I am co-chairing the first Hackathon at the SIIM 2014 Annual Meeting along with Chris Meenan. Check out participation details here.
If the initial interest expressed is any indication, it is going to be an awesome event. I hope that you can join us.
Healthcare IT
Article – Intelligent virtual assistants
A friend sent me this article on “intelligent virtual assistants” today.
I think this type of technology has merit, but not in the applications that they describe. Accessing patient history information (“Accessing prior reports and specific report content”) or performing a query (“show me all unread chest CT cases”) is already solved with effective EPR client/data integration and proper worklist configuration.
Where this has merit, I believe, is when the new report is being created, and specific words are used, the assistant can then comb through the available data and automatically create links (e.g. a link to lesion measurements before and after cancer treatment), highlight key info to the physician (e.g. because they used the word “x”, some potentially important lab values automatically pop up in the corner as a notice), or in communication (e.g. initiating real-time consults with an available colleague from a list of appropriate specialists based on specific words being used in the report).
To have value, the assistant has to automate the mundane and has to deal with context across data formats, like scrolling through several pages of info in the EMR to see is any of it relates to the current exam (i.e. will impact the reader’s diagnosis).
JDI Article Published – Where to build It
Another article I submitted to the Journal of Digital Imaging has been published electronically.
This article compares the pros and cons of building a healthcare IT application in an Established Vendor, a Start-up or a Hospital Lab environment, examining aspects such as access to design input and validation to commercialization and transition to support.
Check it out and let me know what you think.
Favorite Blog Posts of 2013
As the first calendar year of my blog draw to a close, I thought I would compile a list of my favorite blog posts from 2013. I hope everyone has a safe, happy, healthy and prosperous New Year.
- 100th Blog Post: What I know about Software Development and Crisis Management
- The rise of the mobile-only user …and how this helps the underpriviliged
- Review of Stage 2 Meaningful Use Test Procedure for Image Results …and other MU tests
- Quebec EHR …the difference 2 years makes
- Video – Empathy: The Human Connection to Patient Care
- Designing for the ‘Public’ and the ‘Pros’
- Articles on Mobile Health Applications and FDA Regulation
- Plug-ins vs. APIs
- Article from HIMSS: PACS will not remain a self-contained data silo
- Blog posts on SIIM Web site (Part 1 and Part 2)
JDI Article Published – PACS 2018: An Autopsy
An article I submitted to the Journal of Digital Imaging has been published electronically.
Told from the year 2018, it looks back at the market and technical forces that results in the deconstruction of PACS (and RIS) as we know it.
Check it out and let me know what you think.
How Long Before a Computer Writes the Radiology Report?
I play Fantasy Football. Usually very badly. For those that don’t know about this hobby/addiction, this will explain it.
Why am I talking about Fantasy Football on a blog about healthcare IT? Because an intriguing feature showed up this year (I have been in the same league since 1998) on the site that manages our league.
After each week, an article describing the battle between my team and my scheduled opponent’s team appears. It is well-written, insightful and sometimes entertaining. The thing is: it is not written by a human.
The quality of the writing is what makes this interesting. You wouldn’t know that a trained journalist had not written the article unless you knew that a computer did it. Take a look at the image below and tell me that sounds like a computer wrote the article pictured within it.
(BTW, for those Fantasy Football fans that read the article, I missed the playoffs, so the victory described is hollow …I really am terrible at Fantasy Football).
Considering the uniqueness of the scenario—the odds of exactly my 9 starting players playing my opponent’s starting 9 players are extremely rare considering the hundreds of players to choose from, even considering there are tens of millions of leagues operating on the site (yes, Fantasy Football is that big)—the text of the article is highly personalized.
Back to healthcare IT, and how this relates.
Consider the wealth of structured clinical data and diagnostic findings that could be combined with genomic data to produce an information model of a patient. Now consider that an application could take that information and automatically turn it into a narrative report that is optimized for different consumers—for example, one for the GP, one for the specialist, one for the patient, one for the home-based caregiver, etc.
Hyperlinks could make extended clinical or reference data available with the press of a finger.
Obviously, a qualified healthcare professional needs to review and sign/finalize the results before they should become part of a patient’s medical record, but imagine how the report could become more useful to the reader, if tailored to their needs, and how much typing and editing could be saved.
Once all this patient data is unlocked using secure REST-based APIs, like those defined in HL7 FHIR and DICOMweb, some very powerful applications can emerge and revolutionize how results are created.
The interpretation of the images is the high value add that Radiologist provide, not typing or dictating—why not free them up to spend more time with their eyes on the pixels and let the computer do the typing?
Inspiration for innovative solutions to problems comes from all types of places. You just have to look for it. 🙂
Figure 1 – Rare example of A Fantasy Football victory
100th Blog Post: What I know about Software Development and Crisis Management
I started writing this blog post about this…
Opinions on policy and politics aside, this article on the struggles of healthcare.gov tells a classic tale of large software development project failures, and how not to react when trying to solve the issues.
But as I continued to write my thoughts, this became more about my views on software development and crisis management. So, enjoy (or ignore, or comment).
Hopefully, it is worthy of my 100th blog post (which this is).
On software development…
- Software development, no matter how much research is done on development methodology effectiveness, is as much art as it is science. Treat the artists like factory workers, and you get what you deserve.
- Not all software developers are great at developing all applications in all languages, using all tools. Web development, especially when connecting to legacy systems, is a specific discipline. The best Web developers don’t work at large contract system development houses, in my experience. That’s usually because there are more interesting projects in the world for them to work on.
