Impact of an Information Technology–Enabled Initiative on the Quality of Prostate Multiparametric MRI Reports

Rationale and Objectives: Assess the impact of implementing a structured report template and a computer-aided diagnosis (CAD) tool on the quality of prostate multiparametric MRI (mp-MRI) reports. Materials and Methods: Institutional Review Board approval was obtained for this HIPAA-compliant study performed at an academic medical center. The study cohort included all prostate mp-MRI reports (n=385) finalized 6 months before and after implementation of a structured report template and a CAD tool (collectively the IT tools) integrated into the PACS workstation. Primary outcome measure was quality of prostate mp-MRI reports. An expert panel of our institution’s subspecialty trained abdominal radiologists defined prostate mp-MRI report quality as optimal, satisfactory or unsatisfactory based on documentation of 9 variables. Reports were reviewed to extract the predefined quality variables and determine whether the IT tools were used to create each report. Chi-square and Student’s t-tests were used to compare report quality before and after implementation of IT tools. Results: The overall proportion of optimal or satisfactory reports increased from 29.8% (47/158) to 53.3% (121/227) (p<0.001) after implementing the IT tools. While the proportion of optimal or satisfactory reports increased among reports generated using at least one of the IT tools (47/158=[29.8%] vs. 105/161=[65.2%]; p<0.001), there was no change in quality among reports generated without use of the IT tools (47/158=[29.8%] vs. 16/66=[24.2%]; p=0.404). Conclusion: The use of a structured template and CAD tool improved the quality of prostate mp-MRI reports compared to free-text report format and subjective measurement of contrast enhancement kinetic curve

