PDF is an acronym for Portable Document Format. The filetype was invented by Adobe and designed to look identical across different devices and screens - so, it retains consistency and maintains accuracy without formatting issues. However, because it’s standardized, it also means it can’t be edited without the use of a PDF editor like Adobe Acrobat.
Adobe Media Encoder is an encoding engine released by Adobe to function with programs like Adobe Premiere Pro, Adobe After Effects, Adobe Audition, Adobe Character Animator, and Adobe Prelude. It is also useful as a standalone encoder. You can encode audio, video, and different formats to suit your social media and professional filmmaking needs. Professional audio and video editors use Adobe Media Encoder to streamline their work. If you are facing issues with Adobe Media Encoder, this guide has some fixes to help you. Let’s see how we can fix the Adobe Media Encoder not installed error in Premiere Pro or After Effects.
Adobe Media Encoder is not installed. Please obtain and install it to use this feature. Go to https://creative.adobe.com/apps
If you see Adobe Media Encoder not installed error message in Premiere Pro or After Effects, here are some suggestions to resolve the issue.
- Update Adobe software to the latest versions
- Install Adobe Media Encoder manually
- Uninstall Creative Cloud products and reinstall them
Let’s get into the details of each method and fix the issue.
1] Update Adobe software to the latest versions
Adobe products that work interdependently require updated versions to function smoothly. Adobe Media Encoder is used by both Premiere Pro and After Effects to render outputs. You need to update them to the latest versions using the Creative Cloud program. After updating them, restart your PC and see if it has fixed the error.
2] Install Adobe Media Encoder manually
You need to install Adobe Media Encoder manually using the Adobe Creative Cloud or by downloading it from the Adobe website. Run the downloaded file to install and don’t change the default location of its installation.
3] Uninstall Creative Cloud products and reinstall them
If the problem is not yet fixed, you need to uninstall Creative Cloud products like Premiere Pro, After Effects, Adobe Audition, Adobe Character Animator, Adobe Prelude, and Adobe Media Encoder leaving Photoshop and Illustration aside. After uninstalling them, you need to restart your PC and reinstall them from the Creative Cloud. See if it has fixed the error.
Read: Premiere Pro crashing or stops working on Windows
These are the different ways you can use when you see Adobe Media Encoder not installed error on Premiere Pro or After Effects.
How do I fix Adobe Media Encoder not installed in After Effects?
If you are seeing Adobe Media Encoder not installed error in After Effects, you need to install Adobe Media Encoder using the Adobe Creative Cloud or by downloading the executable file from the Adobe website. If you’ve already installed the Adobe Media Encoder and still facing the error, you need to update After Effects and Adobe Media Encoder using the Creative Cloud to the latest versions or reinstall them if none of the other methods fixed it.
Why does Premiere Pro Say Media Encoder not installed?
If Premiere Pro and Adobe Media Encoder are not the latest versions, you might see this error. You need to update them to the latest versions using Creative Cloud. Uninstall both programs and reinstall them, if updating them does not fix the issue.
Related read: Fix Error Code 3, Error compiling movie, Export error on Premiere Pro.
Adobe Acrobat is a professional PDF editing and viewing program developed by Adobe. They have been in the market for many years which a huge user base around the world. You can view, create, edit, print, and manage PDFs using Adobe Acrobat. To use Adobe Acrobat, you need to subscribe to it by paying monthly or annually. You can only get Acrobat Reader DC as freeware. Some users of Adobe Acrobat are seeing a blank screen while they try to save PDF files. In this guide, we have a few solutions to fix when Adobe Acrobat Save As screen is blank.
If you see a white blank screen when you try to use Save As option on Adobe Acrobat, the following methods can help you fix it.
- Check your internet connection
- Update Adobe Acrobat
- Disable Show online storage when saving the files
- Reinstall Adobe Acrobat
Let’s get into the details of each method and fix the issue.
1] Check your internet connection
Adobe Acrobat works on the cloud as well as locally. If you are working on documents from the cloud and see a white blank screen, you need to check your internet connection. If there is any issue with the internet connection, it will not load. Then, you will see only a white blank screen. Run a speed test using the online tools and see if your internet connection is working fine.
Read: Fix Network & Internet connection problems in Windows
2] Update Adobe Acrobat
The error might also have been caused by a bug in the previous update or a corrupted file. You need to update Adobe Acrobat to the latest version to fix it. Use the Help option in the Adobe Acrobat menu and select Check for Updates to find new updates and install them.
Read: Adobe Acrobat Reader DC not showing bookmarks in Windows PC
3] Disable Show online storage when saving the files
Since you are working on a cloud-based program, you need to disable Show online storage when saving the files options if you don’t want to save them online. You can enable or disable it at any time you want. It will fix the Save as blank screen issue on Adobe Acrobat.
To disable Show online storage when saving the files,
- Click on Edit in the menu and select Preferences.
- Select General tab
- You will see various options under Basic Tools. Uncheck the button beside Show online storage when saving the files
- If you want you can also uncheck the button beside Show online storage when opening files to disable storage options completely. Click OK to save the changes.
This should fix Save As blanks screen issue on Adobe Acrobat.
4] Reinstall Adobe Acrobat
If none of the above methods can fix the issue, you need to reinstall Adobe Acrobat. For that, you need to uninstall the program using the Start menu or from the Installed apps in the Settings app. Then, obtain Adobe Acrobat from Adobe and install it on your PC.
These are the different ways using which you can use when you see Adobe Acrobat Save as screen blank.
Read: Fix Adobe CEF Helper High Memory or CPU usage
Why is my save as screen blank on Adobe?
Adobe works on the cloud as well as locally. When the files you are working on are from the cloud and you have a bad internet connection, you might see a screen blank. The bugs in the previous updates can also cause it. You need to check the internet connection, disable online file options in the Preferences, and update Adobe Acrobat to the latest version to fix the issue.
Why is my Adobe Acrobat not saving?
Make sure your internet is working fine and see if the file is from a local disk or from the cloud. Then, go to Preferences from the Edit menu and change the storage settings. Disable Show online storage when saving the files in the preferences to save them locally.
Why is my PDF saving as blank?
If your PDF is saved as blank, there might be corruption occurring with the file. The plugins of the software you are using to save PDFs might be causing it, or the file is not saved fully due to a bad internet connection. You need to see if they are working fine and save the PDF again.
Related read: Adobe Acrobat Reader DC has stopped working in Windows.
The best Adobe Acrobat alternatives offer advanced PDF editing capabilities that rival the best PDF editor.
