The Future of the Personal Health Record (PHR)

I have posted a number of previous notes about personal health records (PHRs). John Moore over at the Chilmark Research blog recently posted on the web one of his lectures about PHRs: Evolving PHR Market: Analysis and Trends. John has been providing some of the most perceptive comments I have seen on the evolution of the PHR. Below is a short list of some of his ideas contained in this specific lecture that caught my attention:

• The PHR market has moved to a B2B model with an employer-provided PHR (35%), provider provided (25%), and health plan-provided (15%).(Slide #5)
• First generation PHRs: isolated. The target was the end consumer and most third party PHRs remain stuck here.(Slide #8)
• Second generation PHRs: Online with some data. One of the major goals was to promote healthy behavior.(Slide #9)
• Third generation PHRs: Highly networked utility. Richer data and a richer experience.(Slide #10)

John is right on target with his remarks. Much of the PHR news recently has been about Google or Microsoft cutting some deal with a large health system or major health insurance company regarding their PHRs. This is a reflection of the increasing importance of the B2B model to which John refers above. John's idea about the third generation PHR as a highly networked utility is pitch-perfect. PHRs will only provide very high value for consumers when they are populated with important medical information. Hospitals, physician clinics, health plans, and health insurance companies control most such information. Therefore, the networked utilities that John describes will serve to connect consumers to providers to payors.

A number of conclusions can be drawn about the networked medical record architecture that John suggests. First of all, the goal of practical untethered PHRs (i.e., the non-networked PHR) that I have supported (see: Implications of the Kaiser-Microsoft PHR Deal) was probably a pipe dream. Secondly, the notion of consumer-space versus provider-space on these networked healthcare utilities is going to get a little fuzzy. I think that this blending and ambiguity will be helpful in the long run. For example, a health care consumer's observations about his or her own health status can be an important component of a health record whereas they are generally not considered to have great value. In addition and starting now, we need to set up standards such that the origin and authors of all data contained in a networked health record can be clearly delineated.

French Unveil Presidency Priorities

The French have set the construction of the European Research Area (ERA) as the main research priority for their presidency of the EU. Other priorities include boosting Europe's role in space and making progress towards a Community patent. The French took over the EU Council Presidency from Slovenia on 1 July.
Read more [eHealth News EU]

Thanks to Shrink Rap for Grand Rounds

Image by Getty Images via Daylife(Better late than never!) Thanks to Shrink Rap for an exceptional Grand Rounds and for including my post on medical applications for the iPhone. Related articles by Zemanta FriendFeed Finally Gets iPhone-Friendly iPhone will ship in green packaging
Read more [Tech Medicine]

Killer SPECT/CT?

I've heard that the Skylight, a room-sized framework suspending two gamma camera heads, was commissioned to do bone scans on racehorses, and having two in my lab (Skylights, not racehorses), I can see where this might have been the case. However, the RT-Image chart indicates that the BrightView SPECT platform, which has a more conventional design, will now be the basis for a second SPECT/CT, available in 2009.

So, once I get my hands on one of these, what will I do with it? The possibilities are really endless. Anything we do with SPECT, we can do better with SPECT/CT. A lesion on a bone scan can be precisely located with the CT component. The blobs of activity that are almost unreadable from a ProstaScint scan suddenly become diagnostic of nodes invaded by prostate cancer when I can see where they actually lie. Cardiac scans gain accuracy with the improvement in attenuation correction. And so on. But there is one theme common to these new and exciting applications: They depend heavily on the CT component. The nuclear literature is chock-full of reports of improvements in diagnosis when using SPECT/CT, especially with diagnostic quality CT's done with IV and oral contrast.

Which leads us into the editorial part of this opus.

The Medical University 100 miles down the road is getting four Symbias. Yes, I said FOUR. Our community hospital here in the boonies has to be competitive, but with luck, I will get one SPECT/CT scanner, so I had better choose the right one.

Equipment vendors are in the business of selling equipment, oddly enough, and they try hard to convince you that their machine is the best, and the other guy's is trash. When I was looking at PET/CT scanners, GE sent me at least a dozen articles that "proved" their older BGO crystals were better than Siemen's LSO crystals. I didn't fall for it, and I'm happy with my PET/CT choice of the Siemens Biograph. (However, I'm very UNhappy with the fact that Siemens released their higher resolution TruePoint machine within a year of our system's purchase, which can't be retrofit our older model.)

GE knows very well that I'm not a Hawkeye fan, but they continue to try to convince me of the error of my ways.

I'll make the assumption that the gamma camera (i.e., the SPECT) components are similar, and that the attenuation correction on each will yield good images. The only reference I could find indicates that the Hawkeye's SPECT resolution is slightly better than that of the Symbia series.

But.... When my Chief Tech asked about the quality of the Hawkeye's CT, she was told, "Why would you need more than attenuation correction?" Excuse me? Obviously, there is a little lack of understanding of one's product here. Attenuation correction is only part of the story, and as the interpreting radiologist, it is the lesser part. When I see hand-waving like this, I know there is something to hide. And it is indeed the CT component.
The Hawkeye's CT (we'll be generous and call it that) can acquire 4 slices simultaneously, although I'm not sure how fast it rotates. You sure as heck wouldn't want the open gantry rotating beyond a snail's pace, or someone is going to get hurt. Slice thickness is (per RT-Image) 5mm. OK, but the darn thing puts out only 1-2.5 mA with a 350 Watt generator! Compare this to the Symbia T6, with a 6-slice CT, that has a 50 KW (50,000 Watts), that can develop 20-345 mA. The Emotion CT platform can scan down to 0.63 mm. That's a real CT, with diagnostic images for correlation. In a departmental pinch, a Symbia can even be used as a stand-alone CT.

Why do I need more than attenuation correction? Because CT is what SPECT/CT is all about, folks. Yes, attenuation correction is important, and it greatly improves the image. But I need the diagnostic CT, and it needs to register perfectly with the SPECT image. In this way, I can match the anatomy to the physiology, and that is what I need to do. Sadly, GE doesn't want to acknowledge this, mainly because its product doesn't have a diagnostic CT component. No doubt they will couple their gamma camera with a proper CT someday, but until then, this little deficiency doesn't seem to bother them. In fact, their strategy takes a rather different turn:

Maximum patient dose is 2.5 ma? I'm not quite sure what that is supposed to mean. The initials "mA" stand for milliamperes, a measure of current, or loosely, flow of electricity. The Hawkeye's tube current is indeed rated at 2.5 mA. Yes, this lower-powered tube does yield a lower radiation dose.

