Affidea – Best Use of Digital Health FINALIST – 2017
JURY’S REASONING
Affidea is a leading, independent provider of advanced diagnostic imaging and cancer care services in Europe. It owns and operates 210 medical centres across 16 countries with over 4000 employees, 800 of whom are medical doctors. Affidea serves more than 5.5million patients per year.
Affidea provides two different kinds of innovative digital health services – the ‘MR Excellence Program’ (MREP) and ‘Dose Excellence Project’ (DEP). The first one offers three key components of MREP, all of which rely on a digital health offering – standardisation, work flow optimisation & knowledge management. The second one uses digital health to optimise the dose of radiation a patient receives by a computed tomography scan of diagnostic image quality.
MREP is active on 22 MRI units in 3 countries providing monitoring of the conduct of MR scanning in real time. In the last 4 weeks, 13,620 MR examinations have been monitored on this system. The DEP involves more than 80 radiologists, 120 radiographers and 12 country project leaders.
Application
Briefly describe the organisation giving the number of facilities, staff, revenue numbers.
Affidea is a leading, independent provider of advanced diagnostic imaging and cancer care services in Europe. It owns and operates 210 medical centres across 16 countries with over 4000 employees, 800 of whom are medical doctors. The technology managed within Affidea is considerable, with 1050 diagnostic and cancer care modalities. These include 145 MRI, 100 CT scanners, 22 linear accelerators, 17 PET CT & 3 gamma knives. Affidea serves more than 5.5million patients per year.
What is the nature of the service in which the organisation is using digital health?
The ‘MR Excellence Program’ (MREP) is the name of the service. It was developed to address the problem of variation, inefficiency and lack of KPIs in this particular diagnostic service. There are three key components of MREP, all of which rely on a unique digital health offering – standardisation, work flow optimisation & knowledge management. MREP is active on 22 MRI units in 3 countries providing monitoring of the conduct of MR scanning in real time. In the last 4 weeks, 13,620 MR examinations have been monitored on this system.
The ‘Dose Excellence Project’ (DEP) is the largest radiation dose management program globally. The purpose of DEP is to optimise the dose of radiation a patient receives by a computed tomography scan of diagnostic image quality. It is operating in 12 countries, involving 67 CT systems from four vendors. The DEP involves more than 80 radiologists, 120 radiographers and 12 country project leaders. 75 standardised CT protocols have been developed, unifying the way in which CT scans are performed. Data from an average of 65,000 examinations per month are analysed in real time to ensure that pre-defined dose limits are not exceeded, and then compared to the group to identify best practice and optimise care. We call this ‘balanced radiography’ – not too much radiation to cause harm, but not so little that image quality is negatively effected.
What is the nature of the digital health offering? Please describe the main IP component of this service.
The MR Excellence Program relies on several innovative, bespoke, digital health products:
The ‘Protocol Exchange Program’ was developed to allow standardised, optimised MRI sequence protocols to be transmitted to centres, without the need for an in-person visit from a technician. More than 1500 pulse sequences were included in the standardised protocols and optimised in 8 MRI systems from 3 different MRI vendors by a group of 4 MR Applications Consultants.
The ‘Affidea Agent’ is an analytics tool that monitors the MRI scanner in real time, uploading anonymised data onto a virtual server.
These data can be accessed remotely via the ‘Affidea Imaging Metrics’ (AIMS) dashboard, to allow users to assess the MR workflow, compliance to best practice and image quality in real time.
In addition, a Moodle based educational site the ‘MRI Academy’ was developed in order to provide access to twelve MRI courses.
The MR Excellence Program relies on several innovative, bespoke, digital health products:
The ‘Protocol Exchange Program’ was developed to allow standardised, optimised MRI sequence protocols to be transmitted to centres, without the need for an in-person visit from a technician. More than 1500 pulse sequences were included in the standardised protocols and optimised in 8 MRI systems from 3 different MRI vendors by a group of 4 MR Applications Consultants.
The ‘Affidea Agent’ is an analytics tool that monitors the MRI scanner in real time, uploading anonymised data onto a virtual server.
These data can be accessed remotely via the ‘Affidea Imaging Metrics’ (AIMS) dashboard, to allow users to assess the MR workflow, compliance to best practice and image quality in real time.
In addition, a Moodle based educational site the ‘MRI Academy’ was developed in order to provide access to twelve MRI courses.
When did the organisation start delivering this service en masse?
MREP – May, 2016
DEP – April, 2014
What are the main key performance indicators? How does the organisation measure the success of the project?
The real-time KPIs available on the AIMS platform include:
– Total number of MRI scans performed by centre and type of scan
– Average total acquisition time (time machine is actually in use)
– Average total waste time (time between scans, when the machine is idle)
– Average compliance to ‘core’ (minimum, ‘best practice’) sequences for that particular indication and body part
– Average deviation from the complete optimised sequence list for that indication and body part
– Image resolution of the scan
The organisation is able to monitor the productivity of the connected MRI scanners in real time and intervene where appropriate. To our knowledge, this is the largest project of its kind in MRI scanning globally, allowing unparalleled insight into the daily operations, and benchmarking between sites and countries.
Success is measured by reduction in waste time, optimising acquisition time, good compliance and small deviation from optimised protocols, and good image quality.
These data have been published and presented at international meetings.
The percentage of alerted examinations that are above the dose level thresholds (≤10%), the percentage of unjustified alerts ((≤1%), the percentage of examinations performed with standard protocols (≥75%), the percentage of optimised protocols (≥80%). The organisation records these values for each and every one of its CT systems to check compliance to the targets. A performance index indicates the success of the project.
This project has been recognised for its groundbreaking work with presentations accepted at international scientific meetings. A list of presentations relating to DEP is attached with this form.
The European Society of Radiology launched the ‘EuroSafe’ project in 2015. It has a ‘Wall of Stars’ that recognises centres undertaking work to optimise radiation exposure – four stars for ‘best in class’ and five stars for ‘best in class, as well as undertaking scientific research on dose optimisation’. There are currently 44 international centres listed on the Wall rated 4 or 5 stars, 19 are Affidea centres: http://www.eurosafeimaging.org/stars/wall-of-stars. These are listed in an attached file.
How has the digital health enabled service impacted on patient/care recipient outcomes?
So far, 74 standardised protocols have been developed and are available on the Protocol Exchange Platform. Agents have been installed in 22 MRI departments in 3 European countries and the KPIs are currently being monitored in real time. Reduced protocol time has resulted in extra imaging capacity in all three countries, with an improvement of objectively measured image quality.
Through DEP we provide safe, optimised and unified CT scans across our network that are quality assured by objective measurements.
A secondary consequence is that through the scientific activity around the project, we have been able to engage clinicians and technicians from numerous countries to work together more closely and also to inspire a culture of ‘dose awareness’ throughout the organisation.