Cristen Bolan is the Editor of Applied Radiology.
The importance of integrating IT networks across the healthcare enterprise is widely recognized in the industry, and backed by the U.S. government in its drive for hospitals nationwide to adopt electronic medical records (EMR).
Yet, according to recent studies, many healthcare networks fall short in their efforts to connect disparate clinical systems and achieve true interoperability.
“Advanced clinical systems exponentially increase the amount of clinical information that is available to drive quality improvement,” said Deborah Bulger, Executive Director, Product Management, Health Systems Performance Management, McKesson Provider Technologies, commenting on the HIMSS 2011 Clinical Transformation Survey.1 “But while data may be widely available, this study suggests that many organizations still have a long way to go before it is accessible in a way that facilitates analysis and rapid, sustainable performance improvement.”
One important area where medical imaging is making inroads into interoperability is in IT-enabled contrast media injectors. Intelligent power injectors play a key role in today’s imaging suites—standardizing imaging procedures to improve quality assurance and patient safety. Much of this has been achieved by connecting power injectors to hospital information systems (HIS), putting access to clinical data right at the fingertips of radiologists and technologists.
Connectivity cuts down on errors
While there is no single road to connectivity in medical imaging, IT-enabled contrast media injectors are paving the way to improved quality of care.
The first step to improving quality and reducing errors is interfacing the flow of data between the scanner and the injector. While many contrastmedia power injector systems are physically connected to the scanner, which transfers the data directly into the injector, other injector systems areIT-enabled, with hardware and software built into the system. These IT-enabled models can pull the worklist and patient data directly from the radiology information system (RIS), picture archive and communication system (PACS), and/or the EMR.
Injector systems that are not IT-enabled may be more susceptible to human error. For example, each time a technologist has to set up a protocol, there is a chance an error may be committed—an error that may then be mistakenly stored in the injector. Another drawback to such systems is the additional expense of subsequently installing the hardware and software required to connect them to the scanner – an expense that can run as high as $20,000 to $30,000.
With IT-enabled power injectors, systems that import data directly from the RIS and EMR, all of the protocols are set up once, and automatically populate the system for each imaging exam.
At Brigham and Women’s Hospital (BWH), Boston, MA, a teaching affiliate of Harvard Medical School, CT Manager Kathy Piazzo oversees 8 computed tomography (CT) scanners at the main center, 3 at the off-site locations, and also manages 50 CT technologists. While BWH has worked for several years with the IRiSCT Decision Support System by Bracco Diagnostics (Bracco), integrated with Empower CTA Contrast Injection systems, the hospital recently installed a new IT-enabled contrast-media power injector system.
“We have many technologists here, and it is difficult to get all of them to do the same thing; this is a 24/7 operation ” Piazzo explained.
“The radiologists routinely call me or send QA feedback forms to me with contrast-related questions in regards to the scans,” she said.
“They want to know what the actual flow rate was, what happened to the bolus, if the patient got sick during the injection, if there was an IV issue, etc.
“With the new system, all of the injection protocols are in the system, so the radiologist can see the amount of contrast injected, the flow rate, the scan time, and a pressure graph of the injection, which is valuable information for them at the time of dictating the exam,” said Piazzo.
Similarly, with Medrad’s Personalized Patient Protocol Technology (P3T®), a contrast-injection software, protocols automatically populate the injectors.
“We put all of our standard 300 to 400 injection protocols in the injector for each indication, for each type of exam,” said William P. Shuman, MD, FACR, Professor, Body Imaging, Vice Chair, Director, Clinical Radiology, in the Department of Radiology, University of Washington, Seattle, WA. “It has a cardiac portion, a pulmonary angiography portion, it has an abdomen CT portion, and we use it for our CT vascular studies, CT angiograms and aortograms, as well. It can also download the information directly into the PACS or HIS.”
Whether connected physically to the scanner or interfaced with the EMR or RIS/PACS, the injector systems perform the critical task of providing patient data at the point of care—essential to quality assurance.
In the HIMSS study, almost 75% of respondents said they need additional IT resources to better report on quality measures. The inability to track patients’ prior CT contrast reaction information can lead to the recurrence of CT contrast reactions, resulting in decreased patient satisfaction and safety, in addition to increased costs associated with managing the reactions.1
The precise tracking of patient data, such as reactions to contrast media, glomerular filtration rate (GFR), creatinine levels, and conditions such as diabetes or heart disease, contributes to establishing uniformity among procedures and promoting compliance with safety standards.
Ensuring imaging exams are reproducible is critical at the University of Washington, Seattle, WA, where doctors regularly treat transplant patients.
“We see a lot of patients, every 6 months, who are waiting for liver transplants,” said Dr. Shuman. “We would like to compare their exams with as many variables removed each time. So if we give exactly the same injection protocol each time, that removes the rate of injection and other variables that occur between sequential scans because we follow the exact same injection protocol as before. It helps my consistency across time when patients are getting multiple exams serially.”
