Evidence-based imaging. Optimizing imaging in patient care
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DIAM provides thought leadership and guidance with respect to IT-supported processes in medical imaging by helping users and buyers of medical imaging technology to efficiently identify existing, and potential future, infrastructure or workflow gaps and by supporting clinical and managerial users of medical imaging technology in reaching decisions on strategic, operational and procurement levels. This is intended to ensure that departments adopt the appropriate digital strategy, taking account of their circumstances, thus maximising the improvement in health outcomes that can be obtained.
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The DIAM framework, with stages from 0 to 7, allows hospitals to gain a clear overview of their existing capabilities; assists in strategic, operational and procurement decisions; and offers the potential for benchmarking with other organizations. If repeated, the DIAM assessment can facilitate the monitoring of progress in imaging IT performance within individual organizations over time.
The insights this provides can have both internal and external applications. In turn, these ten focus areas direct attention towards more than indicators integral to the digitization of imaging workflows. DIAM provides a simple, three-step pathway to enable participating organizations to identify their level of imaging IT capabilities and highlight key areas for improvement based on the essential areas and indicators described above.
An online assessment form, called the DIAM survey, which must be completed by the participating organization. The extent of this assessment depends on the DIAM level achieved by the submitting organization. This score is only shared with the organization which submitted the data. Such information can be of significant value in making sure that departmental strategy is aligned with the overall business strategy of the organization.
Additionally, the fact that DIAM is an external assessment makes it valuable in situations in which internal requests or judgments might be more easily overlooked e.
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In stages 0—4, the model has sequential compliance goals, i. The early stages 0—4 Footnote 1 are concerned with the planning and implementation of imaging IT. The following are some non-exhaustive examples: To achieve stage 1, the organization should have implemented key software applications relevant for managing the workflows as well as the images and reports acquired and produced in the imaging department, such as a RIS, a PACS or a vendor neutral archive VNA.
By stage 3, electronically supported processes for matching patient and examination identifiers ought to be in place. At this stage, it is also expected that software tools are used to manage radiation dose and that some degree of clinical decision support CDS is implemented, e. In this example case, the hospital would have achieved DIAM stage 3; although, it has also made some progress towards higher levels too. Stages 5—7 are non-hierarchical and allow for different approaches when making best use of the most advanced software-related features. If an organization qualifies for stages 6 or 7, an additional validation process will take place before certification.
As previously noted, the DIAM score is designed to assist in benchmarking and alignment of best practices with other institutions—regionally, within a specific country, or around the world. This benchmarking can help identify organizations that have already made sophisticated and valuable use of imaging technology in order to highlight them as best practice cases at HIMSS and ESR-hosted events.
Evidence-Based Imaging: Optimizing Imaging in Patient Care
The score can also play a role in discussions and negotiations e. The intention is to build a network of peers and facilitate the sharing of smart solutions to common challenges. This should create a feedback loop in which the DIAM project becomes more valuable as more organizations join, in turn attracting more organizations. DIAM is designed to assist in the transition to value-based radiology [ 2 ], allowing healthcare providers to maximize their efficiency and optimise patient outcomes.
Value, recognized as quality relative to cost, can be promoted through the avoidance of unnecessary procedures or the use of cheaper procedures where any associated reduction in image quality is inconsequential to diagnosis. Thus, DIAM may also be considered a route towards the implementation of value-based imaging, e. DIAM is not only of utility to healthcare providers, but also offers demonstrable benefits to vendors as follows: it offers the advantage of standardization, it provides access to preference knowledge in relation to imaging IT, it can assist in identification of key market opportunities and it can drive business strategy and tactical alignment.
Having explained what the DIAM model is, how it works, and what it is intended to do, this article will now give an overview of conclusions that can be drawn regarding the state of digital imaging based on the data collected from the organizations that have been assessed so far. It shall then focus on short case studies of four specific organizations in different countries and at different DIAM stages to demonstrate the positive impact the DIAM assessment can have in terms of day-to-day practice and patient care. The majority of these organizations were hospitals The mean DIAM score is 3.
Based on the key areas considered essential to the digitization of imaging by the ESR and HIMSS, a general impression of the state of digital imaging adoption rates on a global scale can be provided and various gaps in digital imaging adoption can be identified. Such information may be of value not just to institutions considering participation in DIAM, but to all imaging facilities. This overview of different institutions from many different countries is, of course, still based on a relatively small sample size; however, it clearly indicates different topics which should be focused upon.
Within the ten key areas that form the basis of the DIAM model, six in particular can be identified as in need of further improvement if digital imaging is to be considered successfully adopted based on analysis of the so-far completed DIAM assessments. These are health information exchange, patient engagement, clinical decision support, pervasiveness of use, advanced analytics and personalized medicine.
Additionally, it is possible to identify two further areas that must be considered for the successful adoption of digital imaging: interoperability and structured reporting. Making appointments for imaging examinations online is possible for patients in less than a quarter of the organizations. Less than a third of organizations offered eConsultation i. The DIAM assessments completed thus far reveal that less than half of the participating organizations have CDS tools integrated into their electronic workflow.
Assuming that organizations without such tools integrated are less likely to have participated in the first place to avoid receiving a low score, even though the scores are not made public without their consent , this would suggest that there is significant room to expand the adoption of CDS systems.
