Quality assurance scorecard for diagnostic medical agent administration

• US 7,933,782 B2
• Filed: 01/29/2008
• Issued: 04/26/2011
• Est. Priority Date: 01/29/2007
• Status: Active Grant

• Current Assignee: Bruce Reiner
• Original Assignee: Bruce Reiner
• Inventors: Reiner, Bruce
• Primary Examiner(s): GILLIGAN, CHRISTOPHER L
• Application Number:
  US12/010,707
• Publication Number:
  US 20090094058A1
• Time in Patent Office: 1,183 Days
• Field of Search: 705 2- 3, 705/9, 600/300
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage

Abstract

The present invention relates to a method and apparatus where pre-defined diagnostic medical agent administration data are prospectively collected and analyzed, in order to provide an objective contrast administration risk-benefit analysis, and provide an impartial analysis for pre-testing assessment, as well as optimization of examination, contrast selection and performance parameters. By storing this data in a standardized and centralized fashion, the data could in turn be used for clinical outcome analysis on a local, regional, and national level.

Claims

1. A computer-implemented method of selecting diagnostic medical agents for administration during an imaging examination on a patient, comprising:

retrieving physiological diagnostic information on the patient from a database of a computer system;

displaying said physiological diagnostic information on a display of a client computer of said computer system;

receiving a request for an imaging examination at said client computer;

performing an assessment of examination appropriateness for the patient by performing an analysis on the type of requested imaging examination in comparison with the physiological diagnostic information retrieved on the patient from said database;

retrieving information on a plurality of diagnostic medical agents from said database of said computer system;

performing a functional assessment of the imaging examination to be performed by determining parameters for administration of a diagnostic medical agent during conduct of the imaging examination in light of said physiological diagnostic information on the patient; and

selecting and displaying on said display, an appropriate diagnostic medical agent for use during the imaging examination based on a result of an analysis of said examination appropriateness assessment and said functional assessment.

2. The method according to claim 1, further comprising:

performing a QC analysis of imaging equipment used for the imaging examination.

3. The method according to claim 2, further comprising:

performing a time synchronization between an injector which delivers the diagnostic medical agent and said imaging equipment to ensure that times on both are synchronous.

4. The method according to claim 3, acquiring technical data from said injector and storing said injector technical data in said database;

wherein said injector technical data includes a type and volume of said diagnostic medical agent administered, injection rate and pressures, and contrast extravasation.

5. The method according to claim 4, wherein said injector technical data is directly correlated with said imaging equipment to provide a direct linkage between contrast delivery and derived imaging data.

6. The method according to claim 5, wherein images are obtained during different phases of diagnostic medical agent administration, to acquire and store said injector technical data.

7. The method according to claim 6, wherein said injector technical information is used to determine an optimal imaging/contrast protocol in accordance with said physiological diagnostic information on said patient.

8. The method according to claim 7, wherein imaging equipment acquisition parameters from prior imaging examinations, and corresponding image quality metrics stored in said database, are cross-referenced to identify optimum exposure parameters used in said imaging examination.

9. The method according to claim 1, further comprising:

obtaining any iatrogenic trauma information associated with insertion of an intravenous catheter for delivery of said diagnostic medical agent to the patient; and

receiving and storing said iatrogenic trauma information in said database.

10. The method according to claim 9, further comprising:

obtaining QA data and diagnostic medical agent delivery data during the imaging examination,

receiving and storing said QA data and diagnostic medical agent delivery data in said database.

11. The method according to claim 10, wherein said QA data and said diagnostic medical agent delivery data includes at least one of timing of an image acquisition during delivery of said diagnostic medical agent, and whether extravasation occurred.

12. The method according to claim 11, further comprising:

performing a physiological diagnostic assessment of the patient after the imaging examination and after the catheter is removed; and

receiving and storing said assessment in said database.

13. The method according to claim 12, further comprising:

notifying a practitioner by electronic means, of any adverse reactions, unexpected or emergent findings, based on said clinical assessment.

14. The method according to claim 13, further comprising:

calendaring follow-up to the patient for additional information.

15. The method according to claim 14, further comprising;

performing an analysis of said physiological diagnostic data, image data, said QA data, and said diagnostic medical agent delivery data; and

providing a report of said analysis.

16. The method according to claim 15, further comprising:

including data on contrast extravasation, clinician orders, consultation notes, or follow-up procedures, in said report.

