New Singapore hospital to deploy “mini-EHR”

This news article is written by a good friend of mine (from FutureGov) and it covers a very interesting concept – a combination of a private hospital and a hotel- catering for medical tourism.

The Connexion, conceived and built by Singapore Health Partners (SHP), is comprised of three main entities: a 220-bed tertiary hospital, a specialist consultation centre with 189 medical suites as well as a 230-room hotel, which is equipped with a conference centre and retail space.

James Woo, SHP’s Vice President for Information Technology explained that the hotel will have rooms ranging from four-star to six-star standards. “This is to make sure that the facility caters to the different needs of our clients,” he says.

Woo was formerly the deputy CIO of Ministry of Health Holdings (MOHH) and CIO of National Health Group.

Expected to open by 2011, Connexion is expected to have 40 to 60 per cent medical tourists among its clientele. SHP, which was formed in 2006, has 44 shareholders, including 40 doctors, one architect and several foreign investors.

“It is the first private hospital to be built in Singapore for many years,” Woo says, stressing a lot of planning is required to make Connexion different and competitive. “We went in with a patient’s perspective to envision what a hospital of the future should be like.”

He explains that in a normal private hospital in Singapore, specialist consultants are like tenants who run their own systems, with little or no sharing of medical or administrative information between each other or with the management of the facility. These specialists often use one system for consultation and another to talk to the hospital, and the two are not interconnected, according to Woo.

“If I go to see doctor A, I have to register myself,” he explains. “When I go to see doctor B the next time, I have to register again even though they are in the same facility.”

SHP has recently signed a five year agreement with Microsoft to deploy the latter’s Amalga Health Information System into both its hospital and consultation suites.

Drawing from his previous public sector experience, Woo explains that he is envisioning Connexion to be like a mini-EHR. Each consultation suite will be allocated certain space in the central data base for detailed medical information, while certain important information such as allergies, active medication will be shared across Connexion, with a single master patient index.

“Integration of two systems will never work as well as an integrated system,” says Woo. “And we don’t want to maintain a large IT department to weave everything together.”

The option of having a single billing system between Connexion’s medical facilities and its hospitality business is also on the drawing board. “We still have to be very mindful,” says Woo.

The adoption of the system is not mandatory for specialist consultants. However, Woo says SHP will try their best to incentivise the uptake. “The system is essentially free for them, they don’t have to worry about license or maintenance,” he explains. “And by adopting the system, not only do they benefit from data sharing, they can also receive our statistical reports to see how well they perform and how they can make improvements.”

“We just want them to focus on patient care rather than worry about administration or anything else,” says Woo. “Our strategy is to help them to turn around more patients with better quality, and by that we will have happy tenants and increased revenue.”

As a green field facility, SHP plans to use internationally available statistics such as reports published by the WHO as a benchmark for the medical results achieved with the help of its IT system.

“WHO says that the chance of you getting harmed while seeking treatment is one in 300, which is very high considering that the ratio for civil aviation is one in 1.1 million,” Woo says. “We need to demonstrate that we can do much better than this.?”

Source : FutureGov

RSNA: Practical informatics for rads includes PACS ‘Prenup’

I also got this off an email from HealthImaging.com and I think its a funny but very much needed topic (it goes to show what stage we are at in the world of Imaging Informatics)

“CHICAGO–There can be a number of reasons in changing PACS, including the original vendor going out of business, no longer having a product that supports the work being done or a change in administration within a healthcare facility or a corporate decision, according to Steven Horii, MD, in a session titled “PACS Divorce” at the Radiological Society of North America (RSNA) annual conference on Monday.

PACS migration is becoming more commonplace as systems are becoming obsolete very quickly, noted Horii, director of radiology at the Hospital of the University of Pennsylvania in Philadelphia.

According to Horii, while change is inevitable, certain factors can be noted as the most problematic. These include the question of what to do with the old hardware, such as MR machines, database migration conflicts, interface problems, missing the changeover schedule and having migration run too frequently.

“Database migration is the biggest problem we noticed,” said Horii. Names and reports that are matched up incorrectly and duplicate names within the system create conflict because they require manual intervention or additional software to correct, he said.

Interface issues were also noted by Horii as being a potential conflict during PACS changeover. “Your PACS is connected to a lot of different information systems and interfaces, which have to be tested on the new system,” he said. “There may be a new round of interface licensing fees involved.” For example, if the RIS and PACS are two separate systems by different companies, a fee would most likely be charged by the existing company to interface its system to the new PACS.

When entering into an agreement with a new PACS vendor, there is the potential for the timed migration estimate by the new vendor to be off-schedule, said Horii. “In their calculation, they assume that they will have access to your whole database 100 percent of the time. You cannot let the migration run 24-hours a day,” he said.

