areas needed attention.

For example, the team upgraded and formalized many of their policies and procedures, such as those documenting communication with referring physicians. They also clarified some job descriptions, and spent time formalizing their education and marketing of radiation safety to patients and referrers.

Agress noted a few elements that make Hackensack unique, including that they have 24-7 coverage by onsite attending physicians, rather than outsourced radiologists or residents and fellows. That makes the radiology department available for consultation at any time, he said, and allows for faster turnaround times.[[{"type":"media","view_mode":"media_crop","fid":"14194","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1973456998479","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"709","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px;","title":"Jason Kreitner, MHA, RT, (R)(T), FACHE","typeof":"foaf:Image"}}]]

Now, with this Center of Excellence distinction, the facility can show to patients and referring physicians that they are taking that extra step, Agress said. “We are really a high-level imaging center [and] we care a great deal about our patients and the quality of what we are doing.”

The 25-page application can be a bit overwhelming, officials said, but it’s worth the effort. And Kreitner has already received calls from other facilities asking how they achieved this recognition and what the process was like.

“This exemplifies to our patients and physicians in our community that quality is paramount,” he said, “and demonstrates that we made the investment in ensuring we deliver the highest possible care to our patients.”

Hackensack University Medical Center has earned ACR’s distinction as one of the first two Diagnostic Imaging Centers of Excellence. Here’s how they did it.

What It Takes To Be an Imaging Center of Excellence

 [[{"type":"media","view_mode":"media_crop","fid":"11717","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6619228342543","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"206","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: right; border-width: 0px; border-style: solid;","title":" ","typeof":"foaf:Image"}}]]A new California law that went into effect this year requires diagnostic radiologists to include radiation dose levels in all CT reports. The dose reporting is expected to lead to data mining opportunities about radiation exposure and public health.

Many radiology departments and groups have turned to technology solutions to help manage this new requirement. In this podcast, Stacy Johnson, director of the radiology business unit at Presbyterian Intercommunity Hospital in Whittier, Calif., discusses their approach using the Radimetrics solution and the broader impact of the legislation.

Stacy Johnson, of Presbyterian Intercommunity Hospital, discusses the use of technology to meet California’s dose reporting requirement and the law’s impact.

Technology Helping with California Dose Reporting Law

[[{"type":"media","view_mode":"media_crop","fid":"11568","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_1305947500652","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"202","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 0px; float: left;","title":" ","typeof":"foaf:Image"}}]]The 

Academy of Radiology Leadership and Management

, launched last year to provide professional skills to radiology practitioners, has awarded its first two Certificates of Achievement. Lisa Lowe, MD, and Amilcare Gentili, MD, participated in 50 hours of education on topics of growing importance in today’s health care environment.

The academy combines courses from five sponsoring organizations under one umbrella, filling the knowledge gaps in areas of finance, human resources, professionalism, and legal/contracting, among others. The organizations are the Radiological Society of North America, the Association of University Radiologists, American Roentgen Ray Society, the Society of Chairs of Academic Radiology Departments, and the Association of Administrators in Academic Radiology Departments.

For Lowe, those skills became necessary when she took on the role of radiology residency program director at the University of Missouri-Kansas City School of Medicine and department chair. “There’s not really a way to prepare yourself for that kind of thing,” she told 

. “And you don’t know what you don’t know.”

Gentili also found he needed more of these skills - particularly in finances and negotiation - when he assumed his role as section chief of radiology at the San Diego VA Medical Center. “During medical school and fellowship, you don’t learn about the business part of medicine,” he said in an interview. For example, when he prepares his budget or puts together a justification to why he needs new equipment or staff, he relies on these management skills, said Gentili, clinical professor of radiology at University of California San Diego.

In this podcast, Lowe explains why she sought these courses and what skills are critical for today’s radiology leaders.

Lisa Lowe, MD, an Academy of Radiology Leadership and Management grad, discusses the training radiology leaders need in today’s health care environment.