Adobe Acrobat DC has long been the go-to PDF editing software - for the very good reason that Adobe invented the PDF format. The filetype allowed true document standardization. No matter what device you viewed the file, it would appear the same to all users.
Today, there are plenty of premium and free PDF editors offering many of the same useful tools and features you’ll find in Adobe’s premiere PDF editing tool, including eSign software and OCR software. So, you’re looking to Strengthen efficiency, productivity, and faster workflows without taking out a Creative Cloud subscription, finding the best alternatives to Adobe Acrobat is essential.
To help you identify the right tools, we’ve tested, reviewed, and rated the best Adobe Acrobat alternatives to see where the competition matches, thrashes, and misses Acrobat’s power.
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The best Adobe Acrobat alternatives in full
Foxit PDF Editor is a stellar substitute for Adobe Acrobat. Like Adobe, Foxit has been offering PDF tools for decades, and users can take confidence from the many high-profile endorsements proudly listed on the Foxit site, with the likes of Amazon, Google, Dell, and Intel among them.
The company's best Adobe Acrobat alternative, Foxit PDF Editor, offers dozens of useful features. This includes watermarking, adding headers and footers, tailoring password permissions, creating templates, and converting other documents to PDFs. One neat feature is being able to drag files of other formats - such as converting Excel to PDF or using the PowerPoint to PDF converter.
In our Foxit PDF Editor review, we felt it might not offer enough value to casual users, but the multi-platform PDF editor app was great for businesses who regularly need to manipulate, edit, redact, annotate, and alter PDF documents.
Indeed, the redaction tools were a special highlight for us. We were impressed with how easily they worked, thoroughly scrubbing sensitive data from documents .The feature is a boon for compliant-conscious teams who understand the importance of adhering to global data laws.
Pricing for Foxit PDF Editor is flexible, with monthly and yearly subscriptions. If on-going payments are one of the reasons you’re looking for the best Adobe Acrobat alternatives, there’s the opportunity to pick up a perpetual license for a one-off purchase.
You’ll also find two upgraded versions of the PDF editing software - Pro and Pro + - which add additional features for power-users.
Read our full Foxit PDF Editor review.
PDF24 Creator isn’t just one of the best Adobe Acrobat alternatives for Windows - it’s also our top pick for best free PDF editor overall.
Despite the no-cost approach, the tool - a PC-only desktop app that works offline and is ideal for low-spec PCs - is surprisingly feature-rich.
During our time with the software, we rated it as “one of the best examples of free tools that go above and beyond. It’s packed full of features, and comes with everything you might need to create and edit a PDF document.”
Tools for PDF creation, compressing, merging, and converting are all present and results are grand. Extras like OCR and eSign are well-implemented. The interface is clean and fresh and emphasizes productivity - you can quickly find what you need and what to do.
We even felt it bested Adobe in one area. Praising Acrobat for its inclusion of tools for almost use-cases, we noted, “the only exception is if you need something more advanced for filling out forms, in which case an editor like PDF24 Creator or PDFZilla could work better, despite looking a bit clunkier.”
PDF24 Creator is available free and unlimited. The experience might not quite match Adobe’s fluid workflow, but it’s a price you can’t beat.
Read our full PDF24 Creator review.
Nitro PDF Pro is probably the best Acrobat alternative for those who absolutely, positively want to avoid subscriptions at all costs. You won’t find any on-going payment plans with this PDF editor. Just a one-off perpetual license.
When we tried out the product, we found it featured an impressive toolkit that compares favorably with Adobe Acrobat. The interface and experience make using the software incredibly simple and easy - a factor the sometimes overwhelming Acrobat struggles to boast.
Other tools to let you make changes to existing PDF documents, and even create one from scratch. You have a lot of tools at your disposal, including various ways to make annotations, leaving instructions for colleagues to follow.
Editing the real content of an already existing PDF isn’t as seamless as we’d like it to be, and that’s probably the weakest tool in Nitro’s arsenal. Everything else is very well implemented, and we especially liked how the ability to convert files to and from PDFs is performed.
Ultimately, we found this Adobe Acrobat alternative “a good PDF editing software package that allows you to make changes to documents, annotate them, and perform numerous alterations on them. It also comes with a good OCR, conversion tools.”
This PDF editing software is capable of running on a PC or a Mac, and costs $180 per license. Volume licensing for businesses is also available.
Read our full Nitro PDF Pro review.
EaseUS PDF Editor is the ideal choice if you’re on a PC - it’s one of the best alternatives to Adobe Acrobat for Windows.
Unlike many of the best Acrobat alternatives, EaseUS has a free, but limited version available alongside the Pro version. This works great in a pinch, but it restricted in many ways - not least adding a watermark to your documents. The Pro version opens up the software, however.
In our review, we described EaseUS’ offering as “a powerful, PC-only PDF editing software tool that allows you to manipulate and alter documents with relative ease. It also comes with more standard features, such as a converter, and has good OCR capabilities.” Elsewhere, you’ll find outstanding PDF converter tools and eSignature tools.
The program is impressively kitted out for PDF editing, splitting pages into boxes that can be moved and resized. Content can also be changed, such as altering the font, color, and the text itself.
And it’s all housed within a refreshingly clean user interface. This makes navigating the tool an absolute breeze - not dissimilar to the excellent user experience offered in Adobe Acrobat, with its focus on maximizing productivity.
Costs for EaseUS PDF editor vary, with monthly and annual subscriptions and a one-time-buy ‘lifetime upgrade’ option. It’s ‘one license for one computer’. Bundles are available.
Read our full EaseUS PDF Editor review.
If you’re looking for the best Adobe Acrobat alternative for Mac, iPad, and iPhone, look no further than Readdle PDF Expert.
While modern Apple machines come preinstalled with the excellent Apple Preview - a tool we felt “should be able to cater to all but the most demanding PDF road warriors” - it’s more of a PDF reader and manipulator, rather than a full PDF editor, like Acrobat.
PDF Expert is much more fully featured, making it a much better alternative to Acrobat. Alongside image and text editing, Readdle’s product also comes kitted out with converter tools for Word, Excel, and PowerPoint, OCR and eSign tools.
When we tested out the software, we were impressed to find it “has lots of useful features for people who use PDF files on a regular basis. It has a very clean UI design and everything is neatly organized so you don’t need a lot of help in understanding how the software works when you use it for the first time.” We also loved how well PDF Expert synced documents on all Apple devices.
A wide range of editing tools include the ability to highlight parts of the PDF and add notes, redact sensitive information, extract or rearrange pages, and merge documents. Being able to draw directly onto the PDF is also useful for those who are using the software on iPad and have an Apple Pencil.
