Ramblings: I’m flying off to the Philippines (again)

I’m going to spend the week in the Philippines, mainly for the Philippine Heart Association 40th Annual Convention for pre-sales support and solution demonstrations. In addition, I will be delivering a lunch symposium lecture title ” Cardiology Informatics: An Enabler of Workflow Efficiency”  (drop me an email if you are interested in this lecture).

As mentioned in my previous trip to the Philippines (last month), the country is gearing up for embracement into healthcare informatics but needs to be better educated before they jump into the bandwagon so I hope this particular lecture will be of some help.

I also made a day trip to Malaysia (last week), while I didn’t really get much out of the trip, I did get a pulse of things in the region (well, its not that far away from Singapore where I am based). During my trip, I noticed another emerging trend (well, related to what I observed previously) that is occurring throughout South East Asia (got to do a little of scoping to see if it is the same in the rest of Asia Pacific).

Stay tune for updates for the Philippine Heart Association 40th Annual Convention.

Cheers~

NHS rolls out radiology kit

The NHS Institute for Innovation and Improvement, a special health authority of the National Health Service in England, has sent a new radiology kit to help trusts improve booking processes and reduce waiting times.

Transforming your Radiology Services Kit: Focus on Booking Processes, intends to reduce the long waiting times often caused by a bottleneck in patient pathways as part of diagnostic imaging exams, according to the institute.

Staff can review and assess booking processes by identifying areas for development, including where technological solutions could be used to improve the system, using the kit.

Resource materials were developed following 12 months of research and pilots by the NHS Institute’s Delivering Quality and Value team, according to NHS.

Ramblings: ClubPACS is part of International PACS Administrator Appreciation Day

Dear fellow Medical Imaging Professionals,

As some of you might have noticed, the URL of www.ClubPACS.com is directed to the same portal as www.PACSAdminDay.com

Don’t worry, there is no DNS mixed up nor any bugs anywhere.

In view of time and resources constraints, Dr Paul Nagy ‘retired’ ClubPACS back in late 2008 / early 2009. As some of you might know, I was the Singapore Chapter’s representative of ClubPACS and (with Dr Nagy’s blessing) I took over the ownership of www.ClubPacs.com on April 7 2009.

So what’s going to happen to ClubPACS? Well, the ideal scenario would be to rebuild the community together but such great endeavors are never easy, so I encourage all previous community participants and volunteers of ClubPACS to join me in this journey (Contact me here).

Let’s celebrate our profession and lead the profession to the next level.

The Philippines in Dire Need Of Telemedicine

I visited the Philippines recently (last month) and blog about the state of healthcare informatics and its potential, hence it comes as a pleasant surprise that the lobby for a national telehealth system has already began.

To create a national teleheath system, Senator Joseph Emilio A. Abaya of the first district of the Cavite province stressed the need for the country to have a law pushing for a telemedicine bill that will facilitate collaboration between public and private institutions, and government and non-government offices.

The call was made during the e-Health and Telemedicine 2009 Conference and Exhibition today (9 May) in Crowne Plaza Galleria Manila in Quezon City, where the congressman noted how the rapid development of ICT has provided a window of opportunity for the health sector to expand its reach.

“The Philippines will benefit greatly from telehealth since the ratio of doctors and other health workers to the general population is dismal.”

“According to 2007 data from the National Statistics Office (NSO), there are only 2955 medical doctors in public hospitals; and this is a paltry number in relation to our burgeoning population (90 million), especially in the provincial areas where people rely on government facilities for their health and medical needs,” said Abaya.

For Abaya, deploying telemedicine and electronic medical records in the Philippines translates directly into better rural medical services. “With telemedicine, state of the art medicine as practiced in our best public and private hospitals can then serve the under-served in our most remote areas, using existing broadband networks,” he said.

Telehealth is already running in some provinces in the country through the National Telehealth Centre, and President Gloria Macapagal-Arroyo’s administration included the allocation of US$2 million in the 2009 national budget for telehealth purposes.

“However, the longer-term goal is to establish a synchronised effort to provide the best available health service to the widest range possible by making the healthcare industry work together with the academia and government,” Anadaya said. “Hopefully, a National Telehealth Service System Act will achieve this.”

Things should be looking interesting.

Sydney Power Outage Kills E-Health Systems

This article from FutureGov serves to remind us that we should not take the availability of electricity for granted and instead, work towards factoring the lost of electricity as part of the Business Continuity process. Tough as it might sound but natural disasters or human-triggered incidents (such as the one in the article below) can post some serious problems when a health facility goes paperless (well, I can also imagine intensive care units and operating theaters to be just as vulnerable).