Clinical audit and quality assurance in the imaging process

Recent decades have witnessed a large and rapid expansion of medical imaging technologies with the development of digital imaging, computed tomography (CT), intervention radiology (IR), magnetic resonance imaging (MRI) and positron emission tomography (PET). The average effective dose per capita in Finland, received from X-ray examinations and interventional radiology has risen within reasonable levels, but the proportional CT scan dose sustained by the population out of the total population dose has increased and is currently over 50% from the total population dose in medicine. These technical developments and an increase in diagnostic examinations have raised concerns regarding the quality and safety of imaging practices. Organizations using medical imaging modalities should have a documented quality assurance (QA) program, as well as methods to justify the use of new radiological procedures ensuring the safe operation and adequate quality of clinical images and the imaging process. According to decree 423/2000 departments using ionizing radiation should be audited in all essential aspects at intervals not exceeding five years. Clinical audits should be arranged to expediently complement the self-assessment of activities. Reports of the two clinical audit periods were evaluated at 14 diagnostic radiation departments in the Hospital District of Southwest Finland (I). Recommendations given during the first clinical audit period were largely implemented by the second run. Auditing appeared to positively affect radiological imaging quality in our study. The use of ionizing radiation always requires a safety license and on-site inspections. The Radiation and Nuclear Safety Authority (STUK) is Finland s regulatory body controlling safety aspects of radiation utilization, and ensuring that safety guidelines defined by the Radiation Act are followed. The contents of the clinical audits and regulatory inspections of radiological procedures were examined and overlaps were searched for in 20 radiological imaging departments in the Hospital District of Helsinki and Uusimaa (HUS) (II). Radiation safety organizations, examination and personal dosimeter usage guidelines, patient doses, the quality control of equipments and self-assessments were evaluated by both the clinical auditors and the inspectors. Clinical audits and regulatory inspections have partly addressed similar topics. The personal equivalent doses of 267 radiation employees were monitored using personal dosimeters at the HUS Helsinki Medical Imaging Center (III). A personal dosimeter was worn by a total of 116 radiologists and 151 radiographers. Exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 59 radiologists and 14 radiographers during a five-year period. Only 10 angiography radiologists recorded doses above 10 mSv during the five-year period. Individual exposure monitoring is justified for radiologists working in interventional procedures. Report quality was examined at the HUS Helsinki Medical Imaging Center. An experienced chest radiologist re-reported 293 chest radiograph examinations in accordance with the original request and without identifying patients (IV). Two experienced radiologists compared the content of the initial and re-reported reports. Three referring physicians evaluated the usefulness of the reports. Radiologists mostly addressed the questions posed by referring physicians, but separate conclusions were seldom included. Significantly shorter reports were initially prepared by general radiologists (29 words on average) than by the chest radiologist (93 words on average) in her re-reported reports. Inter-observer agreement between the two radiologists revealed that identical opinions of the findings was low (0.31), due to unstructured reports containing differing quantities of information. Referring physicians considered the reports clear and intelligible.Röntgentoiminnan ja röntgenlausunnon laatu vaikuttaa suoraan potilasturvallisuuteen Viimeisten vuosikymmenten aikana röntgenissä käytettävät kuvantamistekniikat ovat kehittyneet huimaa vauhtia. Tekniset kehitysaskeleet ja tutkimusten lukumäärän kasvu on tuonut esille tarpeen arvioida kuvantamiskäytäntöjen laatua ja turvallisuutta. Ionisoivan säteilyn käyttö vaatii aina turvallisuusluvan sekä viranomaisen määrävälein tekemiä tarkastuksia, asiantuntijoiden tekemiä kliinisiä auditointeja ja henkilökunnan tekemiä itsearviointeja. Suomessa kliiniset auditoinnit suorittavat röntgenin asiantuntijat eli radiologi ja röntgenhoitaja. Fyysikko on mukana lähinnä yliopistosairaaloiden auditoinneissa. Auditoijat arvioivat yksikön toiminnan ja antavat kehittämissuosituksia. Tutkimuksen kohteena olleet röntgenit saivat ensimmäisellä auditointikierroksella 2000-luvun alussa 80 kehittämissuositusta, mutta toisella kierroksella viiden vuoden jälkeen enää 54 kehittämissuositusta. Ensimmäisen auditointikierroksen kehittämissuositukset oli suurimmaksi osaksi laitettu kuntoon ennen toista kierrosta, joten auditoinnilla on positiivinen vaikutus kuvantamisen laatuun. Säteilyturvakeskus tarkistaa säännöllisesti röntgenlaitteiden turvallisuuden. Kliinisissä auditoinneisssa ja viranomaistarkastuksissa arvioidaan säteilyturvallisuutta, henkilökunnan ohjeistusta, potilasannosmittausten tuloksia, laitteiden laadunvalvontaa sekä itsearvioinnin suorittamista ja niiden tuloksia. Kliinisissä auditoinneissa arvioidaan toimintaa hyväksyttyihin kliinisiin käytäntöihin nojaten, kun taas viranomaistarkastuksissa arvioidaan toimintaa laiteturvallisuuden kannalta. Tutkimuksen perusteella voidaan sanoa, että viranomaistarkastuksissa ja kliinisissä auditoinneissa arvioidaan osin samoja asioita. Radiologit tarvitsevat hyvät lähetteet, jotka sisältävät riittävät tiedot potilaan oireista ja mahdollisen kysymyksen siitä, mitä röntgentutkimuksella haetaan. Lähettävät lääkärit odottavat puolestaan selkeää, helposti ymmärrettävää ja sisällöltään riittävää lausuntoa. Radiologit vastasivatkin useimmiten lähettävän lääkärin esittämään kysymykseen, mutta yhteenveto tutkimuksesta puuttui usein. Eri radiologien röntgenlausuntojen sisällöissä oli huomattavia eroja, ja niiden vertailu oli vaikeaa radiologeille itselleenkin. Erot lausuntojen rakenteessa ja pituudessa viittaavat siihen, että tarvitaan selkeitä ohjeita ja koulutusta lausuntojen sisällöstä. Röntgentutkimuksista aiheutuvat henkilökunnan säteilyannokset vaihtelevat lähes minimaalisesta annoksesta keuhkokuvauksessa huomattaviin annoksiin monimutkaisissa läpivalaisutoimenpiteissä. Tutkimukseen osallistui 267 röntgenissä työskentelevää henkilöä, ja vain 10 angioradiologin rekisteröity annostulos ylitti 10 millisieverttiä viiden vuoden jaksolla. Henkilökohtaisten annosmittareiden käyttö on aiheellista läpivalaisutoimenpiteitä suorittavilla radiologeilla. Säteilyannosmittaus voidaan toteuttaa ns. aktiivisilla mittareilla, jolloin reaaliaikainen mittaus ja tulosten tarkastelu on mahdollista, mikä todennäköisesti johtaa työskentelytapojen systemaattiseen parantamiseen. Yhteenvetona voidaan todeta, että röntgenosaston toimintaa arvioidaan viranomaisten ja ulkoisten arvioijien toimesta sekä henkilökunnan tekemän itsearvioinnin avulla. Tarkastusten ja arviointien tulosten avulla röntgenosaston henkilökunta pystyy parantamaan oman toimintansa laatua ja tämä vaikuttaa potilaan turvallisuuteen ja palvelun laatuun