Podcast: Learning Radiology Management Skills

[[{"type":"media","view_mode":"media_crop","fid":"11966","attributes":{"alt":"James V Rawson","class":"media-image media-image-left","id":"media_crop_5322203072981","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"203","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: left; margin: 5px;","title":"","typeof":"foaf:Image"}}]]Radiology is front and center in health care reform. That’s according to James V. Rawson, MD, chair of the Medical College of Georgia radiology department at Georgia Health Sciences University. The growing use of imaging studies, which has leveled off, makes radiology a target - but gives radiologists a chance to be step up as leaders in reform.

Rawson co-edited the recent issue of the 

Journal of the American College of Radiology 

along with Ruth Carlos, MD, an abdominal radiology professor at the University of Michigan. Rawson also wrote an article in the issue on the 

, which he says was a response to chronic unresolved issues in the health care system, including universal health, population demographics, and value.

Rawson chairs the ACR Committee on Governmental and Regulatory Issues on Academic Radiology and served as a member of the CMS Ambulatory Payment Classification Advisory Panel. He’s also a board member of the ACR’s Harvey L. Neiman Health Policy Institute.

• The impacts of reform on the practicing radiologist,
• The ongoing trend of practice mergers and hospital acquisitions,
• What the industry can do to further ensure appropriate use of medical imaging,
• And what the November presidential election will mean for the industry.

James Rawson, MD, discusses health care reform, appropriate imaging utilization, changes in practice structure, and the upcoming presidential election.

Podcast: The Impact of Health Reform on Radiology

[[{"type":"media","view_mode":"media_crop","fid":"11881","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_3550233481514","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"204","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: left;","title":" ","typeof":"foaf:Image"}}]]Reimbursement for radiology services often relies on proof of the medical necessity of the exam, which means radiologists have to document that well to get paid. To do so, radiologists must work with their referring physicians to get the right information – just one of a few challenges with regard to medical necessity. Another hurdle necessary for payment? Obtaining advanced beneficiary notices from patients.

In this podcast, Stacie Buck, RHIA, CCS-P, RCC, CIC, president and senior consultant for RadRx, which provides coding consulting and support services for radiology providers, details the issues around medical necessity.

• Why showing medical necessity for an exam is critical for reimbursement.

• The role of the advanced beneficiary notice as a protection for provider and patient, and why many radiology groups don’t always get that paper signed.

• Developing an effective process for reducing denials.

• How to work with referring physicians to ensure the radiology practice obtains the proper information to document medical necessity.  

Stacie Buck, of RadRx, details the issues around medical necessity and gives guidance for developing a process for reducing denials.

Podcast: Tackling Medical Necessity

Could the principles of operant conditioning reinforce more of a simpatico relationship between radiologists and technologists?

Creating Your Own Radiological Currency to Motivate Union Technologists

A new study shows that GPT-4 may offer comparable error detection rates to those of attendings and radiology residents in reviewing radiology reports, but researchers noted key caveats as well.

Can GPT-4 Improve Accuracy in Radiology Reports?

In an attempt to navigate the imbalance between rising imaging volume and a shortage of radiologists, researchers proposed a variety of measures that may provide additional resources, bolster productivity, and help mitigate burnout.

Can Short-Term Measures Provide Some Relief with the Radiologist Shortage?

The old adage about bad customer service experiences being shared with 10 other people may apply to objectionable hiring practices in radiology as well. 

Three Strikes and You Might Become Famous in Radiology Recruiting

Women comprise nearly 80 percent of breast imaging departments and 45 percent of pediatric radiology departments at academic institutions, but burnout, the COVID-19 pandemic and discrimination have impeded further progress in radiology, according to a recently published literature review.

Female Representation in Radiology: Where Things Stand

Artificial intelligence (AI) is of course one of, if not the hottest topic at this year's 

, but how is all of the hype translating to clinical practice?

