70-practice Central Ohio Primary Care tells a digital imaging success story

Photo: Central Ohio Primary Care

Central Ohio Primary Care is an independent, physician-owned, primary care group with more than 70 practices and more than 400 physicians serving more than 400,000 patients. It also has three imaging centers around Columbus, and 10% of its physician practices provide in-office imaging capabilities.

THE PROBLEM

COPC needed more advanced radiology communication capabilities to run its practices more efficiently – and a system that would grow with the organization.

“Another significant challenge for COPC was moving hard film from office to office or physician to physician,” said Steve Saeger, manager of radiology services at Central Ohio Primary Care. 

“Even with CD-ROM transfer, immediate access remained a top concern. Lastly, paper scheduling was a tough operational issue with not being able to provide timely scheduling electronically – or access results for efficient sharing across providers.”

PROPOSAL

COPC needed a technology solution to replace the use of imaging CD-ROMs to provide advanced digital capabilities for much more efficient and effective imaging operations. Immediate needs required the implementation of a more advanced picture archiving and communication system (PACS). COPC needed to better manage communications with secure storage and imaging sharing across its practices for its 25,000 annual exams.

“Another critical need for operational efficiencies was the ability to migrate data and move away from paper scheduling,” Saeger remarked. “COPC required an enterprise software solution with PACS technology to improve provider and patient experiences to meet our patient care excellence standards.

“To support the organization’s continued growth, COPC also required a very stable system, so as to not experience downtime – even with upgrade installations,” he continued. “While upgrades can provide enhanced capabilities and practical tools for support that improve patient and provider experiences, installation issues or downtime significantly affect clinical operations.”

“Contacts across various health systems and practices are valuable in the initial digital transformation planning process; it’s important to learn from those that have experienced similar situations.”

Steve Saeger, Central Ohio Primary Care

In addition to system stability, COPC wanted a vendor to drive and advance digital imaging innovation. In COPC’s experience, it is critical that a vendor provide a dedicated support team so when support is needed, technology vendor team members are familiar with COPC’s practice and interface, helping more quickly with operations and IT staff – even making recommendations to catch issues on the front-end before they become problems, Saeger said.

“Communication is a key component of any vendor relationship, so COPC required strong communications as a primary consideration for technology vendor partners,” he said. “The ability to track details such as support tickets with resolution notes would also help more efficiently resolve issues if they occur again.”

MEETING THE CHALLENGE

A colleague of Saeger’s recommended Novarad, and that began an almost 20-year relationship.

“Through our partnership with Novarad, COPC eliminated its inefficient paper processes and cumbersome CD-ROM review of images,” Saeger explained. “One of the substantial benefits of Novarad is that it was founded and is still led by a radiologist. This clinical provider perspective keeps products and services aligned with the seamless communication capabilities required of modern imaging solutions to support accurate diagnosis and ongoing clinical progress monitoring.

“In addition to enhanced operational efficiencies, Novarad’s support was vital in the integration of COPC’s chosen electronic health records and Nuance PowerScribe 360, a real-time radiology reporting platform to enable high-quality radiology reports from physician dictation,” he added.

Paper scheduling also was eliminated with the implementation of the Nova RIS scheduling system for improved operational efficiencies. 

Not only did moving away from paper scheduling intuitively improve scheduling speed, Saeger noted, it also allowed COPC to operate with Modality Worklists in the technologies, in turn increasing the efficiencies of the technologists scanning and reducing the errors associated with the manual input of patient demographics into modality equipment.

“As a result of these incremental changes, COPC has effectively enhanced its clinical services and quality of care and created efficiencies across the organization,” he added.

RESULTS

COPC has seen patient volumes increase annually at a rate of 6-7% in part due to broader imaging system capabilities, effective cost containment and building interfaces with EHR vendors, Saeger reported.

“The interface process was simple, with reasonable costs,” he said. “COPC team members could make changes mid-stream that improved the results without additional costs. One of the most significant benefits to COPC is that the Novarad team always makes COPC feel like they are their top priority, in addition to the fact that Novarad is always looking out for COPC and its team, enabling us to reach the best outcomes and efficiency gains possible for our technology needs.”