The article in the link discusses the supposed danger of too much radiation from too many CT scans, and was inspired by a now-infamous New England Journal article. There has been tremendous debate in our literature, both before and after this somewhat inflammatory piece, concerning the carcinogenic potential of diagnostic radiological procedures in general, and CT in particular. I won't rehash that now. But most agree that it is desireable to keep the amount of radiation to the lowest reasonable level.

GE deserves accolades for its attempts to reduce radiation exposure from its devices, especially in the realm of cardiac CT. But in the SPECT/CT venue, the argument is hollow at best. Because the Hawkeye's CT images are not diagnostic, the patient will have to undergo another CT, and the dose will be added to that from the Hawkeye. In other words, the total dose will exceed what the patient would have received had he or she been scanned on a SPECT/CT unit that had a diagnostic CT in the first place.

Now, being board-certified in both Nuclear Medicine and Radiology, I rather take offense to that last line in the quote from GE about the "Nuclear Medicine Environment". The implication here is that Nuclear Medicine doesn't need diagnostic images. Well, sorry to disappoint you guys, but likely the majority of nuclear medicine exams are read by diagnostic radiologists, and because of PET/CT, most pure Nuc Med physicians are now pretty well versed in reading CT's, so don't even think of going there.

One simply cannot justify the purchase of a SPECT/CT camera on the basis of attenuation correction alone, and that seems to be the majority of what the Hawkeye offers. So, let's not play the radiation dose card, when ultimately a patient scanned on the Hawkeye might get a higher dose than someone scanned on a Symbia or a Precedence. If the extra radiation is so dangerous, and it needs to be limited as much as possible so the scans don't turn out to be harmful (or maybe fatal?), then we need to do only one CT scan and not two, yes?

I'm anxiously awaiting the day that GE delivers a SPECT/CT camera with a real CT in the box. No doubt this will occur. But you will forgive me if I have to pass on the Hawkeye. It just isn't going to be my "killer app".

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Enterprise Archive should be more than a Long-term Storage Solution

The original concept of the Enterprise Archive was to provide a centralized long-term storage solution for multiple department PACS, like Radiology, Cardiology, etc. Deploying the individual "archives" incorporated into each of the Health System's department PACS often requires supporting multiple technologies. That and the obvious redundancy means higher cost of ownership. Several years ago, the simple solution was to deploy a single storage solution that could be shared by the various department PACS, and with a growing number of Radiology and Cardiology PACS vendors supporting open storage solutions, this simple solution was a reasonable solution.

While this solution reduced some of the redundancy, it did nothing to standardize the data. As more and more Health Systems began to realize that replacement of an old PACS with a new PACS required a migration of the data to the new PACS, it became obvious that a solution was also required to address this problem. Thus the original concept of the Enterprise Archive was modified to include a solution to the expensive and painful problem of data migration.

A storage solution alone is not equipped to handle the data migration issue. The management of Radiology and Cardiology data objects requires a feature-rich layer of DICOM services on top of the storage solution. More specifically a DICOM service is required to convert the idiosyncrasies in the DICOM format used by vendor A into the idiosyncrasies in the DICOM format used by vendor B. Simply put, the tools typically used by the data migration service organizations to migrate data from PACS A to PACS B would need to be integrated into the DICOM services package that sits on top of the storage solution. The common term for this format conversion is Tag Morphing. The integration of Tag Morphing into the DICOM layer of a storage solution would enable any PACS to forward image data to this storage solution as well as retrieve image data deposited by itself or any other PACS.

Tag Morphing eliminates the need for future data migration, and Tag Morphing enables data exchange between disparate PACS. Hence the term PACS-Neutral Archive.

The evolution from shared storage solution to PACS-Neutral Archive was a pretty nifty evolution in concept, and it was clearly the genesis of an emerging new segment of the image management market. There are at least six vendors in the United States that offer a product that meets the basic requirements of a PACS-Neutral Archive: Acuo Technologies, Agfa Healthcare, DeJarnette Research, Emageon, InSiteOne, and TeraMedica. There are already several installations of such systems in the United States, and several more in Europe.

But the Enterprise Archive needs to be more than a PACS-Neutral Archive.

Several years ago the concept of accessing image data through the Electronic Medical Record (EMR) was popularized. Then and now, the concept of an EMR is that the vast majority of physicians in a Health System would post their charts and research their patient's study results in the EMR. Therefore it would be convenient if they could access the images associated with those results while remaining in the EMR application. To date EMR products do not include the specialized viewer software required to view Radiology, Cardiology, Ophthalmology, etc. images. Furthermore the EMR is not typically configured with the volume of digital storage required to store a copy of all of these modality images. Instead of incorporating the Image Viewer in the EMR and instead of creating yet another image data repository in the EMR, a much better solution has evolved. A URL interface links the patient study instance in the EMR to the corresponding Department PACS that provides the long-term digital archiving of the study data, as well as the viewing application for the display of the images. The EMR user clicks on a study listed in the EMR and a link takes the user directly to the PACS where the images related to that study are being archived. The viewing application is the same viewer that would otherwise be accessed if the user logged directly into the department PACS. In this case, the user has the benefit of using the department PACS without having to really leave the EMR environment.

This approach is really a major step forward in information access, but it didn't take long to foresee two significant problems. First, enterprises with multiple department PACS would have to support separate URL links between the EMR and each of those PACS. In really large Enterprises, the number of separate PACS is a big number. Second, the physicians who choose to view images from within the EMR application have to learn how to use multiple viewers, each supported by the different PACS.