As exciting as new technology can be, actually using that technology requires a great deal of effort, especially for larger institutions that are faced with training dozens of radiology staff. 

User education is a key component to adoption and uptake, according to Nina Kottler, MD, MS, associate chief medical officer of clinical artificial intelligence at Radiology Partners. Dr. Kottler spoke with 

 at RSNA 2023, where she reflected on Radiology Partners hitting (and recently surpassing) an impressive milestone: utilizing clinical AI in more than 20 million patient exams. None of that would be possible without purposeful training programs to make sure that radiology end-users are comfortable with the new technology and understand the key benefits of use. 

Dr. Kottler, who is also an associate fellow at Stanford University's Center for Artificial Intelligence in Medicine & Imaging (AIMI), also spoke about what she has observed in terms of the affect that AI is having on radiology workflows. 

Watch the interview below for additional insights on AI. 

Nina Kottler, MD, MS, of Radiology Partners, discusses the importance of user education to improve uptake of AI technology and improve ROI. 

Nina Kottler, MD, MS on AI Adoption in Radiology

Click here for more coverage of RSNA 2023.

Dr. Kottler sat down with Diagnostic Imaging at RSNA 2023 to discuss AI imaging milestones and the potential impact of AI on workflows in radiology. 

Nina Kottler, MD, MS on Adoption and Impact of AI in Radiology

While President Biden’s recently issued executive order on artificial intelligence (AI) emphasizes new standards for the development and use of AI models, Morris Panner has a few reservations and suggests that the executive order may turn out to be “HIPAA for AI” in some respects.

“As well intentioned as HIPAA (Health Insurance Portability and Accountability Act) was, it really shut off a generation of innovation in health care because of what it did to information flow and risk taking in innovation around data,” claimed Panner, the president of Intelerad Medical Systems, in a recent interview.

“I understand why we have HIPAA. We respect HIPAA. We care a lot about patient privacy. But HIPAA was and has continued to be something that most people don’t think really has lived up to its reputation as a portability act. In many ways, the executive order takes some legitimate problems and tries to address them but ends up doing it in a way that will stifle innovation and make it harder for us to take risks at the beginning of the AI innovation cycle.”

How Will President Biden’s New Executive Order on AI Impact Radiology?

Can AI Improve Triage Efficiency in Radiology Workflows for Follow-Up X-Rays?

FDA Clears Emerging AI-Enabled Teleradiology Platform

While the executive order references the bolstering of access to technical resources and assistance for smaller companies seeking to develop AI models, Panner suggests the executive order may lead to “a lot of registration and government examination” that would thwart smaller innovative companies and favor more established companies with larger regulatory capabilities but who are also more risk adverse.

For more insights from Morris Panner, watch the video below.

Morris Panner discusses President Biden's recent Executive Order on artificial intelligence(AI) and its potential impact in radiology.

The Executive Order on AI: Promising Development for Radiology or ‘HIPAA for AI’?

In a recent interview about President Biden’s recent executive order on artificial intelligence (AI), Morris Panner, the president of Intelerad Medical Systems, shared his concerns that the executive order, while well-intentioned, may wind up stifling innovation and the continued evolution of AI in radiology.

The Executive Order on AI: Promising Development in Radiology or 'HIPAA for AI'?

ChatGPT may have considerable potential for streamlining radiology workflows and reporting but concerns over optimal prompt engineering and hallucination effects may curtail the use of the artificial intelligence (AI) chatbot in radiology for the time being.

In recent video interviews. Nina Kottler, M.D., MS, Tessa Cook, M.D., Ph.D, and Sonia Gupta, M.D., discussed the potential capabilities of ChatGPT for radiologists and cautioned about current drawbacks of the technology.

Dr. Kottler suggested that ChatGPT could help remedy the frustration of receiving incomplete patient histories.

