Aug 27 - Radiology Town Hall

August 28, 2020

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ID: 5511
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00:09let Doctor Goodman
00:11kick it off and then we will
00:14start question answer session.
00:17Go ahead. Thanks arena.
00:19So thanks everybody. Thanks for
00:22joining us for this radiology town
00:25hole and we put this together
00:28really simply to provide.
00:31An alternative to the faculty meetings where
00:33we have a lot of information to get through,
00:35but it gets quite descriptive and we
00:37want some sessions where there's a bit
00:40more discourse amongst awesome faculty.
00:41So we have solicited some hot topics.
00:44Some questions that you have
00:45sent to us to answer,
00:47so we will go through those in order,
00:49and we have all the vice chairs
00:51on the call as well as knee.
00:53We will leave some time after every
00:55sort of question to throw it open to the
00:58group to ask any follow up questions.
01:00You can do this either by raising
01:02your hand and we will see that,
01:04and then we'll switch on your
01:06microphone and you can talk.
01:07Or you can just type them in the
01:10queue in a box, and Serena will.
01:12Identify which questions to ask.
01:14So let's get things started.
01:16I'll throw it over to Serena to give
01:18us some of the questions that you've
01:20asked. Thanks Rob.
01:21So the first question that I received
01:24multiple times and I'm going to
01:26ask you to answer is how is Kobe
01:29affected the Department finances?
01:31Yeah, so this is a big topic.
01:34It's not a particularly pleasant
01:36topic and I know it's a question that
01:39everybody wants answered and it's an
01:41answer that sort of developing as we
01:44move forward through the kovid pandemic.
01:46You all know that we had an
01:49unprecedented decline in outpatient
01:51volumes during the kovid pandemic,
01:54and this, of course led to a significant
01:57drop in our outpatient revenue.
01:59So I've spoken about this before
02:02at faculty meetings,
02:03but just as a frame of reference,
02:06we usually collect around $5,000,000 in
02:09professional collections every month.
02:10Now, for April, May, June,
02:13July and even August so far were
02:15way off at Mark and.
02:18Our worst month was may where we
02:20collected half of what we usually do.
02:22So like 2 1/2 million dollars.
02:24So you can see that the is going to be
02:27several $1,000,000 of deficit from this year,
02:31which is something that we didn't anticipate.
02:34We had hoped to be exceeding our pre
02:37kovid collections at this point.
02:38Our goal was to exceed our pre curved
02:41volumes as we as we recovered.
02:43But it's not looking like we're
02:45going to get there yet.
02:46And certainly August doesn't look
02:48like it's going to be exceeding
02:49what we collected in August.
02:51In 2019 for example.
02:53And there are lots of reasons for this.
02:56We think one is that breast was
02:59our section at the biggest margin.
03:01So it was our biggest collector in the past.
03:05Breast obviously.
03:06Just shut down really during during
03:08covid there was no screening taking
03:10place and with the ability to screen
03:13patients with social distancing,
03:14getting back up to speed has been slow,
03:18so that set us.
03:19Our other sections,
03:21although they are getting better,
03:22we're obviously not quite at pre kovid level,
03:25so every other section is contributing
03:27to that that dip in collections and
03:30our payor mix is altering as well
03:32as seeing more of an unfavorable
03:34payor mix moving forwards.
03:36So this means that we are looking
03:38at a deficit, certainly this year,
03:41and unfortunately we're certainly last
03:43year and probably this year as well,
03:45so it's likely that we're going
03:48to have to continue to look at
03:50some deep expense reductions for
03:52FY 21 and will be looking at ways
03:55to actually help us do this.
03:57Of course,
03:58the hospital is in the same boat,
04:01Yale medicine is in the same boat.
04:03Your medicines clinical revenue is
04:05down nearly 7%.
04:06In FY20 hours was down little less than that,
04:09so we weren't as bad as as your
04:12medicine as a whole,
04:13but certainly your medicines collections of
04:15have fallen significantly last year as well.
04:17So we are all in this together.
04:19We're all in the same boat.
04:21Everyone is going to have to tighten belts,
04:24but FY21 is going to be a difficult
04:26year where we have to work out
04:28what we can do to actually remain.
04:31Will avoid going into deficit,
04:33so I'll stop there.
04:34Let's give you a minute also to ask any
04:37questions or to type any questions you
04:40have about that.
04:45I'm going to give people a
04:47whole minute just so they
04:48really feel they got time to to
04:49type something or ask something.
04:52If anyone wants to speak,
04:53you can raise your hand and I
04:55will unmute you so you can ask
05:03have a
05:12question. The hospital of
05:19plans for the fall and winter.
05:23You know? In case you know there's
05:26another spike in Covid and an what?
05:29The plan will be will we still
05:32operate and we're going to shut
05:34down like in the spring? Yeah,
05:36the general consensus is that code
05:38will be with us for awhile and we will
05:41be catering for it without having to
05:43discontinue our outpatient operations,
05:45which we did in April, May and June.
05:48So like we did with having our hot
05:50sites and segregated areas where like
05:52we would likely go back to that without
05:55actually stopping operations completely.
05:57So if there is a second spike in the
06:00in the fall, it's not going to be
06:03as drastic as it was in the spring.
06:06We're hoping we're not going to see one.
06:08We hope to get back to normal,
06:11but if there is a second wave we
06:13are likely not to be affected so
06:16badly as we were at this time.
06:19So Rob, we actually have a
06:21question come through and maybe
06:23Jay can actually jump on this one.
06:25Do we have good stocks
06:26of PPE for a second wave?
06:31I. Yeah, I actually haven't
06:32looked at the dashboard recently,
06:34but I know that the hospital has been.
06:37Planning for that in terms of
06:40ensuring that they had enough
06:43and 95 masks and or equivalents.
06:46I don't know Rob if there's been any
06:48updates in terms of the supply chain.
06:50Yeah, landscape with with the chairs meeting.
06:54Yeah,
06:54they are this stockpiling and yellow
06:56medicine are stockpiling as well.
06:58So remember those two entities here.
07:00There's the hospital and as your
07:02medicine for their ambulatory sites,
07:04so both have been even though
07:06our waivers is declining,
07:07there still purchasing and stockpiling
07:09in 90 fives and other PPE.
