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Imaging: how a new paradigm is changing patient care

 

In this Q&A, Kees Wesdorp from Philips Diagnostic Imaging talks about imaging as an ‘ecosystem’ and how the concept of ‘empowering people behind the image’ is changing diagnostics and patient care.

Q: What do you mean by “empowering the people behind the image”?

A: With imaging, we have to look at the needs of many stakeholders – patients, technologists, radiologists, administrators – and understand their unique concerns and challenges. We think that a deeper understanding of their experience can pro­vide important insights that help patients, clinicians and managers.

So we focus on making the process better for all the people behind the image. We work closely with customers as strategic partners to connect data, technology and people, streamlining the path to a confident diagnosis and better outcomes at lower cost.

Q: How is people-centered imaging different from patient-centered imaging?

A: Healthcare is first and foremost about patients. To make the patient experience better, everyone involved in healthcare has to work better – individually and with each other.

We know there are many people involved in the acquisition and interpretation of every image. In this imaging ecosystem, everyone has a unique set of requirements. Supporting and connecting these people in a truly meaningful manner is directly related to creating benefit for patients.

Q: Why is it important to see imaging as a system?

A: From electronic medical records to picture archiving, communications systems, clinical databases and billing systems, health data is often distributed across many applications and departments. This makes it hard to compile a comprehensive view of individual patients and populations.

We’re approaching imaging as an ecosystem in which tech­nology and data connect seamlessly to empower all the stakeholders involved in creating diagnostic-quality images. By merging data with clinical expertise at the image processing level, we can provide the greatest value to patients, providers and health systems.

In an imaging ecosystem, patient comfort is key. Whether it’s a routine procedure or an acute situation, a patient’s level of comfort and stress can impact the diagnostic imaging process – from the physiological effects of stress on image acquisition in PET/CT1 to stress-related movement that can impede high-value, completed scans in MR and other modalities.

We recently investigated patient needs in imaging with an imaging-focused comprehensive patient study. Our research, Patient Experience in Imaging, looked at some 600 diagnostic imaging patients in terms of their satisfaction, expectations, preferences and unmet needs. The results showed three key areas that patients identified as very important: communication, comfort and safety.

Research3 into the effects of patient stress on behavioral and physiological factors critical to imaging quality reveal the significant clinical, operational and financial impact of patient-centered imaging.

In a recent article, Dr. Jennifer Kemp, diagnostic radiologist at Diversified Radiology, made a strong point that if patients are less fearful because they know what to expect, they will be better able to comply with imaging exam requirements such as holding their breath. Dr. Kemp noted how even a simple thing such as telling patients how long they are going to have to hold their breath can make a big difference.

Q: What is the financial impact when the human factor in imaging is overlooked?

A: As global healthcare spending continues to rise, cost containment in imaging will remain a major concern for health systems. There will be a focus on low-value imaging and efforts to reduce it by targeting imaging appropriateness, acquisition and quality parameters.

An investigation by Dr. Jalal Andre at the University of Washington School of Medicine identified motion artifacts (blurring of an image caused by respiratory, muscular or other patient movement) as the cause of repeated sequences in about 20 percent of MRI exams.4

He calculated the financial consequence of repeat sequences due to motion artifacts to be about $115,000 of potential revenue lost per scanner per year.

Q: How does reducing patient stress relate to the other people behind the image?

A: Patient stress affects radiology technologists who are often the one human link between patients and imaging equipment. Providing technologists with a supportive work environment may decrease burnout and increase workflow.

Radiologists face significant challenges in interpreting images, starting with the sheer number of facts they need to consider per clinical decision. Accessing relevant data, mining it and making context-driven conclusions is time consuming and stressful.

At Philips, we’re focused on innovations grounded in artificial intelligence that anticipate radiologists’ need for information and image interpretation to support confident decision-making. We have comprehensive, data-driven tools that assess operational challenges and empower people to guide more efficient and effective practice. This offers insights and directional support assisting department leadership in decision-making, helping radiology practices adapt to continuous change and creating value for the healthcare system.

An ecosystem approach is what is needed to make the most meaningful connections required toward a confident diagnosis.

For more information about Philips diagnostic imaging, click here or contact us.

