ccta « WordPress.com Tag Feed

CCTA to Jump Hurdles - Bill Shea

tmyersnrscmo — Wed, 20 May 2009 11:35:47 +0000

This article appeared in Imaging Technology News, May 2009 Issue

CCTA to Jump Hurdles

While growth for disruptive technologies is coming, it’s all about timing.
By: William Shea, M.D.

Many experts lauded multidetector computed tomography (MDCT) and cardiac computed tomography angiography (CCTA) as disruptive technologies that would abruptly alter the standard of care for those with coronary artery disease. Now, years later, CCTA is slowly gaining acceptance in the medical community, both by providers, payers and administrators. Why so slowly? Perhaps the answer is simply timing.

What are the hurdles? The ones that play a role include cost, radiation safety, the economy and the need for evidence-based clinical outcomes.

Cost of Healthcare

In the last decade, the cost of healthcare in the U.S. and especially medical imaging has skyrocketed. Expensive diagnostic exams became a target for cost containment, which would explain the non-coverage determinant for CCTA by CMS in December 2007, and the ensuing coverage confusion that followed. CMS and the insurance industry simply will not support the use of CCTA as another layer of cost.

Any medical center or practice interested in developing a cardiac imaging program adopted a conservative approach. At the date of this writing, all local Medicare intermediaries and most commercial payers do reimburse for CCTA. However, reimbursement is based on Local Coverage Determinants that vary greatly in the details, and it is the attention to these details that determines appropriate reimbursement. CMS has solicited requests for input into CPT code development, but until there is a clear demonstration that CCTA is cost effective and adds value, we still face the cost restraints that are in place.

Radiation Safety

Secondary effects of radiation exposure are top of mind in the medical community and the general public. Several peer review studies and editorial reviews have highlighted the risks of inadvertent over-utilization of CT scanning, especially in the younger population.

To address this issue, the ACR has adopted the “Image Gently” program, and manufacturers have developed dose reduction strategies. Excellent articles like those from Mayo, et al, (AJR) have delineated the risks when imaging is appropriately performed. We will need to continually monitor this issue and ensure that the appropriate utilization of MDCT prevails.

Economic Recession

Obviously, no one predicted the sudden global collapse of the economy last year. This has further limited growth of CCTA programs. Capital budgets have been slashed, purchases put on hold and FTEs dismissed. Systems must be efficient and, at the very least, cost neutral or they face the piper.

While this is no time for expansion into an arena with questionable reimbursement, fortunately, recent studies have demonstrated cost savings when CCTA is used appropriately. For example, in the ED setting, a negative CCTA allows for safe and rapid discharge, saving a great deal of expense in unnecessary admissions and time of stay. In the office setting, those patients with a confusing presentation can be carefully evaluated with CCTA, reducing the number of more invasive and expensive catheterizations.

Need for Evidence-Based Clinical Outcomes

The recent National Forum on “Appropriate Coverage of Coronary CT Angiography,” organized and sponsored by the SCCT, brought together influential providers and payers to discuss the issues currently surrounding CCTA usage. Payers perceive a lack of evidence that CCTA improves clinical outcomes. This exam must demonstrate this benefit before reaching acceptance.

But how do we measure an improved outcome? There are no definable metrics in place, but rapid and safe discharge, decreased utilization of downstream imaging, and modified patient behavior are being studied. Prospective randomized multi-institutional studies are expensive (especially in this economy) and time-consuming, but must be performed and must confirm these benefits.

So while we must continue to cross these hurdles, the one positive aspect is that they have brought together many groups in a collegial and cooperative way in an effort to educate our industry, medical colleagues and our patients to the potential benefits of this wonderful new capability.

It is up to us to jump these hurdles as quickly as possible.

ITIL - A certification gaining popularity by the day!

hyperlessons — Fri, 24 Apr 2009 05:38:05 +0000

Information Technology Infrastructure Library (ITIL) is the most widely accepted certification for IT Service Management in the world. ITIL is a set of theories and strategies for managing information technology infrastructure, development and operations. ITIL is considered as the best practice in IT Service Management, developed by OGC and supported by publications, qualifications and an international user group.