07:11So I don't think we will have a
07:13peepee issue to the same degree
07:16that we had during the spring.
07:19Another question about funding,
07:21how much relief funding did
07:22the hospital system receive and
07:24has that money been allocated?
07:27So. Remember, we are a physician practice,
07:31so the Care Act dollars that flowed to
07:35us really go to went to Yale Medicine.
07:38Yale Medicine is a group practice.
07:41We are in the same boat as all our
07:44colleagues across your medicine,
07:46from surgery to anesthesiology,
07:48to dermatology, Yale Medicine
07:50was hit very hard by the P PE.
07:53Budget and how much PP they had to
07:55die for their ambulatory sites.
07:57So they are using the Care Act Monies
08:00to actually fund their PPE purchases,
08:03and although that seems a bit disingenuous
08:05for us because we're hospital based,
08:08we don't get the benefit of any P PE that
08:11they had to buy for clinic building in.
08:15In Westport,
08:16we do benefit from it because that
08:18allows the surgeons and the physicians
08:21to practice there and continue
08:23to refer for us to do imaging so.
08:25When I heard first heard this,
08:27I thought that maybe this is
08:28something that is a little unfair,
08:30but the more I thought about it,
08:32I feel that it probably is
08:34the appropriate thing to do.
08:35The young medicine budget for PP
08:37skyrocketed like everyone else is,
08:38and the Care Act,
08:39dollars and a donation from Jonathan
08:41Rothberg actually help them pay for that.
08:43Thank
08:44you, I'm actually
08:46going to turn it
08:48over to Doctor Scout question
08:51about social distancing.
08:53How will we maintain quality
08:56education with social distancing?
08:59So that indeed is a
09:01huge challenge for all
09:02of us and the residents,
09:04and I want to say right from the
09:07start that I really appreciate the
09:10efforts that everybody has made.
09:12First of all, the transition to zoom
09:15conferences as well as the supplemental
09:17video conferences at several
09:19sections have provided have really
09:21been met with great applause by the
09:24residents who really appreciated it.
09:26I think the biggest challenge
09:28is trying to teach.
09:30Through zoom and engage the residence
09:33and that really does take a lot
09:36of creativity and effort and I
09:39would be happy to speak to any
09:42individuals who want to offline
09:44about particular strategies,
09:45but things that are variety of people
09:49have found helpful have been to do
09:52some work ahead of the conference to
09:55send out word slides of teaching.
09:57Little short videos.
09:59Unknown cases so that the residents
10:02can prepare for the conference
10:04and then during the conference
10:07to use the chat feature.
10:10Questions like poll everywhere.
10:11Rsna live other apps like that game formats,
10:16jeopardy,
10:16other type of things but also to
10:19ask for volunteers in terms of
10:22getting a residence to be engaged.
10:26You can identify what level
10:28resident that you want.
10:30You can,
10:31when you do border views is pretty easy
10:33to go through a particular rotation
10:35through the 3rd or the 4th years,
10:38but generally speaking,
10:39rather than trying to call on somebody
10:41whose name you see to actually ask
10:44for a volunteer tends to be helpful
10:46if you have particular projects
10:47where you have difficult things,
10:49you can have people break out
10:51into meeting rooms that that's
10:53very time consuming.
10:54Another option is to get residents
10:57to prepare part or all of a contrast
11:00conference in directly participate
11:01so you can have a Journal club
11:04and assigned journals articles
11:06for people to read.
11:07You can assign people to present
11:10difficult case conferences,
11:11so again, I think focusing on
11:13engaging the residents is really,
11:15really important.
11:16But it's also a challenge to teach
11:19at the workstation and with the way
11:21Regina has arranged the workstations
11:23we now in most sections can allow
11:26residents and Attendings in the same room.
11:28And again,
11:29if you're going to be closer than six feet,
11:32you just have to be sure to wear a mask.
11:36The bigger challenge,
11:37of course,
11:37is trying to educate the people
11:39who are off site.
11:41And once again I just want to point out
11:44that Regina is really making a huge effort.
11:47To try and find other areas where
11:49we can put workstations in house so
11:52that faculty residents can be together.
11:55It's really hard to do,
11:57but she's trying really really
11:59hard and rub and Irina,
12:01Angie to Anet or really making
12:03a big effort to provide adequate
12:05offsite workstations that are more
12:07efficient than the current beady eyes,
12:10so that at least our senior residents
12:13and fellows when they're off site,
12:15they can read remotely more efficiently.
12:18But in the meantime,
12:19until these things become available,
12:21I think the most important thing
12:23is to maintain contact
12:25with the residents that are off site and to
12:28call periodically to review cases with them.
12:31Or set up a specific time that's convenient
12:33for you and the residents that you can review
12:37either their cases or other interesting
12:39cases that you've collected during the day.
12:42If you don't have enough volume,
12:44you can assign items from item banks.
12:47You can assign directed reading,
12:49but I really think the most important thing
12:51is is to acknowledge that this is difficult
12:54and so we have to have a creative approach.
12:57And the most important thing is to
13:00communicate to the residents that even
13:02in this time that you love your job,
13:05you love what you do.
13:07You love reading cases,
13:08you love teaching them and to reach out
13:11to them and demonstrate your enthusiasm.
13:13And again, if any individual wants to talk
13:16to me about specific ways of doing this,
13:19I'd be happy to talk to them.
13:22We did get some great feedback
13:24today from the MSK session.
13:26This really been hit hard with small
13:28reading rooms that using the zoom meeting
13:31format so that they the attending could
13:33share his or her work station with the
13:36offsite resident has been very much
13:38appreciated by the residents and has
13:41been a really effective way of teaching,
13:43so again.
13:44Thank you all for your efforts 'cause
13:46I know it really is difficult.
13:50Thanks Leslie Cicero did share in
13:52the Q and a bucket of suggestion.
13:54I guess in the peed section they
13:56have a zoom meeting room open all
13:58day and they use it to review
14:00cases with residents who are in
14:02the other room slash off site.
14:04So that's something else to
14:05consider for the different
14:07sections as we move forward. Leslie
14:09has to have the residents voice concern
14:11at all to you or education leadership
14:14are bone they have about about how
14:16it's all changed. Yes, Ann.
14:18It's particularly hard in the
14:20sections where the reading rooms
14:21are so small and there are lots of
14:24fellows that there just isn't room
14:26for the residents, particularly now.
