Opinion: Will The Joint Commission’s New Standards Keep You Safe from Unnecessary Medical Imaging? | mHealthWatch

Opinion: Will The Joint Commission’s New Standards Keep You Safe from Unnecessary Medical Imaging? | mHealthWatch.

Mature doctor talking to his patient who is about to receive an MRI Scan.url=http://www.istockphoto.com/search/lightbox/9786662][img]http://dl.dropbox.com/u/40117171/medicine.jpg[/img][/url]

From the 14 July 2015 mHealth post

The following is a guest contributed post by Karen Holzberger, Vice President and General Manager for Diagnostics at Nuance.

The Joint Commission standards for diagnostic imaging, which recently went into effect, are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. Beginning July 1, 2015, these standards require protocols, documentation and data collection, staff education and other criteria that raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals.  What do these standards really mean to the patient?

The new imaging standards focus primarily on the radiation dose index. There are a number of uncertainties tied to the long-term impact of imaging on patients, but researchers agree it impact patients differently depending upon sensitivities to radiation, age, body parts being tested, absorption rates and other factors and these are still being studied. In the meantime, to prevent undue risk, The Joint Commission has put a stake in the ground with these specific standards to help improve patient safety.  The Joint Commission joins other accredited healthcare organizations, such as the American College of Radiology (ACR) and other clinical associations that are releasing new quality-focused recommendations,enhanced education tools and technologies to make it easier for healthcare teams to keep you safe from unintended risks while you receive diagnostic imaging that could shed light on serious health conditions.

…

[Reblog] One nanoparticle, six types of medical imaging – University at Buffalo

One nanoparticle, six types of medical imaging – University at Buffalo.

Tomorrow’s doctors could use this technology to obtain a super-clear picture of patients’ organs and tissues By Charlotte Hsu

Release Date: January 20, 2015

University at Buffalo researchers and colleagues have designed a nanoparticle detectable by six medical imaging techniques. This illustration depicts the particles as they are struck by beams of energy and emit signals that can be detected by the six methods: CT and PET scanning, along with photoacoustic, fluorescence, upconversion and Cerenkov luminescence imaging.

This transmission electron microscopy image shows the nanoparticles, which consist of a core that glows blue when struck by near-infrared light, and an outer fabric of porphyrin-phospholipids (PoP) that wraps around the core. Credit: Jonathan Lovell

“A patient could theoretically go in for one scan with one machine instead of multiple scans with multiple machines.”

Jonathan Lovell, assistant professor of biomedical engineering

University at Buffalo

BUFFALO, N.Y. — It’s technology so advanced that the machine capable of using it doesn’t yet exist.

Using two biocompatible parts, University at Buffalo researchers and their colleagues have designed a nanoparticle that can be detected by six medical imaging techniques:

• computed tomography (CT) scanning;
• positron emission tomography (PET) scanning;
• photoacoustic imaging;
• fluorescence imaging;
• upconversion imaging; and
• Cerenkov luminescence imaging.

In the future, patients could receive a single injection of the nanoparticles to have all six types of imaging done.

This kind of “hypermodal” imaging — if it came to fruition — would give doctors a much clearer picture of patients’ organs and tissues than a single method alone could provide. It could help medical professionals diagnose disease and identify the boundaries of tumors.

“This nanoparticle may open the door for new ‘hypermodal’ imaging systems that allow a lot of new information to be obtained using just one contrast agent,” says researcher Jonathan Lovell, PhD, UB assistant professor of biomedical engineering. “Once such systems are developed, a patient could theoretically go in for one scan with one machine instead of multiple scans with multiple machines.”

When Lovell and colleagues used the nanoparticles to examine the lymph nodes of mice, they found that CT and PET scans provided the deepest tissue penetration, while the photoacoustic imaging showed blood vessel details that the first two techniques missed.

Differences like these mean doctors can get a much clearer picture of what’s happening inside the body by merging the results of multiple modalities.