Doctors in hospitals within Sydney’s west had to temporarily turn back to pen and paper on 2 May when their electronic health record systems went offline. Around 90 hospitals in the greater western, greater southern and Sydney west areas were affected by the outage, losing services such as email and intranet.

According to the state’s Health Support Services division, which handles IT and shared services such as data centre services for NSW Health, the outage began around 9 am on Saturday morning.

Power utility Integral Energy had been doing some maintenance around the area of Health Support Services’ data centre in Cumberland, which meant that the data centre was running on back-up power. When a circuit breaker tripped, power was lost for 45 minutes.

Health Support Services had to reboot and test programmes before clinical systems could come back online after power came back on. This took till 1.30 pm, with further services such as email restored by 7 pm.

Nine hospitals were further impacted, unable to access clinical services such as the newly rolled out electronic medical records system and patient notes had to be recorded using pen and paper.

Despite reports that some records were lost, no data went missing, according to Health Support Services. “All of our data is backed up several times a day. None of the data was lost,” a spokesperson said, adding that all the outage had meant was that doctors and nurses couldn’t enter new information into the records.

Health Support Services is not sure as yet why the circuit breaker tripped. It now has independent engineers looking into what happened to kill the backup. “The ultimate backup when electronic records fail is pen and paper and will always be pen and paper,” a spokesperson for NSW Minister for Health John Della Bosca said.

Since October, 20 out of 180 hospitals within Health Support Services’ care have been fully moved onto electronic medical records and this number will increase during the 18-month roll-out, which will eventually see all hospitals sporting the system.

Ramblings: Swine Flu and HL7 (SG) Standards Sharing Session

So what is the co-relation between the Swine Flu (Influenza A, H1N1) that is causing global panic and Health Level Seven (Hl7)  Singapore Chapter ?

Well for starters, they are both related to healthcare but that’s not the main reason for this blog entry.

I was due to present on the topic of Health IT Standards in the Enterprise -Effective Adoption for Workflow Optimization for an upcoming Health Level Seven (Singapore) Standards Sharing Session but the  Ministry of Health (Singapore) raise the alert to “Orange” (back on the 6th March) which basically means all inter-hospital staff movements are restricted and visits to healthcare institutions are discouraged.

Even though the alert has been lowered to “Yellow”, which means no biggie, the event still got postpone till further notice.

Ah well, all hail the swine flu!

Conficker computer virus snakes its way into medical devices

This article caught my attention, not because its super interesting but rather, I’m suprised that the imaging informatics community didn’t take on the lessons learned from the Blaster Worm virus of 2003.

I wrote an article title “Rethinking PACS Security: The Unusual Suspects” (published at PACSWeb in early 2004) and presented (and lecture) on this topic a few times.

Looking back, the guiding priciples mentioned in my materials still holds in today’s environment so I’d recommend all imaging informatics professionals to have a read (and do provide some comments)

Rethinking PACS Security:

The Unusual Suspectssdsdsdasds

The widespread Conficker computer worm has crawled into hundreds of medical devices, including MRI systems, at dozens of hospitals in the United States and other countries.

The San Jose Mercury News reported that the worm has not resulted in causing harm to patients, but poses a potential threat to hospital operations.

“A few weeks ago, we discovered medical devices, MRI machines, infected with Conficker,” Marcus Sachs, director of the Internet Storm Center, told Mercury News. The Internet Storm Center is an early warning system for internet threats that is operated by the SANS Institute in Bethesda, Md.

Around March 24, researchers monitoring the worm noticed that an imaging machine used to review high-resolution images was reaching out over the internet to get instructions – presumably from the programmers who created Conficker.

The researchers discovered that more than 300 similar devices at hospitals around the world had been compromised. Because the machines were running an unpatched version of Microsoft’s operating system used in embedded devices, they were vulnerable. Normally, the solution would be to install a patch, which Microsoft released in October 2008. However, the device manufacturer said rules from the FDA required that a 90-day notice be given before the machines could be patched, the Mercury News reported.

“For 90 days, these infected machines could easily be used in an attack, including for example, the leaking of patient information,” said Rodney Joffe, a senior vice president at Neustar, a communications company that belongs to an industry working group created to deal with the worm. “They also could be used in an attack that affects other devices on the same networks.”

Conficker spreads by copying itself onto machines running Microsoft’s Windows operating system that lack the security patch. Conficker installs itself and periodically reaches out for directions from its maker that cause it to rewrite its code, increasing its capabilities for malicious action and decreasing its chance of detection.

