A Look at the Electronic Health Records System

With medical devices, medications, and diagnostic studies continuously advancing, it seems that innovation and medicine now go hand in hand. But it is not just the medical systems that are making a turn for the digital; this time, the advancement in the industry is the implementation of both the EMR and EHR system. 

Though there are both positive and adverse reactions towards this new technology, the objective of the electronic records system has been to help improve the quality and efficiency of patient care, and reduce healthcare delivery costs through better coordination of medical services. Improving the Health IT infrastructure is also intended to allow physicians to securely exchange patient data with other health care providers.

What is the Difference Between an EMR and EHR?

Most of us may want to run the other way at the thought of reading an article on electronic health and medical records, but it is important to understand the concept of them as they are a central piece of the new US healthcare reform.

Though EMR and EHR tend to be used interchangeably, both systems actually differ in meaning and intent. However, do note that an EMR is ultimately the source of data for the EHR. EHRs are reliant on EMRs being in place, and EMRs cannot reach its full potential without EHRs in place. The EMR (Electronic Medical Records) is a digital version of the paper charts created in hospitals, which is used by healthcare practitioners to document, monitor, and manage health care delivery. The data in an EMR is considered a legal record specifying the patient’s encounter during their visit to a care delivery organization (CDO), and is owned by the CDO.

An EMR contains the patient’s medical and treatment history, with the ability to track data over time; identify which patients are due for screenings or checkups; monitor patient conditions such as blood pressure readings or vaccinations; and even improve overall quality of care within the practice. However, the information in an EMR does not easily travel out of the practice. In fact, records may even need to be printed out and mailed to specialists and qualified recipients.

An EHR (Electronic Health Records), on the other hand, is designed to reach out beyond the standard clinical data collected from the primary health organization, and focuses on the health of the patient in its entirety. The EHR represents the ability to easily share medical information among “stakeholders” that can consist of patients, healthcare providers, employers, and payers/insurers, including the government. This information moves with the patient to the specialist, laboratory, nursing home, ER or hospital within the state or even span across the country. With fully functional EHRs, all members of the team have ready access to the latest health records and patient history, which allow for more coordinated, patient-centered care. With EHRs, patients can also view their own records such as lab results to keep track of and continue making lifestyle changes to improve their health.

As the health care system has faced several challenges, implementing new healthcare technology, such as electronic records, has potential to advance the efficiency of patient care. However, adopting electronic records has yielded some concerned reactions within the medical community as well. Many providers are not comfortable with the complexities of EMR based documentation, not to mention the costs that may be associated with implementing new software and training. While some practices have utilized EMR systems to improve productivity, others have struggled to reach acceptable levels of business processes; and with the focus shifting towards coordinated care, this trend is likely to continue for a significant period of time. Organizations will need to streamline their practice while properly planning for the risks associated with EMR and EHR based information exchange.

If you would like to voice your opinions about the new policies in today’s healthcare system, or have specific questions about radiology, contact me anytime.

Posted by:

Charla Hurst
General Operations Manager

Charla@ClermontRadiology.com
352-241-6100
www.ClermontRadiology.com

The CT Scan Procedure

The computed tomography (CT) procedure has advanced rapidly since the 70’s, and has become the imaging exam of choice. Patients should keep in mind that CT scans do not cause any pain. During a CT scan, a patient is asked to lie very still on a narrow table that slides into the center of the scanner, called the gantry. They may even be asked to hold their breath for a few seconds, to prevent blurring of the pictures. CT scans take anywhere from 15 minutes to 1 hour to complete, and the length of the procedure depends on the size of the area being x-rayed. Some patients may be concerned with claustrophobia, but the width of the gantry is wide enough to usually prevent feelings of claustrophobia. Aftercare is generally not required following a CT scan. The technologist will continue to keep an eye on the patient for possible adverse contrast reactions immediately following the exam.

Contrast Agents: 
Contrast agents, or “dyes”, are often used in CT exams to demonstrate certain anatomic details that, otherwise, may not be visible. If contrast agents are used in the CT exam, these will be administered (by mouth, injected into a vein, by enema, or given in all three ways) several minutes before the study begins.

The CT Image: 
CT scans allow for a more three-dimensional effect. Clear-cut sections of the body can be located and imaged as cross-sectional views, and various densities of tissue can be easily distinguished. Standard findings on a CT exam show bone, the densest tissue, as white areas. Tissues and fluid will show as various shades of gray, and fat will appear dark gray or black. The radiologist can determine if tissues and organs appear normal by the different gradations of the gray scale. Radiologists can also differentiate among types of tumors throughout the body by viewing details of their makeup.