The data is then recorded and downloaded via P3T as a list of numbers and as graphs into the PACS, explained Dr. Shuman. “All I have todo is look at one image in PACS, and I have graphs that show the injection rate vs. time, injection pressure vs. time, and the volume injected.So I can see exactly how the contrast was administered glancing at one image in the PACS. Then any information I want to save over time, such as contrast allergies, adverse reactions, adverse events can be automatically downloaded into the appropriate place there.”
The EmpowerPlus also ensures exams are carried out consistently from patient to patient. This is particularly important for radiologists at BWH, where oncology patients make up a sizeable portion of their population. “Injection protocols are now standardized throughout the department so, for example, all renal mass exams will have the same flow rate. If the technologist changes it, they will need to document why,”said Piazzo.
Automated protocols can also be customized to the patients’ changing needs as they undergo treatment. By leveraging unique patient data, Dr. Shuman specifically designs injections and image acquisitions for each patient.
The P3T’s injector-based algorithms are programmed to tailor each patient’s contrast protocol, accounting for a range of variables, including body weight, study type, and speed of the scanner and type of contrast.
“It enables us to tailor the way we give contrast to individual patients based not only on the injection rate but also on the cardiac output of the individual patient. We believe that gives us optimal enhancement with less contrast than untailored standardized approaches,” said Dr.Shuman.
Safe and personalized care
Consistency among patients also adds to safety. With technology that tracks adverse events, such as extravasations and allergic reactions, doctors can customize care to each patient’s needs and ensure a higher level of safety.
Both the IRiSCT and EmpowerMR systems track extravasations with the Extravasation Detection Accessory (EDA). The EDA measures electrical variances in the skin surface that can occur when contrast is accidentally injected into the soft tissue, and it can automatically pause the injection before tissue damage occurs. Piazzo, who has used the extravasation tracking system in a different hospital, said it is a great help in preventing extravasations.
Medrad offers the XDS extravasation detector, available as an accessory that integrates with the Stellant CT Injection System. Using radiofrequency (RF) wave technology and a physical property called permittivity, XDS is designed to detect the start of an extravasation under the patient’s skin and signal the Stellant to stop injecting until a clinician can examine the patient.
“For safety, the great thing about it is if anything goes wrong, you have a very precise record of exactly what happened. Did we hit our injector pressure, for example, or did we have an extravasation, and can we see that based on the pressure or rate curve?” said Dr. Shuman. “It’s almost like the black box on the airplane—if anything goes wrong, you have got a record of everything that happened prior to any event. That really helps us track causes of events as they occur.”
He added, “It also helps us over time optimize our protocols. If we see a less-than-optimal degree of contrast enhancement, we can analyze why it was suboptimal, and see if we want to change our parameters or modify our protocols. So the data is useful. You can use it to analyze your safety profile or to incrementally optimize your techniques.”
Another unique safety feature, which also uses RF technology, applies tags to track syringes and contrast media usage. Covidien’s Optivantage DH power injector captures, stores, and transmits data between the RFID-enabled syringe and the RFID-enabled power injector. TheRFID-enabled system interfaces between the contrast media syringe and the power injector to help technologists ensure each patient receives the prescribed concentration and dose of contrast media. In fact, the injector can physically alter the RFID label on a syringe once it is used—a feature designed to reduce air injections or air embolisms caused from using an empty, used syringe.
“All of our lot numbers, expiration dates, the name of the contrast name, and the quantity you are using is automatically copied on a label and printed out to go in the patient’s medical record. You don’t have any mislabeling of the lot numbers and expiration dates,” said Melissa Jennings, Team Leader, Radiology, Fayette Regional Health System, Connersville, IN, where the clinical staff conducts 400-500 CT scans a month.
Jennings added, “It’s a lot less time consuming, allowing you to get patients in and out more quickly.” The system also is engineered to reduce the potential for infection from cross-contamination, by automatically preventing the injection of contents from a previously used RFID-labeled syringe in another patient exam.
IT-enabled power injectors also assist in controlling costs. With features that automatically archive injection information, such as contrast and syringe usage, radiology departments can more effectively identify and reduce waste.
Piazzo has relied on the IRiSCT system to generate monthly reports on contrast and syringes, as well as to process the fiscal budget for the following year.
“When I came to this hospital they were using 300 contrast concentration and they wanted to switch over 370,” Piazzo recalled. “The IRiS data provided me with valuable information needed to calculate what the cost savings would be, which included the amount of contrast filled into syringes, the amount of contrast injected, and the amount of contrast wasted. So knowing what the current cost of the contrast was, I could calculate the total cost savings. I think we ended up saving close to $27,000 in contrast media based on the IRiS information we had.”
With integrated IT solutions, power injector systems help to make exams more consistent, improve quality, ensure greater safety, and save money. As the adoption of IT-enabled contrast media power injectors becomes more prevalent, these devices have the potential to become a central data hub, orchestrating all procedures in the imaging suite—from patient check-in to patient check-out.