If you could describe the perfect company to work for, what would it look like? 

 Daniel Pink outlines 3 main elements that resonated with me, that I want to have in any company that I work for, and that I want to instill with Bern Medical. Autonomy, Mastery and Purpose. Earlier in my career I didn't believe this stuff. I thought it was a way to manipulate people. Now I realize that there is great value in allowing people to do what they are great at, allow them to stretch and with a purpose that matters.

There is also a bucket list of other things that I think are important.
Make good money
Fun place to work
Helps in career progression
Good life balance


These things are all elements that we can help build in a great company. It can rest on each of us to be a part of building the company where we want to work everyday.

This post appeared originally on DiagnosticImaging.com
"Innovation comes from people meeting up in the hallways or calling each other at 10:30 at night with a new idea, or because they realized something that shoots holes in how we've been thinking about a problem. It's ad hoc meetings of six people called by someone who thinks he has figured out the coolest new thing ever and who wants to know what other people think of his idea.

"And it comes from saying no to 1,000 things to make sure we don't get on the wrong track or try to do too much. We're always thinking about new markets we could enter, but it's only by saying no that you can concentrate on the things that are really important."
- Steve Jobs, 2004

What was the last thing you saw in your career that you felt was broken that technology could solve? You knew that there was a better way. It didn't have to be revolutionary. It could have been as simple as an idea for a mobile app, a way to communicate with staff or peers, or a way to order a procedure. Technology is moving faster and the costs of implementation continue to fall. If you have an idea, it can be implemented.

In response to my last post for Diagnostic Imaging about emerging technology that enables transfer of medical images, the president of Accelerad posted a comment that healthcare and imaging is five to 10 years behind technology. We are behind because disruptive innovation isn't originating from solving our issues. The innovation comes from other industries and then is applied to imaging problems.

The reason disruptive innovation doesn't occur within the industry has two main causes: supply and demand. Demand because we are risk adverse and slow to adopt new technology. Supply because the industry insiders are slow to observe the problems and to discover solutions. Both of these cause the delivery of technology to be reactive to trends and not cutting edge.

Last week I attended Ideation Bootcamp, an event to discuss innovation in technology. The presenters proposed a good framework on how to innovate: Start with what you know and start cheaper.

Several people had a chance to pitch their ideas to the audience. The problem with most of the ideas is they lacked insight into real problems even if the presenters had a skill set to solve them. Many are young and don't have a wide range of industry experience, so they innovate with what they know based on their experience and what is currently getting a lot of consumer media coverage. This means that the brightest minds are now being used to innovate on how people view advertisements.

In imaging there will always be opportunities to innovate on important issues. This industry knowledge that each of us has is valuable. Those crazy ideas you have may seem intuitive to you, but they are not widely known. Take those ideas and do something. Collaborate with technical people that can bring the idea to life, but don’t create a committee. Remember the maxim "A camel is a horse designed by committee."

Often when we have an idea, we begin to think of a lot of features and how awesome it could be, and we think of how it could revolutionize the industry. Remember to start smaller and start cheaper. Do the least amount to solve the problem. Say no to the 1,000 features that came out of the brainstorm session over lunch. As you add more complexity it is difficult to manage and understand the impact of changes. Imagine a large banquet hall where chairs and tables are connected with string. Prior to moving a chair you need to predict all the tables and chairs that will be impacted. Start with something simple and add complexity once that initial revision solves the first problem.

The imaging industry can be a source of disruptive innovation in technology. Be the innovator that you are looking for to solve the problems you see.

David Fuhriman is Managing Partner at Bern Medical, where he analyzes radiology data to discover under-billings. He is involved in high tech-startups in San Diego and in helping technology improve our world. He can be reached at David@BernMedical.com.

Mark Suster has a great quote about in hockey you should skate where the puck is going and not where it is currently.  This is a great deck on where the Internet trends are going. There is a presentation (Here) about the Internet Trends. Go to where the puck is going.

1. Globality – We Aren’t In Kansas Anymore…

Meeker revealed that 81% of users of the top ten global internet properties are outside the USA, which makes global markets a force to be reckoned with.

2. Mobile – Early Innings Growth, Still…

iPhones, iPods and iPads have revolutionized the market. But Android tablets and phones, at a different price point, are not to be underestimated.

3. User Interface – Text/Graphical/ Touch / Sound / Move

“Sound is going to be bigger than video. Record is the new Qwerty,” say SoundCloud CEO Alexander Ljung.