14:28Because of course you know the
14:30sections really feel like they
14:32need to train the Fellows,
14:33and so the residents are kind
14:35of getting short shrift,
14:36so that is particularly difficult.
14:38Ann again.
14:39So people are trying to do things like
14:42Cicero that is said MSK has done that.
14:45They use that same format with
14:47the virtual sort of work station
14:49thing through zoom, remember,
14:50Hameed told everybody about how to do
14:53that right when Covid started an again.
14:55It's not perfect, but it works well.
14:57I mean, one of the things that
14:59I've done that I've gotten positive
15:02feedback for is that you know, I said it.
15:05Try and set aside 1/2 an hour
15:07a couple of times today.
15:09Where I'm not reading cases,
15:11I'm actually with a resident
15:12one way or the other,
15:14either in the same reading room
15:16or through the zoom format,
15:17and just, you know,
15:19really focused on them going over
15:21cases and pointing things out,
15:22but it's hard,
15:23you know when when you're not there.
15:26It's really,
15:26you know it's one thing to go over report.
15:29It's another thing to point out.
15:31Actually, the findings on the images.
15:34So it it it takes a lot of effort
15:37and again it is stressful and it,
15:40but it's stressful for the residents too,
15:42which is why emphasize that you
15:44know we all have to try and be as
15:47enthusiastic and positive and make
15:49as much effort to communicate and be
15:51supportive of the residence as we can.
15:55Thanks Leslie. And Jay,
15:56I'm actually going to throw this
15:58question at you so when the maximum
16:01number of individuals and a reading room
16:04was determined to infectious disease,
16:06consider aerosol transmission
16:07in their calculations.
16:08There's been some question about masks
16:10actually being used in the reading rooms,
16:12and so what's the Department policy
16:14regarding activities in like in light of
16:17likely transmission via aerosol spread
16:19with individuals who sit there all day.
16:22Yeah, so this came up even just this
16:25week and I did reach back out to our
16:29liaison with infection prevention
16:31and our current policy is accurate
16:34and is what they do recommend.
16:37Which is, you know,
16:38we encourage routine use of masks while
16:41in the reading room whenever possible,
16:44but it's not mandatory if you're
16:47able to follow appropriate
16:48social distance protocols.
16:50So if you're sitting at.
16:52Greater than six feet away from
16:54anyone else at your workstation,
16:56you technically do not have to wear a mask,
16:59even though you're in the
17:00same room as others,
17:02because you know that's kind of the
17:04state approach as well as the CDC
17:06approach in terms of having adequate
17:08distance to mitigate any risk of spread,
17:10and by spread it really is through
17:12aerosol that infection prevention
17:14team actually did walk around to
17:16the reading rooms to actually
17:17look at the layouts with Regina
17:19and Cheryl Gucci and one of our
17:21quality and safety team members.
17:23Regina also asked him to do some
17:25air exchange value measurements
17:27for the reading rooms like we did
17:29for all of our imaging suites,
17:31and they were actually all very good
17:34in the range of eight to 15 ish,
17:36which is which is actually quite positive.
17:38So it means that we're getting fairly
17:41effective air turnover in the rooms
17:43in terms of adequate removal there
17:45through the hospital's HVAC system.
17:47We also encourage that you leave the
17:49reading room doors open whenever possible.
17:51That also helps to improve air flow.
17:53And kind of prevent stagnation of error.
17:56So they did take all those things into
17:58affect when giving us the guidance
18:01of what we should follow to mitigate
18:03any risk of transmission while we're
18:05in the reading room working together.
18:09Jay, would you confirm that the six
18:11feet is good enough considering
18:13aerosole rather than the droplets?
18:15The six feet is still what's being,
18:18you know, used by the state and
18:21the CDC is as an adequate radius.
18:25It's not a magical number, you know.
18:27I think it's not like you know
18:30covid particles go 6 feet and
18:32then magically hit the floor.
18:34There's been other papers that have
18:36suggested that it could be have
18:38a greater radius than six feet,
18:40at least in terms of travel.
18:42Now, in terms of the risk of
18:44actually being able to travel
18:45farther in a closed room and cause a
18:48potential risk of being infectious,
18:50that's harder to prove.
18:51So we're still left with following
18:53what you know, the CDC and the state.
18:56Department of Public health recommend
18:58and that still stands at 6 feet.
19:00Distancing for adequate social distance,
19:02so that's where we stand.
19:04Most of our workstations that we've
19:06set up are actually probably a little
19:08bit further than six feet away,
19:11but we encourage the use of
19:13mass when you can,
19:14but we can't mandate it when
19:16you're actually able to adhere
19:18to proper social distancing.
19:21We're
19:21not trying to make anyone nervous, of course,
19:23so I'll just add that in. I got a text
19:26message on the
19:27side about that. So yeah, I mean,
19:29the incidence of health care workers
19:31they've discontinued testing us
19:32because our instance was solos people
19:34coming into the reading room of health
19:36care workers and are incidences. It
19:37was less than 1% and then stopped
19:39stop testing. We considered putting
19:42plexiglass partitions between the
19:43workstations when we did the walk
19:45through in the spring and determined
19:47you know the number of Reading people
19:49who could be at the reading room
19:51and if there is interest and more
19:54concern about aerosols and people,
19:56think that those plexiglass dividers
19:57between the desks would be helpful.
19:59We can look into it.
20:01I think we can still most likely order them,
20:04so just let us know we could
20:07try it if there's addressed.
20:09Yeah, it might serve
20:11as some means of a barrier
20:13you know to a certain height.
20:15Obviously it's aerosol, it's Ares.
20:17Also, it can float up and around,
20:19you know, but I'm sure it does help.
20:22Obviously, catch some you know
20:24particles of if someone happened to
20:26be infected and you know asymptomatic
20:28and working in the reading room.
20:30But as of now the data would
20:33still suggest that the risk of of.
20:36Being infected from somebody who is
20:38infected at a greater than a 6 foot
20:42distance is probably pretty small.
20:44And that's what we're currently following.
20:46You know, as the data changes
20:48and the guidelines change.
20:49So what?
20:50We so we're constantly in touch
20:52with our infection prevention
20:53team as issues arise so.
20:57Thanks Trey, any questions on that topic?