A PACS-Neutral Archive can obviously become the EMR Data Repository, as it is the single enterprise archive where all image data from all PACS is stored. But the PACS-Neutral Archive alone is not equipped to provide the EMR with a viewing application. Archives are typically not expected to support a viewing application, but that is exactly what is needed to solve this new problem. The ideal Enterprise Archive would first of all be a PACS-Neutral Archive and therefore be the EMR data repository, and secondly it must support a thin client or web-delivered image viewing application that could display any of the image objects that have been committed to the Enterprise Archive. The trick of course is being able to display different types of images (Radiology, Cardiology, Pathology, Visible Light, etc.) with the same viewing software, maybe on the same display screen and in the same working session. This would be the ultimate multi-modality medical image viewer!

The PACS-Neutral Enterprise Archive configured with a Multi-modality Viewer for the EMR would be extremely useful to even a small enterprise. But there are still more key issues that need to be resolved before one could accurately describe this new kind of Archive. What kind of data objects can it accept? How does it treat different types of data objects? Does every object have to be DICOM? What display feature set is appropriate for the EMR user? Interestingly enough, all of these issues are inter-related, and there is a significant difference of opinion on these issues among the developers of the new Enterprise Archive. In my next post, I'll present some interesting positions on these issues and attempt to defend my own personal opinions.


Read more [Gray Consulting]

The Tour is Coming, The Tour is Coming…

This Saturday begins another epic Tour de France.  The 95th Tour, it will be comprised of some 21 stages, cover 3,500 miles, including a mountain stage towards the end that will have those still in the race climbing nearly 15,000 vertical feet in a single day.  Awesome! Despite the all too numerous drug scandals the Tour [...]
Read more [Healthcare IT: Analyst's Views]

Cardiac Electrophysiology Goes Robotic and 3D with CoHesion&trade;

Hansen Medical of Mountain View, California just received FDA approval to market the company's new CoHesion visualization module for complex electrophysiology (EP) mapping procedures, a technology that bridges St Jude's 3D visualization guidance system EnSite™ with Hansen's 3D robotic navigation system Sensei™. We first reported about Sensei™ robotic system back in January 2007. This integrated EP solution offers a software interface between the Hansen Medical Sensei(TM) Robotic Catheter system and the EnSite(TM) System advanced mapping software from St. Jude Medical, Inc. Hansen Medical's platform solution offers physicians the ability to instinctively navigate a catheter during the diagnostic phase of a complex cardiac arrhythmia procedure. The new CoHesion module imports the EnSite System's 3D cardiac chamber model with anatomic labeling into the Sensei system's main navigation window, allowing physicians to see the location of Hansen Medical's Artisan(TM) Control Catheters within the heart in 3D. The EnSite System offers state of the art technology for localization and visualization of EP catheters in 3D, and the Sensei system offers 3D remote manipulation of catheters with instinctive control. Previously, two dimensional technologies, such as fluoroscopy or ultrasound were used to assist physicians with guiding catheters inside the heart. Combining the Sensei and EnSite System technologies is intended to provide physicians with 3D visualization that is expected to optimize control over placement of the catheter in specific locations. St. Jude Medical's EnSite System is an advanced technology for mapping the electrical activity of the heart, and for localizing and visualizing electrophysiology catheters in real-time. The EnSite System creates 3D graphical displays of cardiac anatomy and arrhythmias, and enables catheter navigation without the use of fluoroscopy. The Sensei system uses computer-based catheter technology to provide stable and predictable control of catheter movement. This innovative technology is designed to provide fine guide catheter control in 3D to enable physicians the ability to access hard-to-reach anatomy, and to maintain stability during interventional procedures. The physician workstation is adaptable to existing EP procedure rooms and can be placed away from the field of direct radiation. The disposable Artisan(TM) Control Catheter is comprised of inner and outer steerable guide catheters that accommodate indicated percutaneous catheters. Product page: Presenting the CoHesion™ 3D Visualization Module... Press release: Hansen Medical Announces FDA Clearance for CoHesion(TM) Module... Flashbacks: The Sensei™ Robotic Catheter System... Michael
Read more [Medgadget]

Motion C5 Mobile Clinical Assistant Gets New Features

Motion Computing has just announced that its clinically oriented C5 tablet PC, a computer covered by us on a number of occasions before (see flashbacks below), has just been upgraded and fortified thanks to a new solid state drive (SSD). Here's more: The C5 now features integrated mobile broadband and solid state drive (SSD) options to extend its usability to the point of care, regardless of patient location. Additionally, the C5 and F5 now feature improved capacity with standard 80 GB hard disk drives (HDD) at no additional cost. “Motion understands mobile workforces and we are focused on improving productivity across a broad range of environments, from the patient bedside to the construction site,” said Mike Stinson, VP of Marketing at Motion. “Customer feedback is a critical part of improving our tablet PCs, and based on recent input we’re confident that these upgrades will enable our target customers to be more productive, no matter where work takes them.” With the C5’s optional integrated mobile broadband, mobile clinicians can improve productivity by accessing important patient information, including digital images and patient history details. For many mobile point of care applications, such as those in home healthcare, ongoing connectivity will enable better collaboration with other treating clinicians and reduce travel time by allowing the immediate transfer of documentation after every patient visit, which can reduce processing delays and improve billing cycle times. Additionally, the optional SSD will help further protect the C5 from the occasional bumps and drops experienced by highly mobile professionals. Press release: Motion's C5 MCA and F5 Semi-Rugged Tablet PC Enhance Mobile Workforce Productivity with Upgrades, New Peripherals... Product page: C5 Mobile Clinical Assistant Tablet Computers... Flashbacks: Motion C5: Mobile Clinical Assistant ; DINAMAP to Marry Motion C5 Mobile Tablet; Hands-on with Motion Computing's C5 medical Tablet PC.... Michael
Read more [Medgadget]

Are You Sure You Want that Genetics Test?