ITIL has been developed by Central Computer and Telecommunication Agency (CCTA), as a framework for efficient and financially reliable use of IT resources. ITIL provides best practices supported by quality services from a wide range of service providers, training agencies and professional qualifications.

ITIL consists of a series of modules giving guidance on the provision of quality IT services, and on the accommodation and environmental services needed to support IT. ITIL has been developed in recognition of organizations growing dependence on IT and represent best practices for IT Service Management.

ITIL Service Modules are:

1. Service Strategy (SS)

2. Service Design (SD)

3. Service Transition (ST)

4. Service Operation (SO)

5. Continual Service Improvement (CSI)

ITIL Certifications are managed by ITIL Certification Management Board (ICMB). There are three main levels on the ITIL Certification Path; Foundation, Practitioner and Manager Level. To pass exams on each level it is necessary to prepare through specialized ITIL courseware which are provided by a variety of vendors, both through instructors and online. For Practitioner and Master Level Certification, it is preferred that one possesses some work experience in the ITIL environment. Else it might be difficult to understand how ITIL processes work and succeeding in the final exams will be very hectic and difficult.

ITIL Foundation Certification is an entry level certification in ITIL.ITIL Foundation course is for those who want to gain basic understanding of the IT Infrastructure Library (ITIL). It focuses on aligning IT Service, improving service quality and implementation of service level agreements. It is a prerequisite for Practitioner and Manager Certifications in IT Service Management. It combines a few lectures with individual and group assignments. ITIL Foundation prepares participants to sit for the 1 hour ITIL Foundations exam, which is independently assessed by EXIN, an accredited ITIL examination body. ITIL Foundation target audience consists of employees and managers at all levels who wants to enhance their skills in IT Service Management.

ITIL Practitioner Certification is an intermediate level certification presented by OGC and the exam is conducted by EXIN. The ITIL Practitioner Certification focuses on the candidate’s capability in understanding and applying of the definite processes within the IT Service Management. ITIL Foundation Certification in Service management is a must for ITIL Practitioner Certification alongside three to four years of experience in ITIL. Practitioner Certification is all about practice and specialty. There are three areas covered in Practitioner Certification which are:

a) Release and Control

b) Support and Restore

c) Agree and Define

It is necessary to deeply understand all aspects of the ITIL process before going for Manager Certification. Practitioner Certification focused on team leaders and specialists who want to enhance their knowledge into new specialty.

ITIL Manager Certification is the top level of certification in ITIL Certification path. ITIL Manager Certification is also called as Master’s Certification due to amount of practical experience required and the extensive range of material and difficulty which categorize the assessment. Rigorous courseware and extensive training is extremely recommended before appearing for this exam. It is also recommended that to attain Manager Certification, you must have several years of experience in the ITIL atmosphere. ITIL Manager Certification is for Managers, Project Leaders in IT Companies.

U.S. v. Morrison -- Federal Convictions for Contraband Cigarette Sales

Matthew L.M. Fletcher — Wed, 11 Feb 2009 11:56:24 +0000

The US Attorney for the Eastern District of New York indicted “reservation retailers” for violations of the Contraband Cigarettes Trafficking Act and of RICO. The defendants moved to dismiss the RICO charge. Here is the opinion denying the motion — us-v-morrison-dct-order

Newer Cardiac Imaging Machines Effective In Detecting Coronary Artery Stenosis?

touchcardiology — Wed, 19 Nov 2008 17:29:21 +0000

I read a recent study which concluded that newer cardiac CT technology – electrocardiographically gated 64-multidetector row coronary computed tomographic angiography (CCTA) – was as effective as invasive coronary angiography for evaluating coronary artery stenosis – do you foresee a shift in coronary artery stenosis evaluation technique based on these findings?

What is ITIL?

