Improved Appropriateness of Advanced Diagnostic Imaging After Implementation of Clinical Decision Support Mechanism.

The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider's first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories ("usually appropriate" [green], "may be appropriate" [yellow], "usually not appropriate" [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with ≥ 200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), -0.8% (95% CI -0.5% to -1.1%), and -3.0% (95% CI 3.3% to -2.7%) in comparison with the first 10, respectively. Providers with > 190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI -1.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with ≤ 10 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions.

Peer learning on a shoe string: success of a distributive model for peer learning in a community radiology practice.

PURPOSE: To describe our 3-year experience operating a peer learning program with minimal resources, calculate the cost of the program, and compare participants' attitudes toward peer learning to the historical peer review system. MATERIALS AND METHODS: The peer learning conference is held monthly for 1 h via a web-based video conferencing platform. Case identification, curation, and conference presentation are performed by individual radiologists. Using national estimates for unit costs of radiologist time and other inputs, we calculated the marginal cost of the peer learning program to the medical group. After 21 months of holding the conference, we conducted an anonymous survey to assess the impact of the conference and how it may be improved. RESULTS: A peer learning conference was established for a 24- person community-based practice, which is part of a large multi-disciplinary medical group. Cases discussed included diagnostic errors, technologist errors, good calls, and challenging cases. Total annual cost of the program is $3288. Survey respondents had overall positive views of the conference and strongly preferred peer learning to the existing peer review system in place, with 80% of respondents rating peer learning more favorably than peer review on education value, supportive environment, and punitive process, and 70% more positively on culture of blaming. CONCLUSION: We established a peer learning program with minimal resources. Radiologists in the group strongly prefer the peer learning conference over the existing peer review program in place. A peer learning program can be successfully started and sustained with limited resources.

Left behind: unintentionally retained surgically placed foreign bodies and how to reduce their incidence--pictorial review.

OBJECTIVE: Unintentionally retained surgically placed foreign bodies have been associated with increased morbidity and mortality, as well as increased costs and medicolegal consequences. This article reviews some of the most commonly retained surgical devices and provides a structured approach to intraoperative image acquisition and interpretation. By increasing the awareness of surgically placed foreign bodies, our goal is to reduce the incidence of and the complications associated with this difficult clinical problem. CONCLUSION: Despite various systems and safeguards available, unintentionally retained surgically placed foreign bodies remain difficult to eliminate completely. Developing a standardized approach to the request, "intraoperative film, rule out foreign body," is essential to reduce the adverse outcomes associated with this problem.

Left behind: unintentionally retained surgically placed foreign bodies and how to reduce their incidence--self-assessment module.

The educational objectives of this self-assessment module are for the reader to exercise, self-assess, and improve his or her skills in diagnostic radiology with respect to the imaging of unintentionally retained surgically placed foreign bodies and to develop a standardized approach to the request for intraoperative imaging to rule out a foreign body.

Research recommendations for the american telemedicine association.

The American Telemedicine Association (ATA) convened a panel of experts to generate a research agenda for the telemedicine community to further support and promote the long-term acceptance and use of telehealth. Three principles to guide research and four key areas within which research is greatly needed were identified. These four areas are technical, clinical, human factors and ergonomics, and economic analyses. It is the hope of the panel that the research recommendations put forth in this document will give investigators the inspiration, tools and goals to make this happen.

Informatics in radiology (infoRAD): A complete continuous-availability PACS archive server.

The operational reliability of the picture archiving and communication system (PACS) server in a filmless hospital environment is always a major concern because server failure could cripple the entire PACS operation. A simple, low-cost, continuous-availability (CA) PACS archive server was designed and developed. The server makes use of a triple modular redundancy (TMR) system with a simple majority voting logic that automatically identifies a faulty module and removes it from service. The remaining two modules continue normal operation with no adverse effects on data flow or system performance. In addition, the server is integrated with two external mass storage devices for short- and long-term storage. Evaluation and testing of the server were conducted with laboratory experiments in which hardware failures were simulated to observe recovery time and the resumption of normal data flow. The server provides maximum uptime (99.999%) for end users while ensuring the transactional integrity of all clinical PACS data. Hardware failure has only minimal impact on performance, with no interruption of clinical data flow or loss of data. As hospital PACS become more widespread, the need for CA PACS solutions will increase. A TMR CA PACS archive server can reliably help achieve CA in this setting.

The role of the Department of Defense in PACS and telemedicine research and development.

The United States Department of Defense (DOD) has played a leading role in the movement of digital imaging, picture archiving and communications systems, and more recently telemedicine with its associated technologies into the mainstream of healthcare. Beginning in the 1980s with domestic implementations, and followed in the 1990s by both small and large-scale military deployments, these technologies have been put into action with varying degrees of success. These efforts however, have always served as a guidepost for similar civilian efforts and the establishment of a marketplace for the technologies. This paper examines the history of the DOD's role in these areas, the projects and programs established, assessing their current state of development and identifying the future direction of the DOD's research and implementation efforts in telemedicine and advanced medical technologies.