17. The method according to claim 13, wherein said adverse reactions or adverse outcomes are stored in a database and used for one of individual credentialing, institutional accreditation, provider education, pay for performance measures, or research and product development.

18. The method according to claim 12, further comprising:

obtaining any specialized image processing parameters assessed for the patient based on said functional assessment and on the imaging examination performed; and

receiving and storing said specialized image processing parameters in said database.

19. The method according to claim 18, further comprising:

notifying institutional personnel by electronic means, of any QA deficiencies in the examination or in performance of the personnel, based on said analysis.

20. The method according to claim 19, further comprising:

forwarding a patient survey to the patient, and storing a response to said patient survey in said database.

21. The method according to claim 20, further comprising:

performing a trending analysis of said analysis and said patient survey.

22. The method according to claim 21, further comprising:

obtaining best practice guidelines;

receiving and storing said best practice guidelines in said database;

performing a comparison of said QA data with said best practice guidelines; and

notifying institutional personnel by electronic means, when clinical guideline thresholds are exceeded based on said comparison.

23. The method according to claim 22, further comprising:

performing economic, workflow and clinical outcomes analyses of said QA data, clinical data, imaging data, and best practice guidelines comparison.

24. The method according to claim 23, further comprising:

posting standardized QA data from said analyses on the Internet for public dissemination.

25. The method according to claim 19, further comprising:

preventing computer access of any personnel found deficient in performance or training, until said deficiencies are overcome.

26. The method according to claim 1, further comprising:

incorporating information on the diagnostic medical agent into each individual image DICOM header.

27. The method according to claim 26, wherein said information includes a time and/or activity curve of each organ presented.

28. The method according to claim 27, wherein said time and/or activity curve is in a preselected color or size of font.

29. The method according to claim 26, wherein said information in said DICOM header includes one or more of:

starting and ending times of said diagnostic medical agent administration, type of diagnostic medical agent, osmolality of diagnostic medical agent, total volume administered, delivery methodology, method of diagnostic medical agent administration, rate of diagnostic medical agent administration, anatomic site of access for delivery, catheter size, attenuation values, differential attenuation values, change in attenuation relative to pre-contrast rate of injection, complications, allergic reactions, treatment of complications, patient disposition, technology used, and data storage.

30. The method according to claim 1, wherein said functional assessment includes parameters on a presence or absence of said diagnostic medical agent, a manner in which said diagnostic medical agent is delivered, phases of image acquisition during said imaging examination, delivery of said diagnostic medical agent, and physiological diagnostic data, historical data and laboratory data unique to said patient.

31. The method according to claim 1, further comprising:

revising examination protocols based on said examination appropriateness assessment and said functional assessment.

32. The method according to claim 31, further comprising:

receiving confirmation of said revised examination protocols by said technologist.

33. The method according to claim 31, wherein said revision is performed by a radiologist.

34. The method according to claim 1, wherein change in patient physiological diagnostic status, indication for the imaging examination, and changes in technology used, are included in said functional assessment.

35. The method according to claim 34, wherein when said change in patient physiological diagnostic status is not available for said analysis of said examination appropriateness and said functional assessment, a user is provided with one of performing said imaging examination without administration of diagnostic medical agents, changing to an alternative imaging examination, or obtaining pertinent laboratory data prior to performing said imaging examination.

36. The method according to claim 1, further comprising:

receiving confirmation of said functional assessment by a technologist or radiologist.

37. The method according to claim 36, further comprising:

performing a patient profile and physiological diagnostic assessment of the patient after said functional assessment and prior to said imaging examination.

38. The method according to claim 36, wherein after selection of said appropriate diagnostic medical agent, said technologist approves same.

39. The method according to claim 1, further comprising:

tracking a bolus of diagnostic medical agent in the patient by a time/activity curve, which includes an injection rate of said diagnostic medical agent at a predetermined time period.

40. The method according to claim 39, further comprising:

obtaining a delayed set of images without injection of additional diagnostic medical agent; and

determining a period of time for said delayed set of images after injection of said bolus of diagnostic medical agent.

41. The method according to claim 39, wherein a slice of a patient image is shown on said time/activity curve on said display.

