Advances in Health Technology

1. Advances in Health Technology
Thomas Osborne, MD
UCSD Clinical Geriatrics Interprofessional Symposium
October 24, 2015

2. Page 2 | vrad.com | 800.737.0610
Introduction & Disclosures

3. Page 3 | vrad.com | 800.737.0610
Introduction:
Thomas Osborne, MD
Director of Medical Informatics
vRad
Medical School:
Dartmouth Medical School
Radiology Residency:
Harvard Medical School, Mount Auburn Hospital
Neuroradiology Fellowship:
Harvard Medical School, Massachusetts General Hospital

4. Page 4 | vrad.com | 800.737.0610
I work for Virtual Radiologic (vRad) as:
• The Director of Medical Informatics
• Neuroradiologist
Disclosures

5. Page 5 | vrad.com | 800.737.0610
Client Markets
Over 350 radiologists reading nearly 6 million annual studies for
2,100+ hospital, health system and radiology group facilities across
the U.S. and around the world.
Disclosures: Who is vRad?

6. Page 6 | vrad.com | 800.737.0610
We are the nation’s leading radiology
practice – and a recognized leader in
evidence-based analytics solutions.
“Analytics for practice comparisons are
largely subjective, and in many cases
unavailable because of the challenge of
comparing disparate data between
healthcare facilities. (vRad’s)
normalized data set … presents a
potential opportunity for radiology to
take control of the dialogue around
quality as it moves from a fee-for-
volume to fee-for-value world.”
Ingrid Lund, Practice manager for the Imaging
Performance Partnership, ABCO
“Moving up the value chain from a company that only
did preliminary reads in 2000, (vRad) has become a
center of excellence in the radiology field, rivaling
major academic centers in its contribution to the
future of radiology.”
vRad

7. Page 7 | vrad.com | 800.737.0610
Medical technology through the lenses of Radiology  & beyond
Lecture Outline
Wilhelm Röntgen's first "medical" X-ray
of his wife's hand, taken on 22 December 1895
3D volume-rendering of aortic aneurysm
EPOS Educational Exhibit. C. Fraga Piñeiro et al
Race to Build a Real Star Trek Tricorder
Past Present Future

8. Page 8 | vrad.com | 800.737.0610
Radiology Past

9. Page 9 | vrad.com | 800.737.0610
Radiology Past
1895 - Wilhelm Röntgen discovered X-rays
1896 - First clinical radiograph in America @ Dartmouth
1896 – Becquerel discovers radioactivity
1898 - Marie and Pierre Curie discovered polonium and radium
1914-1918 Radiological equipment used in field hospitals during WW I
1918 - George Eastman introduced radiographic film

10. Page 10 | vrad.com | 800.737.0610
Radiology Past
1950s - Clinical use of ultrasound begins
1972 - CT is invented by Hounsfield at EMI Laboratories
(Electric and Musical Industries signed the Beatles 1962)
1970s – 1980s MRI developed and used clinically

11. Page 11 | vrad.com | 800.737.0610
Radiology Past

12. Page 12 | vrad.com | 800.737.0610
Radiology Present
Advances marked by Convergence & Interoperability

13. Page 13 | vrad.com | 800.737.0610
Theme: Convergence & Interoperability

14. Page 14 | vrad.com | 800.737.0610
Interoperability:
making systems and organizations work together
Convergence:
migrate previously distinct systems into a unified platform
VS
Convergence & Interoperability

15. Not Interoperability

16. Also Not Interoperability

17. Page 17 | vrad.com | 800.737.0610
Radiology  Teleradiology
1981 - Fuji develops CR technology
+ +
Picture Archiving and Communication System (PACS)
convergence of healthcare, technology and telecommunications
vRad founded 2001
www

18. Page 18 | vrad.com | 800.737.0610
Remote Center
Main
Hospital
PACS
Remote Center
Rad &
Report
local area network
(LAN)
central
Rad &
Report
Remote Center

19. Page 19 | vrad.com | 800.737.0610
vRad Complete – A fully integrated Radiology Service Line
Eliminate the “seam” between on-site and cloud-based radiologists to
increase patient access, become more efficient, measure and prove
quality – and reduce costs.
• Single platform
• Unified worklist
• Customized workflows
• Data-driven operating
plan designed to help
optimize your radiology
service line
Proven Clinical
Leadership
Operational
Infrastructure with
Patented Workflows
Integrated QA
Custom Structured
Reporting
Patent-Pending
Analytics

20. Page 20 | vrad.com | 800.737.0610

21. Page 21 | vrad.com | 800.737.0610
A few examples of leading industry practices
Teleradiology Present

22. Page 22 | vrad.com | 800.737.0610
Assigner Engine
vRad Enterprise Connect – Patented, Rules-Driven Case Assignment
378 378 378 378378
Neuro
MSK
General
Neuro
Pediatric
ASSIGNMENT
RULES
60 23 12 8 3
All Available
Radiologists
Best Available
Radiologists
Internet
General
Subspecialty
Facility
Preference
Current
Worklist
Depth
Remaining
Time
MSK
Breast
Cardiac
Neuro
Nuclear
General
General
Cardiac
• Repeat every 30 seconds for entire practice
• Apply rules to each case
• Assign additional radiologists as needed
1
2
3
License &
Credential
Assignment
Rules