COPC clinical specialists now can access imaging studies electronically, seamlessly and effectively connecting with other healthcare providers, he added. This is especially important in emergencies, such as when a patient is in the ER. Immediate access to imaging studies prevents duplication of imaging – which is safer for patients and more cost-effective for both patients and systems.

“COPC also is focused on population health initiatives, including cost versus expenses for patients, to deliver the best care options and improve the health of the populations they serve,” said Saeger. 

“COPC often uses Novarads’s comparison studies that are immediately accessible through secure web viewing capabilities so radiologists can review and provide diagnostic support to specialists – and save money and time by avoiding the duplication of imaging orders.”

ADVICE FOR OTHERS

“Make sure you are confident in your vendor selection,” Saeger advised. “Most likely, once you have a vendor in place, you are with them for the long haul, and it can be difficult to make a switch.

“Find a vendor that guides the process and offers the ability for database building for healthcare complexities, including procedures, CPT codes and schedules,” he continued. “A knowledgeable vendor should be able to take a database of information and build a program that works. For those that like to be more involved, the more hands-on experience you have in the build, the more you understand the system when you need to adjust or adapt to new circumstances.”

Every minute counts in patient care, so find a vendor that allows one “behind the curtain” so one can fix things quickly when patients need answers, he added.

“Don’t hesitate to dig into the details, be as involved as possible and understand every nuance of the system,” he said. “Find a vendor team that welcomes input and embraces the opportunity to work together as partners – always improving and enhancing services. As true partners, you should have a solid foundation of innovative digital technology – and a stable digital environment – so providers can take the very best care of patients without interruption due to technology concerns.”

And as technology continues to evolve, one should expect additional digital innovations and cost efficiencies to increase patient and provider satisfaction, he added.

“COPC’s goal is to work smarter with patient care through digital transformation and is proud of its current success in operational improvements for both patients and their business model,” Saeger said. “To help other providers prepare for such a transition, COPC invites organizations that are considering similar digital technology to visit our office so they can see the technology in action, ask questions about successful installations and integrations, and learn what to expect.

“I often share this advice: Pick a partner that will invest in your organization’s knowledge base for the best possible outcomes,” Saeger concluded. “Contacts across various health systems and practices are valuable in the initial digital transformation planning process; it’s important to learn from those that have experienced similar situations.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Novel PET tracer is safe and can clearly identify early stages of rheumatoid arthritis

New research shows that a novel positron emission tomography (PET) tracer that targets inflammation is safe and can clearly identify early stages of rheumatoid arthritis. The promising PET tracer, 68Ga-DOTA-Siglec-9, rapidly clears from blood circulation, has a low radiation dose, and can be easily produced. This first-in-human study was published in the April issue of the Journal of Nuclear Medicine.

Inflammation is a significant part of several chronic diseases, including rheumatoid arthritis and its related issues. While PET imaging with 18F-FDG is a valuable tool for the diagnosis and monitoring of the effects of treatments, it is not specific enough to assess inflammation.

It's important to detect inflammation early so that patients can receive the best treatment. Our institution has worked for several years to develop an imaging agent that targets areas of inflammation, and in this study, tested its effectiveness in humans for the first time."

Anne Roivainen, PhD, Professor of Preclinical Imaging and Drug Research, Turku PET Centre, University of Turku and Turku University Hospital in Finland

To evaluate the radiotracer's safety and biodistribution characteristics, six healthy study participants underwent whole body 68Ga-DOTA-Siglec-9 PET/computed tomography scans. 68Ga-DOTA-Siglec-9 was well-tolerated and cleared quickly from the blood, and its radiation dose was similar to other 68Ga tracers. In one additional study participant with rheumatoid arthritis, the tracer was able to clearly detect joints with arthritis.

