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Readers Write 5/17/10

May 17, 2010 Readers Write 6 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Medical Image Sharing: The Future is In the Cloud
By Eric Maki


Is the world coming to an end — the healthcare IT world of proprietary silos, that is? When it comes to the sharing of radiology images and report files, the answer appears to be an emphatic YES.

My facility, the Great Falls Clinic in Great Falls, Montana is just one of dozens I know about that now share full-resolution images and reports via cloud-based technology.

The approach works seamlessly. Both uploading and downloading aren’t much more complicated than sending an e-mail with an attachment. No one needs to babysit the process, which at a leanly staffed rural clinic like ours, is a big advantage. And there are no requirements to establish and maintain the link, unlike the VPNs that were our workaround until recently.

There are advantages to proprietary healthcare IT technology. But when it comes to sharing images, proprietary IT has posed challenges throughout my entire state. Because nearly all of Montana’s medical facilities are less than full-service, we often have to transport patients with major issues to a large hospital in the nearest big city. The docs there, of course, want to see whatever imaging studies and accompanying info we generated at our facility. Proprietary IT forced us to use VPNs or other workarounds like burning and sending CDs.

There was also a major expense involved in all the time we spent to maintain our VPNs every time we installed an IT upgrade such as a beefier firewall. Some of my colleagues in Montana who relied on CDs for file sharing were having other frustrations. Sometimes the CDs couldn’t be read on the recipient hospital’s computers. Sometimes the CDs were damaged, couldn’t be read anywhere, or worse, were lost and never found.

We were fed up with this situation in our state, so 30 of our facilities formed an organization to search for a better solution. We called it Image Movement of Montana, or IMOM. We asked several PACs vendors for ideas and, fortunately, one had just developed a cloud-based service that met our needs. It required no new capital acquisition of hardware or software and bypassed all the proprietary hurdles that had plagued us to this point.

The Great Falls Clinic was one of the six facilities that tested the system on behalf of all 30 IMOM members. It worked pretty much without a hitch. A problem that vexed us for many years was suddenly solved, just like that.

The system we use is called eMix, but there are other players in this game — LifeImage and SeeMyRadiology, for example. From what I’m reading, there may soon be more cloud-based image-sharing services available. It’s clear to me that the medical image sharing’s future is in the clouds.

Eric Maki is manager of information technology at the Great Falls Clinic, Great Falls, MT.


NHIN CONNECT Code-a-thon
By iReporter


ONC sponsored what it called an NHIN CONNECT code<a>thon held in Miami a few weeks back. Like the IHE Connect-a-thon held earlier this year in Chicago, this forum’s attendees were primarily hands-on senior software architects and engineers who are refreshingly working together to tackle our industry connectivity woes. 

This meeting had three components. The main one was two days of in-depth collaborative sessions to discuss a variety of technical topics regarding the current CONNECT version as well as group planning for future version features. The second was the CCD template competition won by Georgia Tech that you highlighted here.

The third and most important component in terms of potential long-term impact on the industry was the creation of the Electronic Health Record Interoperability Special Interest Group (EHRI-SIG). To a standing room only audience (and 60 online participants), the CONNECT team presented their ideas and reached out to the private sector for help in establishing a group committed to advancing the state of practice involving medical record interoperability. 


One unique idea presented involved the use of XMPP, a protocol underneath applications like Skype and instant messaging. The idea presented was to exploit this protocol for implementing new communication and exchanges between doctors, patients, personal health records, laboratories, and pharmacies. Another interesting discussion revolved around the CONNECT teams’ desire to implement no-click solutions and to stop the phone from ringing in the doctor’s office.

The meeting video/audio and presentation and audio can be found here.

This modest event could very well signal the beginning of how health information exchange will fundamentally be changed and accelerated in this country. By combining the best of the NHIN CONNECT industrial strength “trust fabric” with the some of the same concepts being considered within NHIN Direct, this effort is positioned to provide a “sweet spot” that likely will appeal broadly to health care industry stakeholders as they tackle meaningful use under Stages 2 & 3.