Last night, PBS’s science show, ScienceNow (a spin-off of Nova) had a story looking at the controversial issue of consumer initiated genetic testing from such services as 23andMe, DecodeMe, Helix Health, and Navigenics.  The brief video (~10 minutes), does a nice job of framing the issues (though the intro with the “liability rejection” is alarmist [...]
Read more [Healthcare IT: Analyst's Views]

Laser Opto-Acoustic Imaging Technology from Seno Medical

Here's what we know about the opto-acoustic imaging technology from Seno Medical Instruments, Inc., a San Antonio, Texas firm. A recent report on the wires says that there is a new research agreement between Seno Medical and two Canadian universities to study the company's first-ever commercially available opto-acoustic small animal imaging device. It turns out the technology, that utilizes the conversion of laser pulses into acoustic energy once the light hits tissue, can have profound consequences on development of future diagnostic imaging modalities for cancer and beyond. The company explains its technology: Laser opto-acoustic imaging technology combines optics and acoustics with a goal of improving the accuracy of the cancer diagnosis without the use of ionizing radiation (x-ray). The process starts by illuminating the breast with laser light of specific wavelengths. Tumors preferentially absorb the light over normal tissue and become slightly heated. A transient thermoelastic expansion causes a tumor to emit a pressure (acoustic) wave. This acoustic wave is then detected by an array of sensors positioned around the periphery of the breast held within the probe. Signals from the sensors are analyzed and assembled into high contrast, high-resolution images that present the lesion in striking color. Because image contrast is related to both blood volume and oxygenation status, lesions may be correlated with benign or malignant histopathology. This is because malignant tumors possess increased microvasculature, but deplete oxygen from the blood at a higher rate than benign growths. Deoxygenated blood results in brighter images in the presence of a shorter wavelength than it does in the presence of a longer wavelength. This technology has the merit of both the high contrast and spectral specificity of optical imaging and the sensitivity and resolution of ultrasonic imaging. It is more than just a combination of the two methods. The goal is to incorporate laser illumination and ultrasonic detection to achieve very high detection sensitivity. Laser opto-acoustic imaging may permit the identification of tumors as small as 2 mm and has demonstrated the ability to see submillimeter structures. Early detection is important because biologically advanced tumors are more capable of metastasis. Technology page @ Seno Medical: Laser Opto-Acoustic Imaging... Press release: Seno Medical Instruments Launches First-Ever Commercially Available Opto-Acoustic Small Animal Imaging Research System... Flashbacks: Optoacoustic Technology for Early Cancer Detection... Michael
Read more [Medgadget]

CCHIT Certifies 18 More EHRs

The Certification Commission for Healthcare Information Technology in recent weeks has certified specific versions of 18 more ambulatory electronic health records systems under 2007 certification criteria.
Read more [Health Data management Online Current News]

Web Site Lists Radiology Centers

Sunnyvale, Calif.-based RemakeHealth Inc. has launched a Web site giving consumers information about medical imaging centers to help them choose a facility and schedule an appointment.
Read more [Health Data management Online Current News]

Hosted Apps Aimed At Physicians

Annapolis, Md.-based CBaySystems has launched a Web-based, remotely hosted practice management/electronic health records/transcription application for small and medium sized physician practices.
Read more [Health Data management Online Current News]

Russians Commemorate the Enema with a Public Statue

Sometimes we fail to celebrate in a conspicuous way the more mundane but helpful elements of our lives. The good people of Zheleznovodsk, Russia, are doing their small part to help correct this problem (see: Regular Russian City Immortalizes Enema With $42,000 Statue Held Aloft By Angels). Below is an excerpt from this article with a photo (boldface emphasis mine):

For the Russians, [the enema] is something more, because one city there erected an 800-pound, $42,000 statue to honor the device for its many years of unsung service to the backside of mankind. "There is no kitsch or obscenity, it is a successful work of art," said Alexander Kharchenko, a resident of the regularity-loving Zheleznovodsk. "An enema is almost a symbol of our region." ...When you dig a little deeper into this story, you start to see that Zheleznovodsk is in fact the perfect location for this statue. Nestled deep within the Caucasus Mountains region, the city is best known for its spas, and their mineral water-infused enemas drawn from mountain springs. A banner declaring, "Let's beat constipation and sloppiness with enemas" was posted on one of the spa's walls to commemorate the statue.

Commenting at greater length on this story would certainly not improve it and might get me into serious trouble, so I will restrain myself. However, here's a link to a PubMed article in Russian entitled: Errors in directing children to Zheleznovodsk spa. Zheleznovodsk does not sound like a town for the young or faint-hearted. Although, come to think about it, I don't know what the name of the town sounds like at all.

Metal Layering Technique Leads to Fine Tuned Implants

German researchers have developed a manufacturing technique that should make individual bone implants cheaper and more effective. This involves coating a surface with wafer-thin layers of special metal powder. A laser beam heats – or sinters – the powdered metal in the exact places that need to be firm. “It’s like baking a cake,” says Andreas Burblies, spokesman for the Fraunhofer Numerical Simulation of Products, Processes Alliance. Any remaining loose powder is subsequently removed. “The end product is an open-pored element,” explains Burblies. “Each point possesses exactly the right density and thus also a certain stability.” The method allows the engineers to produce particularly lightweight components – customized for each application – that are also extremely robust. In the meantime, the researchers have further enhanced the process to the point where they can actually change the internal structure of the parts after production by means of precision drilling. “We can manufacture and adapt the parts exactly as required,” says Burblies. This makes the technique very attractive to a number of industries, among them the manufacturers of bone implants. It is easy to produce individual implants with an internal structure that resembles the patient’s bone. Metal powders made of biomaterials such as titanium and steel alloys make it possible to reconstruct other bone elements, such as parts of the knee. Press release from Fraunhofer Institute for Manufacturing Engineering and Applied Materials Research: Bake, bake, bake a bone ...... Michael
Read more [Medgadget]

