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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.

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

Through AI recognition of subtle patterns in breast tissue on screening mammograms, the Clairity Breast software reportedly provides validated risk scoring for predicting one’s five-year risk of breast cancer.

Mammography AI Platform for Five-Year Breast Cancer Risk Prediction Gets FDA De Novo Authorization 

The cloud-based platform reportedly facilitates AI-enhanced teleradiology workflow efficiencies across multiple systems and facilities.

Konica Minolta Launches Exa Teleradiology Platform

In a study involving over 1,000 patients who had coronary computed tomography angiography (CCTA) exams, AI software demonstrated a 90 percent AUC for assessments of cases > CAD-RADS 3 and 4A and had a 98 percent NPV for obstructive coronary artery disease.

Can Emerging AI Software Offer Detection of CAD on CCTA on Par with Radiologists? 

Employing deep learning image reconstruction, parallel imaging and multi-slice acceleration in a sub-five-minute 3T knee MRI, researchers noted 100 percent sensitivity and 99 percent specificity for anterior cruciate ligament (ACL) tears.

Could AI-Powered Abbreviated MRI Reinvent Detection for Structural Abnormalities of the Knee? 

Some abbreviations for radiology transcriptions defy reasonable explanation but they continue to persist on multiple voice recognition platforms.

Dealing with Radiology ‘Orphan Issues’ in Voice Recognition Software

While some have predicted that artificial intelligence (AI) may replace radiologists, Samir Abboud, M.D., says generative AI will allow radiologists to maximize their time on image interpretation.

, Dr. Abboud and colleagues evaluated the impact of a generative AI model for providing initial drafts of radiology reports for radiographs. In a total cohort including 23,960 radiographs, the researchers found that use of the generative AI model reduced documentation time for radiology reports by a mean of 29.4 seconds.

While the study noted a 15.5 percent increase in documentation efficiency, Dr. Abboud noted in a recent interview that he has seen “truly eye-popping” efficiency gains of up to 40 to 50 percent with use of the generative AI model for initial draft reporting.

“ … Once you've decided and formed your conclusions about what's going on with that patient, you look over the report that's been generated and decide if you agree or not, and then make any corrections that are necessary. It's just a much more natural way of doing things to my mind, and I think that's the only solution you have to the workforce shortage we have in radiology,” asserted Dr. Abboud, the chief of emergency radiology at Northwestern Memorial Hospital in Chicago.

In a total of 97,651 studies, the generative AI model provided a 72.7 percent sensitivity and a 99.9 percent specificity for unexpected pneumothorax cases that were clinically significant, according to the study authors.

Dr. Abboud attributes the specificity to additional filters incorporated into the Northwestern generative AI model that provide greater context than other AI software models for differentiating between cases of expected pneumothorax and incidental detection with clinical significance. This difference is a key advantage in a large hospital system with many ICU and postoperative patients, according to Dr. Abboud.

“When we ran the trial … the number of flags I was getting a week for unexpected pneumothoraces was one or two as opposed to getting 30 or 40 flags a day,” recalled Dr. Abboud, a clinical assistant professor of radiology at the Northwestern University Feinberg School of Medicine. “You knew right off the bat that if you were getting a flag, it was a real one, not just a stack of flags to then sort through further. The clinical relevance and the net benefit to our radiologists from that sort of approach has been quite a bit more profound than using the more traditional methods.”

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

Generative AI Model Reduces CXR Reading Time by 42 Percent

Study: AI Bolsters Sensitivity for Pneumothorax on CXR and Significantly Reduces Reporting Time

Can Innovations with AI Help Address the Impact of Staffing Shortages on Radiology Workflows?

For more insights from Dr. Abboud, watch the video below.

In a recent interview, Samir Abboud, M.D., discussed new research examining the impact of generative AI in maximizing efficiency and reducing the time-consuming nature of radiology reporting.

Can Generative AI Reinvent Radiology Reporting?: An Interview with Samir Abboud, MD

The challenges in radiology are particularly daunting, ranging from severe workforce shortages to five straight years of cuts in the Medicare Physician Fee Schedule. In a recent interview, Amy Patel, M.D., discussed the impact of continued reimbursement cuts in closing practices and reduced access to health care for patients in rural communities.

The continuing battle for Medicare reform remains a key legislative priority for radiologists in 2025, emphasized Dr. Patel, the chair of the American College of Radiology’s Radiology Advocacy Network

“This affects all of us in the house of medicine, and certainly in radiology, whether (you’re in) academics or private practice, the alarm bells should be sounding off for all of us. We need to really come together and advocate for long-term Medicare reform, and that is what we'll continue to do this legislative session,” maintained Dr. Patel, the medical director of the Liberty Hospital Breast Care Center in Kansas City.

In addition to Medicare reform, Dr. Patel said the radiology profession will continue to advocate for the Resident Physician Shortage Reduction Act as well as breast imaging legislation such as the Find It Early Act and the Access to Breast Cancer Diagnosis (ABCD) Act.