"We have proven that the characteristics of 68Ga-DOTA-Siglec-9 are favorable for use in patient imaging studies," remarked Roivainen. "Future studies will clarify whether 68Ga-DOTA-Siglec-9 PET imaging has the potential to detect other inflammatory diseases early. It could also help to evaluate the effectiveness of treatments and promptly identify patients who are unlikely respond to therapy."

Source:

Society of Nuclear Medicine and Molecular Imaging

Journal reference:

Viitanen, R., et al. (2021) First-in-Humans Study of 68Ga-DOTA-Siglec-9, a PET Ligand Targeting Vascular Adhesion Protein 1. Journal of Nuclear Medicine. doi.org/10.2967/jnumed.120.250696.

Posted in: Medical Science News | Medical Research News | Medical Condition News

Tags: Arthritis, Blood, Chronic, Computed Tomography, CT, Heart, Hospital, Imaging, Immunology, Inflammation, Laboratory, Ligand, Medicine, Molecular Imaging, Nuclear Medicine, Oncology, Positron Emission Tomography, Preclinical, Preclinical Imaging, Protein, Radiology, Radiotherapy, Research, Rheumatoid Arthritis, Rheumatology, Theranostics, Tomography, Vascular

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Brain imaging may predict treatment outcomes for adolescents with anxiety disorders

As with any complex machine, sometimes a simple crossed wire or short circuit can cause problems with how it functions. The same goes for our brains, and even when the short circuit is uncovered, sometimes experts don't have a quick fix.

A new study reveals that an evidence-based treatment may "fix" this human short circuit and, with the help of brain imaging, might predict treatment outcomes for adolescents with anxiety disorders. University of Cincinnati researchers say this could determine medication effectiveness more quickly to help patients.

Study results showed that brain imaging was able to predict — after just two weeks of treatment with almost 80% accuracy — how much a patient would improve.

We also see [through imaging] that the medication in this study increases the strength of the connection between a brain area that generates anxiety and an area that serves as a 'brain brake' for the fear center. In essence, the medication allows the brain to dampen the overactivity of fear areas, and we see this dampening very early in the course of treatment using imaging."

Jeffrey Strawn, MD, Study's Senior Author, Associate Professor and Anxiety Expert, Department of Psychiatry and Behavioral Neuroscience at UC

In this National Institutes of Health-sponsored study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers used brain imaging (MRI) to see how 41 adolescents, ages 12-17, with anxiety disorders responded to a medication called escitalopram, versus a placebo, over eight weeks. Escitalopram is a medication known as a selective serotonin reuptake inhibitor (SSRI) that is approved by the Food and Drug Administration for depression in adolescents and for both depression and anxiety in adults.

Strawn, who is also a physician at Cincinnati Children's Hospital Medical Center and UC Health, says SSRIs work by boosting the activity of serotonin in the brain. Serotonin is one of the chemical messengers that nerve cells use to communicate with one another and one that is involved in anxiety disorders. These medications block the recycling of serotonin into nerve cells, making more serotonin available to improve transmission of messages between neurons.

"These medications are an effective treatment for many adolescents with anxiety disorders. However, how much a specific patient will benefit is difficult to predict," he continues.

He says clinicians typically need six to eight weeks of the patient being on the medication in order to evaluate whether or not the treatment is going to work. "But with the brain imaging in this study, doctors could determine — after just two weeks — if they would need an alternative treatment. Knowing this early in treatment could greatly improve outcomes for patients," he adds. "This study helps clinicians understand how the medication — even early in treatment — changes brain circuits that are involved in anxiety and can help to get patients back to their normal lives more quickly."

Larger studies are needed to further test this, but the results are promising and, as Strawn notes, are really important for better treating adolescents with anxiety disorders.

"Anxiety disorders are the most common mental illnesses in the U.S., with approximately 4.4 million children and adolescents affected," he says. "These disorders are not only common in children and teens, but, if untreated, result in considerable personal and economic cost over the lifetime.

"This study uncovers a way to predict how effectively a medication will treat anxiety in kids and reveals that brain changes occur within two weeks of starting the medication. Additionally, the changes that occur in the brain can predict treatment response and improvement over time which is incredibly beneficial for physicians and can help us determine promising biomarkers for drug development. While not necessarily a quick fix, this could be a quicker fix that could help patients tremendously and improve their quality of life."