The sleek interface and a well-organized toolbar make it simple and intuitive for new users to accomplish everyday PDF editing tasks. In short, PDF Expert makes you feel like a PDF expert.
Pricing is via an annual subscription or a perpetual license - however, only the yearly fee offers use across iPhone, iPad, and Mac.
Read our full Readdle PDF Expert review.
PDF Architect, from pdfforge, offers a range of PDF packages that rival Adobe Acrobat. The free plan includes basic PDF creation for Word, Excel, and PowerPoint docs, and the ability to merge, move, and delete pages and files.
More advanced features rest in the Standard, Professional, and Pro + OCR plans. These open up necessary editing, converting, collaboration tools, and more. When we took a look at PDF Architect, we awarded it 4 stars, calling it “a great choice for those who need a reliable, advanced PDF editor with lots of extra features and a stable, reliable interface.”
We appreciated the excellent interface, which will be familiar to anyone used to Microsoft Office software, and the extensive toolkit - praising the developers for “researching the market and identifying underserved niches.” Best of all, with minimal system requirements, PDF Architect is one of the best alternatives to Adobe Acrobat for low-end, low-spec computers.
However, there are limitations, even beyond the free version. eSignatures, for example, require a separate module in the PDF editor. For that reason, we recommend a free trial to get a feel for what you can and can’t do, to see if it fits your current workflow.
Read our full pdfforge PDF Architect review.
For those with a need to edit PDFs online and on a budget, Sejda offers a tool that might just be the best free Acrobat alternative online.
It’s available as a desktop version that saves files locally to your computer or an online version that uses cloud storage. But watch out for restrictions in the free version. You can only perform three tasks per day, you can only work on one document at a time, and file sizes cannot exceed 200 pages or 50MB.
One of Sejda’s real highlights is its security process. All files uploaded to the server are automatically deleted after two hours. Ideal, then, for businesses with a focus on data protection and compliance.
The tool isn’t without its faults, though. We found in-document text editing to be fairly basic, meaning you might encounter some issues replicating a typeface if the original PDF features a unique or unusual font. But as a useful Adobe Acrobat alternative for infrequent PDF editing, Sejda offers an excellent no-cost or low-cost option.
As we noted when we reviewed the software, it’s “a convincingly powerful PDF editor, but you'll need to pay if you need to use it a lot.”
Pricing comes in the form of a weekly and monthly subscriptions for the web app, or an annual desktop and web app subscription. Team and volume licensing is available.
Read our full Sejda review.
Adobe Acrobat alternatives buying advice
How to choose the best Adobe Acrobat alternative for you
Why you can trust TechRadar Our expert reviewers spend hours testing and comparing products and services so you can choose the best for you. Find out more about how we test.
When deciding which Adobe Acrobat alternative is best for you, you first need to consider how you will be working with PDF files.
Modern operating systems and browsers can open PDFs without additional software, meaning this is all you need if you only want to view the files.
You can make basic edits using a PDF reader, many of which are available as free versions.
If you need to make more in-depth edits, batch process files, or convert between file types, then a fully-fledged PDF editor is the best choice for you.
What is a PDF?
What is Adobe Acrobat?
Adobe Acrobat is a PDF editor for Windows, Mac, Linux, iOS, and Android. Unlike PDF readers, lets users create, edit, and annotate PDF documents that can easily be shared and viewed by others. It’s often considered the industry standard in PDF editing software. Not only did the company design the PDF format, but also introduced a range of tools so businesses can easily build and modify documents
Why do I need an Adobe Acrobat alternative?
The best Adobe Acrobat alternatives deliver similarly effortless interfaces and experiences for PDF editing - without the need for a Creative Cloud subscription. Although Acrobat remains the obvious choice for editing PDFs, and is often considered the industry standard PDF editor, it might not fit your overall workflow, meet your needs, or your budget. This is especially true if you’re not a power-user; if you’re not a PDF power-user, alternatives may meet your needs better.
How we test the best Adobe Acrobat alternatives
To test the best Adobe Acrobat alternatives, we downloaded and installed each piece of software to supply you a first-hand opinion.
Our research looked at operating system compatibility, system requirements, and real-world performance when working with large files.
We explored each program's features, noting any significant additions and omissions compared to Adobe Acrobat.
We also investigated the price, payment models, and free versions (where available) for each Adobe Acrobat alternative. Finally, we looked at the support services and documentation offered by each developer as we feel it's a key part of the overall user experience.
See how we test, rate, and review products on TechRadar.
Looking for cost-effective alternatives? We've rounded up the best free office software
The limited-edition Bentley Batur coupe is undergoing testing ahead of a planned start of deliveries in mid-2023.
Two development cars are undergoing more than 120 individual tests, totaling 58 weeks of testing time between the two vehicles, Bentley said in a press release. Those tests will evaluate things like high-speed stability, aerodynamics, cabin noise, durability, and materials quality.
The first development vehicle—Car #0—kicked off the test program with a 1,553-mile drive across Europe, traveling from Germany through Italy, France, and Spain. That will be followed by seven weeks of durability testing at Bentley's proving grounds, then another 4,660 miles of real-world driving.
Bentley Batur testing
Over four weeks, Car #0 will also undergo 600 hours of direct sun exposure, equivalent to five years in an Arizona desert, according to Bentley. The Batur features some new materials, such as natural fibers as a more sustainable substitute for carbon fiber, and this part of the test program will supply engineers a better idea of how they hold up over the long term.
While it is a development car and won't be delivered to a customer, Car #0 is finished the same as the production cars inside and out—including a bespoke paint color called Purple Sector. The only giveaways of its role as a test car are small white arrows affixed to the exterior that allow engineers to track any shifting of the body panels.
For the Batur, Bentley's familiar twin-turbo 6.0-liter W-12 is tuned to produce 730 hp and 740 lb-ft of torque, which gives the Batur the highest output of any road-going Bentley. That added power comes from a new air intake, modified turbochargers, and revised intercoolers. The stability control was also recalibrated. All of these changes were validated with more than 100 weeks of development time, according to Bentley.
Bentley Batur testing
Unveiled during the 2022 Monterey Car Week in August, the Batur serves as a bridge between Bentley's internal combustion past and electric future. It's based on the bones of the Bentley Continental GT Speed, but its styling previews future electric models, the first of which is scheduled to launch in 2025.
