Using mobile electronic devices to deliver educational resources in developing countries

BACKGROUND

Developing countries have far fewer trained radiography professionals than developed countries, which exacerbates the limited access to imaging services. The lack of trained radiographers reflects, in part, limited availability of radiographer-specific educational resources. Historically, organizations that provided such resources in the developing world faced challenges related to the limited stock of current materials as well as expenses associated with shipping and delivery.

METHODS

Four mobile electronic devices (MEDs) were loaded with educational content (e-books, PDFs, and digital applications) spanning major radiography topics. The MEDs were distributed to 4 imaging departments in Ghana, India, Nepal, and Nigeria based on evidence of need for radiography-specific resources, as revealed by survey responses. A cost comparison of postal delivery vs digital delivery of educational content was performed. The effectiveness of delivering additional content via Wi-Fi transmission also was evaluated. Feedback was solicited on users' experience with the MEDs as a delivery tool for educational content.

RESULTS

An initial average per e-book expense of $30.05, which included the cost of the device, was calculated for the MED delivery method compared with $15.56 for postal delivery of printed materials. The cost of the MED delivery method was reduced to an average of $10.05 for subsequent e-book deliveries. Additional content was successfully delivered via Wi-Fi transmission to all recipients during the 3-month follow-up period. Overall user feedback on the experience was positive, and ideas for enhancing the MED-based method were identified.

CONCLUSION

Using MEDs to deliver radiography-specific educational content appears to be more cost effective than postal delivery of printed materials on a long-term basis. MEDs are more efficient for providing updates to educational materials. Customization of content to department needs, and using projector devices could enhance the usefulness of MEDs for radiographer training.

"EcoRadiology"--pulling the plug on wasted energy in the radiology department

RATIONALE AND OBJECTIVES

We sought to evaluate the power consumption of various devices around the radiology department, audit our use of recycling, and review efforts by vendors to reduce the environmental impact of their products.

MATERIALS AND METHODS

Using a readily available power monitor, we calculated the power consumption of different devices around our department. In particular, we calculated the financial and environmental cost of leaving equipment on overnight and/or at weekends. When it was not possible to measure energy usage directly, we obtained and reviewed relevant technical manuals. We contacted vendors directly to document how the environmental impact of new technology and decommissioning aging technology is being tackled.

RESULTS

We found that 29 of 43 desktop computers and 25 of 27 picture archiving and communications system (PACS) reporting stations were left on needlessly overnight and/or at weekends, resulting in estimated electrical running costs while not in use of approximately $7253 per year, and CO2 emissions equivalent to the annual emissions of over 10 passenger cars. We discovered that none of our PACS reporting stations supported energy-saving modes such as "sleep" or "hibernate." Despite encouraging staff to turn off computers when not in use, a reaudit found no improvement in results.

CONCLUSIONS

Simple steps such as turning off computers and air-conditioning units can produce very significant financial and environmental savings. Radiology can lead the way in making hospitals more energy efficient.

Defining Population Health and Implications for Radiology

Most definitions of population health include improved patient health, reduced inpatient stays and proce- dures, holistic care of the entire population of a country, and a general approach to improve the quality of healthcare. However, there seems to be no mention of payment for services and resources for reimbursement. The term population health can be considered a philosophy of a new model of healthcare based upon future expectations from current laws and studies from the federal government, most notably through the ACA, and healthcare organizations. Radiology departments may perform fewer procedures in the future and receive less money for these complet- ed procedures. Management will need to adjust budgets and staffing to reflect changes. Radiology departments will need to continue the current trend of doing more with less.

Neurointerventional research between 2003 and 2012: slow growth, high interdisciplinary collaboration, and a low level of funding

BACKGROUND AND PURPOSE

Neurointerventional therapy of cerebrovascular disease is a greatly expanding field across many specialty disciplines. The goal of this study was to analyze the characteristics and trends of scientific publications that focused on neurointervention during the past decade.

MATERIALS AND METHODS

A bibliometric evaluation of neurointerventional research published between 2003 and 2012 was conducted by using the PubMed data base. Analyzed parameters included the year of publication, type of document, language of the article, topic, declared funding, country of origin, type of collaboration between disciplines, the first author's specialty, and subject category and the Impact Factor of the publishing journal.

RESULTS

Between 2003 and 2012, a total of 2123 articles were published, of which 1107 (52.1%) were original articles, 1948 (91.8%) were written in English, 192 (9.0%) received funding, 661 (31.1%) were published by the United States, and 1060 (49.9%) resulted from interdisciplinary collaboration. Neurosurgery departments produced the most articles (n = 910, 42.9%), followed by radiology (n = 747, 35.2%) and neurology (n = 270, 12.7%). The time-trend analysis in the number of publications demonstrated slow growth from 2003 to 2012, with an average annual growth rate of +6.0%.

CONCLUSIONS

The fields of neurosurgery, radiology, and neurology have contributed substantially to neurointervention research. Slow growth, high interdisciplinary collaboration, and a low level of funding are peculiar characteristics of research in this field.