This appears to be a great opportunity to improve health and avoid unnecessary hospital admissions in the future that are currently being missed. DIAM, through its promotion of CDS, has the potential to benefit both hospitals and patients by expediting workflows, by avoiding the need to seek pre-approval of procedures from insurers, and by reducing the incidence of inappropriate procedures being carried out.
As an example, if an imaging department has implemented speech recognition software with licences for all staff members, the expectation would typically be that this solution would be used by all radiologists. The organization should thus monitor its radiologists to ensure they actually do use the software in question and, if the data shows that some are using it less often than others, investigate the reasons for this and take appropriate actions to improve the situation e.
Similar experiences were made with the implementation of CDS for imaging referrers, where lack of user adoption can be a barrier to unlocking the full potential of improved imaging utilization. Awareness among users and adequate training and support should be complemented by administrative, financial, clinical or regulatory incentives. Evidence from the DIAM surveys so far completed suggests that currently implemented technologies are not always optimally utilized. The use of predictive risk analysis of patients e. Personalized medicine [ 3 ] is still an area that displays some key gaps: out of five items addressing this in the DIAM survey, four are not used by the majority of the surveyed facilities.
The biggest gap is radiogenomics, i. Systems to support the use of structured information based on imaging biomarkers for image post-processing and quantification in order to optimise the treatment e. In addition to the above key areas, the DIAM assessments have so far highlighted two additional areas that require further improvement if digitization of imaging is to be fully achieved:. Although many especially older radiologists are more comfortable with free-text reports, it is clear that, in general, referring clinicians prefer reports in structured formats [ 4 , 5 ]. Footnote 3. In addition to the general global conclusions that may be drawn from the DIAM data as to the status of digitalisation in radiology, it is also instructive to enquire about the experience of specific hospitals that have completed the DIAM assessment.
For this reason, four case studies have been selected to give brief examples of some of the impacts DIAM has had on institutions with differing levels of digitization. In practical terms, the DIAM assessment gave additional impetus to projects such as the implementation of a VNA, an enterprise-wide Master Patient Index MPI , cross reporting and analytics, which, in turn, had a positive impact on patient care.
As an example, over 50, duplicate records were discovered among Ministry of National Guard Health Affairs facilities. Care providers are now seeing single, unified patient imaging history records, which enable them to increase efficiency. However, after the DIAM assessment, it was noticed that requests for enhancement are now significantly more likely to be justified and, thus, enable IT value. With this in mind, investment in open application provider interfaces APIs , implementation of HL7 standards and patient-centric IT enhancement requests were ranked as a first priority.
To date, six hospitals from the Moscow Health Department have participated in the DIAM project, the highest ranked of which achieved stage 3. Workflow automation and informatization require daily decisions about the implementation and use of digital technologies. Heads of imaging departments in Moscow hospitals now use DIAM action points to build their own data-driven strategies and to justify software implementation.
The ability to build cooperation between different clinics, between clinics and vendors and between different vendors is highly valued. In filling out the DIAM assessment, the need for a real team effort to gather all information and to get a balanced response became clear.
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DIAM was particularly useful in highlighting such discrepancies. Now, DIAM training and workshops are organised in the Netherlands and an active campaign has been started to get as many healthcare institutes as possible to perform the DIAM analysis. This lobby was necessary because the initial small number of participating institutes did not allow easy comparison on a national level.
Most chapters have been written by radiologists in close collaboration with clinical physicians and surgeons to provide a balanced and fair analysis of the different medical topics. To make the book user friendly and to enable fast access to pertinent information, the authors have organised all of the chapters in the same format. The chapters are framed around important and provocative clinical questions relevant to a physician's daily practice. Key points and summarised answers to the important clinical issues are at the beginning of the chapters so that the busy clinician can understand the most important evidence-based imaging data in seconds.
By offering a clear understanding of the science behind the evidence, the book fills a void for radiologists, clinicians and others with an interest in medical imaging and a desire to implement an evidence-based approach. I heartly recommend this test to everyone with aspirations to improve their delivery of medical care to patients in the 21st century. RAD Magazine, Nov.
This book gives the reader a clinically relevant overview of epidemiology, selection of subjects for imaging, selection of imaging strategies, imaging test performance and cost, cost-effectiveness analysis, and applicability to children. Medina and Blackmore have assembled a large number of imaging and clinical experts to produce this volume. Illustrative imaging case studies are presented to highlight the text discussions. Coley, Pediatric Radiology, Vol. The book succeeds in clearly presenting the status of evidence-based imaging and the numerous areas in which evidence is insufficient.
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Buy eBook. Buy Hardcover. Buy Softcover. FAQ Policy. About this book Evidence-Based Imaging: Optimizing Imaging for Patient Care presents the radiologist and clinician with a user-friendly guide to the evidence-based science and the merit behind the diagnostic imaging studies performed in medicine. Show all. From the reviews: Radiology " Halvorsen, Jr, MD; Radiology: Volume Number 2 - May "Evidence-based Imaging presents the radiologist and clinician with a user friendly guide to evidence-based science and the merit behind the diagnostic imaging studies performed in medicine.