Just 18 Baturs will be built for customers, and every build slot has already been filled despite an estimated $1.95 million price tag for each. The testing program may seem like a lot of effort for such a small number of cars, but it's obligatory for any new vehicle. Fellow Volkswagen Group brand Bugatti, for example, recently completed a similar development process for its Centodieci hypercar, which is limited to just 10 units.
AWS Announces Eight New Amazon SageMaker Capabilities
Amazon SageMaker Role Manager makes it easier for administrators to control access and define permissions for improved machine learning governance
Amazon SageMaker Model Cards make it easier to document and review model information throughout the machine learning lifecycle
Amazon SageMaker Model Dashboard provides a central interface to track models, monitor performance, and review historical behavior
New data preparation capability in Amazon SageMaker Studio Notebooks helps customers visually inspect and address data-quality issues in a few clicks
Data science teams can now collaborate in real time within Amazon SageMaker Studio Notebook
Customers can now automatically convert notebook code into production-ready jobs
Automated model validation enables customers to test new models using real-time inference requests
Support for geospatial data enables customers to more easily develop machine learning models for climate science, urban planning, disaster response, retail planning, precision agriculture, and more
At AWS re:Invent, Amazon Web Services, Inc. (AWS), an Amazon.com, Inc. company (NASDAQ: AMZN), today announced eight new capabilities for Amazon SageMaker, its end-to-end machine learning (ML) service. Developers, data scientists, and business analysts use Amazon SageMaker to build, train, and deploy ML models quickly and easily using its fully managed infrastructure, tools, and workflows. As customers continue to innovate using ML, they are creating more models than ever before and need advanced capabilities to efficiently manage model development, usage, and performance. Today’s announcement includes new Amazon SageMaker governance capabilities that provide visibility into model performance throughout the ML lifecycle. New Amazon SageMaker Studio Notebook capabilities provide an enhanced notebook experience that enables customers to inspect and address data-quality issues in just a few clicks, facilitate real-time collaboration across data science teams, and accelerate the process of going from experimentation to production by converting notebook code into automated jobs. Finally, new capabilities within Amazon SageMaker automate model validation and make it easier to work with geospatial data. To get started with Amazon SageMaker, visit aws.amazon.com/sagemaker.
“Today, tens of thousands of customers of all sizes and across industries rely on Amazon SageMaker. AWS customers are building millions of models, training models with billions of parameters, and generating trillions of predictions every month. Many customers are using ML at a scale that was unheard of just a few years ago,” said Bratin Saha, vice president of Artificial Intelligence and Machine Learning at AWS. “The new Amazon SageMaker capabilities announced today make it even easier for teams to expedite the end-to-end development and deployment of ML models. From purpose-built governance tools to a next-generation notebook experience and streamlined model testing to enhanced support for geospatial data, we are building on Amazon SageMaker’s success to help customers take advantage of ML at scale.”
The cloud enabled access to ML for more users, but until a few years ago, the process of building, training, and deploying models remained painstaking and tedious, requiring continuous iteration by small teams of data scientists for weeks or months before a model was production-ready. Amazon SageMaker launched five years ago to address these challenges, and since then AWS has added more than 250 new features and capabilities to make it easier for customers to use ML across their businesses. Today, some customers employ hundreds of practitioners who use Amazon SageMaker to make predictions that help solve the toughest challenges around improving customer experience, optimizing business processes, and accelerating the development of new products and services. As ML adoption has increased, so have the types of data that customers want to use, as well as the levels of governance, automation, and quality assurance that customers need to support the responsible use of ML. Today's announcement builds on Amazon SageMaker's history of innovation in supporting practitioners of all skill levels, worldwide.
New ML governance capabilities in Amazon SageMaker
Amazon SageMaker offers new capabilities that help customers more easily scale governance across the ML model lifecycle. As the number of models and users within an organization increases, it becomes harder to set least-privilege access controls and establish governance processes to document model information (e.g., input data sets, training environment information, model-use description, and risk rating). Once models are deployed, customers also need to monitor for bias and feature drift to ensure they perform as expected.
- Amazon SageMaker Role Manager makes it easier to control access and permissions: Appropriate user-access controls are a cornerstone of governance and support data privacy, prevent information leaks, and ensure practitioners can access the tools they need to do their jobs. Implementing these controls becomes increasingly complex as data science teams swell to dozens or even hundreds of people. ML administrators—individuals who create and monitor an organization’s ML systems—must balance the push to streamline development while controlling access to tasks, resources, and data within ML workflows. Today, administrators create spreadsheets or use ad hoc lists to navigate access policies needed for dozens of different activities (e.g., data prep and training) and roles (e.g., ML engineer and data scientist). Maintaining these tools is manual, and it can take weeks to determine the specific tasks new users will need to do their jobs effectively. Amazon SageMaker Role Manager makes it easier for administrators to control access and define permissions for users. Administrators can select and edit prebuilt templates based on various user roles and responsibilities. The tool then automatically creates the access policies with necessary permissions within minutes, reducing the time and effort to onboard and manage users over time.
- Amazon SageMaker Model Cards simplify model information gathering: Today, most practitioners rely on disparate tools (e.g., email, spreadsheets, and text files) to document the business requirements, key decisions, and observations during model development and evaluation. Practitioners need this information to support approval workflows, registration, audits, customer inquiries, and monitoring, but it can take months to gather these details for each model. Some practitioners try to solve this by building complex recordkeeping systems, which is manual, time consuming, and error-prone. Amazon SageMaker Model Cards provide a single location to store model information in the AWS console, streamlining documentation throughout a model’s lifecycle. The new capability auto-populates training details like input datasets, training environment, and training results directly into Amazon SageMaker Model Cards. Practitioners can also include additional information using a self-guided questionnaire to document model information (e.g., performance goals, risk rating), training and evaluation results (e.g., bias or accuracy measurements), and observations for future reference to further Strengthen governance and support the responsible use of ML.
- Amazon SageMaker Model Dashboard provides a central interface to track ML models: Once a model has been deployed to production, practitioners want to track their model over time to understand how it performs and to identify potential issues. This task is normally done on an individual basis for each model, but as an organization starts to deploy thousands of models, this becomes increasingly complex and requires more time and resources. Amazon SageMaker Model Dashboard provides a comprehensive overview of deployed models and endpoints, enabling practitioners to track resources and model behavior in one place. From the dashboard, customers can also use built-in integrations with Amazon SageMaker Model Monitor (AWS’s model and data drift monitoring capability) and Amazon SageMaker Clarify (AWS’s ML bias-detection capability). This end-to-end visibility into model behavior and performance provides the necessary information to streamline ML governance processes and quickly troubleshoot model issues.