– See more at: http://www.buffalo.edu/news/releases/2015/01/015.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Science360NewsServiceComplete+%28Science360+News+Service%3A+Complete%29&utm_content=Netvibes#sthash.uBpXDk8L.dpuf

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[Reposting] A medical-testing lesson from Minnesota: Less can be more

 

The state’s approach to cutting unneeded medical scans could be a model for federal Medicare savings.

 

From the 6 January 2013 article at Star Tribune – Health

 

A novel strategy that has saved Minnesota millions of dollars in unnecessary medical-imaging scans — and probably prevented dozens of patient deaths — might soon go national.

Leaders from Minnesota’s medical and insurance communities met Monday morning to celebrate the project — which has leveled off the skyrocketing growth of MRI and CT scans for back pain, headaches and other problems — and to promote legislation by Rep. Erik Paulsen that would bring it to bear on the federal government’s vast Medicare program.

Minnesota’s “decision support” strategy, enacted in 2006, created a single set of standards for doctors to follow in deciding when patients need the costly scans. It also created a green-yellow-red coding system to show patients when scans were recommended and when they weren’t. The use of such scans, which had been growing at a 7 percent annual clip, grew just 1 percent from 2007 to 2012.

…

….officials in other states often view Minnesota as “quite peculiar” because of its small, cooperative community of insurers and physician groups, and don’t believe its innovations can be repeated elsewhere, said Dr. Pat Courneya, medical director of HealthPartners, the Bloomington-based health plan.

Getting this type of approach to succeed in Medicare, on the other hand, would cause it to spread to other states, he said.

More than 80 percent of imaging scans in Minnesota are now ordered only after doctors seek out decision-support guidance to make sure they are recommended based on their patients’ conditions and medical histories.

Courneya said the initial guidelines were based on the clinical expertise and recommendations of Minnesota doctors. They have since been revised as studies refine when imaging scans should be used. Research, for example, has identified the types of patients who are suitable for scans to screen for breast or lung cancers.

 

Read the entire article here

 

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• Hospitals Overcharging Patients, Nurses’ Union Says
• Dayton Children’s cuts risk from CT scans

 

More information does not equal better care

 Chalmette, LA, December 16, 2005 – A patient describes his symptoms with a nurse at the Primary Care Clinic in St. Bernard Parish. The facility located in a triple-wide office trailer offers free medical care to area residents, staffed by personnel from the U.S. Public Health Agency and FEMA Disaster Medical Assistance Team (DMAT). Robert Kaufmann/FEMA

A wise, sobering post on the limits of medical/health related information.

Technology is increasingly used to collect and store personal health and medical data. While the amount of personal stored data is rising, this does not necessarily translate into better care. For example, the information stored in electronic medical records is only as good as the data entered.  Medical devices (as imaging and gene testing instruments) generate data that may or may not be useful depending on why they were ordered and how they results are interpreted.

The use of the data is also troublesome. As this post states, medical test results are often misused by the diagnostics industry in over testing.  This leads to unneeded treatments which divert money and resources.  Health care providers, especially those in primary care have less time to listen to and counsel patients.

The money spent on unnecessary treatments is a burden not only on individuals, but also health care facilities and government agencies. Health care facilities become caught in a spiral of justifying diagnostic equipment through marketing and at some point they will find it nearly impossible to recoup their investments. Medicare and Medicaid funds are not used wisely to diagnose and treat, resulting in ever more increased costs to the system.

As this post points out, health care providers would be wise to take a deep look at their role and be realistic about their expectations.
The same can be said about those who consult with health care providers.