23. Page 23 | vrad.com | 800.737.0610
The vRad
Operations Center
immediately calls
attending
physician
Attending physician is
located and connected to
the reading radiologist
vRad radiologist
clicks “Critical
Finding” and
resumes clinical
work
Critical Findings Protocol
Features:
1. Details of verbal communication are
documented on the radiology report
and in the Operations Center records
2. Communication response time reports
available to clients
3. Disruption to radiologist and attending
physician clinical work is minimized
Benefits:
• Expedited time to accurate diagnosis
• Improved patient care
• Documented results
• Reports satisfy ACR and Joint
Commission Requirements
Critical Findings Snapshot
Current average statistics:
• Critical finding relay time: 11 minutes
(Radiologist call request > physician
located > conference call completed)
• Annual critical finding calls: 150,000+
• Daily critical finding calls: 400+
vRad’s strict process and robust support
deliver rapid communications and
reportable documentation

24. Page 24 | vrad.com | 800.737.0610
Stroke Protocol
Treatment is critical in the first 3 hr after a stroke.
The sooner the better: (Time is brain)
Clinical History: 78yo facial droop

25. Page 25 | vrad.com | 800.737.0610
Stroke Protocol

26. Page 26 | vrad.com | 800.737.0610
Stroke Protocol
“Physicians need immediate responses
to make critical decisions. Without
both subspecialty radiologists working
remotely and onsite interventional
neuroradiologists, this [stroke service
line] offering would not be possible”
Brian Ivie
President/CEO
Mercy San Juan Medical Center
Stroke cases designated with our highest
prioritization and fastest turnaround time
target of under 20 minutes
Designating the order as Stroke Protocol in the vRad OMS:
• Immediately assigns the order to all credentialed radiologists who are online at the
time of the study
• Escalates the order to the very top of the radiologists’ worklists with a requirement
that it be read as the next study
• Generates a call to your facility with positive findings (and negative findings if
requested)
Trusted Partner:
• vRad is the trusted partner of stroke centers nationwide
• Current average turnaround time: Under 9.5 minutes
• Top vRad neuroradiologists deliver the very same clinical quality at night as your
patients realize by day
• Over 35,000 stroke studies per year
“According to the American Stroke Association, stroke is the fourth leading cause of death
in the United States, with approximately 795,000 Americans each year suffering a new
stroke or recurrent stroke.”
American Stroke Association

27. Page 27 | vrad.com | 800.737.0610
Treatment is critical in the first “golden hour” after an accident.
Clinical History: 88yo fell down stairs
Exams:
 CT Head
 CT Cervical Spine
 CT Face
 CT Abd/Pel
 CT Thoracic Spine
 CT Lumber Spine
 CT Left Shoulder
 CT Knee
 CT Foot
Trauma Protocol

28. Page 28 | vrad.com | 800.737.0610
Trauma Protocol
Patent-pending workflows designed specifically to
increase the speed of high-quality radiology
reports for trauma patients – up to 40% faster.1
Unique Solution – Studies Read by Multiple Radiologists
• Patent-pending technology automatically “unbundles” trauma cases, assigning each
body region to the appropriate radiologist
to read concurrently:
Neuro: head, face, orbits, cervical spine, and neck
Body: chest, abdomen and pelvis, thoracic and lumbar spine
Lower extremities
Upper extremities
• Cases automatically prioritized at the top of our
radiologists’ worklists, required to be read next
• Radiologists automatically notified which colleagues are reading the other body
regions for the same patient, enabling real-time collaboration
“The average time from when our
imaging department receives the order
to when the ED receives the final
reports from vRad dropped by almost
20 minutes since implementing vRad’s
trauma protocol. That’s a big
improvement and our emergency
physicians have definitely noticed.”
Shawn Snider MS, RT(R)(M)
Administrative Director, Radiology
Services, CoxHealth
Rapid Communications – Reports Sent and Critical Findings Called
• Radiology reports for each body region sent as soon as they are completed allowing
treatment to begin as quickly as possible
• Critical finding calls made to any designated number, priority placed on Head/Cervical
Spine studies
• Calls can be configured to include both positive and negative findings
Current Average Stats for
Trauma Studies
4 minutes: "Eyes on the Images” –
Radiologist begins reading
<12 minutes: Turnaround time
1Turnaround time statistic compares cases designated as trauma
protocol following launch of the vRad Trauma Protocol to
comparable cases for the 12-month period prior to launch.