To learn more about Amazon SageMaker governance capabilities, visit aws.amazon.com/sagemaker/ml-governance.
Next-generation Notebooks
Amazon SageMaker Studio Notebook gives practitioners a fully managed notebook experience, from data exploration to deployment. As teams grow in size and complexity, dozens of practitioners may need to collaboratively develop models using notebooks. AWS continues to offer the best notebook experience for users with the launch of three new features that help customers coordinate and automate their notebook code.
- Simplified data preparation: Practitioners want to explore datasets directly in notebooks to spot and correct potential data-quality issues (e.g., missing information, extreme values, skewed datasets, and biases) as they prepare data for training. Practitioners can spend months writing boilerplate code to visualize and examine different parts of their dataset to identify and fix problems. Amazon SageMaker Studio Notebook now offers a built-in data preparation capability that allows practitioners to visually review data characteristics and remediate data-quality problems in just a few clicks—all directly in their notebook environment. When users display a data frame (i.e., a tabular representation of data) in their notebook, Amazon SageMaker Studio Notebook automatically generates charts to help users identify data-quality issues and suggests data transformations to help fix common problems. Once the practitioner selects a data transformation, Amazon SageMaker Studio Notebook generates the corresponding code within the notebook so it can be repeatedly applied every time the notebook is run.
- Accelerate collaboration across data science teams: After data has been prepared, practitioners are ready to start developing a model—an iterative process that may require teammates to collaborate within a single notebook. Today, teams must exchange notebooks and other assets (e.g., models and datasets) over email or chat applications to work on a notebook together in real time, leading to communication fatigue, delayed feedback loops, and version-control issues. Amazon SageMaker now gives teams a workspace where they can read, edit, and run notebooks together in real time to streamline collaboration and communication. Teammates can review notebook results together to immediately understand how a model performs, without passing information back and forth. With built-in support for services like BitBucket and AWS CodeCommit, teams can easily manage different notebook versions and compare changes over time. Affiliated resources, like experiments and ML models, are also automatically saved to help teams stay organized.
- Automatic conversion of notebook code to production-ready jobs: When practitioners want to move a finished ML model into production, they usually copy snippets of code from the notebook into a script, package the script with all its dependencies into a container, and schedule the container to run. To run this job repeatedly on a schedule, they must set up, configure, and manage a continuous integration and continuous delivery (CI/CD) pipeline to automate their deployments. It can take weeks to get all the necessary infrastructure set up, which takes time away from core ML development activities. Amazon SageMaker Studio Notebook now allows practitioners to select a notebook and automate it as a job that can run in a production environment. Once a notebook is selected, Amazon SageMaker Studio Notebook takes a snapshot of the entire notebook, packages its dependencies in a container, builds the infrastructure, runs the notebook as an automated job on a schedule set by the practitioner, and deprovisions the infrastructure upon job completion, reducing the time it takes to move a notebook to production from weeks to hours.
To begin using the next generation of Amazon SageMaker Studio Notebooks and these new capabilities, visit aws.amazon.com/sagemaker/notebooks.
Automated validation of new models using real-time inference requests
Before deploying to production, practitioners test and validate every model to check performance and identify errors that could negatively impact the business. Typically, they use historical inference request data to test the performance of a new model, but this data sometimes fails to account for current, real-world inference requests. For example, historical data for an ML model to plan the fastest route might fail to account for an accident or a sudden road closure that significantly alters the flow of traffic. To address this issue, practitioners route a copy of the inference requests going to a production model to the new model they want to test. It can take weeks to build this testing infrastructure, mirror inference requests, and compare how models perform across key metrics (e.g., latency and throughput). While this provides practitioners with greater confidence in how the model will perform, the cost and complexity of implementing these solutions for hundreds or thousands of models makes it unscalable.
Amazon SageMaker Inference now provides a capability to make it easier for practitioners to compare the performance of new models against production models, using the same real-world inference request data in real time. Now, they can easily scale their testing to thousands of new models simultaneously, without building their own testing infrastructure. To start, a customer selects the production model they want to test against, and Amazon SageMaker Inference deploys the new model to a hosting environment with the exact same conditions. Amazon SageMaker routes a copy of the inference requests received by the production model to the new model and creates a dashboard to display performance differences across key metrics, so customers can see how each model differs in real time. Once the customer validates the new model’s performance and is confident it is free of potential errors, they can safely deploy it. To learn more about Amazon SageMaker Inference, visit aws.amazon.com/sagemaker/shadow-testing.
New geospatial capabilities in Amazon SageMaker make it easier for customers to make predictions using satellite and location data
Today, most data captured has geospatial information (e.g., location coordinates, weather maps, and traffic data). However, only a small amount of it is used for ML purposes because geospatial datasets are difficult to work with and can often be petabytes in size, spanning entire cities or hundreds of acres of land. To start building a geospatial model, customers typically augment their proprietary data by procuring third-party data sources like satellite imagery or map data. Practitioners need to combine this data, prepare it for training, and then write code to divide datasets into manageable subsets due to the massive size of geospatial data. Once customers are ready to deploy their trained models, they must write more code to recombine multiple datasets to correlate the data and ML model predictions. To extract predictions from a finished model, practitioners then need to spend days using open source visualization tools to render on a map. The entire process from data enrichment to visualization can take months, which makes it hard for customers to take advantage of geospatial data and generate timely ML predictions.
Amazon SageMaker now accelerates and simplifies generating geospatial ML predictions by enabling customers to enrich their datasets, train geospatial models, and visualize the results in hours instead of months. With just a few clicks or using an API, customers can use Amazon SageMaker to access a range of geospatial data sources from AWS (e.g., Amazon Location Service), open-source datasets (e.g., Amazon Open Data), or their own proprietary data including from third-party providers (like Planet Labs). Once a practitioner has selected the datasets they want to use, they can take advantage of built-in operators to combine these datasets with their own proprietary data. To speed up model development, Amazon SageMaker provides access to pre-trained deep-learning models for use cases such as increasing crop yields with precision agriculture, monitoring areas after natural disasters, and improving urban planning. After training, the built-in visualization tool displays data on a map to uncover new predictions. To learn more about Amazon SageMaker’s new geospatial capability, visit aws.amazon.com/sagemaker/geospatial.
