New Article: So, You want to buy an ECG Management System

I was organising the ‘old files’ in my portable hard disk when I came across a research proposal I wrote back in Sep 2008 (for a PhD that never happened). I reread the contents and found it still quite relevant so I ‘dusted’ it a little and trimmed it into a “So, You want to” article.

This article briefly examines some of the considerations one should take note of if they are interested in implementing an ECG Management System, mainly on features selection as ECG Management Systems in general does not require major customisation or enhancement to maximise clinical or operational workflow.

I hope you enjoy “So you want to buy an ECG Management System“.

Microsoft to delve further into health IT with Sentillion acquisiton

Here are some updates from HealthImaging.com on Microsoft’s recent activities in the Health IT arena.

Microsoft today announced its intention to acquire Sentillion, a privately held developer of healthcare software, for an undisclosed sum.

Redwood, Wash.-based Microsoft said it intends to combine Sentillion’s context management and single sign-on technologies with its Amalga Unified Intelligence System (UIS), a real-time data aggregation solution.

Both companies’ solutions aim to address the same challenges in healthcare—“integrating vast amounts of clinical, administrative and financial information that flow in and out of disparate information systems and tailoring that information for use by physicians, analysts, laboratory technicians, nurses and administrators.”

Sentillion said it will “continue to sell and support its products to new and existing customers while Microsoft invests in the long-term evolution of the combined portfolio of Sentillion and Microsoft health solutions.”

Sentillion also will continue to operate out of its corporate headquarters in Andover, Mass. The acquisition is expected to close in early 2010.

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

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

Health IT to become 25% of healthcare market

I got this off CMIO.net,

“Health IT is the fastest growing segment of the $1 trillion global healthcare marketplace, and its 11 percent combined annual growth rate is likely to continue through 2013, according to a report from the life sciences consulting firm Scientia Advisors.

Although the growth presents opportunities for companies to sell more inpatient and outpatient EHRs, expand internationally and provide clinical decision support systems, Scientia’s report cautioned there may be barriers for a company to remain competitive, including government, diagnostic and therapeutic trends.

One of the trends that the Boston-based Scientia noted was that health IT expenditures in the U.S. will be heavily weighted toward inpatient and outpatient EHRs and meaningful use requirements at the expense of specialty/departmental information systems and other capital investments.

Scientia’s report indicated that, by 2013, health IT sales will grow from 4 percent of the worldwide healthcare products market to 5 percent–representing a 25 percent increase in health IT’s market share. Though this creates the opportunity for companies to expand internationally, Scientia concluded that a threat will be posed by new entrants to the field.

Although the study found that most incremental health IT-related revenues will be captured in North America within the next few years, faster growth in China and India will present substantial long term opportunities, according to the firm.

The report also predicted other industry trends and drivers:

* Leading players with large installed bases, proven products and streamlined routes to meaningful use of EHRs are likely to gain share.
* Lower risk and lower cost approaches, such as remote hosting, may become popular for certain small hospitals. In the current economic climate, health IT companies will lend hospitals the capital required to finance IT investments.
* Over the long term, disruptive innovations such as open-source software and software as a service (SaaS) could lead to dramatically lower pricing.

The review was conducted by Scientia and was based on primary and secondary research and proprietary analytic methods, the firm said.”

“EMR Implementation Guide, The Link to a Better Future” by The Physicians Foundation

I just posted this on ClubPACS.com and thought I’ll do the same here

I chanced upon this interesting resource and thought I’ll put it here as the Electronic Medical Record / Electronic Health Record / Electronic Patient Record (or one of the other version) is pretty ‘hot’ these days.

The 105-page EMR implementation guide contains a (rather) comprehensive coverage on the current HITECH guidelines, information on how to prepare the adoption and selection process, case studies for review and (most importantly), the budgeting, financing, and contracting considerations.

The EMR guide is available for download here

Grassley probes 10 health IT companies about software

Now this is an interesting read (food for thought).

