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RSNA Project: Patients Like Cloud-Based Medical Information Exchange, Too

Montag, den 07. Mai 2012 um 21:40 Uhr

So far, medical facilities, not patients, have been the primary end-users in the ongoing transition to cloud-based medical information exchange. But results from a new study show that, once patients are more fully included, they will be just as satisfied as medical professionals have been.

Patients in a beta project found cloud-based sharing "a faster, more efficient way to store and distribute their medical images than current options." Current options include CDs, still the most common way to share radiology files despite a host of drawbacks and limitations previously discussed in this space.

The patients who are taking part in Image Share, a project of the Radiological Society of North America (RSNA). The society describes Image Share as "a network created to enable radiologists to share medical images with patients using personal health record (PHR) accounts."

Image Share is administered by RSNA and includes about 600 patients from five sites: The Mount Sinai Medical Center (Miami Beach, Fla.); University of California - San Francisco; University of Chicago Medical Center; Mayo Clinic; and the University of Maryland Medical Center (Baltimore, Md.).

The project works very much like eMix. Once patients create an account and password, they are allowed access into the system. It enables them to import their images and reports into their PHR. The transfer is secure because the information is encrypted when it is sent and remains that way until it arrives in the patient’s account.

David Mendelson, MD, FACR, is Chief of Clinical Informatics at The Mount Sinai Medical Center and Chief Clinical Investigator for RSNA Image Share. He has stated that cloud-based medical information exchange is "the next revolution in digital imaging." He describes numerous advantages of the approach including giving patients ownership over their records and making radiology information more accessible to physicians.

Plus, he says "it decreases unnecessary radiation exposure that can be caused by physicians’ ordering duplicate examinations due to records not being easily available."

We couldn’t have said it better ourselves.

The Patient-Centered Medical Home: A Home for Cloud-Based Info Exchange, Too

Donnerstag, den 05. April 2012 um 17:50 Uhr

We’ve been told for awhile that there’s a big change coming in how healthcare is delivered and paid for.

Update: The transformation is here, and it places a premium on efficient sharing of healthcare information.

That’s the word from Paul Grundy, M.D., MPH, a presenter at the 2012 CHIME/HIMSS CIO Forum in February. Grundy, who is president of the Patient-Centered Primary Care Collaborative and director of healthcare transformation at IBM, pointed to the growing percentage of healthcare that is now delivered via the patient-centered medical home (PCMH) model – and also the growing share of payments from private and government payers now going to PCMHs.

A PCMH is a team of providers led by a personal physician who coordinates the patient’s care with various sub-specialists. As Grundy noted, no one provider in a PCMH completely owns patients or their data, so data has to be shared with all relevant team members – smoothly, quickly, and reliably.

Cloud-based medical information exchange has a role to play in this process. Where imaging files are concerned, no method better fits the PCMH scenario than a cloud-based service like eMix that almost instantly move medical files and reports to any provider’s Web-connected computer, including tablets and smart phones.

Moreover, today's Facebooking, tweeting patients expect new types of interactions with their providers, including virtual interactions.

As one sign that medical manufacturers have already geared up for this new reality, consider VGo, a new, remote-controlled “telepresence” robot that, among other uses, enables providers to see and interact with patients as if they were in the same room.

To understand the growing potential of patient-centered medical homes, just follow the money.

Two large private payers, WellPoint and UnitedHealthCare, are redoing their reimbursement and delivery approaches. On the government side, the Centers for Medicare & Medicaid Services (CMS) has committed 11 percent of payments to approaches other than fee-for-service. This redirection of payments will drive more and more providers to adopt the PCMH model, Grundy said.

Why the sudden shift? It’s in part because payers are fed up with the inefficiencies of a healthcare system too heavily reliant on unregulated fee-for-service and rescue/specialty care, Grundy said.

The goal of the PCMH is to improve outcomes and reduce costs through coordinated care. Grundy described several studies showing that the PCMHs studied were already resulting in fewer hospital readmissions and shorter hospital stays.

What does it all mean? A new model of healthcare and provider compensation is here to stay. At the same time, robots at patients’ bedsides and imaging files shared via the cloud are carving a place for themselves in contemporary healthcare. The convergence of these new arrivals could be beneficial for all parties.

Virtual HIMSS12 on Cloud-Based Data Exchange

Mittwoch, den 29. Februar 2012 um 23:10 Uhr

Florent Saint-Clair, eMix general manager, recently led an On-Demand Education Session of Virtual HIMSS12 titled "Cloud-Based Medical Data Exchange: What We’ve Learned So Far." Virtual HIMSS 12 was held online from Feb. 20-24.