From the 1 November 2012 article at KevinMD.com

I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of over testing. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”

 

Related Resources

• US Agency for Healthcare Research and Quality (AHRQ)- Consumers and Patients
  • Choosing Quality Care
  • Comparing Medical Treatments
• Evaluating Health Information (Health Resources for All Edited by Janice Flahiff)

Related articles

• Why Health Care is a Civil Right (jflahiff.wordpress.com)
• Misinformation in electronic medical records has consequences (kevinmd.com)
• Shared Decision Making Leads To A Better Patient Experience And Higher Levels Of Patient Satisfaction (introcomm)
• Supplies and Devices Are Biggest Cause of Hospital Cost Increase(jflahiff.wordpress.com)
• 9-part series on over-diagnosis (HealthNewsReview.org)

Environmental Causes of Breast Cancer and Radiation From Medical Imaging

 

From the article abstract at Archives of Internal Medicine (9 July 2012)

[Full text is free at above link]

Susan G. Komen for the Cure asked the Institute of Medicine (IOM) to perform a comprehensive review of environmental causes and risk factors for breast cancer. Interestingly, none of the consumer products (ie, bisphenol A, phthalates), industrial chemicals (ie, benzene, ethylene oxide), or pesticides (ie, DDT/DDE) considered could be conclusively linked to an increased risk of breast cancer, although the IOM acknowledged that the available evidence was insufficient to draw firm conclusions for many of these exposures, calling for more research in these areas. The IOM found sufficient evidence to conclude that the 2 environmental factors most strongly associated with breast cancer were exposure to ionizing radiation and to combined postmenopausal hormone therapy. The IOM’s conclusion of a causal relation between radiation exposure and cancer is consistent with a large and varied literature showing that exposure to radiation in the same range as used for computed tomography will increase the risk of cancer. It is the responsibility of individual health care providers who order medical imaging to understand and weigh the risk of any medical procedures against the expected benefit.

Susan G. Komen for the Cure, the largest grassroots network of breast cancer survivors and activists in the United States, asked the Institute of Medicine (IOM) to perform a comprehensive and evidence-based review of environmental causes and risk factors for breast cancer, with a focus on identifying evidence-based actions that women can take to reduce their risk.¹ Environmental exposures were defined broadly to include all factors not genetically inherited, and the IOM committee appointed to write this report included academicians and chairs from departments of environmental health, toxicology, cancer epidemiology, preventive medicine, and biostatistics in addition to advocates for patients with breast cancer. Committee members conducted their own reviews of the peer-reviewed epidemiological and basic science literature, commissioned several papers specifically for their report, and drew on evidence-based reviews already completed by organizations such as the Agency for Research on Cancer and the World Cancer Research Fund International. The publication Breast Cancer and the Environment: A Life Course Approach was released online in December 2011.¹

Related articles

• Breast Cancer Risk Can Be Lowered by Avoiding Unnecessary Medical Imaging (sott.net)
• Breast cancer risk can be lowered by avoiding unnecessary medical imaging (eurekalert.org)
• Breast Cancer Radiation Therapy, Treatment & Side Effects (cancercenter.com)
• Susan G Komen for the Cure breast cancer charity ‘misleading screening benefits’ (telegraph.co.uk)
• US cancer body oversells mammograms: experts (engineeringevil.com)
• Cut breast cancer risk by avoiding scans (upi.com)
• Komen overstating mammogram benefit? (cnn.com)

 

Huge Increase In Radiation Exposure From Diagnostic Imaging

From the 13 June 2012 Medical News Today article

As imaging technology advances and medical devices improve, healthcare professionals are more inclined to use these state-of-the art scanners to look inside patients’ bodies. Computed tomography usage, for example, more than tripled between 1996 and 2010. Over the same period, MRI (magnetic resonance imaging) usage increased fourfold. It is not surprising, therefore, that patient radiation exposure has also risen.

An article in JAMA, published today, asks the question to see if this technological dependance is going too far or even putting patients in danger with too many scans. Some people are worried about raditation from mobile phones, so stepping inside a multi-million dollar machine that blasts the body with one type of electromagnetic resonance or another, is going to draw warranted safety questions…

..One of the main points made in the article is that there has never been a comprehensive study of how much use healthcare providers are making of imaging technology. The studies that have been done are usually based around private practices and done for insurance purposes, and in these cases, imaging is usually encouraged. Looking at a wider range of patients and facilities enables the authors to provide us with a clear picture.