4. Commerce – Fast / Easy / Fun / Savings = More Important Than Ever…

The ability to click and buy on a mobile device is making a huge difference in mobile commerce. “It’s now an expectation that if you see it on your screen, you can click and buy it,” says Meeker.

5. Advertising – Lookin’ Good…

Look at Google’s click growth for an indicator of advertising health: 23% of clicks on ads is a good sign Meeker says.

6. Content Creation – Changed Forever

Meeker refers to Joanne Bradford from DemandMedia doing a better job at talking about content creation.

7. Technology / Mobile Leadership – Americans Should Be Proud

64% of smartphones have U.S.A. OSes (iOS, Android, Windows Phone) versus 5% 5 years ago.

8. Mega-Trend of 21st Century = Empowerment of People via Connected Mobile Devices

“The ability to get realtime fast and broad information flow is only going to get greater,” says Meeker.

9. Authentic Identity – The Good / Bad / Ugly. But Mostly Good?

“One of the biggest topics of the next ten years,” Meeker says.

10. Economy – Lots of Uncertainty

Despite lots of indicators of uncertainty, “We’ve had a good two weeks.”

11. USA Inc. – Pay Attention!

The US ranks 10th on a list of country by debt. Greece, by comparison, ranks number 3.

This post originally appeared on DiagnosticImaging.com

My new blog post on DiagnosticImaging.com is now available. Check it out here.

Great blog post about writing for press releases. I also this it should apply to blog posts, website content and marketing materials.
1. Omit needless words.Vigorous writing is precise. A press release should contain no unnecessary words, for the same reason a drawing should have no unnecessary lines and a machine no unnecessary parts.
2. Avoid the use of qualifiers.“Rather,” “very,” “little,” “pretty”—these are the leeches that infest the pond of prose, sucking the blood of press releases.
3. Place yourself in the background.Write in a way that draws the reader’s attention to the substance of the press release, rather than to the mood and temper of management.
4. Place the emphatic words of a sentence at the end.
5. Do not overwrite.Rich, ornate prose is hard to digest, generally unwholesome, and sometimes nauseating. It is always a good idea to reread your writing later and ruthlessly delete the excess.
6. Do not overstate.When you overstate, the press will constantly be on guard, and everything that preceded your overstatement as well as everything that follows it will be suspect in their minds.
7. Revise and rewrite.Revising is part of writing. Remember, it is no sign of weakness or defeat that your press release ends up in need of major surgery. This is a common occurrence in all writing, and among the best writers.
8. Avoid fancy words.Do not be tempted by a twenty-dollar word when there is a ten-center handy, ready and able. Anglo-Saxon is a livelier tongue than Latin, so use Anglo-Saxon words. In this, as in so many matters pertaining to style, one’s ear must be one’s guide.
9. Do not take shortcuts at the cost of clarity.Do not use initials for the names of organizations or movements unless you are certain the initials will be readily understood.
10. Do not affect a breezy manner.The volume of press statements is enormous these days, and much of it has a sort of windiness about it. The breezy style is often the work of an egocentric person who imagines that everything that comes to mind creates high spirits and carries the day.

Nassim N. Taleb has written two of the most influential books of our time, "Fooled by Randomness" and "Black Swan". Here is a short bio: Nassim Nicholas Taleb is a Lebanese-born essayist, scholar and former practitioner of mathematical finance. He is best known as the author of the 2007 book (completed 2010) The Black Swan.  Taleb has had three distinct careers, built around what he calls “epistemic limitations and constraints”: probability, uncertainty and the fragility of human knowledge, which he packaged as the theory of Black Swan Events. First, he is a bestselling author with 2.7 million copies sold in 31 languages.  Second, he is a university professor in Risk Engineering (Distinguished Professor), a scholar, an epistemologist and a philosopher of science. Finally, he is a former senior Wall Street trader, risk expert, and practitioner of mathematical finance. (bio via wikipedia.org)

Mr. Taleb is currently writing a book about Anti-Fragility. Below is chapter 4 from the manuscript. I highly recommend reading below and his published books. His books help explain on a macro scale what is happening in the world economy and leads to greater understanding in micro events in life.