Capitec Bank is South Africa's largest digital bank with over 10 million digital clients. “At Capitec, we have a wide range of data scientists across our product lines who build differing ML solutions,” said Dean Matter, ML engineer at Capitec Bank. “Our ML engineers manage a centralized modeling platform built on Amazon SageMaker to empower the development and deployment of all of these ML solutions. Without any built-in tools, tracking modelling efforts tends toward disjointed documentation and a lack of model visibility. With Amazon SageMaker Model Cards, we can track plenty of model metadata in a unified environment, and Amazon SageMaker Model Dashboard provides visibility into the performance of each model. In addition, Amazon SageMaker Role Manager simplifies access management for data scientists in our different product lines. Each of these contribute toward our model governance being sufficient to warrant the trust that our clients place in us as a financial services provider.”
EarthOptics is a soil-data-measurement and mapping company that leverages proprietary sensor technology and data analytics to precisely measure the health and structure of soil. “We wanted to use ML to help customers increase agricultural yields with cost-effective soil maps,” said Lars Dyrud, CEO of EarthOptics. “Amazon SageMaker’s geospatial ML capabilities allowed us to rapidly prototype algorithms with multiple data sources and reduce the amount of time between research and production API deployment to just a month. Thanks to Amazon SageMaker, we now have geospatial solutions for soil carbon sequestration deployed for farms and ranches across the U.S.”
HERE Technologies is a leading location-data and technology platform that helps customers create custom maps and location experiences built on highly precise location data. “Our customers need real-time context as they make business decisions leveraging insights from spatial patterns and trends,” said Giovanni Lanfranchi, chief product and technology officer for HERE Technologies. “We rely on ML to automate the ingestion of location-based data from varied sources to enrich it with context and accelerate analysis. Amazon SageMaker’s new testing capabilities allowed us to more rigorously and proactively test ML models in production and avoid adverse customer impact and any potential outages because of an error in deployed models. This is critical, since our customers rely on us to provide timely insights based on real-time location data that changes every minute.”
Intuit is the global financial technology platform that powers prosperity for more than 100 million customers worldwide with TurboTax, Credit Karma, QuickBooks, and Mailchimp. “We’re unleashing the power of data to transform the world of consumer, self-employed, and small business finances on our platform,” said Brett Hollman, director of Engineering and Product Development at Intuit. “To further Strengthen team efficiencies for getting AI-driven products to market with speed, we've worked closely with AWS in designing the new team-based collaboration capabilities of SageMaker Studio Notebooks. We’re excited to streamline communication and collaboration to enable our teams to scale ML development with Amazon SageMaker Studio.”
About Amazon Web Services
For over 15 years, Amazon Web Services has been the world’s most comprehensive and broadly adopted cloud offering. AWS has been continually expanding its services to support virtually any cloud workload, and it now has more than 200 fully featured services for compute, storage, databases, networking, analytics, machine learning and artificial intelligence (AI), Internet of Things (IoT), mobile, security, hybrid, virtual and augmented reality (VR and AR), media, and application development, deployment, and management from 96 Availability Zones within 30 geographic regions, with announced plans for 15 more Availability Zones and five more AWS Regions in Australia, Canada, Israel, New Zealand, and Thailand. Millions of customers—including the fastest-growing startups, largest enterprises, and leading government agencies—trust AWS to power their infrastructure, become more agile, and lower costs. To learn more about AWS, visit aws.amazon.com.
About Amazon
Amazon is guided by four principles: customer obsession rather than competitor focus, passion for invention, commitment to operational excellence, and long-term thinking. Amazon strives to be Earth’s Most Customer-Centric Company, Earth’s Best Employer, and Earth’s Safest Place to Work. Customer reviews, 1-Click shopping, personalized recommendations, Prime, Fulfillment by Amazon, AWS, Kindle Direct Publishing, Kindle, Career Choice, Fire tablets, Fire TV, Amazon Echo, Alexa, Just Walk Out technology, Amazon Studios, and The Climate Pledge are some of the things pioneered by Amazon. For more information, visit amazon.com/about and follow @AmazonNews.
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You wouldn’t believe how many clients come to me with hormone issues and when I ask if their OB-GYN has ever tested their hormones, they were told, “it’s pointless, because hormones fluctuate so much.”
Or, if they were lucky enough to get tests, the doctor says, “everything looks fine.” I ask the client when in their cycle they were tested, and they often say, “I don’t know – my doctor didn’t tell me I had to go at a certain time.”
(Yes, my eyes tend to roll to the back of my head.)
While it is true that hormones fluctuate throughout both the month and the day, that doesn’t mean checking them isn’t going to supply you good information. Your blood sugar fluctuates throughout the day. Would anyone say it’s pointless to take your blood sugar if you were having blood sugar issues?
A test is always going to be a snapshot (though you do have options for cycling tests that track an entire menstrual cycle), but it gives us often crucial information on steps to take to Strengthen hormone balance. This is particularly true if you deal with menstrual issues such as debilitating PMS, fibroids, ovarian cysts, infertility, endometriosis, or are in perimenopause.
But it is true that the blood tests most doctors run are the least useful of the bunch. This is because they only test for the bound version of the hormone. We want to know the free – or bioavailable – levels of hormones at a given time. Plus, serum labs only test for one point in the day. This is why you want to turn to saliva or dried urine testing.
Because I want women to understand what hormone tests do, what the pros and cons are of each, and why you may need to go outside of your doc in order to get them done (like with a functional health coach such as myself), I’ve compiled a list of testing options for you below.
**Why**
You don’t have PMS just because you are a woman. Fibroids don’t grow just because you are getting older. Ovarian cysts don’t appear out of the blue. Your period isn’t a crime scene because your body is just a rebel.
These things are happening because your hormones are out of balance, plain and simple.
Now, I’m not trying to imply there is some hormonal grail that you can get to and everything will be perfect forever and ever. Hormones will always be fluctuating (as I mentioned above), but when you have imbalances in your cycle, it is a clear sign that your hormones are not acting in concert with each other. There’s many reasons for this, including, but not limited to:
- Stress
- Xenoestrogens/Xenobiotics
- Overloaded liver
- Gut dysbiosis (often stemming from antibiotics, birth control, and medications)
In order to get your hormones-band back together again, you are going to have to look at all these areas in your life. But what is helpful about getting a hormone test if you are in the midst of intense hormonal symptoms is that we have a chance to get really specific, really fast.
Tests that include cortisol levels throughout the day are going to tell us how your adrenals are doing (and how much stress is impacting you). Some hormone tests will show us estrogen metabolites, which will tell us how your liver is doing in terms of detoxing estrogen. Though I recommend the GI-Map and MRT food sensitivities test to actually see what is happening in your gut, hormone testing can point to nutrient deficiencies and microbiome issues.