“Hopefully the malware writers didn’t have a lot of insight into how these medical devices work,” Patrik Runald, chief security adviser for F-Secure, a Finnish computer-security company, told Mercury News. Runald said the worm had also been found at a hospital in Sweden and several hospitals in England earlier this year.

Joffe, who testified before Congress on May 1, asked lawmakers to remove the barriers to coordination between federal agencies so cyber threats, like Conficker, can be addressed.

HHS names health IT committee members

Behold! The Department of Health and Human Services (HHS) has appointed three members to the Health Information Technology (HIT) Policy Committee as well as members of the HIT Standards Committee.

(P.S. Read the list of members appointed by HHS below, check out the Walmart representation)

The two new federal advisory committees were established by the American Recovery and Reinvestment Act of 2009. The first meeting of the Health IT Policy Committee will be held Monday, May 11, in Washington, D.C.

“The Policy and Standards Committees bring together a wide diversity of key stakeholders to help guide the advancement of health IT as an integral part of health reform,” stated David Blumenthal, MD, National Coordinator for Health Information Technology at HHS and chairman of the Policy Committee. “I am confident that these committees will provide valuable insight to help develop important health IT policy in the next few years.”

The HIT Policy Committee will make recommendations to Blumenthal on a policy framework for the development and adoption of a nationwide interoperable health information infrastructure, including standards for the secure and private exchange of patient medical information.

The HHS appointees to the Policy Committee are:

• David Blumenthal, MD, National Coordinator for Health Information Technology, HHS;
• Michael J. Klag, MD, dean, Johns Hopkins Bloomberg School of Public Health; and
• Deven C. McGraw, JD, director Health Privacy Project, Center for Democracy & Technology.

The Acting Comptroller General of the United States appointed an additional 13 members, and four members were appointed by the Majority and Minority Leaders of the Senate and the Speaker and Minority Leader of the House of Representatives.The National eHealth Collaborative (NeHC) said that it is delighted that HHS has chosen six members of the NeHC Board of Directors, including its vice chair, to serve on the new HIT Standards Committee. Jon Perlin, MD, of the Hospital Corporation of America (appointed Chair of the HIT Standards Committee), Steve Findlay of Consumers Union, Janet Corrigan, MD, of the National Quality Forum, C. Martin Harris, MD, of the Cleveland Clinic, Linda Dillman of Wal-Mart Stores, and Kevin Hutchinson of Prematics (vice chair of the NeHC Board of Directors) will bring a diverse set of important perspectives to their new roles, assisting in the development of technical standards and specifications that will permit the meaningful exchange of health information.

A complete list of the Policy Committee members and information about the May 11th meeting can be found at http://healthit.hhs.gov. The Presidential appointments from relevant federal agencies are expected to be announced prior to the HIT Policy Committee’s second meeting in June.

In addition, appointments were made to the HIT Standards Committee, also a federal advisory body, which is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. The first meeting of this committee is scheduled for Friday, May 15.

Members appointed by HHS include:

• Jonathan Perlin, MD, chair, Healthcare Corporation of America
• John Halamka, MD, co-chair, Harvard Medical School
• Dixie Baker, PhD, Science Applications International Corporation
• Christopher Chute, MD, Mayo Clinic College of Medicine
• Janet Corrigan, PhD, National Quality Forum
• Linda Dillman, Wal-Mart Stores
• C. Martin Harris, MD, Cleveland Clinic Foundation
• J. Marc Overhage, MD, PhD, Regenstrief Institute
• Gina Perez, Delaware Health Information Network

Representatives from relevant federal agencies will be named separately. For more information about these committees, meeting dates and preliminary agendas please visit http://healthit.hhs.gov.

HIMSS Publishes ‘Meaningful Use’ Definition

On Monday, April 27, HIMSS published its definitions of ‘meaningful use of certified EHR technologies,’ as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). HIMSS sent a cover letter, plus two definitions: 1) meaningful users of certified EHR technologies and 2) meaningful use for hospitals, to the National Coordinator of Health IT and the Acting CMS Commissioner, within the Department of Health and Human Services (HHS)

ARRA calls for multiple years of Medicare incentive payments to hospitals and physicians who meet the requirements of “meaningful use of certified EHR technology” (an electronic health record). To be eligible for the incentive payments, hospitals and physicians must use the technology in a meaningful manner; to exchange electronic health information to improve the quality of care; and, submit clinical quality measures – and other measures – as selected by the Secretary of HHS. Further, hospitals and physicians must meet the definition within a specified time frame, which as described in ARRA, must be made increasingly stringent over time by the Secretary.