Sand Away Plaque, Keep The Enamel

A new and apparently more precise method to assess the abrasion caused by dental products has been developed by Fraunhofer Institute for Mechanics of Materials scientists. From the press release: A leading manufacturer of dental hygiene products asked the Fraunhofer Institute for Mechanics of Materials IWM in Freiburg, one of whose specialties is the analysis and visualization of surface roughness, to help them develop new prophylactic pastes. The effectiveness of a prophylactic paste has so far been measured by how well the granules that it contains are able to smoothen a rough surface. The test is performed by first roughening tooth enamel or denture materials such as ceramics and titanium to a precisely defined value with an aggressive grinding material. But this does not truly reflect reality, as chewing wears out different materials at different rates. The new measuring method developed by the IWM researchers, a kind of chewing simulation, takes this factor into account. As the experts led by Dr. Raimund Jaeger, head of the Biomedical Materials and Implants department, discovered when comparing pastes and subsequently analyzing the surfaces, some pastes polish the surface but also unnecessarily ablate the tooth material, producing slight grooves on the tooth surface. The ideal paste, on the other hand, polishes so lightly that only the roughness is eliminated while the tooth enamel is hardly ground at all. “Obviously, every case is different,” says Jaeger. “Teeth with particularly heavy plaque or discoloration will need a more abrasive paste.” Normally, however, a gentler prophylactic paste will do the job. Thanks to the IWM researchers, the manufacturer has now been able to optimize the formulation. Press release: Polished to perfection ...... Michael
Read more [Medgadget]

Informaticopia nominated for CW Public sector IT award

It was gratifying to note on the Hodges Model blog that Informaticopia has been nominated for the Computer Weekly blog awards in the Public Sector IT category. Voting is open during July if anyone fancies voting for this blog via the "Vote for me" button & thanks to everyone who contributes here. inPublic Sector ITRodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com
Read more [Informaticopia]

Minimize Brain Injury With Spackle-Like Substance for Cells

A new paper published in the Journal of Biological Engineering describes an experiment in which poly-ethylene glycol (PEG) was used to minimize traumatic brain injury in rats. In the experiment weights were dropped on lab rats' heads (ouch) to cause the brain injury. Some of the rats were treated with PEG shortly after the injury (within 2-6 hours), or received a placebo treatment. The scientists found that the rats that were given intravenous PEG within 4 hours after brain injury had a better recovery than the less fortunate rats. The material works by helping neurons "seal up" leaky membranes. If further studies prove to be successful we could soon see PEG being carried in ambulances for immediate use in head trauma victims. Read more in Nature here... Article abstract... Image: jesusali... jhbarad
Read more [Medgadget]

Mitigating interference between electronic medical devices

By John Halamka Last week, JAMA published an article about the risks of active and passive radio frequency identification to other hospital equipment. The Associated Press and ABC News issued major stories about it. Although the study focused on RFID...
Read more [The Health Care Blog]

University of Utah recovers stolen billing records

The University of Utah Hospitals and Clinics has recovered the stolen patient billing backup tapes that went missing about a month ago.
Read more [Healthcare IT News]

Vendor Notebook - Eclipsys rolls out LIS at Minn. hospital

The Eclipsys Corporation has announced that North Memorial Health Care has selected the Eclipsys Laboratory Information System (LIS) to streamline enterprise efficiencies and communication across inpatient and outpatient settings. Read about this and other business news, contracts and new products in this week's Vendor Notebook.
Read more [Healthcare IT News]

GE Healthcare heads to the Olympics

GE Healthcare will supply an array of imaging technology to assess the cardiovascular and musculoskeletal health of Olympic athletes before, during and after the Beijing Games in China.
Read more [Healthcare IT News]

Survey shows doctors don't trust the government's use of EHRs

Doctors resist the use of electronic health records because they fear the data will be used to control "what they do and how they do it," according to a recently released survey by the Association of American Physicians and Surgeons.
Read more [Healthcare IT News]

Europe sets goal of EHR interoperability by 2015

Europe is setting its sights on the interoperability of electronic health records by 2015. The European Commission on Wednesday issued a recommendation on cross-border interoperability.
Read more [Healthcare IT News]

The Joint Commission posts 2009 hospital standards online

The Joint Commission has reorganized its hospital standards for 2009 and has for the first time made them available online.
Read more [Healthcare IT News]

Medication Bar codes

John Halamka has this interesting post on medication bar coding for inpatient applications. He mentions a company, RxScan, that has an application which can read bar codes off medications labels and translates them to the NDC code and medication name.
Read more [RHIOs, Health Information Exchange and Healthcare IT]

IRIS Hospital Network Chooses dbMotion to Improve Patient Care

IRIS, the organizational network of Brussels' 5 public hospitals, and dbMotion announced the agreement for a major project to provide an interoperability platform for medical information sharing to the Brussels region.
Read more [eHealth News EU]

GBA Updates its Practice Mgmt. App

GBA Health Network Systems has added new functions to version 3.0 of its MEDfx physician practice management software.
Read more [Health Data management Online Current News]

Ancillary Vendor Gets Marketing Help

DocuSys Inc. of Atlanta has partnered with a federal contractor to enable marketing of its ancillary hospital products to medical facilities in the Departments of Defense and Veteran Affairs.
Read more [Health Data management Online Current News]

Trials Partners Integrate Software

East Windsor, N.J.-based ClinPhone, a vendor of information systems to manage clinical trials, will integrate with the data analysis software of Cytel Inc., Cambridge, Mass., to better manage "adaptive" trials.
Read more [Health Data management Online Current News]

Telehealth Technologies Addressing the Global Impending Nursing Shortage

Telehealth Technologies Addressing the Global Impending Nursing Shortage... In addition to providing better care for patients at a distance, telehealth technology applications can provide a real means for the nursing profession to alleviate the impending nursing shortage. According to a report of the Health Resources and Services Administration (HRSA), there will be an unmet need for more than Bobhttp://www.blogger.com/profile/16014609332742259093noreply@blogger.com
Read more [Informaticopia]

Our blog shortlisted for Computer Weekly IT Blog Awards!

in
Public Sector IT


This is a really amazing development.
Thanks to the CW team for the recognition!
It's great to see that Rod Ward is listed too informaticopia
Nursing - Community Informatics - let's spread the care!
Read more [Hodges' Model: Welcome to the Quad]

Agfa's TWO Suitors

The Slaying of the Suitors, image courtesy of http://www.mainlesson.com

I've written before about Agfa being for sale, and Siemens needing a PACS product. In an article yesterday, AuntMinnie.com put these seemingly disparate facts together like chocolate and peanut butter in a Reese's cup:

Agfa-Gevaert of Mortsel, Belgium, reportedly has spoken with Erlangen, Germany-based Siemens about the possibility of selling Agfa HealthCare as part of its strategic review process, according to published reports.

