Sunday, February 1, 2009

My Obama Wish List

One of the few bright spots in the current economic climate is the funding of healthcare IT as part of the recent stimulus package approved by the United States Congress. As both an educator and consumer of healthcare IT, I have a couple of pet peeves with the current U.S. system I'd like to share.
  1. Stringent adherence to standards. My chiropractor complained that he sometimes receives patient images via CD that take him up to 30 minutes to sort through because of the limited viewing capabilities of the software supplied with the CD. No wonder many physicians love film and hate PACS. If technology only hinders access to information instead of facilitating it, who can blame them? What can we do about this? First of all, anyone creating non-standard CD’s should be penalized; perhaps the FDA can mandate IHE compliance from all diagnostic imaging vendors. Second, it would help if vendors would at least construct simple DICOM viewers for CD embedding that allow side-by-side display of different MR pulse sequences. A minimum standard for image display, similar to what is done for digital mammography in IHE, would be a great help.
  2. Universal patient record and format. I recently went to a neighborhood clinic to get antibiotics prescribed for a sore throat and all of my medical history and personal information had to be re-entered. Most U.S. consumers of healthcare have had to go through this process and most struggle (in vain) to provide a complete history of every procedure, vaccination, and physician encounter they’ve had. I did not have to manually fill in the form, as a receptionist was doing the interview and entered it as I gave her information. On my comment that this was all entered about two years before, she answered: "That’s true, but we recently changed our patient software." I am sure this is common; what a waste of time, energy, and money. And let’s not forget the medical errors that are possible as a result of an incomplete medical history. Again, stringent standards would be a great benefit and probably would have allowed for a simple migration from the legacy to the new patient software.
  3. Patient portal. I believe that we would greatly benefit from a personal portal, such as ehrofherman@health.gov. This would comprise the best toolset from personal health records (PHRs) such as Google Health, Microsoft HealthVault, WebMD, and others. This capability would eliminate the re-entering of patient histories as I would be able to authorize physician access to my information. I believe PHRs will see their greatest advocates from major employers and healthcare systems seeking to lower healthcare costs, such as Wal-Mart Stores and the Cleveland Clinic, who have PHR initiatives. In the meantime, I suggest you check out the PHRs available now
  4. Physician buy-in. One of our friends is a primary physician who just started a new practice. She is overwhelmed by the amount of work that’s required to establish a patient-record system which is, surprise... paper-based, as it is with about 80%-90% of all physicians. When I asked why she didn’t select an electronic health record (EHR) system, I was told that it was too expensive ($50-$100k). The macro-economic impact of all patients having a PHR to share with a physician EHR, in terms of overall cost, could be huge. Because there is no incentive for a physician to spend the extra money on an EHR system, the government should provide some. For example, one incentive could be higher reimbursement rates for all Medicare and Medicaid patients when a physician uses an EHR and lower rates when they do not.
  5. The unique patient ID for each citizen. This has been proposed in the past, was shot down by privacy advocates, and did not seem to get any further. Here is what the U.S. could learn from other nations that seem to be able to do this successfully: In the Netherlands, every citizen has an insurance card with a unique patient ID. (Note that “everyone” brings us to the topic of universal health coverage but that is the subject of another article). If, as can happen, a person breaks their leg when skiing in Austria, this same unique ID is used at the Austrian clinic to access the information system in the Netherlands which authorizes treatment. If existing healthcare IT systems can cross country borders, languages and cultures in Europe, I am amazed that we can’t cross states, cities, or even exchange information between two hospitals that are across the street from one another in the U.S. Images from a CD from one hospital have to be imported to the other and patient ID’s have to be changed using a Mater Patient Index system. Compounding the confusion, many hospitals are not able to issue the same patient ID in radiology as is issued in pathology or other specialties within the same facility. A unique patient ID would provide a major benefit to healthcare IT.
These topics are all related, because they all deal exchanging patient health information in a standard manner, which should be a requirement of every healthcare provider. Some of these proposals might make it into legislation; others, such as the unique patient ID, may run into the entrenched fears of “big-brother government” and privacy advocates. My hope is that the new administration will fully and completely consider the benefits and drawbacks of healthcare IT reform and then wisely allocate our money. 

Employment Opportunities for Health Imaging IT Professionals, Part 5

The information found in this article is excerpted from a discussion conducted during part three of our three-part Web conference series on career opportunities in healthcare IT imaging. 