Among the recommendations in easing the PACS migration pain was considering vendor-independent storage solutions, an idea that is becoming increasing acceptable to vendors, said Horii.  “The idea is that you change the other parts of the PACS, but the database only needs minor changes, such as re-mapping database tables,” he said.

Further recommendations included having realistic estimates of data migration time, as well as contingency plans if the time limit is not met, and being prepared for legacy system failure before the implementation of a new system.

“Instating a prenuptial agreement from your PACS vendor” was the central solution offered by Horii.

“You want guaranteed access to your database and your data. You may own the data, but you do not own the schema — that is, how it is organized. That’s a problem if you are trying to migrate.”

Horii suggested that should a vender go out of business, the database should be obtained for the new vendor and details of all inter-system interfaces must be learned. Additionally, Horii discussed the option to continue service contracts on a month by month basis with the old vendor. However, he noted that the same service terms should be kept as the old system still will be in use clinically.

Moreover, Horii said, “You should get the new vendor to agree to work with the old vendor on the details of how to do the migration.” However, this takes time as it may involve contracts and non-disclosure agreements between the two companies“

RSNA: iPhone provides accurate appendicitis diagnosis – only the beginning?

I got this off an email from HealthImagingNews.com,

“CHICAGO—Radiologists can accurately diagnose acute appendicitis from a remote location with the use of a handheld device or mobile phone equipped with OsiriX mobile software, based on study results presented Monday at the 2009 annual meeting of the Radiological Society of North America (RSNA). The researchers are seeking to study this technology for other conditions that require an expedited diagnosis.”

I forsee some changes in clinical workflow coming up (once the research proves successful and the regulations mandated).

The full article can be read here

Imaging in Developing Countries Special Interest Group

Dear fellow friends,

I’d like to share with you folks about the Imaging in Developing Countries Special Interest Group (IDC-SIG), a network of radiographers and other professionals working in the field of medical imaging who are working to support the advancement of radiography in developing countries.

The group was formed in response to the concern of a number of radiographers involved in overseas projects that whilst their projects were achieving a lot in their own right there was no exchange of knowledge and ideas between them. Consequently everyone had to find out everything for themselves; ‘the wheel’ had to be repeatedly re-invented and there was no opportunity for learning from similar projects.

The group was launched at a study day in 2004 which attracted around 30 participants. Since then the group has grown to over 70 members from a range of professional backgrounds including radiographers, radiologists, imaging managers, clinical tutors and lecturers, physicists, students, members of professional bodies and equipment manufacturers.

The IDC-SIG exists primarily to facilitate communication and sharing of ideas between its members. Responsibility for the organisation and financing of projects rests with the individual members themselves. The group does not intend to make rules or policy on how projects should be run, but aims to offer advice based on members experiences.

I personally feel that IDC-SIG serves a very meaningful cause, most of us are passionate about healthcare informatics because we truly believe and wants to make a difference, hence I reckon that there would be some of you folks might want to contribute (somehow).

The official website of IDC-SIG is http://www.idcsig.org/

Ramblings: I passed the CPHIMS exam

I posted an entry sharing on the CPHIMS exam (administer by HIMSS) that I took recently in Singapore (first time its offered in Singapore).

The results just came in the mail, I got 82 out of 100, not bad given that there were a few questions that I couldn’t answer due to the lack of understanding on the US healthcare system  and about 4-5 that I left it as blank as I didn’t have the time to do the math part of it.

Nevertheless, according to the score report, I am now ‘recognized by HIMSS as a Certified Professional in Healthcare Information and Management Systems and may use the CPHIMS credential immediately.’ That’s kind of cool

So there you have it, I am a ‘CPHIMS’.

Till the next certification trophy~

P.S. Anyone interested in getting the Preparing for Success in Healthcare Information and Management Systems:
The CPHIMS Review CD ROM (priced originally at USD $325) I’m letting go of my copy.

Ramblings: What a month it has been..

It has been quite a month and no, the month (of November) is not up yet but what a ‘month’ it has been since I got back from South Korea.

I have basically been spending my time (and will continue till the month is up) on 4 major items this month and I reckon I should talk about the first 2 points (the remaining 2 will be reveal later) because while it appears that I have ’slowed down’ on the work at binaryHealthCare.com, I have in actual fact, work on a great number of related projects

So this is the first 2 items (out of 4) that I have been working on for the month of November;

1) Writing a Book
Before I ramble on ‘The Book”, allow me to share with you a side project I’ve been working on since February 2009  – the development of a post tertiary program on Imaging Informatics (aka PACS Administration) for an institute of higher learning in Singapore (yes, first of its kind in the region with more to come!)