42. The method according to claim 1, further comprising:

providing a scorecard for said medical diagnostic agent used with said patient, said scorecard which includes at least one of;

patient safety, including allergic reactions, side effects, organ toxicity, morbidity and mortality, contrast extravasation, or intravenous access rates;

contrast utilization, including single exam volume, cumulative contrast dose, exam appropriateness, or ionic vs. non-ionic contrast;

contrast optimization, including contrast efficiency;

clinical utility and assessment, including diagnostic accuracy, protocol optimization, or level of diagnostic confidence;

education and training, including continuing education, database management, or technical in-services;

technology assessment, including bolus tracking, data collection and analysis, equipment quality control, or automated contrast cut-off;

customer satisfaction;

or economic analysis.

43. The method according to claim 1, further comprising:

providing a list of quality assurance variables for said scorecard, including at least one of;

education and training, catheter insertion, or iatrogenic complications for a technologist;

exam appropriateness, patient safety profile, or morbidity and mortality for a radiologist;

data input, exam appropriateness, or clinical assessment feedback for a clinician;

staff education and training, or equipment quality control for an administrator;

economic analysis for said patient including subjective feedback or compliance; and

data collection or injection parameters for a vendor.

44. A computer system for selecting diagnostic medical agents for administration during an imaging examination on a patient, comprising:

at least one memory which contains at least one program which comprises the steps of;

retrieving physiological diagnostic information on the patient from a database;

displaying said physiological diagnostic information on a display of a client computer of said computer system;

receiving a request for an imaging examination at said client computer;

performing an assessment of examination appropriateness for the patient by performing an analysis on the type of requested imaging examination in comparison with the physiological diagnostic information retrieved on the patient;

retrieving information on a plurality of diagnostic medical agents from said database;

performing a functional assessment of the imaging examination to be performed by determining parameters for administration of an diagnostic medical agent during conduct of the imaging examination in light of said physiological diagnostic information on the patient; and

selecting and displaying an appropriate diagnostic medical agent for use during the imaging examination based on a result of an analysis of said examination appropriateness assessment and said functional assessment; and

a processor for executing the program.

45. A computer-readable medium containing executable code for selecting diagnostic medical agents for administration during an imaging examination on a patient, comprising:

retrieving physiological diagnostic information on the patient from a database, of a computer system;

displaying said physiological diagnostic information on a display of a client computer of said computer system;

receiving a request for an imaging examination at said client computer;

performing an assessment of examination appropriateness for the patient by performing an analysis on the type of requested imaging examination in comparison with the physiological diagnostic information retrieved on the patient from said database;

retrieving information on a plurality of diagnostic medical agents from said database of said computer system;

performing a functional assessment of the imaging examination to be performed by determining parameters for administration of an diagnostic medical agent during conduct of the imaging examination in light of said physiological diagnostic information on the patient; and

selecting and displaying, on said display, an appropriate diagnostic medical agent for use during the imaging examination based on a result of an analysis of said examination appropriateness assessment and said functional assessment.

46. A computer-implemented method of selecting diagnostic medical agents for administration during an imaging examination on a patient, comprising:

retrieving clinical information on the patient from a database of a computer system;

displaying said clinical information on a display of a client computer of said computer system;

receiving a request for an imaging examination at said client computer;

performing an assessment of examination appropriateness for the patient by performing an analysis on the type of requested imaging examination in comparison with the clinical information retrieved on the patient from said database;

retrieving information on a plurality of diagnostic medical agents from said database of said computer system;

performing a functional assessment of the imaging examination to be performed by determining parameters for administration of a diagnostic medical agent during conduct of the imaging examination in light of said clinical information on the patient;

selecting and displaying on said display, an appropriate diagnostic medical agent for use during the imaging examination based on a result of an analysis of said examination appropriateness assessment and said functional assessment;

receiving and storing in said database, any iatrogenic trauma associated with insertion of an intravenous catheter for delivery of said diagnostic medical agent to the patient;

receiving and storing images acquired, QA data received, and diagnostic medical agent delivery data received, during the imaging examination, in said database;

wherein said QA data and said diagnostic medical agent delivery data includes at least one of timing of an image acquisition during delivery of said diagnostic medical agent, and whether extravasation occurred;

receiving and storing a clinical assessment of the patient after the imaging examination and after the catheter is removed;

receiving and storing any specialized image processing parameters assessed for the patient based on said functional assessment and on the imaging examination performed; and

notifying institutional personnel by electronic means, of any QA deficiencies in the examination or in performance of the personnel, based on said analysis.