HIMSS provided the virtual sessions as a way to take part in activities related to the HIMSS 2012 Annual Conference & Exhibition, other than attending the event in person. Attendees were able to participate from any location in the world. Virtual HIMSS12 included both interactive activities and on-demand sessions such as the one on cloud-based medical data Saint-Clair's session described the evolution of cloud-based medical data exchange from its introduction in 2010 to its increasingly wide use today. He discussed why the technology is a giant leap forward from such troublesome, limited workaround solutions as exchanging files on CDs and sending them via virtual private networks (VPNs).

CD and VPN file exchanges are plagued by such issues as time delays, reliability, and security. Cloud-based medical data exchange has created a sharp, and welcome, break with this troubled past. Thanks to the new technology, a hospital can now securely send an imaging or other medical file to a radiologist's EHR, PACS, or mobile device – indeed, any computer with a broadband connection – in just minutes.

The technology is similar to using email and just as reliable. It is also vender-neutral, which means it neatly hurdles the fact that medical information technology systems are often proprietary and don't easily "talk to" each other. This was the problem that created workarounds such as CD- and VPN-mediated file exchanges in the first place.

Saint Clair's presentation detailed the various ways that patient care has been improved by the increased reliability and speed brought about by services like eMix. He also noted the adjustments that adopters of the services face with respect to their workflow, protocols for handling images, and business processes.

For those who couldn't make it to HIMSS, the session provided an opportunity to get updated on an important new advance in medical data exchange with the depth and sophistication that HIMSS attendees expect.

Joint Commission Sentinel Event Alert: Cloud Computing As One of the Solutions

Mittwoch, den 29. Februar 2012 um 22:59 Uhr

The Joint Commission, which accredits healthcare organizations in the U.S, has issued a Sentinel Event Alert on "radiation risks of diagnostic imaging." Among the several concerns expressed in the Alert is the harm a patient can suffer from the “cumulative effect of … multiple doses over time."

For that reason, the Commission expects institutions to put processes in place to ensure that imaging doses are as low as possible and that unnecessary imaging is avoided entirely.

A Sentinel Alert means the Commission will now hold healthcare organizations responsible for actions called for in the alert. One way to meet the concerns raised by this new Alert is by adopting a cloud-based medical data exchange.

Services like eMix are increasingly well-established tools for avoiding the redundant imaging caused by older forms of data exchange such as burning files to CD. We've described in this blog the pitfalls of exchanging imaging files by CD and why frustrated physicians often order redundant exams when CD exchanges fail.

eMix helps minimize redundant imaging by enabling facilities to exchange files reliably in just a few minutes, even if the IT systems at either end of the exchange are proprietary products that don't normally "talk to each other." Contrast this to the frequent lost, misplaced, unopenable, or corrupted CDs that often lead to redundant imaging when transfer-by-CD is used.

The parent company for eMix, DR Systems, offers other technology that will help institutions meet the Commission's criteria on safer imaging. The Unity(™) Platform Enterprise Imaging Solution includes tools that raise clinicians' awareness of, and accountability for, appropriate dosage levels. These tools include a feature that enables a supervisor to monitor staff adherence to protocols.

The Joint Commission's Sentinel Alert highlights why patient safety and accreditation are powerful reasons to consider the approaches epitomized by eMix and Unity.

eMix Connects the World

Donnerstag, den 17. November 2011 um 20:43 Uhr

We've talked here before about the advantage that cloud-based systems for sharing medical information have over traditional methods such as burning CDs. One more is becoming increasingly apparent: No barriers of time or distance.

A service like eMix instantly creates a pipeline for medical image sharing between any two broadband-connected computers anywhere in the world. The file-sharing can be accomplished in just minutes, whether the two computers are across town from each other or on different sides of the planet.

eMix has demonstrated the global reach of cloud computing over and over in the past year. Here are some recent examples:

In rural England, the family of a young boy with a rare carcinoma located a treatment team in the U.S. whose published paper, which they found online, suggested the team might be able to help the child.

The physicians needed to review the boy's MRI, and that posed a challenge. The family had mailed CDs of their son's imaging studies to specialists several times in the past, often with bad results. Sometimes the CDs got lost in transit. When they did arrive, the several days it took was still frustrating – and dangerous – because the tumor was growing at a furious rate.

When they learned about eMix, through another online search, the family contacted the company. That led to a dramatic intercession by eMix general manager Florent Saint-Clair that enabled the family to get the MRI to the U.S. team minutes after uploading it.

eMix user facility Seattle Children's Hospital tells this story of another eMix-mediated file-swap between the U.S. and UK:

“We wanted to share this good news story with you and also take the opportunity to thank you. Once again you found time to help us provide vital imaging to a care provider and this time it truly was around the globe.

“The organization, Scoliosis SOS located in Suffolk, was in desperate need of imaging that we had of their patient for an upcoming prosthetic fitting appointment. Our ability to provide imaging to an untrained user on another continent speaks to the ease of use and portability of your product. Thanks again.”