Part of the work includes the development of the educational materials and I decided to write the text myself – hence a book (there would be slides and lab practice too). While I have no problem developing presentation slides for conferences and articles for the media, I actually have no experience in authoring a book, even though I took a course on book writing to minimize the learning curve, the actual process is by no means an easy feat (I’ll post more thoughts on this ‘little journey’ once I finish draft one)

2) Building the community at ClubPACS 2.0
Now one would imagine that rebuilding ClubPACS would be ‘a walk in the park’ given its fame and popularity before closing down. Well at least that’s what I thought, boy was I so wrong.

For those who have never managed an online community before but like to visit one, do the community owners / managers of those community a small flavor (if you visit ClubPACS 2.0, do me this favor too). Participate in the forums. Yes, it really helps.

The reason is simple, it actually reflects that there is activity going on in the community. I get so many PM (private messages) asking for help and I made the mistake of actually replying in full – the results? Empty forums, and let me tell you, empty forums is bad because it gives the impression that no one visits the community (which is not true).

The other problem I had was trying to get people to register. For ClubPACS 2.0, no registration is needed, anyone can assess the contents (forums included, unless they want to post) so what happens? People just read through the content / knowledge base. This is ok (that’s what ClubPACS is about – sharing of knowledge) but it just give the impression that the community is not alive and this ‘vicious cycle’ goes on (which is bad if you are trying to build a community).

The good news? It’s actually getting better and the research and practice I did on community management is making me a (slightly) better community manager.

However, if you are reading this and you have not register or post an introduction at ClubPACS 2.0, get it done right now

So there you have it, the 2 items that has been keeping me busy but it is well worth the time because the deliverable from these 2 items will benefit the health informatics on the whole

Disease-matching software could save children

By matching children with rare or life-threatening diseases and modelling potential disease progression, researchers hope to find new routes forward.

Software tools are being developed that can search and compare patient data at hospitals across Europe to find children with closely matched conditions. The doctors can then study how the matched patients at other hospitals were treated and whether that treatment was successful. The information will greatly improve doctors’ ability to choose the right path for their own patient.

The tools being developed within the Health-e-Child project can compare a vast range of structured and unstructured data, including genetic and clinical data, as well as images from CAT and MRI scans and other records.

The Health-e-Child system, protected by high security, links anonymised databases of patient information at hospitals in Paris, Genoa, Rome and London. There are plans to extend the network to 25 hospitals.

Health-e-Child researchers are working on tools for three complex paediatric diseases with at least partly unknown causes: heart diseases resulting from an overload of the right ventricle, juvenile idiopathic arthritis, and brain tumours (gliomas).

The EU-funded project has tackled fundamental data sharing infrastructural problems as well as ethical and data protection questions, data analysis and data mining issues. Both disease-specific and cross-disease tools have been developed.

For unstructured data such as images, the Health-e-Child project has created tools that translate visual information into machine-readable (and therefore machine-comparable) language. The project’s 3D registration tool for MRI scans, and its MRI ‘erosion scoring’ system for juvenile idiomatic arthritis have been recognised as important advances in their fields.

Matching and modelling two in a million

Health-e-Child’s CaseReasoner tool enables clinicians to search thousands of disease diagnoses, treatments and outcomes to find a child similar to their own patients. The clinicians set the search parameters themselves. In the case of heart patients, clinicians could include factors they consider important, such as genetic markers, the age of the child, the heart rate – even the amount of exercise the child takes.

The results can be displayed as a ‘network’ with cohorts of patients with similar diagnoses clustered together and colour-graded accorded to the level of similarity. Clinicians can then dive into the detailed data on any of the patients or clusters to better understand their diagnoses and the success of the procedures the patients have been through.

The CaseReasoner could also be used to search out the procedures that have been most successful, giving the clinician insights into the optimal path forward.

The AITION tool, being developed by Health-e-Child researchers at the University of Athens, seeks to go further. AITION will use semantic tools to search medical literature and interviews with clinicians as well as patient data. Drawing on well-established causal-probability algorithms, AITION will suggest probable disease development. Doctors using AITION will then be able to test their hypotheses on optimal treatment.

Other Health-e-Child researchers have combined a heart modelling tool called CardioWiz with MRI scan measurement software from Siemens, according to Siemens Healthcare’s Martin Huber, technical leader of the Health-e-Child project.

The combination can rapidly generate animated 3D models of a particular patient’s heart. The patient’s doctors can play with the models and simulate the effects of heart surgery or drug treatments to see how the heart would respond.

Child diseases under-researched

The lack of research into child disease adds to the significance of Health-e-Child, says Jörg Freund, from Siemens Healthcare and Health-e-Child project coordinator. Because the numbers of children suffering from these diseases are small, there is little incentive for commercial companies to research them. Some pharmaceutical companies calculate drug doses for children simply on weight – treating the child as a mini-adult. This fails to take account of important differences between children and adults. The most obvious difference is that children are growing.

Research on children can give important insights into the role of genetics in disease. Environmental factors can be less important in child diseases, simply because there has usually not been time in the child’s short life for the environment to have had much effect.