- In software, one of the most common reasons for failure is complexity. For large projects like the one cited in the article, you have to work very hard to come up with an architecture that makes concepts and aspects of the application simple to extend and use. This is not cheap—it takes time and significant energy from artists to achieve. But, when it is achieved, it is a beautiful thing. You owe it to yourself to experience this at least once in your career.
- Never ignore or otherwise skimp on quality User Experience Design (UXD). Never.
- Designs change. New needs and unidentified technical risks are discovered. Requirements evolve. But if you want to get something done on time, quit changing the (in scope) requirements. If a good design forces you to re-write significant parts of your requirements, that is a good sign that you didn’t write effective requirements. In fact, they may not be true requirements at all. And, BTW, a list of features from a competitor’s brochure are not requirements. If you don’t how to write effective, (mostly) design-neutral requirements, learn. Start here. Then read this.
- Well-written use cases—that everyone on the team has read and understands—solve a lot of problems. So does identifying the operating environment and performance goals sooner rather than later. Tip: Print this stuff out and hang on the walls were the developers and testers sit. Or (if you want to save some trees) make a JPEG of it and ask everyone to set it as their desktop wallpaper for the duration of the project.
- Make developers create unit and integration tests for their code. Have them do code reviews with peers. Make them use code comments and consistently format their code. Make them fix their own bugs. Hold them accountable to the quality of software build they provide to the test team. Make them perform design checkpoints with their peers (or even customers) for any significant component. Anything less and they are not a serious professional developer.
- Developing for security and performance are specific skill sets, but these are most often “want to” issues. As in, if a talented developer truly wants their product to be secure and fast, they will figure out how to make it happen.
- Do daily stand ups. Make the product manager show up.
- A good tester is as valuable as a good software developer. So is a good technical documentation person. They are artists too.
- Give them all good, fast computers with at least two monitors and reliable Internet access. You want something done faster, remove inexpensive barriers.
- Don’t make them pay for coffee. And don’t buy the cheap stuff.
On crisis management (in IT)…
- The comment in the article about the “war room” is spot-on. I call it “the body cannon”. When **it hits the fan, there is usually some executive wanting to pull anyone and everyone off their current work and throw them at the problem, with no real plan. They are simply hoping that through volume, that the problem will be solved faster, when in fact it usually has the opposite affect. The better approach: select a small team of talented, trusted artists (that know the code!) and simply ask them: “What do you need?”, and then get it for them ASAP. Then, be prepared to pay the price of pulling these people off their current project (usually in the form of a schedule slip), once the crisis is over. These things are always about choices, not decisions.
- Yelling at software developers doesn’t work. People that choose a career creating art by typing all day with headphones on are not the type that react well to yelling. If you don’t know how to convey a sense of urgency without yelling, the problem is you. If you don’t understand the problem or software really well, get out of the way.
- If you have hired talented people, they can become heroes. Let them.
And, finally, if you are making an application for use in healthcare, take it seriously. Lives are at stake. It can still be fun and rewarding, but the problems within healthcare are large and demand our best efforts all the time. Now, go be great.
Article – Privacy guru knocks patient ID as ploy
I posted some thoughts recently about an article on impact of privacy on patient record sharing.
Now, here is an article that discusses the merits of giving the patient control over how they are identified and how their records should be shared.
Fundamental to this are the two approaches:
- A formal managed infrastructure that provides (cross-)identification and record transport services (like eHealth Exchange, formerly NwHIN), or;
- An ad hoc one that allows participants to send record information from point-to-point (ala the DIRECT or Blue Button Plus projects).
Some thoughts…
- As I discussed with a respected colleague of mine at the recent ACR Informatics Summit, I believe that new standards like the emerging DICOMweb (aka QIDO-RS, WADO-RS, STOW-RS) and HL7 FHIR will more easily enable ad hoc exchange of records, but the role of more formal application infrastructures, like those defined by IHE XDS (and its domain specific variants, like XDS-I) will still be used where a mandate for managed patient records across a consortium exists (such as in Canada with the Canada Health Infoway).
- As I mentioned in my prior post, society may have different motivations than those paying for the infrastructure and tools. This article attempts to express some of the concerns consumers may have about how their data is handled, which contrasts with the prior article’s statements about how “nobody under 30 cares about privacy”.
Key Images are… well, key!
As I discuss key images with vendor and healthcare provider staff, I have come to the realization that they are not well understood. Let’s see if we can correct that.
What are key images?
In most contexts, they are images within a medical imaging exams that the Radiologist reviewing the exam wishes to indicate for others, such as the referring physician and clinicians, that they are important in understanding the diagnosis.
In other context, they may represent important images for teaching purposes, quality control, surgical planning or other purposes.
In any case, they serve some importance over other images in the exam and the user wishes to communicate this. That’s why they are ‘key’.
Who creates key images and how?
In the digital world, any authorized user can mark an image as a key image on any system that supports this function. Typically, this function is restricted to authorized users like Radiologists on systems like PACS; however, they may also be created by Technologists/Radiographers on modality workstations or clinical imaging systems, like an Enterprise Viewer in an EMR.
Key images are normally created in one of two ways:
- Manually by selecting an image and choosing a key image method
- Automatically by creating some other form of markup or measurement on the image (implying that it has some importance)
The latter capability is important as getting Radiologists to take the time to mark images as key is often difficult. And if they are not created, the consumer does not benefit from them.
Special case: In systems that allow the user to create spine labels, these should not result in automatic key image creation.
Article: EHR copy and paste? Better think twice
When I think about how much effort is put into ensuring the right info gets associated with the right patient in standards and interoperable records, the thought that a patient’s clinical info could be “corrupted” through copy-paste by users is very scary.
Don K Dennison 