HAT 2013 - Diabeter

Diabeter has developed seperate institutions for diabetes type 1 patients. One of the main reasons for developing these new institutions was the rigidness of hospitals when implementing dedicated IT systems to treat disease oriented populations not targeted at the local region of the hospital.

In the diabeter centers everything is centralized around technology IT with a high level of medical specialization. Because the patients are not close to the hospital, IT infrastructure is also very important for distance communication with the patient (tele-medicine).

Example innovation: 

Patients are provided with a USB enabled blood sugar measurement device which is coupled to the computer by the patient at home and the data is transferred to the hospital. Users of this USB device are more inclined to often upload their data and include questions about their data and thus are more engaged in their own clinical process.

They developed a very dedicated, specialized electronic patient record system in which analysis of collected patient data, feedback to the patient, etc is automated. 

SSL is used to safeguard the security of the communication as well as avoiding the sending of the identifying information of a patient.

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Cybercriminals Hold Australian Medical Clinic Electronic Patient Records Hostage

The danger of having an EPR that is not properly project. Read the news story on IEEE about cybercriminals that have hyjacked the electronic patient record of an Australian clinic. They broke into the computer system, encrypted all patient data on the system and are now asking for randsom money to decrypt the data again.

Go here for an ABC news TV item, click below to read the story on the IEEE Spectrum website.

Cybercriminals Hold Australian Medical Clinic Electronic Patient Records Hostage

Computer Magazine November 2012 - The move toward electronic health records

Check out Computer Magazine November 2012 for a whole series on the move toward electronic health records. Selected articles are also available Bericht publicerenfor free at the computer magazine website.

Next-gen PACS according to Eliot Siegel

Look at this Diagnostic Imaging interview with Eliot Siegel recorded at SIIM with his vision of the next generation PACS with, what he calls, clinical analytics. http://bcove.me/nfo2uwot

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

Three European Hospitals up to Stage 6 of the EMRAM scale

Besides the hospital in Hamburg, Germany that received Stage 7 on which I reported earlier on this blog, three other European hospitals have obtained Stage 6 on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) scale.

Azienda ULSS 18 Rovigo (Local Healthcare Authority), Italy, Hospital Clinic I Provincial de Barcelona, Spain, and Inselspital, Bern University Hospital, Switzerland, have all achieved the accolade – the second highest rating on the scale.

More  info on Hospital IT Europe website.

New website launched: Doctors Helping Doctors Transform Healthcare

A new website has been launched called Doctors helping doctors transform healthcare. The authors of the website believe that health IT can and should be used to make care better, safer, and more value-laden. The website was started by a couple of pioneers on health IT and Meaningful use to help guide other doctors to find their way in the health IT jungle to put the health IT to the use for better healthcare.

Just launched, the site already contains a load of blog entries, movies, etc concerning topics like EHR Benefits, Meaningful Use, and Transforming Care.

RSNA: Putting patients in charge of image sharing makes for better care

A discussion I raised earlier on this Blog (here) is the fact that it would be well feasible to make patients responsible for their own data and remove the data sharing problem from the list of hospital IT. In the US, pilots are running to assess the possibilities of having the patient share his or her own data. One of the pilots is supported by the RSNA and mentioned here.

Check out the story on this topic on Health Imaging:
RSNA: Putting patients in charge of image sharing makes for better care

RSNA: Practical Informatics for the Practicing Radiologist

This session was organized in conjunction with the Society for Imaging Informatics in Medicine (SIIM).

Keith Dreyer presented on meaningful use where the transition has to be made from a department centered EHr to a patient centered EHR with acces to any information of a patient from any location. Driving forces are consumerism with technology advances and the informed patients, but also economics where the demand is on decrease of healthcare costs. In radiology this means either reducing the cost of imaging or reducing the amount of imaging. A third driving force is quality (image intepretation and report, image access).

The thing that is wrong with a RIS is that it is departmental centric, the RIS should be fully integrated with the EHR. Interaction with requesting physicians and patients must be improved.

In PACS the trends are towards Vendor Neutral Archive (VNA) with standards based archiving and cloud storage. Image display should move to storage independent web/mobile access. Image management should not focus on PACS or RIS based but patient centric.

New technologies that are playing a major role in future radiology informatics are:

• Cloud computing
• Mobile computing
• Healthcare innovations (clinical decision support, personal health records)

German hospital achieves highest level of Electronic Patient Record according to HIMSS Analytics Europe

HIMSS Analytics Europe has granted level 7 of the european EMRAM (Electronic Medical Record Adoption Model) awards to the University Hospital Hamburg-Eppendorf in Germany. They are the first hospital in Europe to achieve this highest possible level. The hospital is running the electronic patient record Soarian of Siemens Healthcare. The European EMRAM model is a modified version of the American EMRAM adapted to the specific demands of European healthcare institutions. The German hospital achieved level 6 early 2011 and now they are at level 7. This level means that they not only work fully paperless internally, but that patient information is also exchanged digitally to other healthcare providers and insurance companies.

This achievement shows that the exchange of patient information is definately possible and should be advocated. Although a European report earlier this year showed that the exchange of data digitally between healthcare institutions is still far from widespread in the European Union, the trend is definately in this direction and hopefully examples like this will inspire decision makers and IT managers of other hospitals to 'dare' to go fully digital.

Also see the announcement in Zorgvisie (in Dutch): Zorgvisie - Duits ziekenhuis behaalt hoogste EPD-niveau met Soarian

Personal Health Record - MIC 2011 Session

In session on Personal Health Records, the question was posed why we should need Personal Health Records. Generally, the trend seems to be that the most important issue of having a personal health record of some sort is that it provides control over your own health related information. However, big questions are concerning integrity, access, and availability of the data.

One suggestion was to just carry your own personal health information around using a USB stick or other portable device. That would provide a backup that will also be available when internet and or power fails or is not available. One difficult issue here is the limited storage capacity of such a device while the amount of data could run into the tens of gigabytes when multiple CT or MR examinations have to be stored onto it.

Furthermore, because the data on the device should be encrypted a password might be required which could be difficult to provide by the victim in an emergency case. Therefore, besides the device, one should somehow (on the device or in a cellphone entry) a ICE (In Case of Emergency) telephone number.
 

The nation wide patient information system was recently terminated by the government in the Netherlands, therefore initiatives are now arising to go from topdown to bottumup, so start with the patient.
A complication here is that the personal health record is intend for and maintained by the patient, but the information is delivered to the patient by healthcare providers, mainly used by the same or other health care providers, and the information is in most cases incomprehensible for patients. Therefore there should be fixed rules about logging, monitoring and maintainig the health information in a patient driven personal healthrecord to allow the patient to become in control of his/her own health record. When this issue is not considered, the information on the personal healthrecord could easily become corrupted.