The May 2016 iteration of FHIR… has arrived. Most notable among its new capabilities: support for the Clinical Quality Language for clinical decision support as well as further development of work on genomic data, workflow, eClaims, provider directories and CCDA profiles.
FHIR (Fast Healthcare Interoperability Resources) is healthcare’s solution to breaking down information silos. It’s an exciting time to enter medical imaging.
Last October, my team started working on a project to bridge the communication gaps between inpatient general medicine and radiology. Despite having done a full year of internship before starting residency, we quickly realized that as radiologists we knew very little about healthcare is delivered on the wards. Understanding how well the imaging workflow runs from ordering to reporting, identifying possible delays by systematically analyzing patient data seemed straightforward.
Hypothesized imaging workflow for admitted medicine patients. Source: post author
A 2-hour meeting, eight weeks of delay, and several email exchanges later, we now rely mostly on manual data collection. This blog post is about what happened. Continue reading
My wife and I take a routine monthly trip to Costco to refill the refrigerator. Now with less than two months from core exam, she said she can drive by herself so I can have more time to study. It was thoughtful of her to offer. I thought for a moment. Buying chicken and cheese may be routine and unexciting, but it is something we do together, and there are some things more important than doing well on a test.
Posted in Figure Stuff Out
“The result of our approach,is that we end up with a team of people who will quickly become bored by performing tasks by hand and have the skill set necessary to write software to replace their previously manual work.”
Google engineers are not afraid of automating themselves out of a job. They embrace the challenge of finding the next best thing in machine learning, in big data, in medicine, or moonshots like longevity, because of this philosophy.
Are we bored with clicking and measuring things by hand yet? Spell checking your report manually for semantic (i.e. error of meaning not spelling) errors? Making a differential diagnosis strictly from memory? We should get bored. Then we can start to improve it.
It’s when we are satisfied from “good enough” that we forget “doing better” is possible.
… and imagine if you could program life itself. Rather than 0’s and 1’s, you have four possibilities, a computing system performing quaternary arithmetics.
I still remember being dazzled as a freshman in college, during the first computer science lecture. The professor spoke of quantum computers, where improvements in speed of calculations can be measured in squaring time 2n rather than the traditional doubling time (i.e. Moore’s law) 2n. And there was biologic computing, using simple building blocks of genetic material ACTG to perform calculations which take place in living cells.
Then, I spent the 15 years that follows writing them off as science fiction, pontifications of an old man.
I was, of course, wrong.
Twenty years ago, medicine and surgery rounds used to start in the reading room. Sitting in a dark room with a viewbox and an alternator, a senior radiologist greeted visiting clinical teams every day and reviewed their patients’ films.
With the advent of digitization and picture archive and communication system (PACS), the last 20 years saw a rapid evolution of radiology. We read studies faster than ever, and radiology workflow focused extensively on the interpretation of images and the associated diagnostic report.
Recently, there has been a revival patient-centered care and communication. Communication is the new radiology workflow.
I had the pleasure of writing about the importance of communication in radiology in a previous post. Just this month, a group at Beth Israel Deaconess Medical Center writes in American Journal of Roentgenology that despite our focus on critical value communication, the bulk (52%) of errors in radiology communication actually occur outside of results.
While most communication errors did not cause patient harm, 37.9% did affect patient care. The radiology value chain, of course, begins as early as the decision to image and extends well into appropriate follow-up imaging of identified lesions (Enzmann, Radiology 2012).
Maybe it’s time we as radiologists take ownership of the whole imaging process, from the decision to image all the way to follow-up.
[Tweet “New AJR paper finds a majority of communication errors in radiology occur outside of results notification.”]
Posted in Radiology Innovation and Quality
Tagged Communication, Error, Quality Improvement, Radiology
When I was in 8th grade, my English teacher wanted to give everyone a book to take into high school. She had a cardboard box full of various books. There was literary fiction like Toni Morrison. There was a memory aid for American presidents. But I came to class really late that day, so by the time I went up to the box, there were only a few books left. I had the great choice between Billy Budd (dryest. book. ever.), Atlas Shrugged, and this book called Getting Things Done.
I picked up Getting Things Done because Atlas Shrugged didn’t fit in my bookbag. It would be years before I realized that self-help productivity books is in itself a major genre of nonfiction. At the time it just didn’t make sense why anyone would need such pathologic level of compulsion to keep things organized.
I stumbled upon Sway today. Microsoft Sway promises to make creating web presentations easy, which is a fairly big claim.
I also happened to be studying MSK for the Core Exam, so I made a Sway approaches to mass lesions in bone. There will also be some comments on Sway.
Here’s the disclaimer: I am not an MSK expert, just some guy studying for the Core Exam! Also, all images here belong to their original owners, not me.
Also, Sway’s navigation is a hybrid between PPT slide show and web-based scrolling. It takes a little getting-used-to. Definitely try it in full screen, but it can also be embedded in a web page like this.
All in all, I was impressed with Sway, and I hope it continues to mature.
It did crash twice on me, but no content was lost as the app continuously saves your edits to the cloud the same way we have come to expect web apps. Sway is the easiest way to create engaging content by removing the guesswork in design layout. Whereas PowerPoint seems to encourage you to create bulleted lists after bulleted lists, Sway encourages you to get your point across through pictures and videos.
I really like the direction the software is taking because this is how radiology content should be shared.
For someone who always needs to be doing something to keep focusing on the topic at hand, Sway kept me on task by providing an immersive environment for creating content. That’s always a plus.
Posted in Figure Stuff Out
If you are a radiology resident, you probably spend more than eight hours a day in front of a computer. Just as a cardiologist might spend hours looking for the best-in-class stethoscope and a neurologist a perfectly balanced reflex hammer, a radiologist might do well to spend some time thinking about spiffing up your workstation.
These are not radiology-specific tools. They are also not mind-blowing innovations. Instead, their existence often go unnoticed. Like air, some tasks that these programs help you with are so ubiquitous you may not even even realize they could be improved.
Screen capturing is easy as 1, 2, 3
There is always a role for downloading full resolution TIFF images for publication purposes. However, sometimes you just want a simple screenshot for case conference or teaching file.
Fortunately, there’s a one that is on just about every modern Windows machine.
Posted in Residency Productivity 'Hacks', Technology and Informatics
Tagged ClipX, Mindmap, OneNote, Productivity, Residency, Tools, Trello, XMind
A friend did me a favor yesterday without being asked. I asked him why.
He said earlier this week his neighbor decided to shovel snow for the entire block. The neighbor dug out everyone’s cars from several feet of deep snow.
The cynical might endorse The Chain of Screaming, but the opposite is equally true. In the aftermath of the most severe blizzard the northeast has seen in recent years comes a warm act of kindness.
Cynicism and kindness are both contagious. Which one will you spread?
Posted in Figure Stuff Out