Plus, we actually get to see what your estrogen, progesterone, testosterone, and DHEA are doing so that we know what foods, supplements, and yes, in some cases, which bioidentical hormone therapy may be called for.
**Timing**
Generally, you want to test your sex hormones between days 19-22 of your cycle. This is because your body only produces progesterone after you’ve ovulated (day 14ish, give-or-take because every woman’s body is different). So if you test your progesterone pre-ovulation, your progesterone numbers will be tanked and you may wonder why; there’s basically no progesterone circulating at that point (unless you are taking supplemental progesterone).
Your progesterone levels peak during this 19-22 window, which gives us an idea of your highest level of progesterone. That means if it’s on the lower end of the scale, you know things usually get worse as your cycle continues.
We also want to compare those progesterone numbers to your estrogen levels. Your estrogen should be lower at this point than it was pre-ovulation, so if you see higher numbers during this point in your cycle, you know you may be dealing with an estrogen dominance situation. (Of course, your numbers could be low, which is also good information for different reasons. This is why it’s so important to work with a practitioner that understands sex hormones and the intricate relationship between them).
You may need additional testing times when infertility is an issue, or if you want to get really clear on issues like missing periods, extremely heavy periods, or periods that are all over the place. In this case, doing a month-long cycling hormone test is going to supply you the most information.
**Options**
Blood test
Pros:
- Can do at doctor’s office
- Quick and easy (as long as you don’t mind blood being drawn)
- It’s the best way to test your thyroid hormones, which have a special relationship with your sex hormones. It can also test LH, FSH, sex binding hormone globulin, and prolactin
- Insurance often covers it
- It gives you basic information of what’s going on with your sex hormones
Cons:
- Serum tests show you the bound form of sex hormones, not the free form that is in your tissues (yes, there are serum test options that look at free hormones, but they are not commonly available. Also, free testosterone is an exception, as this is easily obtained)
- What this means is that you can see normal levels of the bound hormone, but you actually have low levels of the bioavailable form of the hormone, the form you actually use – which you won’t know, because these tests don’t provide this information.
- The test happens once, at one point in the day. Our hormones rise and fall in a rhythm, so simply seeing your hormones at one point in the day doesn’t tell us a lot.
- You don’t get a chance to see the metabolites of your hormones, which we’ll get to below.
Example of a hormone blood test: 
Saliva test
Pros:
- Is usually done at home
- Good for people who don’t like to have their blood drawn
- It measures the free, usable version of hormones
- It involves multiple collections over the day, so we can see cortisol rhythm, which has a huge impact on our sex hormones
- Gives you a clear picture of estrogen and progesterone
- Can assess an entire cycle
- Can assess FSH and LH as well as estrogen, progesterone, testosterone, DHEA, and cortisol
- Have the option to test or retest one hormone at a time
Cons:
- Doesn’t show hormone metabolites (particularly with cortisol, it is important to know the level of metabolites, as this is going to guide how you treat adrenal dysfunction)
- Some people struggle to produce the amount of saliva needed for the vials
- It’s not the best way to monitor hormone replacement therapy (oral forms of HRT often show up really high because it concentrates hormones in the salivary glands)
- Caffeine cannot be imbibed the day of the test
- Insurance sometimes, but often doesn’t, cover it
Example of saliva test results: 
As you can see, this test shows you cortisol levels in the morning, noon, afternoon and nighttime, and shows us what the rhythm is and should be (this particular test includes the additional Cortisol Awakening Response – CAR – which can help to determine if your cortisol is doing what it should first thing in the morning). We can also see DHEA levels along with the cortisol-to-DHEA ratio, which is important as DHEA and cortisol are both made in the adrenals and can point to underlying HPA-Axis dysregulation.
![Photo: Lacie Slezak You wouldn't believe how many clients come to me with hormone issues and when I ask if their OB-GYN has ever tested their hormones, they were told, "it's pointless, because hormones fluctuate so much." Or, if they were lucky enough to get tests, the doctor says, "everything looks fine." I ask the […]](https://img-s-msn-com.akamaized.net/tenant/amp/entityid/AA14HN4c.img?h=335&w=300&m=6&q=60&o=f&l=f)
Photo: Lacie Slezak You wouldn't believe how many clients come to me with hormone issues and when I ask if their OB-GYN has ever tested their hormones, they were told, "it's pointless, because hormones fluctuate so much." Or, if they were lucky enough to get tests, the doctor says, "everything looks fine." I ask the […]
The three estrogens (estradiol, estriol, and estrone) all are shown on this test, along with progesterone, testosterone, and melatonin (helpful to know if you are having issues with sleep, and often corresponds with dysregulated cortisol levels, including high nighttime cortisol).Urine Test
Pros:
- Offers the three main estrogens, progesterone, testosterone, DHEA, and their metabolites, and 4-point cortisol
- Shows bioavailable hormone levels
- Shows 24 hormone secretion instead of just one moment in time
- How your estrogen is metabolized gives you insight into how your liver is doing, both Phase I and Phase II detox. It also lets you know which pathway you prefer: the 2-OH pathway is considered more “protective,” while the 4-OH pathways is considered more genotoxic, or cancer-causing, and the 16-OH is considered “proliferative.” Knowing this information is extremely helpful in determining particular foods and supplementation for an individual.
- It provides additional OAT (Organic Acid Test) markers, including B12, B6, glutathione, melatonin, and oxidative stress
- Caffeine drinkers can drink caffeine up until noon on day of 5pm and 10pm testing; also drink it after final sample, which is 2 hours after waking up
Cons:
- Measures progesterone metabolites and “works it’s way back” to determine progesterone levels. This is not always seem as an accurate measurement of progesterone (vs. saliva)
- Does not assess FSH and LF
- Insurance does not cover it
Two pages from my Dutch test last year, which shows some of the plethora of information you get from this test: 
Though I know this is confusing to look at when you haven’t worked with the Dutch, a practitioner who knows the Dutch gathers a lot of information from this test beyond simply estrogen, progesterone, and testosterone levels. We can see Phase I and Phase II liver detox for estrogen, metabolites that can point to more or less androgenic symptoms, and overall cortisol, cortisone, and metabolized cortisol, among other things.
Now, I understand this is a bit complicated, and that it may bring up more questions. Feel free to add your question below and I’ll do my best to answer it!
University of Maryland Medical System researchers studied the effects of positive reinforcement to encourage physicians and health practitioners to promote referral to tobacco Quitline resources. The researchers observed an uptick in referrals after physicians and health practitioners received letters and certificates acknowledging their referral efforts in January 2022, indicating that positive feedback and acknowledgment may Strengthen tobacco cessation e-referral rates.