Following their successes, the Health-e-Child researchers are publishing an exploitation plan mapping out how Health-e-Child’s partners will take it forward.

The Health-e-Child project received funding from the ICT strand of the EU’s Sixth Framework Programme for research.

Source: ICT Results

Radiologists work more to find time for more play

I got this off from Diagnosticimaging.com

 

Radiologists are working approximately five more hours every week, but they also take 12 more vacation days a year, according to a survey from the American College of Radiology. The results apply not only to private practice radiologists, but to those in academic departments and multispecialty groups as well.

Results from surveys in 1995, 2003, and 2007 show an increase in hours worked per week of approximately 10%, or five hours. Mean vacation days increased from 27 in 1997 to 39 in 2007, which means a 5% decrease in the number of days worked (AJR 2009;193[4]:1136-1140).

“The trend in work hours can show how radiologists are coping in the face of increased imaging,” said Dr. Jonathan Sunshine, senior director of research at ACR and lead author of the study.

A large increase in the work hours of the average radiologist may portend both burnout and expansion of the role of nonradiologists in imaging, driven by the inability of radiologists to keep up with the increase in workload, he said.

Radiologists worked, on average, 53 hours a week in 2003. Broken down into subsets, the researchers found since 1995 an increase in hours worked per week of seven for academic radiologists, four for private practice radiologists, and one for those in multispecialty practices.

In 2007, 25% of radiologists worked 45 or fewer hours a week. The researchers also found 25% of radiologists worked 55 hours or more per week.

“Our practice has definitely increased our workload since 1995, and clearly more than 10%,” said Dr. Robert Pyatt, a radiologist at Chambersburg Imaging Associates in Chambersburg, PA.

Currently, radiologists at the practice read about 20,000 cases per year. They read about 15,000 per year in 1995.

“The actual opposing trends in weekly hours and days worked per year may reflect the more intense demand for after-hours coverage faced by radiologists over the study period,” Sunshine said.

Academic radiologists worked more hours than nonacademics: 25% work-ed 48 hours or fewer a week and 25% worked 58 hours or more per week.

“I probably work the same number of hours in the department as I have in the past, but spend at least as much time working outside the hospital on academic activities,” said Dr. Stuart Mirvis, a professor diagnostic radiology at the University of Maryland in Baltimore.

Business Leadership Seminar by Singapore Computer Society

This is an important blog entry that I had to make sure I get it posted, it’s on the Business Leadership Seminar organized by the Singapore Computer Society that took place on the 7th November 2009 (on a Saturday morning) at the Singapore Management University, Singapore. I attended the event with two purpose in mind;

• I needed the CPD points. I’m a Certified IT Project Manager and this seminar awards 6 CPD points towards my ‘unmet quota’
• I wanted to listen the track on Transforming Healthcare through IT by Dr Sarah Muttitt – Chief Information Officer of MOH Holdings, Singapore

Ok, so it was really more for point two than one but in all, I think it was a fruitful trip as I learned quite a fair bit from the other speakers too – Robert Yap, CEO of YCH Group (I didn’t know they dabble in some aspects of Health IT until I google the company) and Howie Lau, GM of Lenovo ASEAN.

I love the session from Howie as he provided some very good examples of how he applied certain marketing concepts and theory (given that the seminar took place in a university’s auditorium, one can be forgiven if the impression given was that an MBA lecture on Marketing was going on).

The session that was most insightful was of course the one provided by Dr Sarah Muttitt as it gave me (further) heads-up to the direction Singapore is heading towards in the national wide electronic health project.

I also managed to talk personally to Dr Muttitt on a side project of mine that will benefit the health community at large but that’s another story for another time (I don’t want to give away the element of ’surprise’).

In all, it was a good seminar (even for one on a Saturday morning

Ramblings: New short course I am taking – I bet you never saw this coming

Ok, before I start, I must put on a disclaimer – “This has nothing to do with health informatics – unless you see it from my point of view”

So I am taking up a new course – a short 12 audio lessons (with assignments to be done) on communicating with toddlers (I’ve a young daughter and the ‘terrible two’ is quite beyond me).

For the ‘uninitiated’, dealing with toddlers can be much more difficult than dealing with physicians (well, like toddlers, most of them are friendly and accommodating but the occasional ‘one off’ can really drive you insane).

So I sign-up (well, my wife did actually) for a course on how to improve my communication skills and ‘build powerful skills of influence’ so I can get my kid to comply with my ‘requests’ more often and reduces ‘the occurrence of fights and screaming matches’  (sounds familiar to your work as a Health IT professional? lol)

Alright, so I jested a little but heck, one can always apply knowledge gain from difference sources in different areas, I do that all the time so I reckon I might just pickup something to ‘improve my communication skills with Doctors