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

Globally, 303 000 women die each year from preventable causes related to pregnancy, with the Democratic Republic of Congo (DRC) having the tenth highest maternal mortality rate. Maternal Death Surveillance and Response (MDSR) is a surveillance-action cycle that aims to eliminate preventable maternal mortality by linking actionable data on maternal deaths with multi-level actions. While countries are increasingly adopting MDSR, there are research gaps on its implementation, outcomes, and best practices in developing countries including the DRC. This study assessed MDSR implementation in Goma Health Zone (HZ), DRC, specifically its structure, process, quality, outcomes, and influencing factors. A qualitative case study design was utilized, comprising semi-structured interviews with 15 key informants from seven sites, a review of 52 MDSR documents, and an observation of a maternal death review. Data analysis was conducted in Dedoose using the constant comparative method. Findings suggest that MDSR integration into an existing Integrated Disease Surveillance and Response system in the DRC has facilitated its acceptability and institutionalization in integrated (i.e. government-affiliated) health facilities in Goma HZ, where it is sustained by existing organizational resources. However, the MDSR system had weak community and private health sector linkages. Additionally, this study revealed a systematic implementation of early MDSR phases (notification-review) but gaps in completing advanced MDSR functions such as response implementation. With respect to quality, the MDSR system’s major strengths were its simplicity, acceptability, and timeliness in integrated health facilities, while its major challenges were its acceptability, data quality, and timeliness in communities and non-integrated facilities. The political commitment to MDSR and strong support from the HZ and facility leadership were key enablers of MDSR implementation, while unregulated private facilities and the links between MDSR and disciplinary action were the most prominent barriers. While MDSR in Goma HZ has yielded some improvements in the quality of care at HZ and facility levels, its overall impact on maternal health outcomes remains reportedly weak due to limited response implementation at higher levels of the health system.To strengthen Goma’s MDSR, this study suggests the need for a non-threatening MDSR environment, multisectoral partnerships, and mechanisms to follow-up on recommendations

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

Artificial intelligence as a strategic tool to reduce marine pollution - using expert interviews to identify strengths, weaknesses, opportunities and threats of integrating ai in the in-situ management of marine litter

Artificial Intelligence (AI) and Sustainable Development are phenomena disrupting our society. This work analyzes how the breakthrough technology AI can be used as a strategic tool to minimize marine litter and contribute to achieving SDG 14. Expert interviews were conducted, and the results were categorized into the dimensions of a SWOT framework, indicating the factors that affect the potential of AI in the context. The overall results suggest that AI is not a panacea in the world of sustainable development, but it is a great strategic tool for marine litter management that is likely to improve in the future

A case study: the executive leadership response at a community hospital to the value-based purchasing requirements of the Patient Protection and Affordable Care Act

This qualitative case study examined the perceived effectiveness of executive leadership team processes at a community hospital in the southeastern U.S. in relation to the Value-Based Purchasing (VBP) requirements of the Patient Protection and Affordable Care Act (PPACA) through an analysis of documents and a repository database (http:www.hospitalcompare.hhs.gov) relating to service quality, patient satisfaction, and governmental reimbursements; and, structured interviews. Today, the PPACA or “Obamacare” continues to challenge the executive leadership teams at U.S. hospitals to effectively navigate the intricacies of the legislation in order to remain solvent in a volatile healthcare arena. The Plan-Do-Check-Act (PDCA) model was utilized to guide the theoretical framework for this qualitative case study in terms of process improvement. Hill’s (2010) team leadership model was also applied to examine the perceived effectiveness of the executive leadership team processes in terms of analyzing any change in core measures and patient satisfaction scores from the federal fiscal year (FFY) 2013 and 2014, respectively. The VBP data reflected consistent core measure scores in the 48th percentile and an increase in patient satisfaction scores from the 20th to 33rd percentile. The results revealed that the executive leadership team processes were perceived by the researcher as effective as evidenced by a strong collaboration among administration, the bord, and medical staff in implementing several strategies via a team oriented approach that impacted Medicare patients during the FFY of 2013-2014. This study offers a starting point in terms of generating more understanding of the importance of executive leadership team processes at a community hospital in relation to the VBP requirements of the PPACA which can be studied on a broader scale in the future

Data quality assurance for strategic decision making in Abu Dhabi's public organisations