20:59I'll let it sit for a minute and then we'll
21:01move on to an IT question that we have.
21:18Why have our IT systems
21:22been so fragile recently?
21:25Well, during the last two months,
21:28unfortunately we have had not
21:29only packs failures but also power
21:32failures and network failures,
21:33and I know that for us as users
21:36it doesn't make any difference
21:38be cause the end result is that
21:41we just can't work efficiently.
21:43In the case of power failure network failure,
21:47we're really at the mercy of the backup
21:50systems to come back quickly and
21:52also not to affect our both our packs
21:55as well as some of our modalities.
21:58You know some other cities and so
22:01on sometimes don't come back up,
22:03so we not only depend on the backup systems,
22:06but also in good communication and I
22:09have to say that in the last episode
22:12last week within full system network failure.
22:15It was the communication was lacking
22:17an we're working with the hospital to
22:20establish a better communication system
22:23by developing an IT major failure policy.
22:25We know what to do when there is just
22:28an epic downtime because we do that
22:31routinely whenever it gets upgraded,
22:34but we do not have good communication
22:37in radiology,
22:38was not informed of these network failure.
22:41It took us awhile to even figure
22:44out what was going on.
22:46Irina, can you just speak up?
22:47I'm getting some people saying
22:49they can't hear you OK, and
22:51I'm also going to put my volume
22:53higher up if needed. Thank you.
22:56Ex failure the most recent failures
22:59have affected both primordial
23:02Anpara Scribe an what we do not
23:04have good cost from the company.
23:07We mainly have differential diagnosis.
23:09Going from that could have been the
23:12antivirus software so we remove the
23:15antivirus software that didn't help.
23:17It could have been also due
23:20to lack of memory.
23:21It was also thought that the
23:24distributor which had been updated
23:26may have caused some failures.
23:29An even workstation local problems.
23:31So what we have done so far,
23:34these number one.
23:35We installed a new primordial client.
23:38We also have put more memory reimage
23:41their workstations and in some cases the
23:44older workstations have been replaced
23:47including the Indian in the ballroom.
23:49So that seems to have improved
23:52the performance of primordial.
23:54The problem is that now prescribe is
23:57also having significant problems.
23:59And I know because we have heard from
24:02users that the system is dropping worse,
24:05including sentences,
24:06and that some people have even had
24:09to go to even typing some reports.
24:12So we were in touch with CEO and
24:14vice president or nuanced yesterday
24:16requesting that logs that we have
24:19been providing the company get
24:21evaluated quickly by the engineers,
24:24and if that doesn't result in some
24:27solution within the next 2 days.
24:29They even bring engineers some site
24:31because this really has become
24:33a very serious issue.
24:34We are very aware of it and so we
24:37are hoping that once can turn this
24:39around and give us some either
24:41engineers on the ground or at least
24:44an explanation of how they're
24:46going to be solving these issues.
24:51Very muted myself.
24:52Thank you. Sister was a
24:54question we were asked not to use
24:56our own mice and keyboards and
24:58then told we would be provided with
25:01Department sanctioned high end ones.
25:02Do you have any news on this front?
25:06Yes, I think that we have determined
25:09that right now the failures that we have
25:13are not related to people using their
25:16own microphones or keyboards and mouse,
25:19and so while we discourage people from
25:23putting any UBS port so some other
25:26devices in their computers where we're
25:28doing an we have worked with G2 on
25:32analyzing what will be summer orgonomic
25:36devices that we will be able to.
25:38Either provide or suggest that people
25:41get and so once we are over the hump
25:44of all these failures which we need to
25:47resolve before we add new variables.
25:49Once we have that result we will
25:51communicate with the faculty where
25:53will be the applications that we
25:55recommend or that we will provide.
25:58Thank you.
26:00Any questions for Irene
26:03about those topics?
26:11OK, I'm going to send it over to
26:13doctor made ouf what research projects
26:15have redone with visage so far?
26:19Thanks Serena, so Fortunately there's
26:21been a lot of research projects
26:24being done with this is, you know,
26:28this is just one of our mean vendors.
26:32But I wanted to say is that the projects
26:35that we have been involved in are at
26:38very different stages of completion
26:41and these projects can be classified
26:43into really two distinct groupings.
26:46First, we have clinical studies
26:48that are aimed at answering specific
26:50questions related to solid organs
26:52and or their associated diseases,
26:54and Secondly to improve the
26:56overall functionality and tools
26:58used for the image analysis.
27:00So, as many of you already know.
27:03The first clinical study with this
27:05it was really one that was on breast
27:09density AI classification that Leanne
27:11did as the P and this was really
27:14to reduce the Inter variability of
27:16breast density classifications at
27:18the streamlining clinical workflow.
27:19This was then followed by a pet
27:22IQ noise recovery study.
27:24It was done by Chen Lu to improve
27:28the usability of pet images that are
27:31often seemed to be of low quality.
27:34In addition,
27:34Merriam Aboyan has been working with
27:37message on radio genomics of brain tumors,
27:40and this includes both the brain tumor
27:43core as well as Adima AI Segmentation
27:46and Irina and Chris Dunge have been
27:49the P for something called kobzar.
27:52I've been involved in the beginning.
27:54Of this with, you know,
27:56visage and a bunch of centers.
27:59Covas R stands for Kovid Dischage
28:01Archive and this is a data repository
28:04that is forming the basis for
28:06some multicenter multiorgan,
28:08an multidisciplinary projects
28:10that have been related to Kovid.
28:12Currently the chest and neuro section
28:15specifically have had multisensor
28:17initiatives that have been on going.
28:19And then Lastly, there have been
28:22two studies that have been done.
28:24Started by Julius Shapiro.
28:26Related to liver oncology,
28:28one that is a Lie Reads AI Classifier.
28:31It will be used to standardize
28:34reporting and lexecon that describes
28:36imaging features of liver lesions for
28:38diagnosis and therapeutic assessment,
28:41and the second has been holding for
28:43AI segmentation to identify new AI
28:46based image Biomarkers and to help
28:48create workflows for diagnosis,
28:51staging and characterization of
28:52tumors for both therapeutic triage.
28:55An assessment.
28:56For improving image analysis,
28:58there has been work done with this
29:01is to aid and identifying the data
29:04to fully embed Hiyori Pie Radio
29:07Mix Export which is been used
29:10in Merriam's already genomics.