The physician payments sunshine act: what the average radiologist and manager need to know

The Physician Payments Sunshine Act (PPSA) was enacted in 2010 and requires applicable manufacturers of medical devices, drugs, biological material, or medical supplies to report payments or transfers of value that are provided to physicians or teaching hospitals. PPSA has value in creating greater transparency in the financial relationships between industry, physicians, and teaching hospitals, and in potentially reducing problematic conflicts of interest. PPSA requires that this data be published, in searchable form, on a public website. CMS has delayed the reporting under PPSA until after January 1, 2013, and has yet to issue its final rules for PPSA; however, Physician Payments data already exist in a publically searchable database. It is important to realize that names of individuals may appear in the PPSA public database, even if those individuals did not actually receive a transfer of value. As with all broad-stroke legislation, consequences not anticipated or not considered sufficiently important for our government leaders may well present a problem for individuals. It behooves all physicians and healthcare managers to carefully follow the CMS PPSA regulations. In advance of meeting or interacting with any PPSA-applicable manufacturer, obtain a clear and mutual understanding regarding what reportable value, if any, will be prepared for and provided by the applicable manufacturer. In this, as in all situations in which government regulations are at play, "knowledge is strength."

Medicare reimbursement: what R.T.s should know

Amid continued attention toward cutting the cost of Medicare, medical imaging continues to be an area that legislators focus on for reducing expenditures, which ultimately affects the amount of money available in health care facilities to provide services and pay personnel. These issues support the need for medical imaging and radiation therapy professionals to understand how the Medicare program works, the provisions health care facilities must meet to obtain payment for services provided to Medicare beneficiaries, and how recent changes in Medicare reimbursement rates affect a medical imaging or radiation therapy department's bottom line.

Clinical decision support for imaging in the era of the Patient Protection and Affordable Care Act

Imaging clinical decision support (CDS) systems provide evidence for or against imaging procedures ordered within a computerized physician order entry system at the time of the image order. Depending on the pertinent clinical history provided by the ordering clinician, CDS systems can optimize imaging by educating providers on appropriate image order entry and by alerting providers to the results of prior, potentially relevant imaging procedures, thereby reducing redundant imaging. The American Recovery and Reinvestment Act (ARRA) has expedited the adoption of computerized physician order entry and CDS systems in health care through the creation of financial incentives and penalties to promote the "meaningful use" of health IT. Meaningful use represents the latest logical next step in a long chain of legislation promoting the areas of appropriate imaging utilization, accurate reporting, and IT. It is uncertain if large-scale implementation of imaging CDS will lead to improved health care quality, as seen in smaller settings, or to improved patient outcomes. However, imaging CDS enables the correlation of existing imaging evidence with outcome measures, including morbidity, mortality, and short-term imaging-relevant management outcomes (eg, biopsy, chemotherapy). The purposes of this article are to review the legislative sequence relevant to imaging CDS and to give guidance to radiology practices focused on quality and financial performance improvement during this time of accelerating regulatory change.

Accountable care organizations for neuroradiologists: threats and opportunities

Accountable care organizations (ACOs) are one of the more interesting and (perhaps) highest impact components of the 2010 Federal health care bill. Neuroradiologists should examine them carefully for opportunities to participate and contribute to ACOs as well as to understand the potential threats. Although there are questions about the viability of the proposed models, neuroradiologists should not assume this is a fad. All specialists should pay close attention to the evolution of ACOs. It seems likely that many of their features will come to pass during the coming decades with substantial impact on the profession.

Patient-centered outcomes in imaging: quantifying value

The Patient-Centered Outcomes Research Institute was created in response to a mandate to conduct comparative effectiveness research in clinical care to inform decision making. The institute will be funded by the Patient-Centered Outcomes Research Trust Fund, through congressional set-asides, and by Medicare and private health insurers, through a per beneficiary fee. The institute is governed by a board with a broad stakeholder constitution. Key committees set the national agenda for patient-centered outcomes research, the agenda for funding priorities, and communication and dissemination of the evidence with the goal of increasing the rate of implementation of the evidence into policy. In imaging, patient-centered outcomes go beyond the traditional metrics of patient satisfaction. Instead, these outcomes need to encompass the benefits and harms, focus on outcomes relevant to patients, and provide information to inform decision making. Therefore, radiologists need to be involved as stakeholders in the design, conduct, and dissemination of this research.

A model to correct for short-run inefficiencies in economic evaluations in healthcare

Important assumptions that underlie cost-effectiveness analysis (CEA) are that production technologies are convex and that production processes always perform at constant returns to scale. However, in the short run these assumptions are likely to be violated. Therefore, CEAs might overestimate cost-effectiveness in the short run. To come up with a more precise cost-effectiveness outcome, we present a model that is able to correct the long-run incremental net benefit (INB) for short-run inefficiencies. This provides decision makers with a more realistic view of the expected efficiency gains. This model starts by determining the initial efficiency losses inflicted by inflexible resources. Then the model is made dynamic in order to adjust the efficiency losses by allowing for refilling and writing off freed capacity. Finally, the model calculates the length of the short-run time frame in which such efficiency losses exist, and a correction term with which the usual long-run INB should be adjusted to account for short-run inefficiencies. The model is applied to two cases: dialysis and digitizing a radiography department. The dialysis case shows moderate short-run efficiency losses while in the radiography case short-run efficiency losses are sufficiently large to cause a switch in cost-effectiveness from favorable to inefficient in the short run.