Mohamed Elashri — Mon, 10 Nov 2008 07:44:46 +0000

ITIL is a public framework that describes Best Practice in IT service management. It provides a framework for the governance of IT, the ’service wrap’, and focuses on the continual measurement and improvement of the quality of IT service delivered, from both a business and a customer perspective. This focus is a major factor in ITIL’s worldwide success and has contributed to its prolific usage and to the key benefits obtained by those organizations deploying the techniques and processes throughout their organizations. Some of these benefits include:

increased user and customer satisfaction with IT services
improved service availability, directly leading to increased business profits and revenue
financial savings from reduced rework, lost time, improved resource management and usage
improved time to market for new products and services
Improved decision making and optimized risk.

ITIL was published between 1989 and 1995 by Her Majesty’s Stationery Office (HMSO) in the UK on behalf of the Central Communications and Telecommunications Agency (CCTA) – now subsumed within the Office of Government Commerce (OGC). Its early use was principally confined to the UK and Netherlands. A second version of ITIL was published as a set of revised books between 2000 and 2004.

The initial version of ITIL consisted of a library of 31 associated books covering all aspects of IT service provision. This initial version was then revised and replaced by seven, more closely connected and consistent books (ITIL V2) consolidated within an overall framework. This second version became universally accepted and is now used in many countries by thousands of organizations as the basis for effective IT service provision. In 2007, ITIL V2 was superseded by an enhanced and consolidated third version of ITIL, consisting of five core books covering the service lifecycle, together with the Official Introduction.

The five core books cover each stage of the service lifecycle, from the initial definition and analysis of business requirements in Service Strategy and Service Design, through migration into the live environment within Service Transition, to live operation and improvement in Service Operation and Continual Service Improvement.

مديريت مشكلات (Problem Management)

Masoud Ramezani — Mon, 22 Sep 2008 11:39:21 +0000

هدف مديريت مشكلات ، حل دليل اصلي رخدادها و پس از آن به حداقل رساندن تاثيرات منفي رخدادها و مشكلات روي موسسه است كه با توجه به خطاها در زيرساختهاي IT ساخته شده ، و جلوگيري از رخداد دوباره مربوط به اين خطاست. يك مشكل يك دليل نامعلوم و ناشناخته از يك يا چند رخداد است، و يك خطاي شناخته شده ، مشكليست كه به صورت موفقيت آميز تشخيص داده شده. CCTA مشكلات و خطاهاي شناخته شده را به شرح زير تعريف كرده است :
يك مشكل وضعيتيست كه اكثر اوقات به عنوان نتيجه چندين رخداد كه داراي عوارض يكساني هستند شناسايي ميشود. مشكلات همچنين ميتوانند شناسايي شوند توسط يك رخداد خيلي مهم ،‌ شاخص يك خطاي واحد، براي آنهايي كه دليلشان نامربوط است، اما براي آنهايي كه تاثيرات مهم هستند.
يك خطاي شناخته شده وضعيتي است كه دليل اصلي يك مشكل در آن موفقيت آميز شناخته شده است و گردش كاري مناسب روي آن انجام شده است.
مديريت خطا با مديريت رخداد متفاوت است. هدف اصلي مديريت مشكلات، پيدا و حل كردن ريشه اصلي مشكلات و جلوگيري از رخدادهاي جديد است. هدف مديريت رخداد اين است كه سرويس را در سريعترين زمان ممكن به حالت نرمال باز گردانده به طوريكه كمترين تاثير منفي ديده شود.

کلیاتی از کتابخانه ITIL v2

ناصر حاجلو :-: Nasser Hajloo — Thu, 04 Sep 2008 13:49:14 +0000

کتابخانه زیربنایی فن آوری اطلاعات ( IT Infrastructure Library – ITIL ) از یک مجموعه کتاب تشکیل شده است که هر یک ، یک تجربه ( Practice ) در مدیریت سرویس فن آوری اطلاعات ( IT Service Management – ITSM ) را پوشش می دهد ، تعداد جلدهای کتاب های کتابخانه ITIL به سرعت از نسخه یک زیاد شده و به 30 جلد رسیده است . به منظور بیشتر در دسترس قرار دادن ITIL به آنهایی که علاقمند به مرور آن هستند ، یکی از اهداف نسخه دوم ITIL یکپارچه سازی و یکی کردن نشرها در دسته های منطقی است که نسبت به مفاهیم مدیریت IT ، برنامه و سرویس در گروه های جداگانه ای قرار گرفته اند .