The Financial Times reported that Los Angeles-based equity group Gores Group also has shown interest in acquiring Agfa HealthCare. If Gores were to acquire the division, the story added that Gores is likely to leave management of the healthcare operations in place.
Gores already has holdings in the healthcare market. In July 2007, the group purchased the diagnostic imaging division of HealthSouth of Birmingham, AL. The new company, Diagnostic Health, is one of the larger imaging center chains in the U.S.

The report also noted that an acquisition of Agfa HealthCare by Gores could generate opposition from organized labor in Belgium, adding that the transaction would result in some short-term layoffs.

In 2007, Agfa HealthCare posted net sales of approximately $2.2 billion (U.S.).

Representatives for Agfa and Siemens Healthcare of Malvern, PA, declined to comment to AuntMinnie.com on the report.

Today's Healthcare CIO - C. Martin Harris, MD, MBA

Dr. Harris is on the cover of Health Management Technology, the July Issue. The article is an interview on being a CIO in a health care organization. Who better to explain the role that someone leading a key organization into the future of EMRs, PHRs (including a Google Health partnership), eResearch, and online consults. Certainly a leader and an innovator. 

Technorati: Healthcare IT

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New Client Signs for Eclipsys' Lab

North Memorial Health Care in Robbinsdale, Minn., which includes a 518-bed hospital, will implement the Sunrise laboratory information system from Eclipsys Corp., Atlanta.
Read more [Health Data management Online Current News]

Labedz Takes Over at HealthPort

HealthPort, a vendor of physician software, transactions processing, and document imaging and management software, has named Mike Labedz as president and CEO.
Read more [Health Data management Online Current News]

CIGNA Tests Second Life Tech

Health insurer CIGNA is testing the first of a series of planned Second Life virtual health care communities to help members develop behavior changes that improve health.
Read more [Health Data management Online Current News]

Shameless Self Promotion

Once in a while you have to promote yourself. Well, in this case HIMSS has done it for me. I am please to receive the Spirit of HIMSS Award. Nice article about mean appears today in their HIMSS Weekly Insider.
Not often does one get such acknowledgement for volunteer work but HIMSS finds ways to do this on a regular basis as they are dependent on many devoted volunteers to make the organization a success. I am pleased to be part of that process. I am in good company for this award.

Technorati: PHRs

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eHealth Initiatives to Support Medical Assistance While Travelling and Living Abroad

The European Commission today launched two initiatives to improve the safety and quality of care to people who require medical assistance while travelling or living abroad: a Recommendation on cross-border interoperability of electronic health record (EHR) systems and the Smart Open Services (SOS) project.
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Baseline Article on PHRs - Half Correct

One of the better IT publications is Baseline.  Their reporters typically do in-depth stories on various IT subjects and their case studies of large IT implementations are some of the best I have seen (and in my decade plus as an analyst, I’ve seen a lot). This week, Baseline published an article on privacy and PHRs.  [...]
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Some Interesting Insights into Companion Diagnostics

I have posted a number of previous notes about companion diagnostics (see, as one example, the following: Companion Diagnostics Gaining Ground, But Slowly). Now comes an interesting article that describes in detail about the partnership between a diagnostics company and a pharmaceutical in the future development of such a companion lab test. Below is an excerpt from the article with boldface emphasis mine:

The area of companion diagnostics - ideally defined as a diagnostic developed in tandem with a drug to screen patients for clinical studies and then be commercialized alongside the drug for diagnostic and treatment purposes - has been getting more attention since last year's approval of Selzentry (maraviroc) from New York-based Pfizer. That drug, designed specifically to target HIV patients who test positive for the CCR5 receptor, was developed with the help of Trofile, an HIV co-receptor tropism assay, from Monogram Biosciences. The companies began working together in 2002, and Pfizer used the assay to determine which patients would most likely to respond to treatment for enrollment in clinical studies. In 2006, South San Francisco-based Monogram licensed to Pfizer global rights to Trofile. In that case, "Pfizer came to Monogram," [an analyst] said. "They were developing an entry inhibitor for CCR5 and wanted to select patients appropriately for the trial." And that's the way it likely will have to work between pharma and diagnostics firms in the future, with pharma responsible for driving the development. "For diagnostics firms, it's difficult for them to develop a test without seeing the drug on the other side," [he] said. "It's tough for them to fund that innovation. You wouldn't have seen Monogram developing Trofile on its own, hoping that somebody comes out with a CCR5 therapy."

Here's another quote from the same article:

But [the analyst also] said one of the biggest hurdles is convincing pharmaceutical firms to jump on board the diagnostic train, mostly because pharma has been reluctant to move away from their blockbuster-drug approaches, selling a single pill that can reach a broad market. "Drug companies can be somewhat cautious that having a companion diagnostic might limit the drug's label," .... So "pharma and diagnostics firms aren't really on the same page yet."

All of this makes perfect sense. Big Pharma has been cautious about the wide availability of companion diagnostics in the past because of the belief that such lab testing may constrain the sale of a particular drug. However, as the goal of developing blockbuster drugs begins to fade, Big Pharma now finds it useful to approach diagnostics companies to develop a companion test in parallel with the drug development and clinical trials in order to select the most appropriate subjects for clinical trials and also patients downstream. As I composed this note, I could not help thinking about my previous note (see: Moving Resources from the Therapeutic to the Diagnostic Silo) about using lab tests to monitor therapeutic efficacy. Companion diagnostics provide one of the means by which the right drug can be selected for the right patient.

2009 Joint Commission Standards: Now Available Online

The Joint Commission's revised standards are now available online. Additional details about the revisions are available on the Standards Improvement Initiative web page.

The timetable for the release of the new standards, manuals and scoring information is as follows:

• July 2008: Standards will be posted to The Joint Commission website
• August 2008: Scoring information will be posted to the website
• September 2008: Hard copy manuals will be available for Phase 1 programs (ambulatory, hospital, critical access hospital, home care, office-based surgery)
• November 2008: Hard copy manuals will be available for Phase 2 programs (behavioral health care, laboratory services, long term care)*
• November 2008: Single-user access to E-dition (electronic manuals) will be available for all accreditation customers.
  

