More Post-SIIM 2013 Annual Meeting Reflections

dondennison Healthcare IT , , , ,

For years, I have heard providers lament at the slowing (dormant?) pace of innovation in PACS and RIS from established vendors.

Why might this be happening?

It could be that the current architectures have reached their limits. It could be that, with the saturation of PACS in mature markets, vendors are reducing R&D investment in this area. It could be that they can’t sustain the talent needed to innovate, losing creative and skilled people to more interesting/promising areas of IT. It could be innovation-suppressing regulatory burdens. Or the shift of spending to support staff in order to sustain the now sprawling installed base.

Regardless of the root cause(s), I see the emergence of interest in start-ups (such as those in the SIIM Innovator Alley) and open source projects (as seen by the steady traffic at the SIIM Open Source Plug Fest) that attempt to solve problems that the larger vendors appear not to be interested in solving. It seems providers are starting to accept that they are not going to get everything they need from their incumbent PACS vendor in today’s EMR-enabled, Cloud-hosted, analytics-driven, enterprise-accessible market.

Of course, the challenge of the start-up is breaking into the provider’s enterprise where the incumbent vendor may put up some resistance (overtly or passively). And open source is only as good as the staff (or paid service provider) you have installing, integrating and supporting it.

The informatics skills and knowledge provided by SIIM are more important than ever. If SIIM is to continue to lead in providing its members the knowledge and skills they need to survive and succeed, it will likely have to adapt how it organizes the materials to align with new and evolving learning goals. It also needs to adapt the medium by which its members learn, providing focused, on-line options where travel policies and budgets mean attending the annual meeting is not feasible.

I believe in the SIIM strategic plan and am wholly committed to helping the society that has helped me so much over the years thrive.

Post-SIIM 2013 Annual Meeting Reflections

dondennison Healthcare IT , , , , , , , ,

Another great SIIM annual meeting is behind us and it was great, as always. I am going to post some thoughts and reflections this week.

Today, I have been thinking about analytics and, in particular, the use of a workflow engine and a standardized set of terms and definitions (such as what is being defined in SWIM) to ensure analysis of workflow events (type, timing, relationships, patterns, etc.) consistently across systems.

There were several great talks by Dr. Brad Erickson and Chris Meenan and others on the topic and these were followed by a large turnout of engaged attendees for a SWIM demo (see pic below).

...SWIM lessons
…SWIM lessons

My thoughts…

  • The use of a mature, off-the-shelf (open source or commercial) workflow engine has been considered by PACS and RIS vendors, with some attempting to use them in their product. It has not been widely adopted for two main reasons (I believe)…
  1. Most PACS from large vendors were bought, not built by them—the risk of replacing the built in logic with an external engine without introducing functional regression is high (read as: it would be expensive);
  2. Unless the workflow engine spans several systems, it would not have the full benefit (see more on this below).
  • The workflow examples cited often started with the arrival of the image objects from the modality (initial event that starts the workflow channel). Ideally, the workflow engine extends to before the order is placed, managing the order placement, decision support to ensure the right procedure is ordered, scheduling, protocoloing, and acquisition, along with the reading and post-processing steps. It should also span to the results distribution and archiving, managing the timing and destinations of the report and the lifecycle of the historic imaging data.
  • One of the limitations of using a parallel image management pipeline (e.g. sending images through a system before arriving in PACS) in order to detect the event that triggers the workflow can introduce some points of failure. Consider if the system integrated with the workflow engine goes down and images don’t get to the PACS—this outage would limit the value of the integrated image management and workflow engine system. A possible solution is to extend PACS and other systems, such as the RIS, EMR, CDS, VNA, Enterprise Viewer, document management system, etc. to expose the event information. This would allow the workflow engine to apply the desired workflow rules and orchestrate the data flow and work steps without being a potential bottleneck.

More thoughts from SIIM later. Stay tuned.

SIIM 2013

dondennison Healthcare IT , ,

I am at SIIM 2013 until Sun. I am looking forward to learning some great new things and meeting some new awesome people, as I always do. I will try to tweet and/or post about some hot topics when I can.

Look for #SIIM13 on Twitter for info.

Article – FCC, FDA, ONC seek input on mHealth regs

dondennison Healthcare IT , , , , , , ,

I find the topic of this article interesting.

