Ian P. Murphy

CHICAGO - Social media outlets such as Facebook, Twitter and LinkedIn have grown to be incredibly influential in business and personal lives, but are they really the place to be for diagnostic imaging practices?

A vast majority of practices say “yes.” During an interactive session at RSNA 2013, nine out of 10 (91.7 percent) participants agreed practices should have a presence on social media. And with that involvement could come criticism.

The chatter generated on the social media can have “more impact on your practice’s reputation than your best marketing efforts,” said speaker Abraham Seidmann, PhD, a professor at the University of Rochester’s Simon School of Business in Rochester, NY. “Eighty-two percent of patients say that online reviews affect their decision to visit a doctor. Why do they rank us? Sometimes because they’re happy and sometimes because they’re not. You have to monitor your comments from the outset.”

With its “Like” and comment functions, Facebook has become a key platform for reviewing medical providers, alongside general ratings sites such as Yelp! and healthcare-focused resources such as ZocDoc. “Many patients already use social media to share and rate their experiences with healthcare,” Seidmann said. “Public ratings have become important differentiators among healthcare organizations and providers.”

And while the power of a review declines as it ages, 91.8 percent of attendees agreed that negative reviews have much more impact than positive ones.

In many cases, Seidmann said, social media corrects what might be considered failures in the offline world. For instance, social media makes what otherwise might be challenging tasks such as keeping up with old friends, networking and looking for work simple. “Say you want another job,” Seidmann said. “One alternative is that you come to RSNA and give out your business card, and your boss asks you about it later. The other alternative is LinkedIn.”

A company can take one of two digital strategies on an outlet like Facebook, Seidmann said. It can set up a static company or “brand” page that potential customers can seek out. But, he noted, few people wake up and say, “What a great day! I think I’ll look for a good radiologist.” The other alternative is social strategy that uses a platform such as Facebook Connect to improve existing relationships and build new ones.

Once a presence is established, new analytical software technologies can identify positive and negative reviews from common keywords to determine how one’s reputation stacks up, and as established leaders in records management and diagnostic software use, radiologists are well-positioned to take advantage of such technologies. “We can and should use big data and social media at our healthcare organizations to better serve our rapidly growing, global patient population,” Seidmann said.

“Can online comments predict patient satisfaction?” he asked. “Yes. One big-name physician got bad reviews for his bedside manner and had to leave his practice. It’s not the outcome - it’s how a patient 

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CHICAGO - Radiology practices should establish a presence on sites like Facebook, LinkedIn and Twitter. Here’s why.

Social Media Matters for Radiologists

CHICAGO - MRI is recognized by doctors as one of the most significant developments ever to occur in healthcare, and now, three technologies are improving or set to improve its effectiveness and ease-of-use.

PET/MR systems are already the market or in development from Siemens, Phillips and GE, and the units are helping produce shorter examinations and better-synced scans. “The two technologies are very complementary,” said David A. Bluemke, MD, PhD, and director of Radiology and Imaging Sciences at the National Institutes of Health Clinical Care, speaking at RSNA 2013. “MRI excels at structural anatomy, and PET is good on the cellular level.”

PET/MR scans have the edge over CT scans in minimizing radiation exposures in patients needing multiple tests, and can produce a full-body scan in about 20 minutes with fewer shifts in patient position. PET/MR scans are particularly effective in spotting neuroendocrine tumors and bone lesions, Bluemke said, and in testing, PET/MR scans produced better imaging in 24 out of 134 instances, while a PET/CT combination was superior in just two. “The sensitivity is comparable to the current state of the art,” he said.

MR Elastography (MRE) follows the same principles as palpation to test the mechanical properties of tissue in conjunction with conventional MR, using an acoustic driver to generate vibrations that are imaged in color by a special MRI pulse sequence. The technology is particularly effective in identifying hepatic fibrosis and determining the severity of meningiomas in the brain, and is less invasive than a biopsy. “It’s an excellent tool for diagnosing liver disease,” said Richard L. Ehman, M.D., Professor of Radiology at the Mayo Medical School in Rochester, Minn. “Fibrosis can be reversed if diagnosed early and treated.”

While MRI’s capabilities are almost limitless, the machines tend to be loud, and that noise often adds to patient anxiety. With the continuous chirp of the cryocooler and the rattling clunks of magnetic field gradients switching on and off, a typical MRI scan can be in the 95 to 115 dB range. “People have reported transient hearing loss, just like going to a rock concert,” said Frank R. Korosec, PhD, director of Research Resources in the Department of Radiology at the University of Wisconsin.

The days of earplugs and headphones may soon be over, he said, as companies introduce “silent MR” systems that use software to reduce noise levels. A new parallel imaging strategy can bring an MRI’s sound down to about 70 dB, while radial sampling techniques can cut machine noise by about 30 dB. The bonuses? Improved patient comfort and communication; soon, machines may be quiet enough to scan sleeping children, Korosec said.

CHICAGO - Three advancements in MR technology - PET/MR, MR elastography and so-called silent MR - are improving the modality’s effectiveness and ease-of-use.

New MR Technologies Offer Better, Quieter Scans

CHICAGO - As many as 90 percent of radiologists are eligible for financial incentives provided by CMS for the adoption and meaningful use of certified EHR technologies, and some radiology practices have already qualified for incentives, say experts speaking this week at RSNA 2013.

“Some practices are in Stage 1, and others are transitioning into Stage 2,” said Alberto F. Goldszal, PhD, director of Medical Informatics for the University of Pennsylvania Health System’s Department of Radiology.

Yet, others are taking a wait-and-see strategy, opting out of the program until larger systems can establish qualified patient informatics systems they can adopt without an often substantial administrative burden. Transitioning to “robust” EHR systems, it is hoped, will streamline information exchange, thereby enhancing diagnosis speed and improving care coordination across a spectrum of practitioners.

