October 7, 2011 — U.S. Food and Drug Administration (FDA) Commissioner Margaret A. Hamburg, M.D., released a blueprint containing immediate steps to drive biomedical innovation, while improving the health of Americans.

When it comes to medical imaging, pick any part of the body other than the female breast and the FDA pays little notice. This particular part of the anatomy gets an extraordinary amount of attention, particularly as it pertains to cancer.  Politics has a lot to do with it.

Radiologist John Feller, M.D., medical director of Desert Medical Imaging in Indian Wells, Calif., and local urologists have joined forces to test a promising new way to detect and diagnose prostate disease. When a traditional transrectal ultrasound (TRUS) biopsy proves negative for the presence of disease, yet a patient’ s prostate-specific antigen (PSA) levels continue to rise, magnetic resonance imaging’s (MRI) excellent soft-tissue imaging quality may be the answer to a difficult diagnosis.

The sign outside the Women’s Center for Radiology in Orlando, Florida, announces the arrival of 3D mammography. Susan Curry, M.D., founder and medical director, wants to get the message out to women in Central Florida about 3D mammography and the difference it can make in the early detection of breast cancer.

Figure 1: The most important measure of a teleradiology provider was to have highly qualified radiologists reading studies.
Figure 3: Clients look to receive regular feedback and analysis of turn around time, as shown here for strokes.
Figure 3: Clients look to receive regular feedback and analysis of turn around time, as shown here for strokes.
Figure 3: Clients look to receive regular feedback and analysis of turn around time, as shown here for strokes.

While determining how to best measure quality in a teleradiology operation is more of an art, rather than a science, I want to propose the following equation:  TQ = fn (CV + QA% + TAT + QoS). In this equation, teleradiology quality is a function of the credentials of the reader (CV), the miss rate (QA%), the turnaround time for studies (TAT) and the overall quality of service (QoS) delivered.

With the need to transport images and make imaging studies readily available to referring physicians, WCGH got into the picture archiving and communications system (PACS) game relatively early, implementing its first system in 2003. When it contacted Infinitt North America (then SmartPACS) at that time, no one knew it would be the start of a technology partnership that would support them into the next decade or that its PACS would become the hub of its clinical IT platform.

“The time we save is priceless,” said Thomas G. Frazier, M.D., medical director of the Comprehensive Breast Center at the Bryn Mawr Hospital, referring to their use of the KUBTEC XPERT 40 specimen radiography system in the operating room. A nationally recognized surgical oncologist specializing in breast cancer, he performed the first immediate breast reconstruction surgery in the Philadelphia area. He uses the XPERT 40 at Bryn Mawr Hospital, “at least four or five times a week, maybe more, in the operating room alone!”

Cerner is one of several vendors offering a CPOE solution. PowerOrders is part of its PowerChart electronic medical record.
McKesson offers Horizon Expert Orders CPOE .

Although computerized physician order entry (CPOE) systems have been around for a few years, only a few vendors really embraced the market with robust offerings and only a few healthcare providers showed interest in adopting them — until the 2009 passage of the American Reinvestment and Recovery Act (ARRA). After that, the landscape changed considerably, as many providers wanted to take advantage of reimbursements available in meeting meaningful use (MU) requirements and the rate of adoption grew significantly.

Desert Radiologists is a high-efficiency practice in Las Vegas, Nev., that performs 1.25 million exams per year with a staff of 45 radiologists. Yet the practice operated with an outdated and overloaded picture archiving and communications system (PACS) that had no common worklist, no flexibility and could no longer handle its daily imaging volume. Additionally, as Desert Radiologists’ imaging volume continued to increase, its existing storage solution could not keep up. That system was a vendor-neutral archive with on-site SAN/NAS units. However, sending data to the vendor-neutral archive created two PACS and increased the complexity of managing and purging the data.

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