Approved by the HIMSS Board of Directors, the definitions resulted from consensus-building effort with input from HIMSS members (73 percent of which work in end-user settings), and the public at-large. HIMSS represents more than 20,000 individual members and 350 corporate members.

In summary, HIMSS recommends the following:

1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
2. To achieve incremental maturation of “meaningful use,” adopt metrics that can be reasonably captured and reported beginning in FY11/2011,* and then made increasingly stringent using intervals of not less than two years. HIMSS’ definitions include specific metrics to enact, in phases, over a multi-year period.
3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
4. Reconcile the gap between “certified EHR technologies,” “best of breed,” and “open source” technologies.

As noted in the letter, HIMSS believes that the Act has tremendous potential to improve the quality, safety, and cost-effectiveness of patient care.

• Read the HIMSS definition for meaningful use of technology in hospitals
• Read the HIMSS definition for meaningful users of EHR technology
• Read the HIMSS letter sent to ONC and CMS

*ARRA requires the hospital-focused definition to be effective FY11 (October 1, 2010). For meaningful users (physicians), the definition must be effective January1, 2011.About HIMSS
The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States and the globe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

For more information, contact:
Joyce Lofstrom/HIMSS
312-915-9237 – jlofstrom@himss.org

Pharma Sees a Bigger Role for Imaging in Trials

This is an interesting article and I must say, it came in a rather timely manner because I was doing a fair bit of googling on the co-relation of imaging informatics with clinical trials and data management (I see it as the bridge from healthcare informatics to a branch of bioinformatics).

Acquiring medical images is an art form, especially when those images serve as endpoints for clinical trials. So says Kenneth Faulkner, VP of medical imaging for Perceptive Informatics, a subsidiary of PAREXEL. Proper acquisition of images is gaining importance as pharmaceutical and biotechnology sponsors embrace imaging more frequently in the earlier phases of clinical development as a tool for faster separation of the more promising compounds from less hopeful ones.

To expand the role of early imaging in clinical trials, sponsors are engaging multiple investigative sites, and are recognizing the need for those sites to acquire images in a uniform manner. “In a multi-center regulated environment, the most important thing is consistency. We need to have all of the sites doing things the same way so we can guarantee that any difference in response is due to the drug, and not due to differences in procedure,” Faulkner says.

Kenneth FaulknerTo facilitate greater use of standardized imaging practices in early clinical trials, Perceptive (along with its PAREXEL parent) has established a dedicated early phase investigational unit offering streamlined image collection, comprehensive image management, and independent image interpretation by industry experts. The company uses its network of sites and provides them with the necessary training to acquire images uniformly in compliance with protocol. In addition, Perceptive is working actively with the Society for Nuclear Medicine as well as other organizations to establish guidelines for the use of exploratory imaging endpoints, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), in early phase multi-center studies. Standardized training and procedures are critical as sites can acquire images in various ways, making the task of consistent image compilation and interpretation nearly impossible.
As an added quality control measure, sites are tested periodically throughout studies for competency. The company maintains early phase testing sites in the United States, Latin America, South Africa, Europe, and Asia.

The push toward earlier imaging comes with broader use of techniques such as PET, fMRI, and single-photon emission computed tomography (SPECT). Traditionally, these techniques have been the domain of academic medical centers where they have been used in small studies involving a handful of sites, often as few as one or two. As Faulkner explains, “Expanding the use of PET beyond the realm of the academic medical center has been difficult because of challenges involved in standardizing how procedures are done.”

Consistent imaging practices yield results that are increasingly recognized for the value they bring to the clinical development process. First, they can help sponsors make better and faster GO/NO-GO decisions by detecting early clues of safety and efficacy. Taking this step sooner, rather than waiting until later phases to introduce imaging, cuts time and expense from clinical development timelines. Also, reliable imaging results can do more than identify endpoints that comply with guidelines for regulatory submission. They can actually provide a marketing advantage. “To go to market, you may need other endpoints that are not accepted for regulatory approval. For example, a regulatory endpoint for rheumatoid arthritis might be images of painful swollen joints. But there may be early signals using magnetic resonance imaging (MRI), x-ray, even ultrasound that are not for regulatory submission but can detect when that disease is starting before it progresses to the point of irreparable damage,” Faulkner comments.

By the time the patient seeks help for swollen joints, the disease has already progressed to the point that clinicians can do little more than relieve their pain. If it is detected earlier, there might be a chance of reversing the damage. It is this broader use of imaging as a diagnostic tool that is often rooted in clinical trials and eventually reaches patients the world over as it becomes part of routine medical practice.