29. Page 29 | vrad.com | 800.737.0610
Future of Medicine

30. Page 30 | vrad.com | 800.737.0610
• Clinical & corporate efficiency
Integrated systems, specialties & technology
• Move to system of payment for quality/outcomes
• Improving healthcare accessibility & participation
• Growing importance of deep analytics & AI
Future of Medicine Trends

31. Connected Systems
• Improved clinical care:
– Improved knowledge delivery to physicians and patients
– Reducing medical errors
– Improved workflow and treatment analysis
– Foster innovation
• Improved business health:
– Reduce waste, reduce cost, increase efficiency
– Break down silos b/t isolated business units, teams & systems
– Eliminate redundant systems  create unified operating system
– Government/payor compliance

32. Care Professionals
Legal
Other?
Business
IT

33. Social Science includes:
•communication
•anthropology
•economics
•political science
•Psychology
•Sociology
•History
•law
•linguistics
Information:
•analysis/research
•collection
•classification
•manipulation
•storage
•retrieval
•movement
•dissemination
Behavioral Science includes:
•psychology
•psychobiology
•cognitive science
methodical processes:
•feasibility
•structure
•expression
•mechanization
For information:
•acquisition
•representation
•processing
•storage
•communication
•access
Business:
•executive
•finance
•marketing
•sales
•IT
•HR, Etc
Leadership:
• vision
•strategy
•direction/decision
•alignment
•coalition/collaboration
•empowerment
•energizes
Management:
•organization
•agendas
•timetables
•resource allocation
•structure
•rules and processes
•roles and responsibilities
•corrective actions
Information
Science
Social
Science
Behavioral
Science
&
Computer
Science
Care Professionals
Business
Leadership
Management

34. Page 34 | vrad.com | 800.737.0610
Corporate
Regulatory
Critical
Document
Control
Clinical

35. Page 35 | vrad.com | 800.737.0610

36. Page 36 | vrad.com | 800.737.0610
Search
0:00:00
0:01:26
0:02:53
0:04:19
0:05:46
0:07:12
0:08:38
0:10:05
1 2Pulse (1:05)other (8:41)
Results
> 8X faster

37. Page 37 | vrad.com | 800.737.0610
• Business/Practice
• Practice Staff
• Clients
• Gov/Insurance
• Patients
Analytics For:

38. Page 38 | vrad.com | 800.737.0610
1. Powerful, user-friendly analytical tools: Get custom information and
insight unavailable in your existing systems – delivered right to your inbox.
• Teleradiology Metrics ReportSM
• GPISM (Global Practice Information) Report with 24/7 cross-
practice metrics (including facility, modality and physician-specific
benchmarks)
• Hospital Insight ReportSM
2. vCoderSM patent-pending data normalization: The industry’s first data
normalization tool used on inputs for any hospital or radiology group
delivering a single and consistent retrospective view across our clients’
facilities.
3. National and peer group benchmarking with RPCSM (Radiology Patient
Care) Indices: Compare your data with the first findings-based national
and peer group benchmarking metrics. Our indices are at the aggregate
level, adhering to industry confidentiality requirements – while providing
critical comparisons and relevant context for your decision making.
4. Expert collaboration, consulting and transformation: Our Advisory
Solutions radiology experts provide actionable insight from your data with
recommendations tailored to your organization to optimize your practice
and your radiology service line.
You can’t get paid for
quality if you can’t
prove it.
And you can’t prove it
if you don’t measure it …
Transforming our clinical data repository into
actionable insight
vRad Analytics

39. Page 39 | vrad.com | 800.737.0610
Natural Language Processing technology provides quantitative measures of
qualitative clinical and operational information currently locked within your
reports – all with automated and consistent output.
Example GPI Report Components: What Can Be Measured?
Evaluate your percent positive findings
by referring physician
Why? Are your referring physicians ordering
appropriately based on practice and peer group
benchmarks? vRad’s GPI Reports give you the ability
to provide fact-based insight to your physician
partners – making your practice an indispensable
partner. Use consistent metrics to identify best
practices – and areas of opportunity to improve
quality and cost.
Looks for key words that
indicate positive findings

40. The Future-Is Now
Advances mentioned in the prior section will become standard of care practice
+
Additional early stage trends will accelerate

41. Future Directions
Telemedicine in hospital care

42. Future Directions
Telemedicine pharmacy clinic care

43. Future Directions
Telemedicine at home

44. Mobile Health Market To Reach
$26B By 2017 - InformationWeek

46. Future Directions
Connected Apparel, etc

47. Accelerators for
Future Medical Technology
Technology
Innovation
Insurance/Gov
Cost alignment
Growing educated & vocal
patient population

48. Conclusion
• This is about medicine utilizing technology,
not the other way around
• Principles of medicine unchanged
• These are just tools
• Must be directed by healthcare professionals

49. Thank You
linkedin.com/in/TomOsborneMD
twitter.com/TomorrowMed
Thomas.Osborne.MD@gmail.com