Rules of Interpretation with Fractures

In last week’s post we talked about how BoneStation automatically generates an assessment. A couple of sample sets of rules were provided for BMD. This week we’ll extend those rules to include fractures.

As a review, BoneStation’s rules engine takes inputs from three sources: BMD scan data, patient data, and online questionnaire. It generates output, which is an assessment.

When adding fractures an additional input is needed: the VFA scan. More specifically, vertebral fractures as noted by the reading physician (using BoneStation) are used.

Here is an updated diagram depicting the rules engine.

Before we show the updated rules for VFA, it is important to note:

  • In BoneStation there are four choices for indicating the presence of a fracture on VFA: Yes, Maybe, No, and Indeterminate.
  • Fractures may be indicated on the questionnaire – as patient reported. See sample questionnaires below for examples of how fractures may appear in questionnaire form.

Only the rules for normal bone density (T-score ≥1.0) are displayed below. Showing all the assessment categories will be too lengthy. The rules for the other categories would be similar.

The original BMD rules used these inputs:

  • Age
  • T-score
  • Z-score

For fractures we added:

  • QN Fx = Fracture indicated on the questionnaire
  • VFA Performed = Yes/No – if a VFA was performed
  • VFA FX = Fracture indicated on VFA

The sample rules above represent one way to automate the assessment of bone density scans. There are many variations.

BoneStation’s rules engine is very flexible. Rules, questionnaire, and output (assessment) text may all be customized.

Here are some sample questionnaires.

Rules of Interpretation

BoneStation is a web-based reporting system for DXA based bone densitometry. In many of our blog posts we mention that BoneStation requires no transcription and no dictation. That is because BoneStation automatically generates a suggested assessment.

What is meant by that? How does it work?

BoneStation combines three inputs:

  • DXA Scan Data – The bone mineral data from the DXA scan
  • Patient Data – Information about the patient
  • Questionnaire – Online questionnaire that is built into BoneStation

The scan data, patient info, and questionnaire answers are fed into a rules engine. The engine outputs the assessment text, which is displayed to the reading physician as a suggested assessment. The reading physician can accept the assessment or alter it.

A simple set of rules may look like this, where the T-score and Z-score are the lowest values for all measured sites:

The above rules make use of information that is available from just the DXA scans (T-score and Z-score) and patient (age). One common variation on this set of rules is to incorporate the gender and menopausal status of women. The rules can be adjusted to look like this, where the menopausal status is indicated on the questionnaire.

BoneStation is very flexible. The questionnaire, rules, and (output) assessment text are all customizable. Some BoneStation customers’ rules consist of more than 50 rules when factoring in fractures (VFA) and other patient conditions.

Here are some sample questionnaires:

In our next blog post we’ll look at how fractures and VFA can be factored into the above rules.

Bone Density Reporting and SaaS?

What is SaaS and what is its relevance to bone density reporting?

SaaS stands for Software As A Service. The financial model and logistics behind SaaS may be compelling for bone densitometry given low reimbursement rates.

A key characteristic of SaaS is that users pay for only what they use. Also startup costs are typically minimal.

With SaaS software the same fully featured software is available regardless of the size of the company using the software. BoneStation, for example, is a SaaS software package for reading bone density scans. The set of features is the same for all customers regardless of size of the practice. Practices performing 200 scans a month are using the same software as those performing 1000 scans a month.

There are other cost savings to SaaS. For example, SaaS software packages usually include support and upgrades. With the traditional model, software packages frequently have costly annual maintenance fees (typically priced at 10% to 20% of the original software). And upgrades are an extra cost too.

There are other benefits to SaaS.

Software based on the SaaS model is often times “cloud based”, meaning it runs in a web browser. There is no special client software to install on each user’s computer. This implies convenience, in that the software can be used on any computer with a browser. Installation and support are easier and less costly also.

Software As A Service is a newer model for offering technology and software. It provides many advantages, in terms of price and convenience – appealing characteristics for bone density practices running on tights budgets.