EHRI-SIG will be making specific decisions on how to move forward at its second meeting in DC on June 2.  As a true working meeting, attendees are required to submit short use case descriptions and be representatives of EHR, lab, pharmacy, PHR, etc. vendors so that the outcome of the discussion can potentially translate into enhancing their own product capabilities. Information can be found here.

This initiative is an open challenge to the healthcare industry vendor community to demonstrate true leadership at a critical time in order to improve outcomes by getting the right information to the right person at the right time. It will be interesting indeed to see who steps up and who does not.

Creating Efficiencies through Enhanced Communications: Alerts and Notifications
By Jenny Kakasuleff


With the recent passage of health care reform and the 30 million newly insured individuals estimated to enter the marketplace, providers are under increasing pressure to improve productivity and efficiencies to meet increasing demand. These challenges must be met while simultaneously improving the quality of care patients receive.

Historically, providers of health care services have taken a piecemeal approach to implementing health information technologies. This has resulted in a number of disparate systems that do not communicate with one another, and contribute to a growing army of devices that health care providers must haul around with them, or have at their disposal in a largely mobile environment.

The alerting and notification systems still in use at many hospitals today are a conglomeration of proprietary systems and devices utilized to perform one particular function — a bedside monitor that sends an alert to the central nursing station to report a change in a patient’s vitals; a tracking system that allows any provider with computer access to locate a device; or a lab information system that sends an e-mail to indicate an abnormal lab result.

While this approach provides many individual solutions to overcome past inefficiencies, it has been uncoordinated, and as a result, creates its own set of problems. The responding provider is saddled with a number of different communication devices to perform a range of non-standardized tasks.

Most professionals today have the ability to perform all of their business-related (and personal) activities via a single mobile device. We make phone calls, check our e-mail, manage our calendar, pay our bills, locate people and places using GPS, listen to music, connect with friends and family through SMS text and instant messaging, or through social media networking — all through one multi-functional device. It is amazing that the same demand is not pervasive in the medical sector.

Health IT solutions now exist that not only address the problems of the past, but work to streamline the disparate systems currently in use into a single, standardized messaging system that delivers a range of alerts and notifications of varying importance to the appropriate recipient. Also, with the integration of an enterprise-class communication solution, providers now have the ability to receive alerts from each proprietary system — electronic medical record (EMR), hospital information system (HIS), nurse assignment, lab information system, etc. — via a single device powered through a unified communications system.

Different messages are delivered based upon their level of importance and escalated until its receipt is acknowledged. The HIS is then updated and auditing trails create a measure of quality tracking and control. The recipient can then respond to the relevant options generated without locating a phone, computer, or other staff member.

As the American Recovery and Reinvestment Act (ARRA) forces health care professionals to evaluate how best to implement and utilize their EMR systems to qualify for meaningful use incentives, their approach should be holistic; cognizant of current and future challenges; and focused on gaining as much mileage as possible from the investment.

Jenny Kakasuleff is government liaison with Extension, Inc. of Fort Wayne, IN.

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Currently there are "6 comments" on this Article:

  1. Great points by Jenny K.

    Smartphones do have unbelievable potential to redefine point of care communication.

    Unfortunately, consolidation of alarms and notifications is not a novel concept.

    “Health IT solutions now exist that not only address the problems of the past, but work to streamline the disparate systems currently in use into a single, standardized messaging system that delivers a range of alerts and notifications of varying importance to the appropriate recipient.”

    This is the same value proposition Emergin / GlobeStar / Commtech brought to the table 5-6 years ago.

    Alarm and alert consolidation is great, but it is only 1/3 of the equation.

