Over the last year, I’ve had the pleasure of working with RedRick Technologies to create the 2018 updated edition of “Medical Imaging Reading Environment Optimization; A Planning Guide.” This recently updated guide is designed to help health system staff optimize their medical imaging reading environments in order to help reduce repetitive stress injuries (RSI’s) and improve interaction between radiologists and clinicians.
The updated planning guide summarizes best practices that meet the unique needs of medical imaging departments and defines the many factors that constitute good reading room design and siting, including how they can enhance the practice of radiology. Using practical, educational guidance for architects, designers, facilities planners, and clinical department leaders involved in the design and renovation of medical imaging reading room environments, the guide addresses the importance of proper reading room location to enhance communication among healthcare staff. The guide also addresses how RSI’s, which impact physician health and wellbeing, can be eliminated through good economic principles.
The new guide, which was unveiled at RSNA in late 2017, can now be downloaded here.
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There are truly hundreds of powerful ideas I could share from my experience last week at the Radiology Society of North America (RSNA) conference in Chicago, but I believe the key message is this: it’s time for healthcare to stop designing patient environments with one arm tied behind its back.
More literally, it’s time to stop treating very credible processes and tools like evidence-based design (EBD) and simulation modeling as optional assets at our disposal. If we’re truly committed to creating the best healthcare spaces for patients, these tools need to be integrated into everything we do. Otherwise, we’re leaving an element of guesswork in design efforts that doesn’t need to be there – and doesn’t guarantee desired performance and results.
I was fortunate to present on this topic at last week’s RSNA conference and will share further insight later in this post, but to best understand the topics, it’s key to understand the conference.
The RSNA Conference
The RSNA event is not really a healthcare conference, but actually the largest clinical conference in the world. The RSNA, an international society of radiologists, medical physicists and other medical professionals with more than 54,000 members spanning 136 countries, hosts the event each year. The conference in Chicago draws an average of 55,000 people each year. It’s a massive week-long event full of captivating speakers and rich ideas. The RSNA keeps the conversation going throughout the year by publishing peer review journals that are globally respected as the reference for all things radiology.
Our Presentation – EBD and Simulation Modeling
I’m still humbled that RSNA asks me to speak at their prestigious event. This was not the first time I presented at RSNA, but I was very especially excited for this event as I was asked to team up with imaging leaders at Texas Children’s Hospital in a two-part presentation. Their team focused on using LEAN and Green methodologies in healthcare to eliminate waste and improve flow and value stream mapping. When I took the stage for the second piece, I focused on how to plan departments to incorporate these processes they have in place. Specifically, I wanted the audience to walk away with the below learnings:
- Know how to apply evidence based design planning and design principles to improve efficiency and patient satisfaction
- Understand how to plan an “intelligent” flexible department that can deal with imaging complex processes and constant technology changes
- Recognize why good design is good business
Presentation Focus: Evidence-Based Design
Embedded in these learning goals was a focus on elevating people’s understanding of the value of EBD. To illustrate its importance, I needed to speak deeply about the process of EBD which all begins with establishing a guiding principle to drive the design. If you’re going to create or improve an outpatient facility, what are you trying to achieve? Are you designing for safety? Are you trying to reduce noise distractions?
Once you have that guiding principle identified, you then need to do research on the topic to secure data. Then, interpret the research and apply it to the design. There are always insights to be gleaned from past studies that when strategically applied can improve outcomes. Creating EBD architecture is a simple and proven process, but we too often forego it for cost and deadlines. We need to do more to educate our clients and partners that EBD isn’t an optional tool – it’s the path to achieve their desired outcomes.
Presentation Focus: Intelligent Planning – Simulation Modeling
One of the best EBD tools at our disposal is simulation modeling. It’s a way for us to ensure we’re designing everything to the client defined guiding principle. We often rely on REVIT models, but REVIT models don’t allow us to track how people will move and processes will play out in real time. With simulation modeling, we can see everything that will be moving within the building – patients, supplies, family members, staff – and we eliminate the guesswork. This approach allows us to incorporate LEAN strategies, green principles in a way that achieves that desired outcome. The design tool of the future will be an integrated program that allows us to design the building and AT THE SAME TIME design and visualize all aspects of the business model. (workflow, financials, etc.)
Again, if we’re not using these tools, we’re not giving health design our best effort. Simulation modeling isn’t an add service, it’s a necessary step – and we need to help our clients understand the value.
Beyond Our Presentation – The Bigger Picture
Presenting at RSNA was a great honor, but I also enjoyed the rest of the week immensely. The conference theme, “Innovation is the Key to Our Future” was on full display. There was great emphasis throughout the conference on what we can all do to pave the way toward healthcare reform and how medical imaging has the ability to translate innovations into successful clinical practices. Here are a few other key takeaways from the event:
- There was great focus on how we can improve our current methods to achieve better resolution, lower radiation and increase efficiency. Several presentations touched on the need to embrace patient centered care and 3D printing.