NYT: CT Angiography May or May Not Be Worth the Cost

The New York Times has an interesting piece out on the overuse of medical technology. To summarize their five pager: There's not enough data out to suggest that CT Angiography actually reduces costs or improves patient outcomes, but doctors tend to request the tests all the time anyway. They go on to do a so-so job of generalizing the phenomenon... The problem is not that newer treatments never work. It is that once they become available, they are often used indiscriminately, in the absence of studies to determine which patients they will benefit. ... Once the F.D.A. approves a test or device, Medicare rarely demands evidence that it benefits patients before agreeing to pay for it. But last year, Medicare officials raised questions about the benefits of CT heart scans and said it would demand more studies before paying for them. But after heavy lobbying by cardiologists, Medicare backed down. One thing The Times fails to highlight is the factors driving the decision on behalf of the doctors. Not only will they be paid as a result of running the test, they're absolved of potential liability of not running the test. It was our experience in the Ortho world that MRIs and CTs were ordered "just to be safe," lest they be questioned on what could have been found in future malpractice proceedings. Obviously, medical decisions should be based on statistically sound evidence, but there's a fundamental paradox to gathering sufficient evidence before reimbursement: who pays for all of those scans while the data's collected? More from the New York Times...... Tim
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Radial Jaw 4 Biopsy Forceps From Boston Sci

Boston Scientific thinks that its endoscopic Radial Jaw 4 Biopsy Forceps, a device introduced back in July 2006, is better than all other similar products on the market. To its effect, the company touts the results of the study by Garth Swanson MD, et al from Rush University Medical Center that found that "jumbo RJ4 biopsy forceps improved tissue sampling in Barrett's Esophagus compared to standard large capacity forceps." The big idea behind the device is that it features a larger bucket and newly designed holes to allow mucus to flow from the tissue sample. More features from the product page: New jaw configuration is designed to provide: Large tissue specimens for sample handling, preparation and accurate histological diagnosis Jumbo: More than 1.7 X the Jaw Volume of Radial Jaw 3 Large Capacity Forceps Large Capacity: More than 1.2 X the Jaw Volume of Radial Jaw 3 Large Capacity Forceps Consistent sample retention for precise sample identification Enhanced passability through tortuous anatomy Improved micro-mesh tooth design is engineered for a clean, precise bite New streamlined catheter is designed to provide the right balance of columnar strength and flexibility for pushability and control during scope passage New positioning markers are engineered to assist in the insertion and withdrawal of forceps to enhance procedural safety and efficiency Single-use design to eliminate the risk of transmitting patient-to-patient diseases Product page: Radial Jaw® 4 Biopsy Forceps ... Study abstract: The Effect of a New Jumbo Biopsy Forceps on Tissue Acquisition in Barrett's Esophagus (.pdf)... Michael
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Novel Molecular Probes Detect Protein-Protein Interaction

Investigators from MIT are reporting in the online June 27 issue of J. Am. Chem. Soc. a new method to tag intracellular (or in vitro) proteins to allow the study of their interactions. Here's what the authors note in the study: One protein partner is fused to Escherichia coli biotin ligase (BirA), while the other protein partner is fused to BirA’s “acceptor peptide” (AP) substrate. If the two proteins interact, BirA will catalyze site-specific biotinylation of AP, which can be detected by streptavidin staining. To minimize nonspecific signals, we engineered the AP sequence to reduce its intrinsic affinity for BirA. The rapamycin-controlled interaction between FKBP and FRB proteins could be detected in vitro and in cells with a signal to background ratio as high as 28. We also extended the method to imaging of the phosphorylation-dependent interaction between Cdc25C phosphatase and 14-3-3ε phosphoserine/threonine binding protein. Protein−protein interaction detection by proximity biotinylation has the advantages of low background, high sensitivity, small AP tag size, and good spatial resolution in cells. The following is from a statement issued by MIT: The new technique allows researchers to tag proteins with probes that link together like puzzle pieces if the proteins interact inside a cell. The probes are derived from an enzyme and its peptide substrate. If the probe-linked proteins interact, the enzyme and substrate also interact, which can be easily detected. To create the probes, the researchers used the enzyme biotin ligase and its target, a 12-amino-acid peptide. Their work is conceptually related to an approach that uses GFPs (green fluorescent proteins), which glow when activated, as probes. Half of each GFP molecule is attached to the proteins of interest, and when the proteins interact, the GFP halves fuse and glow. However, this technique results in many false positives, because the GFP halves seek each other out and bind even when the proteins they are attached to are not interacting, said Ting. The new probes could be used to study nearly any protein-protein interaction, Ting [Alice Ting, MIT Pfizer-Laubach Career Development Assistant Professor of Chemistry] said. The researchers tested their probes on two signaling proteins involved in suppression of the immune system, and on two proteins that play a role in cell division. They are currently using the probe to image the interaction of proteins involved in synapse growth in live neurons. Press release: New probe may help untangle cells' signaling pathways... Michael
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Wearable Muscle Tension Sensors Know More Than What You Feel

A collaboration of European engineers is working on minuscule muscle tension sensors that can be woven into fabric to provide real-time data taken from a person's state of electrical excitation of the muscles. From the statement issued by Fraunhofer-Institut für Zuverlässigkeit und Mikrointegration: [The vest] consists of sensors woven into the fabric that register the electrical excitation of the muscle fibers, and thin conducting metallic fibers that pass the signals to an electronic analysis system. People’s muscle tension changes with their stress level – the greater the stress, the more likely the muscles are to produce a synchronous twitching effect. Though this is barely perceptible, the electrodes register the change. The idea of the sensor vest originated with biomedical scientists at the Catholic University of Leuven, Belgium, who needed an inconspicuous measuring tool for stress studies. Until then, they had affixed electrodes directly to their test subjects’ chests. But this itself induced stress, with the result that the tests delivered very little useful information. The new vest is designed to ensure a more relaxed test environment. The project members are exploring further potential applications such as a special vest for computer games. By selectively tensing the torso muscles, players could use the vest to control figures on the monitor and for instance burst their heroes’ chains and fetters. The vest could also contribute to safety at the workplace – perhaps ensuring that workers do not lift loads that are too heavy for them. And sports coaches could tell from the electronic vest whether athletes have reached their performance limits or still possess energy reserves. ”The most important requirement for everyday use is a robust electronic system,” says Torsten Linz of the Fraunhofer Institute for Reliability and Microintegration IZM in Berlin, the partner responsible for the “packaging”. The entire electronic system has to be resistant to water and perspiration. The electric conductors must not fray even after repeated laundry cycles, and the sensors must be no larger than buttons to ensure that the garment is comfortable. The IZM researchers have meanwhile developed stable metallic fibers, watertight connections and durable sensor buttons. Their task over the next few months will be to integrate the analysis electronics. The project partners have already demonstrated during field hockey training that the vest really works; it enabled players to choose the ideal moment for striking the ball and to hit it much further than usual. We... Michael
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Killing Bugs With E&M