    A virtual “pager toolbelt” on a smartphone is the same as a physical “pager toolbelt” for clinicians… old thinking + new technology = no improvement in workflow and the same frustration for our caregivers.

    iReporter’s comment on XMPP provides a much more progressive view on healthcare communication:

    “One unique idea presented involved the use of XMPP, a protocol underneath applications like Skype and instant messaging. The idea presented was to exploit this protocol for implementing new communication and exchanges between doctors, patients, personal health records, laboratories, and pharmacies.”

    Leveraging ideas, technologies, and thinking from other industries is where we are going to see the revolutionary change in communication at the point of care.

    We are at the very early stages of smartphones entering healthcare… Now is the right time to step back and take a fresh view of point of care communication. Treating a smartphone like a pager, Cisco 792X, Ascom DECT phone, Vocera Badge, or Spectralink (Polycom) is an insult to the power these devices have, and what they could become for our clinicians.

    -Trey Lauderdale
    VP of Innovation

  2. >>> As the American Recovery and Reinvestment Act (ARRA) forces health care professionals to evaluate how best to implement and utilize their EMR…

    I find it disgusting how those in HIT almost gloat about the existence of the ARRA, which is a lousy law aimed at extending the power of the Federal Government in areas they should stay out of.

    The ARRA will not “force” any physician to get into an investiment which will not increase the bottom line. The woefully inadequate $44000.00 grant to set up a system that will cost upwards of $300000.00 in the first 5 years will not get a significant number of doctors going EHR. When penalties begin to fly after 2015, the real losers will be the elderly who will find themselves unable to find a primary care physician to care for them. If I continue to see Medicare patients, I will simply pass on the 5% penalty as a yearly fee.

    EMRs need to come down in price, become simpler to use, pare down to only what physicians want, and most importantly they should NOT rely on the Federal Government to force docs to do anything that they, as businessmen, would not normally do. That would be a recipe for failure.

    The CDC on 12/2009 put out their biannual HIT numbers and only 6.8% are ready for ARRA. Why am I not surprised?


  3. “old thinking + new technology = no improvement in workflow…”

    We used to refer to that as “paving the cow path”.

    Nevertheless, Judy is right about the need to resolve disparate communications methods. It may be an old concept, but the problem remains.

  4. Eric Maki makes a great point : image sharing between healthcare providers is essential for efficient patient care and to avoid unnnecessary exams.

    So why isn’t medical imaging in the meaningful use matrix until 2014 ?

  5. Indeed, “consolidation of alarms and notifications is not a novel concept;” nor does the article suggest that it is. In fact, as I understand it, this concept has existed far longer than 5-6 years – and yet, this “old thinking” has never managed to make a substantial breakthrough in the marketplace amid all of the competitive offerings you mention above.

    I am much more interested in the “why” than the “how” of this concept. Most tech companies get lost talking about HOW they accomplish things with technology rather than taking a deep dive into WHY they put their solutions together. Why do clinical staff and patients need our solutions? Have dated products that streamline systems and devices been inadequate? Are they prohibitively expensive? What is available today to address failures of the past?

    There is a new way of thinking about alarm and event notification that is not only addressing the problems of the past, but which also enhances the capabilities of those currently in use. It is this new era of intelligent interaction between systems that I hoped to highlight – hence the discussion on Smartphones.

    By the way, Voalte’s white paper on Smartphones was insightful and a great use of industry data to support their value. It seems we probably agree on more than your response suggests, but thank you for your feedback.

    In RE: to ARRA – It is not my aim to advocate on behalf of the government, but because these funds are available and presumably more desirable than a penalty; it is important to ensure that those who are seriously considering an EMR can take the necessary steps to receive a maximal return on their investment.

  6. Great site, congratulations.
    My only remark is that your cute logo of a doctor smoking a pipe is a very bad example, indeed. Long term pipe smoking is a causal factor for mouth and pharingeal cancer, tooth decay, etc.
    WHO is strongly against doctors smoking in public, particularly when preserved permanently on the web!

    [From Mr. HIStalk] I’ve explained that here many times: it’s intentional 1950s irony, placed chronologically by the reflector on the doctor’s head.

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