Here’s why…

  • We have had notebooks and netbooks on WiFi accessing Web-based and other types of applications deemed medical devices (e.g. PACS) for years. The essential difference between a tablet and a netbook is the keyboard. They pose the same risk as a client application platform.
  • If this is what regulators are worried about, wait til they get a load of the bigger billy goat coming across the bridge next …mobile apps are one thing, but what about a portal framework that aggregates patient data from distributed sources, in real-time? Imagine a screen where each discrete element of the patient record is managed in a different system. The values used to define and indicate normal and abnormal test results are from a public Web site. Where does the “medical device” start and end? Who is the “manufacturer” responsible if an issue arises? How do you manage the medical device labeling? With mobile, we are simply trying to figure out how to do what, in many cases, we do today, only now without a wire. …regulatory affairs folks are in for a world of change (or healthcare will fall ever farther behind the IT curve).

Article – Beware: The top 4 hurdles to a successful EHR implementation

dondennison Healthcare IT , , ,

Check out this article. Some fairly common observations for an IT veteran, but good advice for EHR buyers.

Some mitigation tips for each point (read the article for the 4 hurdles)…

  1. Build in resiliency. Evaluate options to operate using locally cached data , if supported.
  2. Learn ITIL, and follow the prescribed best practices. If you do, you won’t be putting in upgrades without putting it through a test plan on a test system before moving to production.
  3. If the EMR allows customization of “templates” (or forms), they need to be validated with the representative user communities before imposing them. Some structure, and form element input validation, is needed to ensure completeness and quality of records.
  4. The application and system performance needs to be considered in the overall plan. Inventorying and analyzing transaction and interaction types and volumes, and working with the vendor to spec a system that meets the need, if an important but often overlooked step. Also, assessing the EMR for ease of scalability prior to purchase is recommended.

In regards to the comments on the trade off of lost productivity vs. potential new revenue, check out this post from a month ago.

The rise of the mobile-only user …and how this helps the underpriviliged

dondennison Healthcare IT , , ,

A friend shared this article from HBR on the rise of people that use their phone as their primary method of accessing the Internet.

When I read about these users, I envision a Starbuck’s-carrying, iPhone-toting mover-and-shaker on the way to a spin class, but there are other parts of the world that are mobile-only by necessity and not by choice.

A good (and very talented) friend of mine courageously left the corporate world to dedicate his time to TulaSalud, an organization that helps healthcare workers in rural Guatamala provide better care. If you speak Spanish, check this site out too.

The only IT platform available to the users are cell phones. Note that I said cell phones, not smart phones (at least today). And network connectivity is not always available. Want to test your mettle as a developer? Try delivering solutions in this environment.

The more mobile-first solutions are available, the faster care can be improved in the areas of the world that need it most, so this trend can only be good.

They are getting some amazing results (lots of folks talk about better outcomes; these folks are getting them) and are an inspiration of mine. I’m sure if you would like to help, they would love to hear from you.

Quebec EHR …the difference 2 years makes

dondennison Healthcare IT , , , , , , ,

The news from today (May 2013) “Quebec to expand $1.6 billion EHR“. And, from 24 months ago (May 2011), “Quebec’s EHR late and over budget, AG says“.

One thing is for sure: implementing an EHR of that size and scale (with public funds), is not for the faint of heart.

Healthcare reform inspires innovators

dondennison Healthcare IT , ,

A friend forwarded this article on to me. It is great to see the energy being put into innovation in healthcare IT—it certainly needs it.

I have attended a few talks on the challenges facing start-ups when entering the realm of healthcare applications. Not only is healthcare a complex domain, with established vendors too often hoarding data in closed systems, but the whole issue of potentially having to becoming a registered medical device manufacturer can be daunting. I am hoping that some entrepreneurs with experience in regulatory affairs and quality system management emerge to provide affordable consulting services to start-ups. Full-time regulatory staff are often expensive and bureaucratic.

I have a written a couple of papers on innovation in different sized companies and environments. They will be published in the next few months. Stay tuned.

Article – 9 ‘Cs’ lead to accountable care …part 2

dondennison Policy ,

Earlier this week I posted an article on Accountable Care. Well, here is part 2. Check it out.

The “business” C’s (from the article)…

  • Collaborative learning
  • Cost-effectiveness
  • Capacity expansion
  • Career satisfaction