Source:

University of Cincinnati

Journal reference:

Lu, L., et al. (2021) Acute Neurofunctional Effects of Escitalopram in Pediatric Anxiety: A Double-Blind, Placebo-Controlled Trial, California. Journal of the American Academy of Child and Adolescent Psychiatry. doi.org/10.1016/j.jaac.2020.11.023.

Posted in: Child Health News | Medical Science News | Medical Research News

Tags: Adolescents, Anxiety, Brain, Children, Depression, Hospital, Imaging, Mental Health, Nerve, Neurons, Neuroscience, Placebo, Psychiatry, Serotonin

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Child brain tumors can be classified by advanced imaging and AI

Child brain tumors can be classified by advanced imaging and AI

Diffusion weighted imaging and machine learning can successfully classify the diagnosis and characteristics of common types of pediatric brain tumors a UK-based multi-center study, including WMG at the University of Warwick has found. This means that the tumor can be characterized and treated more efficiently.

The largest cause of death from cancer in children are brain tumors in a particular part of the brain, called the posterior fossa. However, within this area, there are three main types of brain tumor, and being able to characterize them quickly and efficiently can be challenging.

Currently, a qualitative assessment of MRI by radiologists is used; however, overlapping radiological characteristics can make it difficult to distinguish which type of tumor it is, without the confirmation of biopsy. In the paper, “Classification of pediatric brain tumors by diffusion weighted imaging and machine learning,” published in the journal Scientific reports, led by the University of Birmingham including researchers from WMG, University of Warwick. The study found that tumor diagnostic classification can be improved by using non-invasive diffusion weighted imaging, when combined with machine learning (AI).

Diffusion weighted imaging involves the use of specific advanced MRI sequences, as well as software that generates images from the resulting data that uses the diffusion of water molecules to generate contrast in MR image. One can then extract an Apparent Diffusion Coefficient (ADC) map, analyzed values of which can be used to tell you more about the tumor.

The study involved 117 patients from five primary treatment centers across the UK with scans from twelve different hospitals on a total of eighteen different scanners, the images from them were then analyzed and region of interests were drawn by both an experienced radiologist and an expert scientist in pediatric neuroimaging. Values from the analysis of Apparent Diffusion Coeffcient maps from these images’ regions have been fed to AI algorithms to successfully discriminate the three most common types of pediatric posterior fossa brain tumors, non-invasively.

Professor Theo Arvanitis, director of the Institute of Digital Health at WMG, University of Warwick and one of the authors of the study explains:

“Using AI and advance Magnetic Resonance imaging characteristics, such as Apparent Diffusion Coefficient (ADC) values from diffusion weighted images, can potentially help distinguish, in a non-invasive way, between the main three different types of pediatric tumors in the posterior fossa, the area of the brain where such tumors are most commonly found in children.

“If this advanced imaging technique, combined with AI technology, can be routinely enrolled into hospitals it means that childhood brain tumors can be characterized and classified more efficiently, and in turn means that treatments can be pursued in a quicker manner with favorable outcomes for children suffering from the disease.”

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Evidence for routine brain tumor imaging is murky, but research can shed light

tumor

What is the best way to monitor a brain tumor? This question is at the heart of a new Position Statement published in open-access journal Frontiers in Oncology. The article is the work of a large collaboration of UK experts and stakeholders who met to discuss the value of routinely imaging brain tumor patients to assess their tumor treatment response, which is known as “interval imaging”. Their verdict: there is very limited evidence to support the practice at present. However, the article also discusses how future research could determine and maximize the value of interval imaging by assessing its cost effectiveness and how it affects patient quality of life, treatment and survival.

Medical staff use brain scans at predetermined times to assess if a brain tumor patient is responding to treatment, but scanning frequency can range from every few weeks to every few months. Different countries and hospitals use different approaches, but what is the best approach and is any of this based on science?