While I am sure I don't understand all of his thoughts in his previous books, I do understand enough to see how these theories impact Bern. In radiology we can work on eliminating steps, improve workflow and create a revenue cycle that is almost perfect. Where there should be no issues. We may develop software interfaces to transfer information. This is an improvement on what we had before. But, this causes us to be blind when errors occur. We expect the process to be perfect and it isn't. When a disruption occurs in the process it may not be recognized. There are so many things in the process that can go wrong. It probably doesn't fall on the billing department or 3rd party billing company because no one else would have caught it.

Think of it this way. In a living room there are so many ways to organize all the items. The couch, the carpet, the rug, the walls, the coffee table, the lamps, the pictures, the books, the clock, the pillows etc.... As we come into the room we bring more things. A plate, a cup, all the clothes we are wearing, bag and its contents etc... there are only a few ways in which the room can remain clean and ordered. But almost an unlimited number of options for them to be unordered.

What Bern is looking for in radiology is anything that is unordered and we get to look for 12-18 months. The fact that errors exist is more a reflection of the complex environment and not on the competency of the people or systems involved. Again, the fact that improvements can be continuos, reflects the complexity and not the competency. There will always be errors and there will always be ways to improve.

#1- Do what you love so that you can persevere. Otherwise you are going to fail.#2- Be a great talent scout. Refine intuition and build an organization that can build itself.

This article originally appeared in DiagnosticImaging.com
 Tim Myers, MD, is a practicing radiologist and director of professional services at vRad (Virtual Radiologic). He has more than 15 years of private practice experience and served as the chief medical officer for NightHawk Radiology Services before its merger with vRad.
I don't think it's possible to read a newspaper or journal that has to do with medicine that doesn't also include information about reimbursements being cut. Business managers are doing everything possible to improve billing.

So, why do many radiologists and practices still make easily correctable mistakes? The answer: I have no idea, except to say that it takes some of us a while to develop different patterns of thinking and then dictating.

Becoming familiar with the CPT code and the ICD-9/ICD-10 coding is important for proper performance of the examination and proper billing. Following standards of care which have been delineated within the medical literature is also important.

I would not recommend performing an examination or a specific component of an examination just for billing. Remember, we want to appropriately scan the patient, appropriately evaluate all the structures necessary to treat that patient and then discuss those specific elements within the examination. If, by medical determination a limited study is adequate to treat the patient, perform a limited study.

Here are the first five of 10 common mistakes and how to correct them. Stay tuned next week for the next five correctable mistakes.

1. CT angiography of the chest: The most common mistake is first to only do multiplanar/MPR reconstructions of the chest and not MIP/3-D reconstructions. Most imaging protocols across the country now provide for MIP/3-D reconstructions. I believe this has now become standard of care for these studies, so if you are not currently doing them you should consider correcting the protocols you use. Once you have changed the protocol to include these, or if you already do them, you need to make sure that in your dictation, the 3D/MIP reconstructions are discussed.

2. Abdominal ultrasound: Please note that anything less than a complete study is a limited study. Even if one element is missing, it is a limited study. If it is not billed as a limited study, this can have potentially serious consequences. Enough said. For a complete abdominal ultrasound, the usual suspects have to be mentioned including the liver, gallbladder, common duct, pancreas, spleen and kidneys. If a structure is attempted to be visualized, for example the pancreas, but is not seen, mentioning that fact is adequate. The most common mistake? Not mentioning the abdominal aorta and inferior vena cava. Not mentioning these changes a completely imaged study to an incompletely dictated study and billing as a limited study.

3. MRCP: Most protocols include MIP/3-D reconstructions. Some don't. This, like the 3-D reconstructions for the CTA chest, is typically considered standard of care and if you are not currently doing them, you should consider changing protocols. Once done, the fact that MIP/3-D reconstructions were obtained should be discussed. Additionally, if these are performed at a separate workstation versus on the MR scanner itself, that should be mentioned as well.

4. Including contrast and route of administration: Many times radiologists just dictate that contrast was administered or that this is an examination with contrast. Not mentioning the route of administration, in this case the important descriptor is intravenous or IV, should lead to a down coding to a noncontrast study.

5. Renal/retroperitoneal ultrasound: We typically think of a renal/retroperitoneal ultrasound as having to do with the kidneys and perinephric spaces. A complete study, in the billing sense, also requires that we perform and then discuss an evaluation of the bladder. This is especially necessary if the clinical history has to do with urinary tract pathology.

Have a mistake to add to the list? Tell us about it in the comments below.