A conversation between Janet Skinner, president of Oldsmar, Fla.-based Healthcare IT recruiting firm Skinner and Associates, and Michael O'Meara, president of Peoria, Ill.-based patient safety organization ORQA, about the current employment market for RIS and PACS professionals. 

Mike, can you compare and contrast the role of a PACS professional at a vendor vs. the hospital environment? Are there a lot of differences in terms of travel and job responsibilities? 
A PACS administrator requires a strong balance of clinical, plus people skills, plus the technical side. I think on the vendor side you see a lot more specialization. They have support people to do the technical stuff, they have the engineers, and they have the marketing people to do the sales. But a PACS administrator really has to juggle all three. So you see a lot more jack of all trades on the hospital side in the healthcare setting. 

What can you tell us about the size of your hospital and the types of responsibilities you have there? 
My last facility I worked with, OSF Healthcare, had seven hospitals and I worked in corporate IT infrastructure for the enterprise and I managed all the imaging applications. So basically I managed a team of PACS administrators and RIS analysts. We were starting to break out of the strict radiology field for PACS and we were starting to take on PACS responsibilities for getting the technology into surgery. We had the goal of being an enterprise service-orientated architecture to be able to access all the non-PACS clinical data; so that any kind of EKG reports, images, or other objects that would be attached to the clinical records. 

In the size of an organization such as OSF would there might be more of a bend toward an IT background compared with a clinical background? 
We kind of broke it up a little bit more and I think it really created a lot more career opportunities than you’d see in a smaller institution. We had roles that we called "PACS coordinators" or “imaging coordinators” that worked in the department of radiology. A lot of them were file room clerks that moved up, or x-ray techs that were looking for more managerial administrative duties. So it was a great opportunity where they would handle most of the day-to-day demographic issues. 

When workflow exceptions happened they’d work with resolving the issues; they also handled training the new radiologists and technologists on how to use PACS. They were really kind of the gateway--the first step for support. If they couldn’t handle the issue on their own, then they would engage IT, and IT had the more technically dedicated people, system analyst and system administrators to do more troubleshooting operating system issues or server issues or storage issues. 

A lot of our system administrators we got from moving people out of radiology and into IT because they were interested in more responsibility on the technical IT side. I think also that type of a division was there because of the corporate structure of OSF. There was one IT department for seven hospitals, but there were seven radiology departments. 

Do you think PACS certifications are a growing trend? 
I got the CIIP (Certified Imaging Informatics Professional) certification and I think it does have a good value. As I alluded to earlier, with the vendors employees tend to be more specialized and I think getting a PACS certification--whether it’s the PARCA or the CIIP--demonstrates that you have a sense of the big picture of what it takes to do image management in healthcare. 

I think it demonstrates that you’re more than just a rad tech, you’re more than a project manager and that you can really handle all the hurdles and challenges that you might come across. So it’s definitely something I would look for in a PACS administrator or PACS coordinator role. 

What three characteristics or qualifications if you will do you think are most important for PACS professionals or PACS administrators? 
Well, I think it’s hard to break it down to three. I think being well rounded is huge for the job of PACS administrator and obviously nobody is there from the get go and no one usually gets a job of a PACS administrator already having all those skills; it’s kind of an acquired thing. 

What I look for is somebody that is coming out of one of those specialized fields, whether they’re a rad tech or a help-desk person in IT or a file room communications. We look for somebody who has a strong core skill set within their specialty, but then they demonstrate a desire to expand their horizons and really get out more and understand the concepts. You have to be able to talk to physicians, and you’ve got to be approachable, you’ve got to be able to talk in both in layman's terms to a referring physician or to a patient, and at the same time you have to be able to deal with the IT managers. 

In terms of career growth, you started a company. Any suggestions for people on career development? 
I think there is a lot of potential, especially with the larger healthcare organizations. You know PACS isn’t just radiology anymore. It’s growing and I think some of the PACS projects can really be a success story for an IT department. We are starting to see measurable real gains in productivity, we’re starting to be able to really measure quality improvement in patient care and I think those kind of achievements and those kind of bullet points on a resume are the kind of things that give somebody the skill set to be able to move into a senior management role or director role; either on the clinical side as a radiology director or on the business or IT side. In PACS, we measure financial success in millions of dollars, so those are great things for any resume or future career. 

Is there any additional advice you would give in terms of ways to advance a career? 
Something I look for in people is that they’re involved in the career field outside of the company they work for. I think that’s a good thing to know what’s going on in the industry and where we are going to be in the future. People tend to lock themselves into a career path that might be a dead end, if they’re not in touch with their industry peers.