“A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of Master of Philosophy”.Data quality is an important aspect of an organisation’s strategies for supporting decision makers in reaching the best decisions possible and consequently attaining the organisation’s objectives. In the case of public organisations, decisions ultimately concern the public and hence further diligence is required to make sure that these decisions do, for instance, preserve economic resources, maintain public health, and provide national security. The decision making process requires a wealth of information in order to achieve efficient results. Public organisations typically acquire great amounts of data generated by public services. However, the vast amount of data stored in public organisations’ databases may be one of the main reasons for inefficient decisions made by public organisations. Processing vast amounts of data and extracting accurate information are not easy tasks. Although technology helps in this respect, for example, the use of decision support systems, it is not sufficient for improving decisions to a significant level of assurance. The research proposed using data mining to improve results obtained by decision support systems. However, more considerations are needed than the mere technological aspects. The research argues that a complete data quality framework is needed in order to improve data quality and consequently the decision making process in public organisations. A series of surveys conducted in seven public organisations in Abu Dhabi Emirate of the United Arab Emirates contributed to the design of a data quality framework. The framework comprises elements found necessary to attain the quality of data reaching decision makers. The framework comprises seven elements ranging from technical to human-based found important to attain data quality in public organisations taking Abu Dhabi public organisations as the case. The interaction and integration of these elements contributes to the quality of data reaching decision makers and hence to the efficiency of decisions made by public organisations. The framework suggests that public organisations may need to adopt a methodological basis to support the decision making process. This includes more training courses and supportive bodies of the organisational units, such as decision support centres, information security and strategic management. The framework also underscores the importance of acknowledging human and cultural factors involved in the decision making process. Such factors have implications for how training and raising awareness are implemented to lead to effective methods of system development

A situated method for modelling and analysing the efficiency of cognitive activity during the radiology reporting workflow using eye-tracking

The success of modern medical imaging systems has created a data overload problem, where an ever-increasing number of examinations, generate more images per study, which all need to be evaluated by radiologists or other reporting practitioners. This operational bottleneck hasthe potentialto create fatigue and burnout due to the high mental workload that is required to keep up with the demand. The focus of this problem centres around the cognitive complexity of the radiology reporting workflow, and the associated workstation interactions involved in diagnostic report generation. There has been a significant body of work evaluating the behaviour of radiologists using controlled laboratory-based techniques, but these non-naturalistic studies fail to address the highly context dependant nature of the radiology reporting workflow. For example, the early eye-tracking work of Charmody et al; the psychometric studies by Krupinksi et al; and also the workstation interaction evaluations of Moise et al; whilst highly principled, can be all be questioned on the grounds of ecological validity and authenticity. This thesis asserts that the only way to truly understand and resolve the radiology data overload problem, is by developing a situated method for observing the reporting workflow that can evaluate the behaviours of the reporting clinicians in relation to their authentic reporting context. To this end, this study has set out to develop a new approach for observing and analysing the cognitive activities of the reporters relative to the demands of their genuine working environment, and supported through the application of a Critical Realist’s perspective to naturalistic workplace observations. This goal was achieved through the development of four key project deliverables: • An in-depth exploratory study of the radiology overload problem based on an extensive literature review and situated observations of authentic reporting workflows. • A descriptive hierarchical activity modelof the reporting workflow that can be understood by both clinicians, application designers and researchers. • A generalised methodology and research protocolfor conducting situated observations of the radiology reporting workflow, using an analysis based on the process tracing of sequencesof Object Related Actions, captured with eye-tracking and multimodal recordings. • A set of case studies demonstrating the applicability of the research protocol involving 5 Radiology Consultants, 2 Radiology Registrars and one Reporting Radiographer at a single NHS Hospital within the UK. The final workflow evaluation of the case studies demonstrated that activities such as error correction, and the collection of supporting radiological information from previous studies is complex, time consuming and cognitively demanding. These types of activities are characterised by long, low utility actions that correspond to what Kahneman refers to as “Thinking Slow”. Also, the participants appeared to be self-optimising their workflow via a sparse use of complex functionality and system tools. From these observations, the author recommends that any intervention that can reduce the number and the duration of the object related actions used to produce radiology reports, will reduce cognitive load, increase overall efficiency, and go some way to alleviate the data overload problem. 4 This study establishes a new set of situated techniques that are able to capture and quantify the complex dynamicactivities that make up the radiology reporting workflow. Itis hoped that the ability to distil usefuland impactful insightsfrom the user’s workstation behaviours can be used as the basis for further development in the area of workflow analysis and redesign, which will ultimately improve the working lives of Radiologists and other Reporting Clinicians. Lastly, the generic nature of these techniques make them amenable for use within any type of complex sociotechnical human factors study related to the cognitive efficiency of the user