Imaging 3.0 at ACR Annual Imaging Informatics Summit

Quote: “If you don’t like change, you are going to like irrelevance even less.”

Dr. Bibb Allen talking about the importance of accepting change to the practice of Radiology, explained the rationale behind the American College of Radiology’s Imaging 3.0 framework.

Imaging 3.0 - Dr. Bibb Allen

Articles: EHR Stress

The benefits will come, but we must get through the change and this will be painful. Think of the shift from film to filmless, and paper to paperless (with coded, structured records) is this, times a thousand.

Post-SIIM 2013 Annual Meeting Reflections

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.

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

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.

Quebec EHR …the difference 2 years makes

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.

Apps for Health – Tips for Building an App, Key Trends in Health IT

Prezi presention from @azbib (Heart and Stroke foundation) from today’s Apps for Health event.

Product developers, have a read: 10 great, practical tips on approaching app development that applies to mobile and traditional application products.

Also, some key trends in health for 2013 (originally from Forbes).

Blog – Hospital versus clinic EMRs: what’s the difference?

Technology is easy these days—it really is. Knowing how to use it to solve a problem is harder. And truly understanding the problem is often the difference between success and failure.

I have always felt that one needs to understand the motivations, habits, and even fears of the user, as well as the environment where the product will be used, before design can start.

In this commentary, the author compares the differences between the hospital and clinic environment, and the people working there. I found it insightful, well-written and I learned some new things—check it out.

Article – DoD yanked from health records project

This article is intriguing (and a bit depressing).

First, because it shows once again that the amount of money (say like, US$1 billion) that you throw at a problem does not assure success. Aligning goals and system design principles—and getting firm commitment from all stakeholders—is critical, and it doesn’t seem like that happened here.

Also, there is no mention of the use of commercial HIE technology for record exchange. The article mentions the exploration of commercial EMR technology vs. a custom (“home grown”) EMR, like the VA’s VistA. How is the ONC—a government agency—promoting the use of HIE solutions as part of their patient record evolution, but the VA and DoD not looking at the same approach?

Finally, the vision of an open system is not flawed. And by open, I mean interoperable with modern Web-based APIs. It could even mean open source.

Article – AMA: EHRs create ‘appalling Catch-22’

I enjoyed this article.

Often, policymakers and executives debate the merits of an initiative. What is often lost in the shuffle are the important lessons and optimizations that make the program a success.

In the article, a number of folks discuss the implications of an EMR after implementation, including the possibility of fraud, or the incorrect perception that it has occurred.

My thoughts…

  • Fraud is easier to detect the more the information is electronic and coded. In fact, any pattern is easier to detect if extensive, well-structured data is available. Algorithms that detect possible fraud patterns will emerge, just as they did for credit card transactions. I recall a investigative news show on Medicare fraud where the agent stated that the move to electronic transactions and ‘smarter and smarter’ alogrithms have made their job easier. False positives will be a problem for a while until they get it right.
  • Coding of records is about to become a huge push. Beyond regulations for coding of data, there are several initiatives to provide codes for orderable procedures, lab/clinical observations, medical terms, diseases, medical/surgical/diagnostic services, and even imaging workflow concepts. Other groups are working to provide practical guidance on how to best use these codes in different contexts. This article talks about the need for better and more coding.

And here is an article on a Web site where EMR users can rate their EMR. There are some interesting comments in the article.

Also, an Accenture survey finds a significant increase in the use of EMR and HIE technology by physicians.