Infographic Health Informatics

This infographics by the University of Illinois at Chicago gives details on what Health Informatics is and which role it will play in healthcare in the future. They state that the future is in desperate need of a large number of health IT professionals that will help to keep the healthcare system affordable.

This link will give you access to the original on the website of the University of Illinois: http://healthinformatics.uic.edu/resources/infographics/the-intersection-of-healthcare-and-it/

Full version to be found here

RSNA 2012 - Next Generation Infrastructure for Medical Imaging

Interoperability and Integration—from HL7, DICOM, IHE, to SOA

Modern radiology workflow requires consumption, choreography, and orchestration of content from multiple disparate information systems that do not natively “talk to each other.” Without optimal integration and interoperability amongst these systems, humans are required to serve as “integrating agents:” this frequently results in inefficiency and error because humans are not good as a integrating agent.
Examples of practical integration strategies that have been used successfully are web viewer EHR integration, single sign-on, RIS vs PACS driven workflow).
Advanced integration strategies, include using vendor APIs, state aggregation, SOA, and IHE.
Interopability is not just about single logon but should address the integration of the different software tools on a granular scale.
IT should move from choreography to orchestration. Instead of just providing a static edge environment, a more versatile system should be available which is loosely coupled using a middle (bus) layer and move towards a service oriented architecture. A component based architecture that supports composite applications and orchestrates these applications into complex workflows.
SOA is, according to dr. Chang, not going to work in healthcare although everyone else is doing it since healthcare IT groups will not make the effort to go for SOA. However, applications can be implemented to mimic a similar environment collecting and combining all available data in the hospital that can go into a dashboard. In this action, normalization of medical data is essential.

Image Sharing—A Fond Farewell to CDs

We are currently moving from sharing data on CDs to Sharing healthcare information in the cloud. Although it is solving part of the problems with CDs a major concern becomes security and confidentiality when moving to network sharing. Some proprietary enviroments are available but the industry should move to the available standards. The IHE XD profiles should be used when applicable.

RSNA 2012 - IT should be embraced by radiology

As stated by the cover story of today's RSNA daily bulletin, IT is required to become a value innovator in radiology. In future radiology, IT influence should not be restricted to RIS and PACS, but extend to embracing new developments in mobile computing, social networking and virtual collaboration.

IHE TCE Selector demonstration with Mirc

At the Dutch radiologists days we demonstrated the IHE TCE Selector profile together with a central Mirc server. Besides a KPacs implementation, three companies on the exhibit floor also connected to the server using either the freely available TCE selector or their own implementation (Rogan Delft, Sectra and Alphatron).
It proved to be an easy setup that could be configured quickly with high stability. A lot of interest from the participants in the RSNA Mirc teaching file software with special interest for the implementation of more structural setup of teaching files using RadLex (a radiology lexicon also developed by RSNA).

Health and Technology 2012 - Better care by secure data sharing

Presentation by two employees of NEN, the Dutch normalization institute. Medical technology and data sharing are getting more a joined issue. Legislation for medical technology/ devices is in place or developed, but legislation for medical data sharing are not specified yet. There are multiple standards and legislation relevant for medical devices and data sharing such as standards and legislation for ICT, quality and risk management, EU legislation, information exchange, apps and social media. Currently, projects are ongoing nationally and internationally to provide an overview of the available standards (e.g. By Nictiz in the Netherlands).

An important issue is that software is regarded to be a medical device and should apply to the legislation. The NEN has developed a decision tree to determine whether the software is a medical device or not.

This means that most software used in healthcare should be confirming to the guidelines and thus be tested and validated. To determine if software should be regarded tot be a medical device, the Intended use of the software is an important issue. The risk level of the software will dictate the requirements for approval.

These risk levels are:
1. No injury or damage to health is possible.
2. Non serious injury is possible.
3. Death or serious injury is possible.

Go to www.hat-congres.nl for acces to the presentations of the conference

Health and Technology 2012 - Towards empowerment for wellbeing and healthy living

Prof. Hummels started with a movie showing the problems in healthcare. Technology could help tackle a lot of the problems but the patient should be central. Fundamental science only is not the way to solve all problems, science for society is required to have the link to evereyday life. One of the areas of research of the TU/e are smart environments. The aim is empowerment of people to live healthy using technology.

Development and trends in health And healthcare are:
1. Aging and chronic diseases
2. Transforming the healthcare system
3. Healthy lifestyle: primary prevention
4. Integrative care
5. Unique personalized solutions
6. Self-management via networked technology
7. Ethics, safety and privacy

Technology trend such as social networking, knowledge economy could help tackle the challenges involved in healthcare if we can evolve to a transformation economy where solutions are developed locally with collaboration of involved stakeholders.