Dr. Patel remains enthusiastic, noting the development of strong radiology advocates on both sides of the aisle in Congress. She also pointed out recent wins with diagnostic breast imaging legislation in Missouri, Iowa, Vermont, and pending legislation in New Hampshire.

However, expressing concern about a recently introduced bill in Texas that would allow image interpretation by mid-level providers, Dr. Patel emphasized the need for increased vigilance and more radiologists to propel the legislative agenda for radiology.

“We have these immense issues that we're facing in an increasingly more competitive health-care environment, and we'd love for radiologists, radiation oncologists to join us, maybe those who have never joined us before, because it's definitely going to take all of us as we tackle all of these challenges,” emphasized Dr. Patel.

For more insights from Dr. Patel, watch the video below.

Amy Patel, MD, discusses current and emerging legislative priorities for radiology in 2025, including advocacy for long-term reform of Medicare reimbursement and mitigation of the radiology workforce shortage.

Current and Emerging Legislative Priorities for Radiology in 2025

In a recent interview, Amy Patel, M.D., discussed key points of emphasis for legislative advocacy in radiology, including long-term reform in Medicare reimbursement, improved coverage of breast cancer screening and mitigation of the ongoing radiology workforce shortage.

Increased transparency is a cornerstone of the recent 

draft guidance from the Food and Drug Administration (FDA) on submissions for AI-enabled software

. While this will result in an increased amount of documentation on the training as well as limitations for adjunctive use of AI models, Nina Kottler, M.D., maintained in a recent interview that this well-intended effort at transparency may fall short of having an impact in daily practice.

“ … Any of this documentation that the FDA is requiring right now is not so helpful at the point of care. It is good that they're doing it. It's not a bad thing. It's a very good thing, but we need a way now to translate that information to be helpful at the point of care,” posited Dr. Kottler, the associate chief medical officer of clinical AI at Radiology Partners.

Whether it comes in the form of heat mapping or a color-coded assessment by the adjunctive AI, Dr. Kottler says the capability of the AI tool to express a degree of confidence in the evaluation can be beneficial for end-user radiologists.

Additionally, Dr. Kottler maintained that there should be clear transparency on how the adjunctive AI is making its assessment. She cautioned that most people don’t recognize that adjunctive AI doesn’t consider every single piece of input data in its interpretation.

“ … Another thing that the FDA should be requiring is to tell the end user, what are the images, or what are the components of the language, or whatever that the AI is using so radiologists know when they're looking at a study, ‘Oh, this series wasn't even evaluated by the AI.’ That is really important information,” emphasized Dr. Kottler.

How Will the New FDA Guidance Affect AI Software in Radiology?: An Interview with Nina Kottler, MD, Part 1

Mammography Study Shows Merits of AI for Improving Breast Cancer Detection and Effectiveness of Recalls

Study Assesses Lung CT-Based AI Models for Predicting Interstitial Lung Abnormality

For more insights from Dr. Kottler, watch the video below.

Nina Kottler, MD, discusses the increased transparency emphasis of the recent FDA guidance on AI-enabled software and the potential impact upon radiologists.

How Will the New FDA Guidance Affect AI Software in Radiology?: An Interview with Nina Kottler, MD, Part 2

In the second part of a two-part interview, Nina Kottler, M.D., says the transparency emphasis of the recent FDA guidance on AI-enabled software is welcome but needs to go beyond additional documentation to clarify how adjunctive AI is making its decisions.

The recently issued draft guidance from the Food and Drug Administration (FDA) on submissions for AI-enabled software reflects more of an emphasis on the total product life cycle for AI products, according to Nina Kottler, M.D., the Associate Chief Medical Officer of Clinical AI for Radiology Partners.

Accordingly, in a recent interview, Dr. Kottler noted that a key cornerstone of the 

 is continuous monitoring of AI software, which may be challenging for smaller AI developers in radiology. She suggested that perhaps an independent group could assist with continuous monitoring of AI software.

“ … What if we had a separate group that could not only help out the AI vendors that maybe couldn't afford to do it, or don't have access to all the data, or (are) not mature enough yet to be there?” posited Dr. Kottler, the Associate Chief Medical Officer of Clinical AI for Radiology Partners.

While Dr. Kottler said the FDA guidance’s increased emphasis on transparency of the training and development of AI software is an important priority, the resulting information needs to be conveyed in a practical way for end-user radiologists.

“Now as an end user, as I'm going through my day looking at 100 cases or 200 cases, many of which are using AI, am I going to that document to look and say, ‘Is this patient and is this exam something that (the AI software) was very specifically trained on? No, that's not realistic. So how do you translate these guidelines into something that's more realistic for the end user? That's going to be the important component. That's the part that I really care about,” maintained Dr. Kottler.

Current and Emerging Insights on AI in Breast Imaging: An Interview with Mark Traill, MD, Part 3

Diagnostic Imaging’s Top Five AI Content of 2024

In the first part of a two-part interview, Nina Kottler, M.D. offers insights and perspective on the recently issued guidance from the FDA on AI-enabled devices and how it may impact developers in the radiology field.

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