Getting things right is important. Not scanning someone enough could mean that doctors miss the signs that a patient requires further treatment. Conversely, scanning someone excessively is inconvenient and impractical for patients and medical staff alike, and can cause patient anxiety, especially if the results of the scan are unclear.

Scanning patients is also expensive, and with limited budgets, healthcare facilities need to use their resources as cost-effectively as possible. Most interval imaging aims to find increases in tumor size, but tumors grow differently in different patients, which sometimes makes it difficult to draw concrete conclusions from interval imaging results. Would patients be better off receiving scans only if they experience new symptoms?

A group of experts and other stakeholders met to discuss these issues in London in 2019. The group was diverse and included numerous people with an interest in these issues. “Charity representatives, neuro-oncologists, neuro-surgeons, neuro-radiologists, neuro-psychologists, trialists, health economists, data scientists, and the imaging industry were all represented,” said Dr. Thomas Booth of King’s College London and the lead author on the article. Their findings are presented in this latest Position Statement.

The group discussed the evidence behind current interval imaging practices in the UK. “We found that there is very little evidence to support the currently used imaging interval schedules and that the status quo is no more than considered opinion,” said Prof. Michael Jenkinson of the University of Liverpool, and senior author on the article.

So, how can we determine if interval imaging is valuable? The meeting participants also discussed a variety of potential research approaches that could cast light on the most important factors—patient quality of life, patient survival, and cost effectiveness. However, this is not without its challenges.

“The treatment complexity and relative rarity of brain tumors mean that solutions beyond traditional ‘randomized controlled trials’ alone are required to obtain the necessary evidence,” said Booth. “We propose a range of incremental research solutions.”

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What is Angiography?

Angiography involves the use of x-ray imaging to examine blood vessels. The images generated during an angiography procedure are known as angiograms.

Coronary angiography – Image Copyright: kalewa / Shutterstock

First, a needle is placed into the femoral artery. All areas of the body can be addressed from this one site. After needle access is established, catheters and wires are threaded through the arterial system to the target area of interest.

When the imaging is performed, an iodine-based contrast medium is usually injected into the system. The medium highlights the blood moving through the vessels.

Angiograms are performed in hospitals with patients usually under local anesthesia. The procedure may take from 20 minutes to several hours, depending on the difficulty of the test and how much contrast is required.

The Need for Angiography

If a patient has problems with their circulation, a physician may suggest that the patient undergoes an angiography to determine what is causing the problems. The results of the test may also help the physician develop treatment options.

Angiography can be used to detect significant arterial disease, which can lead to such conditions as stroke, heart attack, gangrene, and organ failure. The imagery from coronary angiography can help physicians plan a patient’s treatment for angina and heart attacks.

Types of Angiography

A variety of angiography procedures are available that can be harnessed to diagnose different medical conditions.

  • Computed tomography angiography (CTA) utilizes x-rays, software, and hardware to produce horizontal, or axial, images, or slices, of blood vessels for diagnosis.
  • Coronary angiography visualizes the inside of the coronary arteries. These images can locate stenoses in the arteries that may be responsible for chest pain, and which could cause a heart attack.
  • Digital subtraction angiography (DSA) images blood vessels in the brain to check blood flow.
  • Radionuclide angiography is a nuclear medicine procedure. A small amount of radionuclide (radiopharmaceutical or radioactive tracer), aids the examination of the target tissue. Resting radionuclide angiography assesses the heart's chambers in motion.
  • Pulmonary angiography images the blood vessels to evaluate various conditions, such as aneurysm, stenosis, or blockages.
  • Magnetic resonance angiography (MRA) uses magnetic resonance imaging (MRI) and contrast dye to visualize blood vessels. Physicians often use MRA to examine the heart and other soft tissues, and to assess blood flow.
  • Renal angiography, also called arteriography, images the renal blood vessels to detect any signs of blockage or abnormalities affecting the blood supply to the kidneys.