The authors summarize the use of various imaging techniques:

• Radiography and angiography/fluoroscopy rates were relatively stable over time: radiography increased 1.2 percent per year, and angiography/fluoroscopy decreased 1.3 percent per year.
• Computed tomography examinations tripled (52/1000 enrollees in 1996 to 149/1000 in 2010, 7.8 percent annual growth)
• MRIs quadrupled (17/1000 to 65/1000,10 percent annual growth)…

…while healthcare has obviously improved with the use of technology, given the high costs of imaging, some $100 Billion annually, combined with the cancer risks and other possible side effects, the benefits of sending patients for scans, should be balanced by weighing the medical needs against both financial and heath risks of the technology itself.

Related Resource

   Choosing Wisely (US Agency for Healthcare Research and Quality)

Choosing Wisely™ aims to get physicians, patients and other health care stakeholders thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.
Includes tips,scenarios, and information to get the most out of doctor visits.

 

English: Osteoarthritis Initiative (OAI) researchers at Ohio State University look through the opening of an MRI machine, used to image the knees of patients. The OAI, a public-private partnership, led by NIAMS and the National Institute on Aging with additional support from five other Institutes and Centers, funds research and information sharing resources to aid in the identification of biological markers for osteoarthritis. (Photo credit: Wikipedia)

 

Related articles

• Huge Increase In Radiation Exposure From Diagnostic Imaging (medicalnewstoday.com)
• Substantial increase in rate of advanced diagnostic imaging, associated radiation exposure (eurekalert.org)
• Diagnosing Disease (nlm.nih.gov)
• Locally, precautions taken to reduce radiation risk (jacksonville.com)
• Patients’ radiation levels boosted by increased medical scans – CBS News (cbsnews.com)
• Huge Rise in CT, MRI, Ultrasound Scan Use (nlm.nih.gov)
• Greater use of imaging tests raises radiation fears (sfgate.com)
• MRI and CT scan use spikes, study finds (vitals.msnbc.msn.com)
• MITA Statement On JAMA Article On Imaging Utilization Trends (medicalnewstoday.com)
• Locally, precaustions taken to reduce radiation risk (jacksonville.com)
• Imaging, Radiation Exposure Up, Even At HMOs (huffingtonpost.com)
• CT scans warning after study claims too many could lead to brain cancer (guardian.co.uk)

ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients

 

From the 14 December press release via Eureka Alerts

As part of its ongoing efforts to ensure safe, effective and appropriate medical imaging, the American College of Radiology has joined the ABIM Foundation and eight other medical specialty societies in Choosing Wisely. The new campaign promotes wise choices by physicians and patients to improve health outcomes, avoid unnecessary interventions and make efficient use of healthcare dollars.

The ACR will develop a list of five things to reduce unnecessary imaging exams ordered by physicians and improve quality of care. The list names imaging exams whose necessity should be discussed before being ordered. The list also equips providers with steps to help ensure safe, appropriate use of scans.

“Medical imaging exams are a perfect fit for Choosing Wisely. Scans lower healthcare costs by replacing more invasive surgeries and allowing for shorter hospital stays. Although imaging use is down significantly since 2008 and Medicare spending on imaging is the same as in 2004, opportunities remain to ensure appropriate ordering of scans. As greater access to imaging is directly tied to increased life expectancy, ACR will identify areas where care can be improved without restricting patient access,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors……

…….

The ACR list, and those of other Choosing Wisely partners, will be released in April 2012. To learn more, visit ChoosingWisely.org.

The ChoosingWisely Web page includes the following under Resources

• Five Things Physicians and Patients Should Question
• Choosing Wisely Video Mini-Series
  

This series of six video vignettes featuring physicians and patients emerged from research the ABIM Foundation conducted to better understand public and professional attitudes about stewardship of finite resources. Watch the videos.

 

Related articles

• ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients (medicalxpress.com)