Preparing for the CT Scan

Be sure to remind your patients of these simple steps prior to their scheduled CT scan:

• Wear comfortable, loose-fitting clothing to the exam. (Hospital gowns may be provided during the scan.)
  
  
• Metal objects including jewelry, eyeglasses, dentures and hair accessories should be left at home or removed prior to exam.  Hearing aids and removable dental work may also need to be removed.
  
  
• If contrast material will be used during the exam, patients may be asked to avoid eating or drinking anything four to six hours prior to the scan. 

• Be sure to inform the physician of all medications or about any allergies, especially to contrast materials (such as iodine or even shellfish). Bring a list of current medications (prescriptions, over the counter medications, and vitamins.)
  
  
• Inform the doctor of any recent illnesses or medical conditions, or history of heart disease, asthma, diabetes, kidney disease, or thyroid problems.  Any of these conditions may increase the risk of an unusual adverse effect.
  
  
• Women should always inform their physician or technologist if there is any possibility that they are pregnant. Pregnant women or those who could possibly be pregnant should not have a CT scan unless the diagnostic benefits outweigh the risks.

Risks:
The most common concern with CT scans is the radiation exposure. It is true that the radiation exposure from a CT scan can be higher than from a regular x-ray. However, not having the procedure can be more risky than having it. People considering a CT scan must weigh the risks and benefits.

If you have any questions about the CT procedure, or the equipment itself, do not hesitate to call or drop me a line. 


Posted by: 

Charla Hurst 
General Operations Manager 

Charla@ClermontRadiology.com 
352-241-6100 
www.ClermontRadiology.com

Fun Facts about Radiology History

A while back, we wrote an article on interesting facts about the invention of x-rays. Since then, I have received a number of requests to put up more interesting facts about radiology history. Since many new creations have been born following the discovery of the x-ray, we have narrowed down the list to our favorite fun (and important) facts about the history of radiology.

X-Rays, CT’s, MRI’s, Oh My!

X-rays not only have a phenomenal use in the radiology world, but they have been discovered and enhanced by some of the most phenomenal people. They have set the foundation for many of us to detect early abnormalities, and most importantly, get a second chance at life.

A Happy Accident. 
My favorite radiology fun fact is still the scientific breakthrough of x-rays being an accidental invention. While studying the path of electricity, Wilhelm Roentgen noticed that the image sticking to a paper contained details not found in an ordinary photograph. After further investigation, he took his first actual x-ray of his wife’s hand. Following Roentgen’s discovery, Dr. Harvey Cushing further advanced the technology for diagnostic clinical x-rays. In 1902, he began performing ground-breaking work in surgery, including brain surgery, using the technology to help him locate and remove tumors.

From the Tesla to the First MRI. 

Nikola Tesla was known as a brilliant inventor, assisting in inventions such as remote controls, generators, radio, and more. However, it was his discovery of the rotating magnetic field and invention of Tesla units in the late 1800s that makes him such an important figure in medical imaging history. Though MRI technology wasn't used until later, it was thanks to the Tesla unit that the use of magnetics was able to reach new heights in medicine. MRI machines are calibrated in Tesla units, with the strength of a magnetic field generally measured in Tesla as well. In 1977, the first MRI exam was performed. Though it took almost five hours to produce just one image, Dr. Raymond Damadian, and fellow colleagues labored for years to do what many said could not be done. Today there are thousands of MRI scanners in the country with images being produced in seconds as opposed to hours.

Saving the Ta-Tas.

Mammography is most commonly used in medical imaging for breast cancer detection. Dr. Jacob Gershon-Cohen was one of the first doctors to utilize the yet unproved technology in the 1950’s. He conducted a five year study that screened thirteen hundred healthy women every six months (colleagues even questioned why he performed mammograms on healthy women). His astounding results indicated that while 92 of the healthy women were diagnosed with non-malignant tumors, 23 were diagnosed with malignant tumors. The results of the study started an era of early detection and improved survival, and he received numerous awards and prizes for his work and dedication. His determined advocacy convinced physicians about the merits of mammograms and how important it was for healthy women to be screened. Recent studies show that each screening mammogram reduced the risk of breast cancer death by 31% and has saved millions of breast cancer patients!