در حالی که دسته مدیریت سرویس ( Service Management ) که حاوی Service Support , Service Delivery می باشد بیشتر از سایر دسته ها منتشر شده ، فهمیده شده و مورد استفاده قرار گرفته است ، ITIL یک دسته بزرگتر ( ‌وسیعتر ) از تجربیات را فراهم کرده که دست نخورده باقی مانده است . طرفداران بر این باورند که استفاده از یک کتابخانه وسیعتر ( broad ) یک دسته بزرگ از راهنمایی ها را به یک پیاده سازی تکنیکی ( Technical Implementation ) ، راهنمای عملیات و نیازمندی ها ( Operations Guidlines and Requirements ) با استفاده از مدیریت استراتژیک ( strategic management ) ، مدیریت عملیات ( operations management ) و مدیریت مالی تجارت مدرن ( financial management of a modern business ) پیوند می دهد .

کتابها و نظام های ITIL v2 عبارتند از :

دسته مدیریت سرویس ( Service Management ) :

تحویل سرویس ( Service Delivery )
پشتیبانی سرویس ( Service Support )

دیگر راهنماهای عملیات

مدیریت زیربنای فن آوری اطلاعات و ارتباطات ( ICT Infrastructure Management )
مدیریت امنیت ( Security Management )
دید تجاری ( The Business Perspective )
مدیریت برنامه ( Application Management )
مدیریت دارایی های برنامه ( Software Asset Management )

برای کمک به پیاده سازی تجربیات ITIL یک کتاب کمکی منتشر شد که راهنمایی هایی را در پیاده سازی ( بیشتر در ارتباط با مدیریت سرویس – Service Management – ) فراهم می کرد .

برنامه ریزی برای پیاده سازی مدیریت سرویس ( Planning to Implement Service Management )

ودر این اواخر ضمیمه هایی برای راهنمایی شرکت های کوچک IT اضافه شده است ، که در هشت کتاب منتشر شده اصلی موجود نیست :

پیاده سازی ITIL در مقیاس کوچک ( ITIL Small-Scale Implementation )

ITIL در یک فرآیند-مدل ( Process-Model ) بر اساس دید کنترلی و مدیریت عملیات ایجاد شده ، و اغلب به W. Edwards Deming نسبت داده می شود . توصیه های ITIL دردهه 1980 بوسیله سازمان دولتی CCTA انگلستان ، برای پاسخ دهی به وابستگی رو به رشد در IT و شناسایی استانداردهای بدون تجربه ، ‌آژانس های دولتی و قراردادهای محرمانه ای ( Private Sector Contract ) که بطور مستقل تجارب مدیریت ITمی ساختند و تلاش دوباره در پروژه های Information and Communications Technology (ICT) که منجر به بروز خطاهای عمومی و افزایش هزینه ها می شد ، توسعه پیدا کرد . در آوریل ( اردیبهشت ) 2001 ، CCTA با Office of Government Commerce – OGC, که یک دفتر ( اداره ) در UK Treasury بود ادغام شد .

یکی از مهمترین مزایای این امر در رابطه با ITIL در حوزه IT Community تهیه کردن فرهنگ لغات بود . که دربرگیرنده موارد ( terms ) تعریف شده دقیق و با مقبولیت عمومی گسترده بود . یک واژه نامه جدید و اضافه هم ، مانند یک کلید قابل حمل برای ITIL v3 ( که با نام پروژه بازنگری مجدد ITIL یا ITIL Refresh Project شناخته می شود ) توسعه پیدا کرد .