Smart environments involve staying healthy (prevention), empowerment in daily life, and making healthcare sustainable.

Go to www.hat-congres.nl for acces to the presentations of the conference

Monitoring of Health IT systems

According to a webpublication of Hospital IT Europe, there are five steps to simplify IT infrastructure monitoring. These steps are:


1.  Filter your data to only show information which is relevant - minimise the noise
2.  Correlate your monitoring data to identify where you need to focus resources
3.  Track end-user experience to identify changes in performance before the users notice
4. Outsource your infrastructure monitoring to a dedicated managed service provider (MSP)
5. Install modelling software


For a description of the steps, please visit the HITE website.

Study: Poor health IT implementation planning affects patient care

Every hospital is running IT implementation plans and has procedures and regulations to follow and obey to. In all cases it is advocated and believed that implementation of new IT systems such as Electronic Patient Records, and Radiology and Hospital Information Systems will have positive effects on the Healthcare institutions involved in increase of productivity and decrease of cost. However, planning is everything in projects like these as was shown by a paper in the American Journal of Managed Care.
A poorly planned health IT implementation can have deleterious effects on the quality of patient care, and can even increase inpatient mortality, according to an article published in the March edition of theAmerican Journal of Managed Care.
Study: Poor health IT implementation planning affects patient care

ECR - MIR@ECR - Managing Radiology

Three presentations were given in this session.

The first one was on the implications for radiology of Imaging and benchmarking by dr. Schouman. Benchmarking is the comparison to best practices based on measurements. She promoted benchmarking to achieve improvement of the productivity and performance of a radiology department. The current situation with EHR, RIS and PACS starts to enable efficient benchmarking. Problems are
- Cumbersome data capture
- Poor data quality
- Lack of standardization
- Reductive analysis
- Meaningless comparisons
One of the key points is the assurance that manual data entry is done correctly. For example the information going into the RIS.

Second was the added value of in-house radiological IT by dr. Jakobsen. He showed, based on examples, that IT is crucial for the operation of a radiology department and that the absence of IT would take down that complete radiology department. The in-house IT support is critical to keep the IT up and running since they can either solve the problem or knows who to contact. Concluding in-house radiology IT can effectively prevent a stop in workflow.

Finally, dr. Senol talked about Risk management in radiology. As definition of risk he gave: The potential that an chosen action or inaction leads to a negative outcome. Risks in radiology are:
- related to reporting
- direct harm to the patient
- related to decision making
Risks related to reporting are:
- delay
- errors in reporting (up to 4% of reports)
- false positive or negative errors
- incorrect diagnosis
When an error occured patient and hospital should be informed and the root cause of the error should be assessed.

ECR 2012 - MIR@ECR - Communication with our Partners

Three presentations were given in this session.

First dr. Kahn talked about computerized physician order entry and decision support. He approached this from the side of the appropriateness criteria. He stated that those criteria are not meant for the radiologist but for the referring physicians. However, delivering it to them in an enormous pdf file is not very efficient. It should be integrated into the exam ordering process using computerized systems inside the electronic health record. By doing this the referring physician can enter the properties of the patients and get decision support on their order. This should reduce the number of wrong diagnostic tests or may even reduce the number of diagnostic tests. Kahn remarked that we should be talking about a radiology examination request and not an order. Furthermore he stated that decision support should be regarded as advise and not the law and that a physician should be able to reject the advice.

Next, dr. Centoze gave a presentation about communication of urgent and unexpected findings. He started to state that efficient and correct communication is crucial. ESR has release guideliness on communication of urgent and unexpected findings published in insights in imaging. Ideally an automatic alert and feedback system should be implemented. Urgent information should always be communicated directly with the referring physician. Unexpected findings could be communicated with other methods like e-mail .

Finally, a presentation on implications of reporting infrastructure - general reading room vs. Individual office was given by dr. Strickland. She presented her personal preference of a general reporting room and discussed pros and cons of that choice against private offices. The pros are:
- less costs because of maximum use of the workstations
- optimized ergonomics in the central reading rooms
- camaraderie: reporting is a social activity/teambuilding
- facilitates clinician access
- enhances inter-radiologist consultation
The perceived cons are
- noise
- personalized workstation settings lost
- pre-existing building architecture
Extra small reporting rooms could be beneficial to have. But they should not be personal.

Free IPad magazine on HIT

HITExchange magazine is now available for free through the Apple iTunes store. It deliveres an HIT interactive magazine that really starts to use the capabilities of digital magazines to the iPad for free.
HIT Exchange magazine connects healthcare executives who set strategy for their organizations and the IT professionals charged with implementing this strategy throughout their facilities. Each issue covers the most salient IT issues, innovations, and trends from both business and technical perspectives throughout their facilities-reaching more than 72,000 HIT decision makers nationwide.