29:12Study for exporting images and
29:15segmentation masks to nifti file format.
29:18To get the use of GitLab for team coding,
29:21it's been actually used for the wire
29:24as classifier and to get that up and
29:26running on the research server and
29:28also to improve the capability for
29:31Yale researchers to embed their own
29:33AI models using Docker container
29:35into the research visited research
29:37server on their own.
29:38So as you can see there's been a
29:41number of major projects with one
29:43of our key collaborators, visage.
29:45There has been some other AI work as well.
29:48And I don't want to exclude the
29:51fact that AI
29:52doc is another one of our major vendors,
29:56and there's been some neural work
29:58as well as work done with CT,
30:01pulmonary pulmonary emboli and lung nodules.
30:04And Clio's has also been used for
30:06some breast and thyroid studies.
30:09There's also subtle we're in the
30:11process of piloting a memer neuro and
30:14musculoskeletal AI to accelerate imaging
30:16protocols and to enhance image quality.
30:19So as you can all see,
30:21there's been a lot of interest in AI.
30:24There's been a lot of interest in
30:26working with some of our key vendors,
30:29and I think that overtime will
30:31have even more relationships and
30:33more interested in a lot of the
30:35academic pursuits of the Department.
30:38Thank you.
30:43Any questions for David?
30:49OK, Regina, Big question for you.
30:52What are plans for triennial
30:55this year this year or next
30:58year next year?
30:59We all know that the triennial
31:02sabbatical leave policy has evolved
31:04over the last several years,
31:06trying to be more in line with the
31:09medical school expectations and the
31:11current policy is written up as
31:13an aesopi that's on the Internet,
31:16so hopefully everybody knows the resources
31:19there with the ESO peas on the YDR Internet.
31:22That said, the current policy.
31:26You know has some Kings to it,
31:30and we also had a triennial town Hall
31:33pre kovid where lot of the faculty
31:37were dissatisfied with the direction
31:40an of the triennial sabbatical leave.
31:43One of the main dissatisfying points
31:46was the thought that we would take the
31:50triangle sabbatical leave and block in
31:53month blocks overtime as opposed to.
31:56Perhaps days spread over six
31:58months or or a year,
32:00and that's something that we're
32:02working on with the medical school so
32:05that we hope that next year will be
32:08able to take days spread out over a
32:11year and not just one month blocks.
32:14This, of course,
32:15is going to be worked on by the committee,
32:19the triangles sabbatical leave committee.
32:20They are planning to meet again this
32:23year and will work on incorporating
32:25this and possibly some other.
32:28Modifications to our policy for next year.
32:32I think the triennial committee is going to.
32:37All the committee also was is to
32:40review the applications and sort of
32:43consider the merits of the various
32:45activities to determine the amount
32:47of leave required for the request.
32:50This is in line with what peer
32:52institutions that still have triangle
32:55sabbatical leaves often do.
32:56They'll also be the help help guide.
32:59You know what kind of coverage
33:02the section needs,
33:03'cause as many of you also know,
33:06we do section planning.
33:07Once or twice a year where we try
33:10to plan ahead for the next 6 to 12
33:12months to figure out what all the
33:15sections need to cover their shifts so.
33:18The lead given to people granted
33:20to people will be based probably
33:23on their activities as well as
33:26whether the section can.
33:28Can can can afford having that person off for
33:31a block or days off over the years time so.
33:35There's some things that
33:36probably won't ever come back.
33:38You know the roll over into the
33:40following year or two years,
33:42which happened before,
33:43where you could have your Tri annual
33:45sabbatical leave rolled over two or
33:47three years,
33:48probably.
33:48Won't come back and I think in the
33:52past you could monetize that leave
33:55by earning why payments and that
33:58probably won't come back either.
34:01So the policy is still evolving.
34:04We're working and listening to faculties
34:07concerns and balancing that also
34:09with the expectations of the school.
34:14Thanks for Gina. Just a reminder
34:16that everyone can raise their
34:17hands and ask questions or type him
34:19in the Q and a box and I will share
34:22them with our panelists so we have
34:23some dialogue back and forth here.
34:27OK. Give it a minute. Austria
34:35when are the applications do for
34:38triennial sabbatical? Like if you
34:41want to take it next year,
34:44what do they do? Um,
34:47it's normally early fall,
34:49so I'll have to get the date,
34:51but with the new Dean I believe
34:53will might have any not processed,
34:55but new timeline so I can circle back
34:57to the triennial sabbatical committee.
35:00And you and Rob so that
35:02we can plan appropriately. Usually around
35:04November, yeah, usually random
35:05number and you remind people
35:06that they are up for leave or do
35:08they have to remember like 'cause?
35:10Sometimes it's hard to keep track.
35:12It's like 3 years,
35:13so we'll make sure that Marla and
35:15her team reach out to people who
35:17are eligible for leave so that they
35:19can start planning accordingly.
35:20OK, we're trying to get.
35:21I know that the committee was hoping
35:23we could get into a longer cycle,
35:25so we would give people like a year
35:27or year and a half to know that they
35:30could start planning and be able to
35:32actually go away if they chose to or.
35:35Really plan.
35:36In blocks and be out for awhile so. K
35:40Rob next questions for you.
35:44Our leadership positions were
35:48enumerated appropriately.
35:52Right OK so. I
35:55mean, as the Department has evolved
35:57and developed over the years,
35:59we've certainly created many,
36:01many leadership positions,
36:03and most of these are certainly remuna
36:06rated in time or money or a bit of both.
36:11And I think we've asked
36:13this question is correct.
36:14I think it's time that we actually
36:17reviewed these and harmonize them and
36:20tried to make it transparent as to what
36:24our leadership roles are consist of.
36:26We've tried to follow various algorithms,
36:29for example, the section Chiefs stipends
36:31we've based on the number of faculty
36:34that they have within their sections.
36:37We tried to do the same for
36:41our fellowship directors.
36:43Some AC gme roles,
36:44they have rules that one now needs to follow.
36:47For example,
36:48the program director of the size of our
36:50residency program is required to have
36:5240% time off the clinical schedule,
36:54and there are various other
36:56metrics now developed for large
36:58fellowship directors as well.
36:59Are APDS all get the same or
37:01vice chairs or get the same?