Fluoroscopy Then & Now. 
Years after Roentgen’s discoveries, the fluoroscope was born. Early models were simple cardboard funnels closed with a thin layer of fluorescent metal salt; the images produced were not nearly as detailed as they are today. Due to the limited light produced from the fluorescent screens, radiologists were required to sit in a darkened room where the procedure was performed, adjusting their eyes to the dark and increasing their sensitivity to the light. Red adaptation goggles were developed to address the problem for adaptation to the dark, but quickly became obsolete when the development of x-ray image intensifiers and the television cameras in the 50's revolutionized fluoroscopy. Over the years, modern improvements in screen phosphors, image intensifiers and even flat panel detectors have resulted in increased image quality and minimal radiation doses.

Who Do We Thank for Detecting Radioactivity? 

Safety became a concern as scientists and others who worked with x-rays began dying unexpectedly. Two time Nobel Prize winner, Dr. Marie Curie, and her husband, discovered the radioactive metals: radium and polonium. Curie found that the harmful properties of x-rays were able to kill tumors, but made a mindful decision not to patent methods of processing radium or its medical applications. Curie eventually died of leukemia, ironically caused by her repeated exposure to radioactive material. Due to her work and discoveries in the field, safety advancements were made in radiography and radiology that protect both patients and caregivers.

The Fast CAT. 
During the course of its history, CT/CAT scans have continued to become more patient-friendly, and scan times have gotten even faster, allowing for more anatomy in less time. Furthermore, research and development have resulted in excellent image quality at the lowest possible x-ray dose. The original CT systems were intended for head imaging only, but whole body systems with larger openings became available in 1976. The first CT took hours to acquire raw data for a single slice, and took days to reconstruct a single image from that raw data. Today, multi-slice CT systems can collect up to 4 slices of data in about 350 milliseconds, and reconstruct a 512 x 512-matrix image from millions of data points in less than a second!

Sending X-Rays to Outer Space. 
X-ray technology typically focuses on detecting small details inside the human body, but in 1979, the technology was turned towards larger targets when NASA used x-ray technology to take amazing images of outer space. NASA helped pioneer the development of x-ray astronomy and continues to operate today.

If you have any questions about radiology, or would like to share more facts with us, we would love to hear from you!

Posted By:

Charla Hurst  

General Operations Manager  

Charla@ClermontRadiology.com 

352-241-6100 

www.ClermontRadiology.com

See How X-Rays Have Come a Long Way

Something we can be thankful for this year in the medical imaging world is the invention and progression of x-rays. X-ray technology has certainly advanced in the 20^th century, making it one of the most invaluable diagnostic tools in radiology.

A Trip Down Memory Lane

X-rays were initially discovered in 1895 by Wilhelm Conrad Röntgen, who went on to receive the first Nobel Prize in Physics in 1901. Since then, several important discoveries have been made that have revolutionized the development of x-rays.

Researchers recently tested first-generation x-ray equipment from 1896 and found that it produced radiation doses to the skin (hand x-ray) that was 1,500 times higher than the dose from modern x-ray equipment. Moreover, the exposure time needed to image the hand decreased from 90 minutes in 1896 to about 20 milliseconds in 2010. Though there was some image blurring, the century-old system surprisingly produced good images with clearly visible anatomical details. This was the first time methodical measurements on this equipment had been done, since the systems had quickly been replaced by more sophisticated ones.

It is apparent that x-rays have come a long way, improving rapidly with significantly lower radiation doses and exposure time, not to mention improved image quality, making it one of the most convenient and safest imaging modalities.

Interesting Facts About Röntgen, the Inventor of X-Rays

• Röntgen had never received a high school diploma, and was even kicked out of college. Despite his lack of valid credentials, he went on to become a renowned physicist, graduating with a PhD in 1869 from theUniversity of Zurich, and eventually received offers to teach at various universities.

• Great things happen when you least expect it…or don’t expect it at all. Röntgen actually invented the X-ray purely by chance. In 1895, he was working in his lab experimenting with cathode rays to prove that the powerful rays could penetrate glass. Instead, he discovered a new kind of ray (a shimmering of the barium platinocyanide screen) that he temporarily called an “x-ray”. As he further investigated, it was safe to say a powerful discovery was made.
  
  
• Röntgen did not want any part of the profits or royal titles for the work he did, and did not apply for a patent for his most famous invention. Despite his advances, the critical acclaim, and success as a physicist, he lived a quiet life out of the social spotlight. He even donated the money he earned from his Nobel Prize to a university…and was said to have nearly been broke when he passed away.
  