Angiography Therapies

During an angiography, certain therapies can be performed, such as angioplasty or stent placement. Percutaneous coronary intervention (PCI), known as coronary angioplasty, is a non-surgical procedure that opens narrow or blocked coronary arteries.

The procedure restores blood flow to the heart muscle, which may have been blocked by plaque buildup. If the plaque ruptures, a blood clot can form on its surface.

A large clot has the potential to block the flow of blood through a coronary artery, a common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

PCI can restore blood flow to the heart. During the procedure, a thin, flexible catheter with a balloon at its tip is threaded through a blood vessel to the affected artery, guided by x-ray imaging.

Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.

The procedure can optimize symptoms of coronary heart disease, including angina. The procedure also can lessen heart muscle damage caused by a heart attack.

Stents can be placed in arteries during PCI. Before the balloon is inflated, a stent is placed around it. When the tip of the catheter moves to the desired site, the balloon is inflated, pushing plaque against the artery wall. This widens the artery and helps restore blood flow. The fully extended balloon also expands the stent, pushing it into place in the artery.

The balloon is deflated and pulled out along with the catheter. The stent remains in the artery. Over time, cells grow to cover the mesh of the stent.

Potential Complications

With angiography, patients may experience bleeding or bruising where the artery was entered. They may have an allergic reaction to the contrast. Not often, the access artery may be blocked. Very rarely during angioplasty or stent placement, part of the arterial blockage can break off and travel to other arteries.

Sources

  • http://www.nhs.uk/conditions/Angiography/Pages/Introduction.aspx
  • www.nhs.uk/Conditions/Angiography/Pages/What-is-it-used-for.aspx
  • stanfordhealthcare.org/…/radionuclide-angiogram.html
  • https://vascular.org/patient-resources/vascular-tests/angiogram
  • https://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty
  • http://www.nhlbi.nih.gov/health/health-topics/topics/stents/placed

Further Reading

  • All Angiography Content

Last Updated: Feb 20, 2019

Written by

Joseph Constance

Joseph Constance has written about research, development, and markets in the health care and related fields. He has authored a number of articles, and business analysis/market research reports in the medical device, clinical diagnostics, and pharmaceutical areas. Joseph holds an MA from New York University in Communications. He enjoys spending time with his wife, biking, traveling, and learning about different cultures.

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Point of care imaging can help patients receive sight saving treatments faster

Simple, non-invasive imaging at the point of care can aid the diagnosis of corneal infections, reducing the risk of sight loss and helping patients’ vision return to pre-infection levels.

Bacterial keratitis is one of the most common corneal infections in the western world, often caused by contaminated contact lenses, and results in frequent visits to emergency departments in eye clinics worldwide. It can have a major impact on patients’ day-to-day lives, causing visual impairment and resulting in two million cases of blindness in one eye every year. It can be caused by gram-negative and gram-positive bacteria, each of which have different implications for treatment.

Corneal infections are typically identified through microbial cultures from corneal scrapings, which means sending samples to a laboratory and takes around forty eighty hours to get the results back. This can lead to delays in providing the correct diagnosis and treatment, which are essential for getting the best possible outcome for patients.

This new study, led by the University of Southampton, examined 45 patients with bacterial keratitis using Optical Coherence Tomography, a non-invasive imaging technique that clinicians can use to examine patients at the point of care. The researchers also examined features of cytokines, proteins emitted from cells, in the patients’ tears to determine whether this is also an effective technique for assessing the inflammatory response.

The results, published in the scientific journal Nature Scientific Reports, showed that both techniques could rapidly distinguish between gram-negative and gram-positive infections. As gram-negative infections present a higher risk to vision, this could help clinicians prescribe the right antibiotics straight away and reduce the impact of anti-microbial resistance if the wrong treatment is applied.

Dr. Parwez Hossain, associate professor of ophthalmology at the University of Southampton said, “The availability of OCT machines nowadays means they could be widely used in optometry practices. This would be especially useful inthe majority of clinical practices around the world where they do not have access to laboratorymicrobiology facilities.”

The study also showed that faster application of topical steroids such as prednisolone could reduce the inflammatory response.

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