At Georgia Tech Research Institute a new device tuned to kill biological contaminants has been created. Using specific phosphors that emit UV light via cathodoluminescence effect, the device kills tiny critters on surfaces and within. From Georgia Tech: Using flat panel modules that produce X-rays and ultraviolet-C (UV-C) light simultaneously, the researchers can kill anthrax spores in two to three hours without any lingering effects. The system also has the ability to kill anthrax spores hidden in places like computer keyboards without causing damage. "This is certainly an improvement over previous techniques," said Brent Wagner, GTRI principal research scientist and director of its Phosphor Technology Center of Excellence (PTCOE). "The UV-C attacks spores on surfaces and the X-rays penetrate through materials and kill spores in cracks and crevices." The new decontamination system resembles a coat rack with radiation modules arranged on rings at various heights that face outward to broadcast radiation throughout a room. Since the X-rays and UV-C are lethal at the flux densities used, the system operates unattended and is turned on outside the affected space. UV-C light in the modules is produced using the optical and electrical phenomenon of cathodoluminescence. Numerous electron beams are generated by arrays of cold cathodes, each acting like the electron gun in a cathode ray tube. "When an electron beam hits a powder phosphor, it luminesces and emits visible and/or non-visible light," explained Hisham Menkara, a senior research scientist in GTRI’s Electro-Optical Systems Laboratory. With the Sarnoff phosphors in hand, Wagner and Menkara set off to determine the best UV-C emitting phosphor and optimize its properties for use with X-rays in SMD’s small flat panel display. To find the best phosphor that emitted light in the UV-C region of the spectrum – wavelengths below 280 nanometers – the emission spectra of each phosphor was measured against the DNA absorption curve. This curve shows the optimal wavelengths to destroy an organism’s DNA. After investigating many different phosphors, the researchers chose lanthanum phosphate:praseodymium (LaPO4:Pr or LAP:Pr) as the most efficient phosphor, with a power efficiency near 10 percent. Since the UV emission didn’t fall completely under the DNA absorption curve, the relative “killing efficiency” was approximately 50 percent. In the laboratory, Menkara created the phosphor by mixing precursors lanthanum oxide, hydrogen phosphate and praseodymium fluoride (La2O3, H3PO4 and PrF3, respectively) in a glass beaker with methanol (CH3OH) and ammonium chloride (NH4Cl). Air drying the... Michael
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Tiny MRI Machines

A team of researchers from the Fraunhofer Institute for Biomedical Technology Engineering (Fraunhofer-Institut für Biomedizinische Technik IBMT) in Sankt Ingbert, Germany along with Magritek, a Kiwi firm, has been developing tiny MRI machines using permanent magnets in a specific alignment. It is not clear yet what the medical implications for this imaging modality would be. We imagine one can view ingrown toe nails with one of these. The Magnetic Resonance working group at the Fraunhofer Institute for Biomedical Technology Engineering IBMT in Sankt Ingbert has made magnetic resonance imaging mobile. They collaborated with the New Zealand company Magritek to develop small portable devices. Dr. Frank Volke, head of the Magnetic Resonance working group, explains the core technology: "Instead of the large superconducting magnets that have to be cooled with liquid helium and nitrogen, extra-strong permanent magnets are installed in our devices. There is no need for cooling anymore." To make this possible, several permanent magnets are so arranged that the magnetic field lines overlap to form a homogeneous field. In this way, the developers have succeeded in developing small, less expensive, and above all portable magnetic resonance spectrometers that can even be powered by batteries. Press release: Pocket-sized magnetic resonance imaging ... Magritek technology page...... Michael
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Implantable Heart Monitor May Provide Real Time Cardiac Data

Imperial College London researchers have developed an implantable cardiac monitor that supposedly can detect changes in cardiac contractility, hence can function as a continuous (and also wireless) heart failure monitor. From the press release: The sensor is constructed from silicon and vibrates at a rate which varies according to the pressure inside the heart. Once at home, patients would wear a reader, a miniature device that detects these vibrations through radio pulses, and translates them into precise measurements. Patients would be able view their own readings at home via the reader, while doctors could take measurements by dialling up the reader via a mobile phone or by logging onto a secure internet site. The reader could also be set to automatically send alarms to the doctor if a patient’s heart reading reaches critical levels. Lead researcher, Professor Christofer Toumazou, from Imperial College London’s Institute of Biomedical Engineering, says: “The heart pressure sensor could transform the lives of people living with chronic heart problems and has the potential to revolutionise heart monitoring. At the touch of a few buttons a family doctor could dial up their patient’s heart history and plot pressure trends to better manage their condition and prevent the progression of heart failure.” Sir Magdi Yacoub, Professor of Cardiothoracic Surgery at Imperial College London, has trialled the pressure sensor successfully on animal laboratory models. Press release: Implantable sensor will revolutionise the management of heart disease, say Imperial researchers ...... Michael
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Finding What You're Looking For?

Have you ever been at a loss for a data definition that you see in the NPR Report Writer, but couldn't find in the Meditech Data Definitions for your release of Meditech?

Try looking at the Data Definitions that comes after the release you are currently on. If your hospital runs Client Server 5.55 SR2; try looking at the CS 5.6 SR data definitions.
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