37:03But we do have other leadership
37:06positions that seem to be ad hoc,
37:08So what I think would be good
37:10for us to do because this is a.
37:13A topic that people are concerned
37:15about is that we should probably ask
37:18the compensation committee to actually
37:20review all the leadership roles
37:22within the Department to identify
37:24a policy as to how these should
37:27be regenerated in time or money,
37:29or both.
37:30May be the compensation committee
37:32should also get involved in some
37:34guidelines for retention or
37:36recruitment negotiations as well,
37:38because often these crop up when
37:40we are recruiting new faculty or
37:42we're trying to retain faculty.
37:45Uh,
37:45and this can can lead to to areas of concern,
37:48so I think given that this is an area
37:51that people are concerned about,
37:53we will open this up.
37:55We will ask the compensation
37:57committee to look at remuneration
37:58for rolls across the Department.
38:00We will make some changes if need be,
38:03and we will make it as transparent
38:05as possible.
38:10Thanks Rob, any questions.
38:12We did have something coming
38:13back for the triennial.
38:15So Virginia I'm just going back
38:16to you but Rob might want to
38:18jump in for those who lost most
38:21of their triennial due to kovid.
38:23Do they have to wait the same
38:24period As for another full cycle
38:26for triangle triangle to come back?
38:31I, I believe that if you
38:33had you took triennial time
38:36during the kovid period, then.
38:39You would have to wait the full
38:41cycle because you did take some
38:43of your triennial time. Then
38:45Yeah, that was that was the
38:47the approach the Dean gave us.
38:48If you didn't get your training,
38:50you could take it the following year,
38:51but if you did get some of your triennial,
38:54even if it was truncated,
38:55then you have to wait the next cycle
38:56to give your next eligibility.
39:03Can Leslie question for
39:05you about the ABR exam?
39:08What are the implications for the
39:11new ABR exam to the Department? So
39:15that's a little bit of a confusing question.
39:19The content of the ABR exam,
39:22to my knowledge has not changed at all,
39:26so the exam that they're going to get is
39:29the standard exam that they've all was.
39:33Had. And so the preparation won't really
39:36change other than this particular year,
39:39we're going to have two sets of
39:42residents that are taking the exam.
39:44The difference for the residence is
39:46at the exam will be given virtually,
39:48which means that they will not
39:50be traveling to either of the
39:52two avr monitored test centers.
39:53One is, you know is in Chicago
39:55and the other is in Tucson.
39:57The ABR has not given any of us very
40:00much information and we still don't
40:03know how it's going to be delivered.
40:06Virtually they have two major areas of
40:08concern that they're trying to sort out.
40:11One is exam security and one is
40:13the resolution of the monitors,
40:15but to my knowledge,
40:17at this point they haven't made
40:19a decision exactly how the exam
40:21will be delivered virtually,
40:23but in terms of specifics in
40:25terms of preparation for the exam.
40:28If that's what the question means.
40:31They are going to offer the exam
40:33for the 4th year residents.
40:35The ones that were supposed to have
40:37taken it in the spring of 2020.
40:40In February of 2021, two sessions,
40:42each of them three days instead of two days.
40:45The 1st and 3rd of February or
40:48the 8th and 10th of February,
40:50and then the third years will be taking
40:53the exam in June again 2 three days sessions,
40:56the 2nd through the 4th in the
40:597th through the 9th in terms of.
41:01Our plans,
41:02which are still in the process
41:04of being discussed,
41:06the current fourth years are not going
41:09to be requesting border views during
41:11the morning and afternoon conferences.
41:14They will be reaching out to certain
41:17faculty to schedule independent
41:18border views in areas that they
41:21think they particularly need.
41:23Some help,
41:24but those will be outside
41:26of the resident conferences.
41:28They will be given some time to prepare.
41:31But it will be less than what we
41:34normally have given the residence,
41:36because they've had an additional
41:38six months to prepare for.
41:40Basically the exact same exam.
41:42In terms of the third years,
41:44it'll be taking the exam in June.
41:47They're going to have their border
41:49views scheduled in March and April,
41:51and they will be given likely the
41:54standard amount of time that we've
41:56always given them to prepare for the boards,
41:59and that basically is a certain
42:01number of half days.
42:02Plus they can take any of their vacation
42:05time that they want to in order to prepare.
42:09We will share information with
42:10the Department as we get more
42:13information from the ABR,
42:14but they have been very
42:16reticent about details,
42:17and that's really all that I know
42:19an I'd be happy to answer any other
42:22questions related to this topic.
42:29I just think we anticipate the reasons
42:32having to do the exam in the reading room,
42:35so I think we couldn't create exam
42:37environments within the Department
42:39and we can't displace are reading
42:41radiologists for our residents
42:43to do exams at work station,
42:45so I'm guessing they're going
42:46to have them at these learnings,
42:48learning stations locali
42:50the big issue actually is,
42:51from what I understand it is mammography,
42:54an IR, and it has to do with the
42:57resolution because if Pearson Vue,
42:59which is the major teaching center,
43:01doesn't have a resume.
43:02The resolution on their monitors so they can
43:05see micro calcifications on a mammogram.
43:07Then it's going to be impossible now a
43:10couple of years ago there was actually
43:12a glitch in the exam delivery in a
43:15certain percent of the residents didn't
43:18even get any of their mammography
43:20questions and they had to take it later.
43:23So it's not impossible that they'll
43:25build on that and that they'll take
43:28most of the exam at Pearson Vue,
43:30and then they'll have to take
43:32their 60 mammography questions,
43:34possibly there 60 IR questions.
43:35In House where they can use a workstation,
43:38but then it would be, you know,
43:41a much shorter situation and I don't know.
43:44I'm just speculating.
43:45Maybe that's why they reserved three days
43:48for it instead of the standard two days,
43:50and so maybe it'll be part and part,
43:53but I don't.
43:54I honestly don't know.
43:56Thank you.
43:59So I ran
44:00away. I have a question about my chart.
44:03Are there any plans to further reduce the
44:05time patients see their reports in my chart?
44:09Well, as you know this is a system
44:12wide initiative and it was a very hard
44:15sell to get to where we are right now.
44:18It was a full year of negotiations across
44:21the system to gain three days on the
44:24releasing other reportes to the outpatient.