“Ranking member of the Senate Finance Committee Charles E. Grassley, R-Iowa, has sent a letter to 10 health IT companies requesting consumer complaint information about their health IT products.

The Oct. 16 letter was sent to 3M, Allscripts, Cerner, Cognizant Technology Solutions, Computer Sciences, Eclipsys, Epic Systems, McKesson, Perot Systems and Philips Healthcare and asked them for infomation about complaints received from Jan. 1, 2007 to Oct. 16, 2009.

Grassley is seeking information to conduct an oversight investigation of the manufacturers of health IT and computerized provider order entry (CPOE) systems. In the letter, Grassley said he has received complaints from numerous health industry parties “regarding difficulties they have encountered with the health IT and CPOE devices in their medical facilities.” These complaints, he noted, have included “faulty software…that resulted in incorrect medication dosages.”

The senator pointed out that $19 billion have been earmarked for the development and implementation of these systems, and went on to state that he has “a special responsibility to protect the health of Medicare and Medicaid beneficiaries and safeguard taxpayer dollars.”

“It is appropriate,” Grassley said, “that [taxpayers'] monies are appropriately spent on effective and interoperable health IT systems and devices.”

He also is requesting companies’ information on settlements relating to health IT/CPOE devices and products in the last 18 months, and whether or not they offer financial incentives to healthcare providers for purchasing their products is also being requested.

Grassley revealed in the letter that it “has been reported that IT/CPOE contracts with medical facilities may include ‘hold harmless’ provisions that absolve manufactureres…of any liability for errors that are allegedly [health] IT/CPOE system or software failtures.”

“Gag orders” may be included in these contracts, Grassley wrote, which might prohibit healthcare providers from disclosing flaws and defects in the software.

In addition to the earmarked funds and consumer complaints as reasons for the oversight process, Grassley stated that “there is no system in place to track, monitor and report the performance of these systems/devices, which could impact a healthcare provider’s ability to make informed decisions regarding the implementation of an IT/CPOE system.”

Grassley asked for appropriate responses to be submitted no later than Nov. 6.”

Source : www.CMIO.net

Report: Health IT central to healthcare debate

Health IT is taking a central role in the current healthcare debate, according to a report published by the Institute for Health Policy at Massachusetts General Hospital, George Washington University Medical Center and Robert Wood Johnson Foundation (RWJF)

The report, funded by the Princeton, N.J.-based RWJF, is a continuation of reports done in 2006 and 2008, which outlined the challenges to increasing EHR adoption. The current U.S. survey of hospitals was conducted by the HIT Adoption Initiative, in collaboration with the American Hospital Association.

According to the authors, there is broad bipartisan support to speed health IT adoption and the American Recovery and Reinvestment Act of 2009 (ARRA) has made promoting a national interoperable health information system a priority, authorizing significant resources to achieve this goal.

Among the findings were:

• Less than 2 percent of non-federal general acute-care U.S. hospitals have a comprehensive EHR, and 7.6 percent have a basic EHR.
  
• The individual functionalities most commonly reported as implemented across all units of the hospital were electronic viewing of laboratory (77 percent) and radiology reports (78 percent) and radiology images (78 percent). Approximately one in five hospitals reported fully implemented computerized provider order entry and clinical decision support.
  
• Given the focus on financial barriers, additional reimbursement for EHR use and financial incentives for implementation were the policy options most often cited as likely to have a positive impact on adoption.
  
• Between 2005 and 2008,168 pieces of health IT legislation were passed by states.
  
• Two main barriers prohibit large-scale EHR use for collecting and reporting clinical quality measures. First, the current level of EHR adoption is dismally low in virtually all clinical settings. Second, adoption of records and systems with the capability to enhance and accelerate measurement and public reporting is likely even lower still.
  
• Quality measurement and reporting, combined with the potential of meaningfully applied health IT, could prove to be the necessary accelerator for rapid improvements in the quality and efficiency of care Americans receive.

Source : www.CMIO.net