  1. Intervention to lower anxiety of 18F-FDG PET/CT patients by use of audiovisual imagery during the uptake phase before imaging. Journal of Nuclear Medicine Technology 2012 40:92-98 published ahead of print May 8, 2012.
  2. Muscarneri. Evaluation of anxiety level in patients waiting to undergo diagnostic radiological exams. European Society of Radiology. 2013.
  3. Grey SJ, Price G, Mathews A. Reduction of anxiety during MR imaging: a controlled trial. Magn Reson Imaging. 2000; 18:351-55.
  4. Andre JB, Bresnahan BW, Mossa-Basha M, et al. Toward quantifying the prevalence, severity, and cost associated with patient motion during clinical MR examinations. J Am Coll Radiol. 2015; 12:689-95.

 

This article is brought to you by Philips.

What you need to know about sharing clinical images via smartphone

 

Imagine this scenario: you’re a recently graduated doctor working at a medical clinic in rural Australia. A person presents with a bite of what seems to be a poisonous spider – but you’re not sure. You take a photo of the skin lesion on your phone, and post it in a social media group to source swift advice from more experienced experts.

Digital image capturing devices like smartphones have enormous potential to facilitate communication for time critical medical interventions. And, as a society, we all seem to be part of a contract where we tacitly consent to immediate, mass distribution of images depicting us.

But there’s a catch: image capture and storage may fail to comply with current legislative frameworks for privacy, with significant ethical, legal and security implications.

As a society, it’s time for us to review how digital imaging is changing healthcare, security and other specialities.

Legal use of information

Australian legislation refers to the 1988 Privacy Act framework for guidelines about the legal and ethical use of information, including images.

This legislation was developed during a time of centralised practice of medical photography – when images were physically stored at a hospital, and could not be reproduced, or accessed, without due authorisation.

But all this changed with the advent of smartphone-enabled cameras that can capture, process and mass distribute an image instantly.

Legislative changes to the Australian Privacy Act took effect in March 2014 following the introduction of the Privacy Amendment Act 2012 and the Privacy Regulation 2013.

Under these changes, people or medical professionals with unsecured patient images on their smart devices could face fines up to A$340,000, and institutions up to A$1,700,000 for breaches of patient privacy.

At a national level, mandatory data breach notification obligations will come into force in early 2018.

But it’s not clear how this federal legislation interacts with state regulation of digital images. Individual state governments apply a range of acts to meet specific requirements in some sectors.

For example, those that apply in the medical sector in Victoria include the Freedom of Information Act, Guardianship and Administration Act, Medical Treatment Act, Health Records Act, Charter of Human Rights and Responsibilities Act and the Mental Health Act.

Different states and territories have different acts, and this is problematic. Digital images can be sent instantly across state or national borders and easily redistributed through social media. So which laws should apply?

How photos aid medical practice

Medical photographs can be an essential part of patient treatment. They allow medical staff to document the treatment of illness, to communicate among medical professionals and to teach.

A phone capture of your health image may be shared without your consent.
www.shutterstock.com

Surveys of image usage in Australian hospitals suggest that medical professionals frequently capture and store patient data on smartphones, sharing them between colleagues.

Although legislation requires signed informed consent for the storage and use of images, this appears often not to be collected, especially if a patient is not in a state to be able to grant consent. This means there is a large disconnect between image usage, and legislative requirements.

Medical professionals including doctors and nurses have probably been the most progressive in enabling surveys of current professional practices. This serves as a high value source of information for considering how changes in technology and work practice may need to be reflected in consistent legislation, independent of state borders.

Also a problem in policing

Collection and application of digital imagery in policing similarly presents new legal and ethical challenges.

In Australia, various states are either trialling or using body cameras, and police may be permitted to use personal capture devices.

But guidelines for when images of a potential crime should be captured are different between Australian states. Concerns over when evidence should be collected, and who has access to such evidence have only started to be considered in Australia.

Towards solutions

We recently discussed issues relating to legal and ethical use of digital images at the 2016 Australian Ethics Network conference.

The field of ethics management aims to ensure that data is collected, stored and distributed in a way that is consistent with moral principles, and legislative framework within a given jurisdiction. The use of digital images that can be instantly transferred across state and national borders presents many challenges.

We need sector and region specific information to answer these questions. What are the benefits to a medical professional of having instant image access, how should this be balanced with personal consent if a life is in danger? How should use of images for policing be balanced with privacy if image distribution may result in the prevention of crime?

The ConversationPossible technology solutions could include developing apps that securely store and manage data by restricting access to authorised persons. Such a process will require coordination between policymakers and professional sectors, and a conversation with the public on how we can best use digital images in an ethical way, not only for medicine but across research disciplines.

Adrian Dyer, Associate Professor, RMIT University; Jair Garcia, Research Officer, RMIT University, and Ted Rohr, Director, Research Ethics & Compliance Support, UNSW

This article was originally published on The Conversation. Read the original article.