- Another key topic was the need to develop special mobile radiology tools for multi-purpose use. I’m particularly interested in this topic as it builds on an idea I presented on a year ago which looked at the end of inpatient imaging departments as we know them today and suggested a mobile “vertical” department where the patients don’t need to move.
- The ability to simultaneously correlate molecular and functional events with whole organ anatomy – which is unique to imaging – was a big point of discussion.
- Precision Medicine: This is “The holy Grail” for the radiology industry. It is about spotting disease earlier, being more predictive about where the disease will take place and marrying that with personalized therapies.
Attending, speaking and learning at RSNA is always a thrill. It’s an important conference with key ideas for the future of healthcare and clinical outcomes. I’m already looking forward to next.
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One of our newest educational resources, “Medical Imaging Reading Environment Optimization – A Planning Guide,” is the result of a very long, personal “radiology adventure” for me – and I must share some background information on it.
View the Planning Guide Here >
The adventure began in 1998 when my previous firm was hired to create the University of California Los Angeles (UCLA) Ronald Reagan Westwood Replacement Hospital and part of our task was to design the Radiology and Imaging Departments. Since this was 1998, it was the days before digital imaging and Picture Archiving Computer Systems (PACS) were fully developed. The notion of a filmless clinical environment was first described around the early 1980s, but it was not until the late 1990s that PACS technology proved mature enough for widespread implementation. It was also around that time when I met my dear friend, Dr. Osman Ratib.
Carlos Amato (left) learning to “read” conventional film in 1999 to understand various problems and limitations associated with existing “hybrid” reading rooms in which conventional film-based readings are performed on lightboxes adjacent to digital softcopy workstations.
Carlos at RSNA building the first custom digital reading workstation prototype.
Dr. Osman Ratib, currently a professor and the chair of radiology at University Hospital of Geneva in Switzerland, was then a vice chair of radiology at UCLA where he was involved in implementing a PACS network at UCLA’s medical center. Ratib was frustrated by the inability of PACS software at the time to handle large datasets, and thought he could build a better mousetrap. While at UCLA, he enlisted the aid of Dr. Antoine Rosset, a radiology resident and computer programmer who was also from Switzerland, to develop a homegrown application for viewing DICOM-based medical images. They created OsiriX, an image processing application for Mac dedicated to DICOM images.
At an early stage, Ratib and Rosset decided to base their work on open-source software code, which can be shared and improved upon by anyone. They also decided to run the software exclusively on Apple Macintosh computers, due to the graphics capabilities of these machines. The first official version of OsiriX became available in early 2005.
But, rewind back to 1999 before Dr. Ratib had achieved all of this…and there was a point when he and I teamed up to try to discover what a paperless digital imaging department would look like. We took the opportunity to reengineer radiologists’ working space by developing new diagnostic workstations. In collaboration with radiologists and computer scientists, we used three dimensional computer modeling (it was still the heydays of AutoCAD) and simulation techniques to create and evaluate different ergonomic designs for diagnostic workstations and radiology reading rooms.
RSNA first reading station prototype
Dr. Ratib and I revealed our prototypes, in an infoRAD exhibit at the Radiology Society of North America (RSNA) annual meeting.
The cyber models emphasize ergonomics with integrated high-resolution flat-panel displays, advanced navigation software, customer cabinets and indirect dimmable lighting. Our project won the InfoRad Cum Laude Award, and earned publication in several radiology media and journals.
Encouraged by this, we continued to race against east coast thought leaders like Dr. Eliot Siegel from the VA in Baltimore and Dr. Steve Horii who had also begun studying the same issues. Our research on the subject of digital radiology continued over the years, leading to multiple publications in clinical journals and presentations at clinical congresses in the US, Germany, Switzerland, Italy and Spain.
And, all of this brings us back to the new planning guide. Last year I ran into Greg Patrick, an old colleague and owner of Redrick Technologies. While talking about the future of imaging and how we got to where we are today, I pointed out to him that although hundreds of resources had been written about reading rooms over the last 15 years, I was not aware of what I would consider, “the definitive guide.” There were bits and pieces, but none covering ALL planning aspects. So, I proposed to Greg that we write it.
The document we’ve created takes readers through key fundamental design goals and provides specific design guidelines for reading rooms.
It also provides insight on what the future will hold. For those ideas, I once again reached out to Dr. Ratib who contributed one of the most through provoking pieces in the guide. He brought focus to the contradiction between the concept of mass reading (the radiology factory) and a future view which considers radiology as integrated with the clinical management environment. In this future view, radiology is aided by intelligent patient models that could potentially eliminate the reading room altogether.
I hope you enjoy the planning guide. More importantly, I hope it triggers new ideas about what is yet to come.