“We’ve never (received) great (clinical) histories. That decreases the quality of our output and causes us to hedge a lot,” notes Dr. Kottler, associate chief medical officer of Clinical AI and vice-president of Clinical Operations at Radiology Partners. “ChatGPT could either summarize information from the EMR (electronic medical record) and provide us with that robust patient history or summarize prior reports for us so we get that history and the pathology that we’re finding.”

Another potential benefit of ChatGPT could be converting patient summaries of radiology reports into different languages and possibly expanding access to care, suggested Dr. Gupta, the chief medical officer of Change Healthcare and a board member of the American Board of Artificial Intelligence.

(Editor’s note: For related content, see “

Emerging Insights on Improving Radiology Workflows

Assessing the Value Proposition of AI in Radiology

Emerging Trends with AI in Radiology in 2023

However, Dr. Kottler noted that the quality of the prompt input has a strong effect on the results one gets with ChatGPT. Drs. Cook, Gupta and Kottler all emphasize having appropriate safeguards in place to ensure the accuracy and verifiable referencing of information provided by ChatGPT. While Dr. Cook noted use cases with ChatGPT that have provided a synthesis of literature on a given topic, she said other cases have demonstrated “hallucination effects” in which there has been rewritten history or the “invention of citations that don’t exist.”

“Just because ChatGPT is far more fluent than any other chatbot we might have encountered in the past doesn’t necessarily mean it is not fallible in some way as well,” cautioned Dr. Cook, an associate professor of radiology, and director of the Center for Practice Transformation in Radiology at the Hospital of the University of Pennsylvania.

For more insights from Drs. Cook, Gupta and Kottler, watch the video below.

In recent video interviews, Tessa Cook, MD, PhD, Nina Kottler, MD, MS, and Sonia Gupta, MD shared their insights and perspective on potential benefits and drawbacks of ChatGPT in radiology.

Can ChatGPT Have an Impact in Radiology?

Noting the prevalence of dense breasts in approximately 40 percent of women in the United States, their increased risk for breast cancer and the inconsistency of state laws on breast density notification, Wendie Berg, M.D., Ph.D., said 

implementation of a national standard for breast density notification (to begin on September 10, 2024)

In a recent video interview, Dr. Berg said the patient breast density notification language in the recently issued final rule updates from the Food and Drug Administration (FDA) to the Mammography Quality Standards ACT (MQSA) emphasizes direct communication as to whether a woman has dense breasts or not, touches upon the limitation of mammography for women with dense breasts and encourages supplemental screening in this patient population. With the FDA requiring this language in all mammography reports as of September 10, 2014, Dr. Berg says there will be a level of consistency with breast density notification that has not been there with varying state laws in 38 states and the District of Columbia.

“What this does is establish a bare minimum of communication that is uniform across all states no matter where a woman lives, which is certainly desirable to reduce confusion,” noted Dr. Berg, a co-founder and chief scientific advisor for 

FDA Issues Final Rule on National Breast Density Notification for Mammography Reports

New Meta-Analysis Says MRI is Best Supplemental Imaging for Dense Breasts

What a New Study Reveals About Breast Density Awareness

As patients become more educated on the elevated breast cancer risks with dense breasts and seek out supplemental imaging options, Dr. Berg said the education of referring providers is paramount to help ensure optimal outcomes.

“I think that has been an area where there has been a relative gap,” maintained Dr. Berg, a professor of radiology at the University of Pittsburgh School of Medicine. “It’s never really clear who is taking the time to explain all these issues to patients. I think radiologists actually can serve a primary role in large part in helping to educate. If they don’t educate the patient directly, they can at least educate their referring physicians about the options and issues with risk assessment and breast density.”

In a recent video interview, Wendie Berg, M.D., Ph.D., discussed the newly issued final rule from the Food and Drug Administration (FDA) requiring a national standard for breast density notification (starting on September 10, 2024) as well as its potential impact in mammography reporting and facilitating supplemental screening for patients with dense breasts.



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