Each stage of the program takes about two years to complete once a practice opts in. In Stage 1, the goal is to collect patient data in 24 areas including information on demographics, medications, allergies, and smoking status. Stage 2 asks practices to introduce additional data points and quality measures, and Stage 3 will attempt to use all information collected to improve clinical outcomes. Goldszal, for example, has shepherded his system through Stage 1 certification and is well on the way to Stage 2.

Up to 10 percent of those attempting to qualify will be audited, Goldszal said; based on his own experience, an audit can take about five months and involve multiple requests for information.

“The initial request asked for a core measures dashboard and proof of CEHRT [Certified Electronic Health Record Technology],” he said. “On the second request, the audit board wanted more information on records, risk analysis, patient lists and the immunization registry. Once that was justified, they asked for a third round of information.”

Primary care practices are likely better equipped to handle the administrative burden, admitted Alan D. Kaye, MD, chairman of the Department of Radiology at Bridgeport (Conn.) Hospital and president and CEO of Advanced Radiology Consultants in Shelton, Conn., but radiology practices should “get on this bus” as soon as possible regardless. “Radiology should lead the way in EHR,” he said. “We’re an IT business. We want good information. We made it an organizational imperative, [and] the incentives gave us capital to pursue other projects.”

Having launched into its first year of data acquisition on the way to Phase 1 certification, Phoenix, Ariz.-based Southwest Diagnostic Imaging has found qualifying for incentives to be anything but smooth sailing, said James Whitfill, MD, c

. The program’s “definition of patient encounters is murky” for radiologists who don’t see patients face-to-face on a regular basis, he said, and “these programs are fairly expensive to implement and maintain. I share Albert’s concern that the ongoing costs are going to become non-trivial.”

Seeing these challenges, practices such as Advanced Medical Imaging Consultants in Fort Collins, Colo., have chosen the program’s “hardship option,” which allows up to five years to implement a qualifying EHR strategy before penalties kick in. “When we assessed this, we felt that we would have to have our own compliant EHR, and it would have to interface to a large variety of other systems over which we have no control,” said J. Raymond Geis, MD, a radiologist with the firm. “We’re going to wait and watch for better software.”  

Geis’ hope is that the two large hospital systems in the area will adopt a system, and the clinic can “piggyback” off the information they collect for most patients. “That’s going to make our lives easier.”

CHICAGO - While some radiology groups are embracing meaningful use, others are taking a wait-and-see approach or opting for the exemption.

Some Radiologists Embrace Meaningful Use, Others Wait

CHICAGO - Change is the only constant, as the old saying goes, and nowhere is that more true than in healthcare. But instead of resisting change, said speakers appearing in a Tuesday session at RSNA 2013, practitioners should anticipate and promote change with an eye toward organizational culture.

“The pace of change in our society is quickening,” said N. Reed Dunnick, MD, president-elect of RSNA and chairman of the Department of Radiology at the University of Michigan Health System in Ann Arbor, Mich. “This is true not only for imaging technology, but also for the entire healthcare industry and the regulations that govern our behavior. If our field is going to respond effectively to these challenges, we must understand the cultures of our professional organizations to enable them to better implement the needed responses.”

Healthcare in the United States is seen as too expensive for the quality it delivers, Dunnick said, and market-based healthcare reforms are forcing radiologists to make their practices more efficient, patient-focused and results-oriented. Diagnostic imaging will likely no longer be a 9-to-5-job, and the culture - that shared set of attitudes, values, goals and practices - of many organizations will need to evolve to meet new demands.

Success breeds complacency, added Michael N. Brant-Zawadzki, MD, executive medical director of Neurosciences at Hoag Memorial Hospital in Newport Beach, Calif.., and while diagnostic imaging technologies have been incredibly successful, they are one reason that healthcare costs are so high in the United States. As a result, cost has become the dominant message, not their effectiveness in supporting healthcare.

 you do, they buy why you do it,” Brant-Zawadzki said. “We have to articulate the ‘why’ of the process, and the ‘why’ is that we are at the core of the emerging healthcare system. Our information is critical to diagnosis, triage and decision support. We provide better value for the dollar. We can help patients decide whether they go further down the patient-care road or not.”

Without cultural change, however, organizational efforts to improve quality, add value or restructure will fail. “It’s really the culture that has to change for these tools to work,” Dunnick said. “Is the culture consistent with the strategic plan? If not, you must move the culture or rewrite the plan.”

To build support, leaders must empower people by sharing the timeframes, measurements and metrics for the changes ahead. “As leaders, we must walk the talk,” Dunnick said. “Recognize that people will be anxious about change, seek input, develop a plan and communicate that plan clearly.”

Organizations that plan for change can exercise more control over it. “We have to have a systematic method for change,” said William T. Thorwarth Jr., MD, principal of Catawba Radiological Associates in Hickory, N.C. “The first steps are a vision and a mission statement. A mission statement is a guiding light and filter for strategic planning, [and] a living document. It cannot sit on a shelf or in a closet.”

Get buy-in from colleagues on the plan and its revisions. Understand who your allies and adversaries are in effecting change, and monitor the plan at every stage from the drawing board to post-implementation review. “Surprises are unavoidable, but they are inversely proportional to planning,” Thorwath said. “If we keep the patient the primary focus of what we do, we will stand in good stead.”

CHICAGO - The healthcare landscape is constantly changing, and radiologists should anticipate and promote change with an eye toward organizational culture.

Ian P. Murphy

Articles

Social Media Matters for Radiologists

New MR Technologies Offer Better, Quieter Scans

Some Radiologists Embrace Meaningful Use, Others Wait

How Radiologists Can Manage Change