منبع :‌ http://en.wikipedia.org/wiki/ITIL

کلیاتی از کتابخانه ITIL v2

ناصر حاجلو :-: Nasser Hajloo — Thu, 04 Sep 2008 13:37:41 +0000

کتابها و نظام های ITIL v2 عبارتند از :

دسته مدیریت سرویس ( Service Management ) :

تحویل سرویس ( Service Delivery )
پشتیبانی سرویس ( Service Support )

دیگر راهنماهای عملیات

مدیریت زیربنای فن آوری اطلاعات و ارتباطات ( ICT Infrastructure Management )
مدیریت امنیت ( Security Management )
دید تجاری ( The Business Perspective )
مدیریت برنامه ( Application Management )
مدیریت دارایی های برنامه ( Software Asset Management )

برنامه ریزی برای پیاده سازی مدیریت سرویس ( Planning to Implement Service Management )

پیاده سازی ITIL در مقیاس کوچک ( ITIL Small-Scale Implementation )

منبع :‌ http://en.wikipedia.org/wiki/ITIL

گسترش ITIL

Masoud Ramezani — Sun, 29 Jun 2008 08:01:25 +0000

چیزی که هم اکنون به عنوان ITIL نسخه یک معرفی شده است تحت حمایتهای CCTA و به نام Government Information Technology Infrastructure Management Methodology (GITMM) گسترش پیدا کرده که پس از سالها سرانجام تحت پروژه ای که در CCTA توسط پیتر اسکینر و جان استوارت رهبری میشد به تالیف 31 جلد کتاب منجر شد. از آنجا که مجموعه های بیرون از دولت انگلستان ترجیح میدادند این مجموعه را به شکل یک کتاب درسی ببینند، نه یک مجموعه راهنما اسم این مجموعه تغییر یافت.
CCTA در طول سالهای 1980 از دو طرف تحت فشار بود. یکی شرکتهای IT که میخواستند به جای CCTA مشاور دولت باشند و دیگری واحدهای دولتی که میخواستند نقش خودشان را حفظ کنند. سرانجام CCTA مبارزه را واگذار کرد و ایده مدیریت مرکزی IT دولت انگلستان به دست فراموشی سپرده شد. و این بدین معنی بود که ایده های CCTA از جمله ITIL در زمان دیگری محقق خواهند شد چون سازمانهای دولتی مختلف در برابر پذیرفتن نقش جدیدشان مقاومت میکردند.
بعضی از این راهنماییها به طور کامل فراموش شدند. به عنوان مثال گروه CCTA IT Security and Privacy بخش IT Security Library را برای GITMM تهیه کرد ولی Security Service وقتی که CCTA از بازی خارج شد امرات این بخش را به عهده گرفت و در ادامه جنگی که بر سر مسئولیت های امنیتی داشتند ادامه کار را متوقف کردند.
با اینکه ITIL در طول سالهای 1980 هنوز هم در حال توسعه بود ولی بنا به دلایلی که در بالا توضیح داده شد نتوانست تا اواسط دهه 1990 مقبولیت گسترده ای پیدا کند. مقبولیت بیشتر ITIL باعث شد استانداردهای زیادی راجع به آن به وجود آید از جمله ISO/IEC 20000 که استانداردی بین المللی راجع به بخش مدیریت سرویسهای انفورماتیکی ITIL (Information Services Management) است. از ITIL بیشتر اوقات در کنار دیگر چارچوبهای تجربه های موفقی مثل ISPL ، ASL ، DSDM و CMM/CMMI نام برده میشود و حتی بیشتر اوقات از طریق COBIT به IT Governance مرتبط میگردد.
OGC در دسامبر 2005 تغییراتی در ITIL ایجاد کرد. این تغییرات که به ITIL نسخه 3 معروفند در ماه می 2007 معرفی شدند. ITIL نسخه 3 در ابتدا شامل 5 بخش مهم زیر بود:
1) استراتژی سرویس (Service Strategy)
2) طراحی سرویس (Service Design)
3) انتقال سرویس (Service Transition)
4) عملیات سرویس (Service Operation)
5) بهبود مستمر سرویس (Continual Service Improvement)
این مجموعه کتابها بیشتر بخشهای نسخه 2 را به روزرسانی کرده و حوزه تاثیر ITIL را در بحث مدیریت سرویس بهبود میدهد.