The authors assert that providing physicians and health care providers with access to accurate EHR data can also be a valuable tool in improving clinical outcomes in vulnerable populations and that recognition of physicians' and practitioners' efforts can potentially be expanded beyond tobacco cessation to address other areas of practice.
Tobacco use is one of the most preventable causes of morbidity and mortality in the United States. In our project, positive reinforcement for tobacco cessation referrals was accomplished by recognizing physicians/practitioners across the University of Maryland Medical System (UMMS) for their commitment to tobacco cessation.
The tobacco e-referral outreach and education initiative includes the entirety of the UMMS, which spans 12 hospitals and more than 150 ambulatory clinics in 11 counties and Baltimore City.
There are more than 4,600 affiliated physicians providing primary and specialty care who can utilize the tobacco cessation e-referral within the Epic electronic health record (EHR) to refer patients who use tobacco to the Maryland Quitline, or to the on-campus Tobacco Health Practice.
Outreach and education are conducted across UMMS to physicians/practitioners to promote the use of a tobacco cessation e-referral to the Maryland Quitline or to the Tobacco Health Practice for patients who use tobacco products. Referrals to the Maryland Quitline have been demonstrated to reach the most vulnerable segments of our population. Over 500 physicians/practitioners and staff were educated across 40 presentations on how to use the e-referrals.
Educational syllabus include tobacco epidemiology, types of tobacco products including e-cigarettes/vape devices, tobacco cessation pharmacotherapeutics, tobacco treatment options, and EHR workflows. Education occurred via grand rounds, departmental meetings, webinars, pre-recorded presentations, Epic tip sheets, and one-on-one academic detailing.
Data from the Epic EHR were reviewed to identify the number of tobacco cessation e-referrals to the Maryland Quitline by physicians/practitioners across the UMMS in 2021. Physicians/practitioners who e-referred 10 or more patients in a 12-month period were considered "Tobacco Cessation Champions," and those who e-referred less than 10 patients were considered "Tobacco Cessation Advocates."
Each physician/practitioner received a letter and certificate via e-mail celebrating their work and inspiring them to encourage their colleagues to e-refer their patients for tobacco cessation. Letters and certificates were tailored to Champions and Advocates, respectively. In 2021, 264 physicians/practitioners e-referred patients to the Maryland Quitline.
These physicians/practitioners received a letter and certificate in January 2022. There were 203 e-referrals submitted to the Maryland Quitline in the 4th quarter of 2021 and 269 e-referrals submitted to the Maryland Quitline in the 1st quarter of 2022. There were also 443 referrals to the Tobacco Health Practice in 2021. The sustainability of this effort is supported by having developed a scalable EHR workflow and training material existing in perpetuity.
Positive reinforcement and acknowledgment of physicians'/practitioners' work to Strengthen their patients' health may help increase tobacco cessation e-referrals. Physicians/practitioners self reported enthusiasm at being acknowledged for their effort. Access to accurate EHR data can be a valuable tool in quality improvement to Strengthen clinical outcomes in vulnerable populations.
Recognition of physician/practitioner efforts can potentially be expanded beyond tobacco cessation to address other areas of practice. Future iterations of this effort should consider the proportion of patients who smoke and patients who do not require referral for treatment. Utilizing the rate of eligible smokers who need and are referred for treatment may produce a more accurate representation of physician/practitioner treatment efforts.
The research was published in The Annals of Family Medicine.
More information: Niharika Khanna et al, Tobacco Cessation Champions: Recognizing Physicians Who Ask, Advise, and Refer, The Annals of Family Medicine (2022). DOI: 10.1370/afm.2891
Citation: Positive reinforcement can spur physicians and health practitioners to promote tobacco cessation (2022, November 29) retrieved 9 December 2022 from https://medicalxpress.com/news/2022-11-positive-spur-physicians-health-practitioners.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
by Harvey L. Neiman Health Policy Institute
A new Harvey L. Neiman Health Policy Institute study found when patients are treated in the Emergency Department (ED) by non-physician practitioners (physicians assistants and nurse practitioners), there were 5.3% more imaging studies performed than if patients were seen only by physicians. This JAMA Network Open study was based on a nationally representative demo of Medicare fee-for-service beneficiaries with 16,922,274 ED visits between 2005 and 2020.
The increased imaging associated with non-physician practitioners was due to both a greater likelihood of an ED visit having imaging (3.4% increase). "While our study notes the correlation between the presence of non-physician practitioners in the ED with more imaging, it does not make any judgment about the efficacy of this increase in imaging," stated Eric Christensen, Ph.D., director of Economic and Health Services Research at the Neiman Institute. "The variation we found in practice patterns between physicians and non-physician practitioners highlights an opportunity to ensure the judicious use of imaging. These efforts need to address both when and what imaging is appropriate."
"To put this 5.3% imaging increase in context, it equates to more than one million imaging studies per year when applied to the roughly 20 million annual ED visits for the entire Medicare fee-for-service population," Christensen noted. "Although we focused on Medicare, there are approximately 130 million annual ED visits in the United States, so this figure could be substantially higher."
When the research team examined the specific imaging modalities, "We found that the presence of non-physician practitioners in the ED was associated with increases of 3.2% for radiography, 7.3% for CT, and 14.2% for other modalities (MRI and ultrasound)," stated co-author Richard Duszak, MD, professor and chair of the Department of Radiology at the University of Mississippi Medical Center. "Thus, the higher imaging associated with non-physician practitioners was most pronounced in these modalities in which we and others have observed rapidly increasing ED utilization."
The study noted that the share of ED visits managed by non-physician practitioners had steadily risen from 6.1% in 2005 to 16.6% in 2020.
"From an overall cost perspective, services rendered by non-physician practitioners have the potential to lower health care costs given that the Medicare Physician Fee Schedule pays for these services at 85% of what it pays physicians," stated co-author Timothy Swan, MD, Diagnostic and Interventional Radiologist, Marshfield Clinic Health System, Marshfield, WI.
"However, the increased imaging and other associated costs generated by these practitioners would offset these lower reimbursements. We did not address this cost question, but future research should explore the total cost impact of non-physician practitioners in the ED, considering both reimbursement and imaging orders."
More information: Eric W. Christensen et al, Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries, JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.41297
Provided by Harvey L. Neiman Health Policy Institute
Citation: Non-physician practitioners in the ED associated with 5.3% more imaging use (2022, November 11) retrieved 9 December 2022 from https://medicalxpress.com/news/2022-11-non-physician-practitioners-ed-imaging.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
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