Healthcare IT

Thoughts on Telemedicine

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In reading some of the comments from Lynn Britton, president and CEO of Chesterfield, Mo.-based Mercy at the ATA’s (American Telemedicine Association) 18th Annual International Meeting & Trade Show from this article, it reminded me of some comments I made in this post.

The quote from the article that stood out to me…

“If we had thought about the classic return on investment around the infrastructure we built, we would have had second thoughts about it,” he said. “But the return is there, because that infrastructure is robust and sound, because we can provide those services in every one of those communities you saw on that map.”

Message to providers: expand your network, expand your services, lower your costs …or fall behind.

Here is another article titled “3 things that will help telemedicine go mainstream and win over pessimists” based on ideas shared at the ATA’s annual meeting.

And here is an article titled “3 ways telemedicine is helping Wyoming”, which describes how telemedicine is providing valuable services to the people of the 2nd least densely populated state (only Alaska has fewer people per square mile).

Blog – FHIR Version 1.0

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Check out this blog discussing FHIR. While the initial post seeks to simplify the intent of FHIR to a practical application (essentially a summary document), if you read the author’s own comments on their post, they are already starting to realize the real value of FHIR.

FHIR creates the platform, and the summary document is an application of the platform.

Article – The 8 RIS innovations you need now

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Here is a summary (note: may need to register with site to access) of some RIS (Radiology Information System) innovations that providers should be looking for.

Sneak peek…

  1. Digital dashboards
  2. Electronic medical record aggregation
  3. Clinical decision support
  4. Critical results reporting
  5. Customer service
  6. Technologist feedback
  7. Peer review
  8. Data mining, surveillance, and outcomes

I am working on an article on how (and why) RIS and PACS will be deconstructed and will not exist (as we know them today) in the future. Stay tuned for that.

Article – ARRS: Facial photos curb wrong patient errors

dondennison Healthcare IT ,

This is an interesting study.

Providing patient pictures were found to significantly improve the Radiologist’s ability to detect that images had been associated with the incorrect patient.

I have heard of the idea of using pictures to ensure the correct patient is involved in a procedure or treatment (when the patient is actually in front of you), but not in the diagnostic image review process. It would probably make sense to ensure that the patient picture was available in the EMR, and that the EMR was available (in context of the patient) at the PACS client—that way, even non-PACS users would benefit.

Article – CHIME presses HHS for HIE certification

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This makes sense.

If we are going to certify EMR technology, HIE should be held to the same standard. Especially as more physicians turn to their HIE to provide basic EMR-like access to patient records (mostly because the HIE interface is better than their own EMR’s, the collaboration tools are better, and there is more of their patient’s data from more sources in the HIE).

Article – Enterprise Imaging: Beyond Cloud-based Image Sharing

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Read this, seriously.

Some thoughts…

  • I agree with most of what the article covers. I believe that Radiologists will be more consultant than owner of the Enterprise Imaging (EI) platform.
  • One topic that is not covered is the informatics around the metadata to collect at the time of capture. DICOM and IHE provide guidance as to what metadata we want to capture and include when doing a CT exam, but what needs to be captured when a clinical images are captured and stored is far less defined (though this will evolve as EI is adopted). Hopefully, we can start defining this by using some standard lexicons and codes (like SNOMED CT), as these are more mature now than when we started defining metadata values for traditional radiology modalities.
  • There needs to be close attention paid to the indexing of metadata in the EMR and the EI platform; more than is traditionally done when doing a basic EMR and PACS viewer integration. If an HIE is in place or planned, this also needs to be considered. Not all systems will be capable of managing all the desired metadata (including unique identifiers).
  • The EI platform should be considered a component of the EMR and managed as such–don’t put EI in your radiology PACS; just don’t.
  • We need to develop EI professionals through education and shared experiences, if we want to succeed. I may be biased, but I believe that SIIM is one of the organizations well-positioned to provide this. Check out my two-part blog post (part 1, part 2) on the SIIM web site.

UK study: Telehealth not cost effective

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UK study: Telehealth not cost effective …I have two thoughts on this.

One, telehealth is not only about cost reduction—it is also providing patients access to scarce resources, such as a cardiac specialist. Patients with chronic disease in rural or otherwise under served areas can use telehealth to get services where they otherwise would go without. In this case, telehealth costs equal to, or even a premium above, standard costs may be warranted (or, at least, a comparison to average costs is unfair considering the inflated costs to provide equal services in an area where resources would need to travel to the patient).

Two, costs will come down. And, an 80% reduction in costs (as cited in the article) is not that difficult to achieve if one compares dedicated enterprise solutions to consumer solutions (e.g. smartphone apps). The cost of a widely shared set of web services in the cloud accessed by off-the-shelf, multipurpose consumer devices, like smartphones and tablets, is much lower than deploying and maintaining dedicated vendor-proprietary solutions.

Open mHealth vs. HL7 FHIR

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OK, so check this out. I signed up to the mailing list for Open mHealth, an initiative that promotes the use of designs and technologies that I believe in, like REST APIs and JSON. They have started to post some documentation and specs, and have even have published some early implementation code. They have some discussion going on in a Google Group.

But what I am trying to figure out is how this relates to HL7’s FHIR. They seem to be using the same tools with similar missions.

It will be interesting to see which one gets traction:

  • the open initiative (seemingly) driven by the user community (doctors and people working in hospitals), or;
  • the standard from the well-established and accepted healthcare standards body

It reminds me of MINT (open community) and DICOM Working Group 27‘s (standards body) output (but in this case it was many of the same people involved in both).

In general, the open community moves faster, drives rapid innovation, and gets lots of attention, but the established healthcare IT vendor community often waits for the responsible standards body committee to provide a formal, consensus-driven specification (with design controls and governance around it to prevent unexpected changes), before implementing the API. Also, initiatives like IHE will typically only reference final standards in their integration profiles.

Articles on Mobile Health Applications and FDA Regulation

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Check these out…

Dear FDA: Qualcomm’s Robert Jarrin lists his wishes for FDA regulatory action

Where is the ‘fine line’ between safety and free rein for mobile development?

Some thoughts…

  • At risk of ending up on some government list of subversives, I question how often FDA (or equivalent agency in other countries) regulations actually result in protecting patients when they are applied to health IT products. Yes, good design, development, and validation practices are necessary for quality products. And, yes, health IT products are managing very important, not to mention legally protected, information that—when misused or when a defect affects its operation—can result in improper actions being taken …sometimes with adverse effects. But, for those that have worked for a registered medical device manufacturer, we spend more time with our eyes on paperwork than we should be. Time we could be spending on better design, or additional testing before launch. Too much of the paperwork is about evidence creation, and not about actual quality. Many process and method innovations developed in general IT product development are often difficult to adapt to the expected models in the FDA’s so called good manufacturing practices (GMP), and therefore do not achieve the same benefits/results.
  • If the U.S. government is generating revenue from the new medical device excise tax, is it possible that the FDA may be motivated to determine that more, not fewer, mobile apps are medical devices, and therefore subject to taxation? OK, I may have crossed the line into full-fledged conspiracy theory there. Sorry about that.