44:27So where we're working on is are
44:29some alternatives which will still
44:31accelerate the release of report.
44:34First of all, the ediane impatience
44:36should be receiving the reports
44:38at the time of discharge.
44:40For instance,
44:41bridge for hospital already gives
44:43a print out to the report to the
44:45patients when they are these charge,
44:47and so it is planned that systemwide
44:50impatience an indie will receive the
44:52reports at the time of discharge.
44:54The second thing is that will be
44:57working with yellow medicine so
44:59that there would be an opt out
45:02policy so that when providers.
45:04Now have the ability of these
45:06reports as soon as they read them
45:09will have to opt out of their button
45:12of Review and release,
45:14which right now is just a voluntary,
45:17but that it should be more of
45:19an opting out so that as soon as
45:22they are reviewing the report they
45:25should be releasing the majority
45:27of these reports to the patients.
45:30The third initiative will be that
45:32we are about to.
45:34Allow the patience to review.
45:35The image is not just the reports on
45:38my chart, so that will be also for them.
45:41Easier to access,
45:42not just before,
45:43but the images download them
45:45and share with their providers.
45:47It needed an IV is that we are
45:49setting up our follow-up manager,
45:51which is a new primordial module for
45:54the follow up of incidental findings
45:56and as part of that module it gives
45:58us the radiologist the ability and
46:01the choice to add the patient to
46:03the communication that they need.
46:05Follow up studies and so we're
46:07going to have a little more control,
46:09or when those reports do go to
46:12the patients and make them a part
46:14of that decision.
46:15As you know, there are some states,
46:18like for instance in Pennsylvania,
46:20where it is now mandatory to
46:22give patients a report when
46:23they are incidental findings and
46:25communicate at the same time you
46:27are communicating to the provider.
46:29So I think that all of these
46:32parallel initiatives are going to
46:34improve the access to the report's,
46:36if not really.
46:37Make it much faster because again
46:39that will be a major change
46:41for the culture of the system,
46:44but I think these will be optimizations
46:46that the patients are really going to enjoy.
46:51So we just have two comments and
46:53excuse me one question, one comment.
46:55So Leanne saying Mamo images are already
46:57visible to patients on my chart.
46:59It's caused a bit of concern in some cases.
47:04So we like to hear more about about that.
47:07Leanne. I know that the reports
47:09are available because you
47:11given the patients the letter.
47:13Also the time the patients get discharged
47:15from screening and diagnostic.
47:17So I know that in mammography
47:19that's the case, but I wasn't sure
47:21that the image is already there.
47:23So I guess I have to shop with
47:26my team because I didn't know
47:28the image is also available.
47:30I know that there are some
47:32patients who have called.
47:34Asking for the results and what is
47:36this white thing on my mammogram,
47:38and so maybe it is true that the
47:40images have been released for
47:42their, you know, they've
47:44been there for months. OK,
47:46so certainly the reports
47:47you know the normal reports,
47:49or at least instantly and all our
47:51calls may be worried about patients
47:54calling the Department with questions.
47:56All our calls for normals about mammography,
47:59just about terminology,
48:00so it's interesting that people
48:02haven't really been calling
48:04about anything apart from normal
48:06mammography results.
48:07And they're not many calls. I mean,
48:09they're really not. No, we were
48:11bracing ourselves for non slip
48:13so we didn't really get anything.
48:16I believe actually it's.
48:17It's beyond just mamo.
48:19I think we are largely live
48:21with patients having access to
48:22their images through my chart
48:24for all diagnostic radiology.
48:26I know we've edited the verbiage
48:27that we sent out to our patients
48:30and their post appointment.
48:31You know, emails and text messages
48:34which gives them information
48:35on billing and my chart and we
48:37have edited the language that
48:39actually says to encourage people
48:41to sign up to my chart that you
48:44now have ability to see reports.
48:46And access your images.
48:47So I believe it's actually a
48:49live. You absolutely right?
48:51I think that what I just now
48:53remembering that we are not
48:55allowing them yet used to download
48:57and share their life in there.
48:59Thank you, yeah.
49:02Would you know have a question
49:03for you about vacation?
49:04What will happen if we can't take our
49:06vacation this year? Well, although
49:09you may not be taking vacation
49:11to the Caribbean or you know
49:14Europe or wherever Bali,
49:15everyone needs to take the time
49:18off or or what most people call
49:21vacation petio or paid time off.
49:23It's really important to take that time off.
49:27Throughout the year,
49:29please don't save it all to the end of the
49:32year because if everyone saves it till April,
49:35May and June then there won't be
49:38anybody left to cover the clinical
49:40services and you may not get that time,
49:43so please take your vacation or PT.
49:46Oh. I think most of us know we can't
49:50roll over these days into next year.
49:53We can't save them for later,
49:56so unused vacation would be converted either
49:58into academic days throughout the years,
50:01the year,
50:02so it's better probably just to take it.
50:05And then this is also true for CME on.
50:09You see Me,
50:10Time will typically convert
50:12to academic days as well.
50:14We want to avoid in general
50:16faculty working over target.
50:17Unless you're in a section that short
50:20staffed and we're trying to recruit,
50:22in which case you would perhaps have
50:24the ability to work over target button.
50:27Generally want to keep people
50:29at Target throughout the year.
50:32So take your time.
50:36I'm on vacation right now in my car.
50:401st Place I
50:42can go. I had I
50:44had a full and
50:46enjoy yourself. Four
50:48days of zoom vacation this
50:50summer is Bliss. Yeah,
50:51I've enjoyed our garden, you know,
50:54for the entire summer, so there you go.
50:58Jay, while we have you from your vacation.
51:02What can we do about improving
51:05critical result critical test results?
51:07Communication at the BHO hours
51:09locations? Yes, so this has been a.
51:12This has been an issue now
51:14since we've we've taken over.
51:16BHO are now it's been expanded with,
51:19you know us providing services at Milford,
51:21which is part of the Bridgeport Network
51:23as well as RED group and even some of
51:27our subspecialty groups providing care at
51:29Bridgeport Hospital during the nights.
51:31It's actually a project that Rob
51:33has brought up this year to both
51:36myself and Irina to try to come to a
51:39solution and reach a solution for this,
51:42it's painful. You know,
51:43I I I'm at Park Ave and and Milford not
51:45that infrequently and to not have the
51:48verify or the critical result system work.