  
• Röntgen was referred to as a “genius” as well as a “scatterbrain” by many of his colleagues and students (during his lectures, he jumped from concept to concept without clear teachings). As they say: genius often breeds insanity. Some of his most famous experiments, including the x-ray, were done in secret with rarely any witnesses. The following weeks after he accidentally discovered the x-ray, he ate and slept in his laboratory as he further investigated. He actually left little instruction of his discoveries and experiments and ordered that all of his scientific findings be destroyed upon his death.

Nonetheless, his legacy lives on throughout the world of radiology. In fact, in many languages, instead of the term "X-ray", Röntgen's name is used to refer to radiology and its products.

Posted By:

Charla Hurst  

General Operations Manager  

Charla@ClermontRadiology.com 

352-241-6100 

www.ClermontRadiology.com

Minimizing Radiation in CT Scans to Help Lower Health Risks

No matter how much we try to avoid it, small doses of radiation seem to be everywhere - from computer monitors, television sets, and airport body scanners to nuclear power plants, smoke detectors, and dental x-rays. While radiation can be used to treat and sometimes even cure certain cancers, it also has a potentially serious downside: the ability to damage DNA and possibly cause cancer in the long run.

Radiation from certain medical-imaging techniques can far exceed levels of radiation found in the environment. CT scans alone are said to provide three-fourths of Americans’ radiation exposure. CT scans are commonly used to detect hidden problems such as broken bones, lung lesions, heart defects, tumors, and more. When more radiation is used, the clearer the picture becomes for the results.

However, researchers are exploring ways to reduce radiation levels from CT scans while still allowing doctors to properly diagnose the patient. The challenge lies in calculating how low the radiation can be set without compromising the result itself. Some doctors are now using computer simulations to help them determine how much to vary radiation doses based on size, gender and other factors that can affect how much radiation is absorbed.

Minimizing Radiation Doses
To help study the lowest effective doses of radiation, scientists at Duke University developed a computer tool that adds "noise" to CT scan pictures; this in turn resembles what would happen if the image were taken using a lower dose of radiation. The pictures are then given to radiologists to determine whether they can detect the physiological abnormality. So far Duke researchers have shown that radiation could be reduced substantially and still allow for detection for certain conditions. However, it is imperative to remember that how well pictures are read also depends in part on the expertise of the radiologist examining the image.

Medical groups are also working to better educate patients and doctors about overuse of CT scans. There are diagnostic techniques that do not use radiation, such as an MRI and ultrasound, which can be used in place of CT scans, though a CT is often preferred in traumatic-wound situations because they can better detect bleeding than an MRI.

Legislation can also be utilized to help restrain, or at least monitor, radiation doses. A new California law now requires radiation doses used for CT scans be recorded in every patient’s medical record and inadvertent overdoses be reported to the state immediately. If such recordings become a nationwide mandate, these records could help doctors and patients keep track of radiation exposures and provide further incentive to steer clear of unneeded imaging.

What Can I Do to Help Myself?
Radiation exposure should be limited whenever possible, so the next time you are recommended to undergo medical imaging, always ask why it is being done; whether the procedure is actually going to make a difference; and if it can wait. Both doctors and patients have a responsibility to carefully consider the risks and benefits before performing and undergoing a radiation-based procedure. Patients are certainly urged to participate in the decisions of their tests and treatments.

Still, when a CT scan is deemed critical, patients should get it. "Those [radiation] doses just are not really significant at this point compared to the benefit of extending lives, saving lives and improving the quality of lives," says Dr. Ellenbogen of the American College of Radiology, also a radiologist at Southwest Diagnostic Imaging Center in Dallas.

While you can’t go back in time to calculate the doses of radiation received in the past, you can certainly take steps moving forward. For example, many are now only considering procedures such as dental X-rays and additional CT scans if there is a cause for concern – not just for preventive reasons anymore.

Posted by: 

Charla Hurst 
General Operations Manager 

Charla@ClermontRadiology.com 
352-241-6100 
www.ClermontRadiology.com

How to Keep Your MRI from Losing its Cool.

Below are some helpful tips to keep your MRI cool, suggested by experts in the field. As a result, this can help your operation continue running smoothly and cut down on unnecessary costs in the event of an outage.

1.) Service Contract

The cold-head and compressor must be running in order to keep the MRI cool. Compressors are cooled by cold water, which is supplied by a chiller. However, the chiller is a big obstacle when trying to keep the system cool as the compressor and cold-head will shut down if the chiller is not working. Experts advise buyers to include service contracts on their chillers and conduct inspections throughout the year. Service contracts can also help with continuous monitoring of your helium and scheduled fills.