51:50There can really really kill your day,
51:52especially if you're really
51:53struggling to find somebody on
51:55the phone to communicate with.
51:57So I kind of feel like you know we've
51:59all gotten a little bit spoiled with
52:02the with how easy it is for us to be
52:05able to record a message and send it
52:07off to a provider for an orange or
52:09yellow or even occasionally or red.
52:11So we are going to explore.
52:13What we can do?
52:14This year,
52:15irena and IT group as well as Chris
52:17Kanjar working looking at system wide
52:19solution as well that would involve
52:21Greenwich, Ellen M and Westerly.
52:23But that's going to be a longer
52:25term project and goal,
52:27but we hope to have something that
52:29we can implement in this in a shorter
52:32period of time to help us all out
52:35and make it easier for us to do our
52:37job and communicate those results.
52:39So what will explore things like
52:41Reading Room Assistance or perhaps
52:42re purposing?
52:43Some fire room staff at Bridgeport
52:45to help us get people on the phone
52:47that advanced radiology group at
52:49Bridgeport Hospital is also very
52:51keen on this.
52:51They struggle with this as well,
52:53so it's a problem and we hope to
52:56have something in place.
52:57You know this year to make it
52:59easier for all of us.
53:05And it's something that's really distinguish.
53:06We all know where better than
53:08our private practice competitors,
53:09but this is something that private
53:11practices do a lot better than us.
53:13They pick up the phone and they get
53:15the referring doc on the on the on
53:17the line and they speak to them.
53:19That's something that we've got to be
53:21able to replicate in RB HR practices,
53:23so it's a high level agenda item
53:25for the Department for this year,
53:26and it'll probably, as Jay said,
53:28be a Fusion of of people.
53:30A person was able to get the
53:32referral on the phone for us so
53:34that we can actually talk to.
53:35Two to the referring Doc.
53:38Yeah, may I just
53:39say that I know that some of the
53:41private dogs they they text each
53:42other on their personal cell phone,
53:44which of course we really can't do.
53:46But that's true, fairly common. Yeah. Yeah,
53:50I mean all the private practice
53:51groups in the health system have
53:53actually voiced a concern to myself.
53:55Robin Arena that this is a problem for them.
53:58It's it's a problem across the
54:00nation as we all get busier.
54:02It's hard, you know,
54:03having attending radiologist,
54:04sitting on hold for 10 minutes,
54:06waiting for somebody to pick up the phone.
54:09You really feel like you're not
54:11using your time like you should be.
54:13So they've told us that we could come
54:15up with something to help them out as
54:18a health system for for radiology.
54:20It would really help them as well,
54:22so I think there's a win win that
54:24we could possibly help ourselves
54:25as well as help others and make it
54:28more reliable and easier while still
54:29being able to provide you know,
54:31efficient care so.
54:34Thing is important, this is made a priority.
54:37An even in with the situation that we have
54:40with freezing the hiring of any new FDS,
54:43there's going to be need for additional FT.
54:46Es are file room certainly cannot
54:49take up anymore tasks as it is and
54:52the other networks need to come up
54:54with either existing or help out with
54:57making the case that we need new efds
55:00to take care of this particular task.
55:05Is the question about texting?
55:09Can I answer that real quick?
55:14Yeah, we can only text using the mobile
55:17heartbeat phone an by strict rules.
55:19You really need to be in the mobile
55:23heartbeat app and text once you open the app,
55:26so you can just use your
55:29mobile heartbeat and text.
55:30You actually have to open the app
55:33which most of the radiologists
55:35don't have actively open during
55:37the day and text by that.
55:40So it's really best to sort of text.
55:43Code and then maybe email
55:45using your Yahoo email and I'm
55:47happy to share that policy.
55:48It's on the Yale Medicine practice standards.
55:51So yeah, and
55:52I would also emphasize you anytime
55:55you're communicating a critical
55:56result that has to be a closed loop.
55:58So it's really important to you.
56:00Can't just send a message out and
56:03assume that the person saw it.
56:05So for you know by Joint
56:07Commission standards and so forth,
56:08you have to ensure that the
56:10other person received the result
56:12understands and that way you can
56:14document that it was communicated.
56:16Just sending a one way message out
56:18doesn't fulfill the requirement.
56:19Unfortunately,
56:20for communicating it has to be
56:22closed loop so that you ensure
56:25the person receives it.
56:26For
56:27anyone who may not always use,
56:29verify or the doctors not on verify,
56:32this doesn't happen.
56:33Often happens in Malmo, But.
56:35You can send an epic message. Ann.
56:38Have a confirm atory read but it still.
56:41They have to reply back that they read it.
56:44You can hit a little button and it
56:46confirms and then it will remind you
56:48in like 2 days you set the time.
56:50One day, two days three days and will
56:51remind you that that person didn't respond.
56:54It's not.
56:54It's certainly not perfect.
56:55It does not replace verify.
56:56But if you are sending an epic message
56:58and you want to reply and confirm
57:00there is a there is a new task
57:02melting you little feature there.
57:06And Susan's point about Yale.
57:07Yale Health Plan is valid.
57:09I think Yale Health would be another
57:11area that we'd really like to get
57:14onto our communication system so
57:16that we can reach their dogs too.
57:18Lots of work,
57:19yeah, good point. Stringer
57:21at the Witching hour then
57:23yes, we are.
57:24It's 259th and have a minute later.
57:27Any questions want to come through
57:28the Q and a box or raise your hands?
57:30I can definitely turn it over, but.
57:32We have a minute we don't want
57:34to keep everyone from reading.
57:43Not. OK, we'll call it there then.
57:46Thanks very much for your
57:47everyone for joining us.
57:48Sorry it's such a peculiar time,
57:50but we have recorded it.
57:51So those of your colleagues that couldn't
57:53watch live can watch it remotely.
57:54And thanks to all the vice chairs for
57:56donating their time or for the hard
57:58work they've done over the last year.
58:00Sorry it's been such a strange year,
58:02but hopefully things will
58:03get back to normal in 21.
58:04So thanks for your questions.
58:05Give us any feedback if you
58:07want this again in the future.
58:08Let us know what happened to do it and
58:10enjoy the rest of your day, thanks.
58:13Thanks Rena, thanks.