2.) Remote Monitoring

Power outages during off hours can cause major helium loss for the system, and go unnoticed for a long period of time. If remotely monitored, MRI owners can receive warnings via email, text messages, or voicemails if the cold-head/chiller is not working. With this prompt alert, owners can contact tech support to get the system restored before losing valuable helium.

3.) Maintenance

End users should always perform preventative maintenance, even if the system is working. In the event that the cold-head shuts off, customers will lose a good amount of liquid helium. And with the latest helium shortage issue, it can be challenging to get the system serviced and replace helium at the same time. Remember, with the loss of helium also comes the loss of money as the cost rises with each liter of helium lost.

4.) Get Systems Checked

If you have any doubts on your system’s performance, get it checked before a minor problem becomes major. Experts have seen machines whose cold head hasn’t been running for days without the site even knowing. While the machine can still scan, and patients are still being put through, the system may have lost a large percentage of helium before the end user notices.

We’d love to hear your thoughts! Feel free to contact us with any questions or to share additional MRI tips and techniques.

Posted by:

Michael Schroer 
MRI Technologist 

MRIMike@ClermontRadiology.com
352-241-6100
www.ClermontRadiology.com 

Preparation for an MRI Scan

Today, an MRI is the modality of choice for a number of neurological and musculoskeletal applications. An MRI provides an unparalleled view inside the human body, with an extraordinary level of detail compared with any other imaging modality. Though almost all individuals in need of an MRI get apprehensive about doing the exam, the only other way to see inside the body any better is to cut it open (ready for that MRI now?). It may be an uncomfortable process, but the vast benefits of an MRI can certainly outweigh the few drawbacks of claustrophobia, noisy machines, and sitting still for extended periods of time. Patients today can also choose between a High-Field MRI, Open MRI, and Upright MRI.

An MRI scanner is often used to evaluate and diagnose conditions such as tumors, infections, developmental issues, damage caused by stroke, suspected breast cancer, and chronic conditions such as multiple sclerosis (MS). Physicians can also gain information though an MRI about changes and injuries to the spinal column and vertebrae, the joints, and the structure of the heart muscle, as well as detect problems in many internal organs. The benefit of an MRI compared to an X-ray is that it is much more detailed, it can view more then just bones and joints, and it can produce three-dimensional images allowing the body to be viewed from many angles.

Very little preparation is needed for an MRI. Be sure to eat and drink normally, and continue to take usual medications. Under certain conditions, there may be dietary restrictions requested by the physician in cases when the MRI requires an injection or ingestion of a contrast agent, sedation or anesthesia, or other special considerations.

Keep in mind, patients will be asked to change into a gown and remove all accessories, glasses, dentures, hearing aids, prosthetic devices, and other metallic objects. It is best to keep them at home if possible. Also, avoid wearing any makeup as makeup may contain metal filaments.

It is also crucial to inform the staff if there is any metal in the body that cannot be removed such as pacemakers, heart valves, surgical staples and wires, insulin pump, etc. If patients were metal workers at some point, or had a piece of metal penetrate the eyeball, it is important to inform the doctor of this.

Most facilities prefer not to image pregnant women, as there has not been enough research conducted in terms of biological effects on a developing fetus. The final decision of whether or not to scan a pregnant patient is made on a case-by-case basis.

What to Expect During and After the MRI Scan

Prior to scans, patients are encouraged to use the restroom as scans can take an extended period of time. A trained MRI professional will help position the patient on the scanner bed. Whether or not the patient goes in head first or feet first, as well as how far in they will go, is determined by the type of exam. Once the body part to be scanned is positioned in the exact center of the magnetic field, the scan can begin.

All a patient must do when the exam begins is relax and lie as still as possible. Take a few deep breaths before going in, and choose music that is calming, if offered headphones. Patients are able to talk to a member of the staff via a two way intercom system throughout the scan. Patients may also have a companion stay in the scanning room. Parents are especially encouraged to be in the room with their children during the scan.

Immediately following the exam, all normal activities and diet may be resumed. The fact that MRI systems do not use ionizing radiation is a comfort to many patients. MRI contrast materials also have a very low incidence of side effects. There are no known biological hazards to humans from being exposed to magnetic fields of the strength used in medical imaging today.

Just remember, MRI scans are painless and harmless. Try to practice some relaxation techniques as the key to successfully get through an MRI is to relax.

If you need more information about an MRI procedure or the equipment itself, please give us a call anytime.

Posted by:

Michael Schroer 
MRI Technologist 

MRIMike@ClermontRadiology.com
352-241-6100
www.ClermontRadiology.com