Because eMix has established a successful track record at the University of California San Diego, a radiologist there is now able to provide second opinion services for a physician in the Ukraine, with eMix used to transmit the radiology files.

Health Canada, the government single-payer health system, recently OK'd the marketing of eMix in its country.

Such global exchanges are hardly news with ordinary commerce. But medical facilities have struggled even to move files within the same city because of proprietary information systems that are technological islands. With the cloud, however, islands are easily hopped, even if there's an ocean or more between them.

eMix Connects the World

Donnerstag, den 10. November 2011 um 20:20 Uhr

eMix has demonstrated the global reach of cloud computing over and over in the past year. Here are some recent examples:

In rural England, the family of a young boy with a rare carcinoma located a treatment team in the U.S. whose published paper, which they found online, suggested the team might be able to help the child.

eMix user facility Seattle Children's Hospital tells this story of another eMix-mediated file-swap between the U.S. and UK:

Because eMix has established a successful track record at the University of California San Diego, a radiologist there is now able to provide second opinion services for a physician in the Ukraine, with eMix used to transmit the radiology files.

Health Canada, the government single-payer health system, recently OK'd the marketing of eMix in its country.

Imaging Studies on CDs – Why They Fail

Mittwoch, den 19. Oktober 2011 um 22:23 Uhr

Clinicians, techs, and many patients have long known that sharing CDs with imaging files can be a challenging process.

The obvious ones include the time staff has to spend uploading the large files to the media, the transport expense if the CDs are express mailed or sent by courier, and the total time from upload to delivery, which can be days. On top of all this, CDs can get lost in transit.

Other problems pertain to the actual medium itself – essentially, the ability for recipient physicians to load, open, or read the CDs if they do arrive in time to be used.

A survey published in the January 2011 issue of the Journal of the American College of Radiology (JACR) provides some important insights into the messiness of file-sharing by CD. Lead author, Vivek Kalia, MS, from Johns Hopkins University, and colleagues identify the numerous troubles with CDs that provoked their survey's questions. These include:

CDs sometimes don't load because of proprietary formats.
CDs sometimes lack embedded viewer software.
If viewers are included, they may be difficult to use because of complex or unfamiliar interfaces (there is no standardization).
CDs that do load may take a long time to do so.

Plus:

Files that are not in the standardized formats DICOM or IHE PDI
Poor image quality
Wrong, missing, or incomplete studies
Images that can't be manipulated
Compressed data
Corrupted discs
Security measures at the recipient institution “that prevent auto-run and executable files on the recipient's workstation” (true at 20% of respondents' facilities)

Given all these potential hiccups, it’s no surprise that only about 60% of respondents claimed that most (75%-100%) outside digital media were readable or importable.

This also means that as much as 25% of media were not usable, in the experience of most respondents, and that the other 40% of respondents said their experience was even worse. Imagine if 25% of music CDs failed to play when you put them in a CD player. Do you think the format would ever have succeeded?

The survey unintentionally revealed one more important finding. The authors offered two future solutions that could help make the troublesome medical CD obsolete. One was the expanded use of virtual private networks (VPNs). But VPNs have their own issues. The other scenario they place their hopes on is the growth of regional health information organizations (RHIOs). But RHIOs, no longer a new idea, have never fulfilled the promise many held for them years ago -- and some have failed in part because they couldn't agree on a protocol for sharing electronic information.

Interestingly, the authors show no awareness of what we believe is the most logical solution to the data-sharing challenge: cloud-based services, as you might have guessed.

Services like eMix are being used successfully in a variety of ways and settings and addressing all the issues with CDs, including speed, reliability, interoperability, vendor neutrality, and so on. Perhaps a new survey is in order – on user satisfaction with sharing medical data via the cloud.

ONC Plan Misses Obvious Strategy: Cloud-based Medical Information Exchange

Donnerstag, den 15. September 2011 um 20:33 Uhr

The federal Office of the National Coordinator for Health IT (ONC) has developed a Federal IT Strategic Plan aimed at reducing IT disparities between underserved communities. ONC published a draft of the plan in an online blog and is now seeking comments and suggestions.

We have one suggestion: Promote widespread adoption of cloud-based medical information exchange.

While the plan refers to telemedicine in general as one way to improve the usage of healthcare IT, there is no evidence the ONC recognizes that this long-used term should now include cloud-based data exchange. Nor is there any recognition of the superiority of cloud-based services for meeting the plan's other goals.

Three of those goals are:

Achieve adoption and information exchange through meaningful use of health IT
Improve care, improve population health and reduce healthcare costs through the use of health IT
Inspire confidence and trust in health IT

Cloud-based medical information exchange advances these goals in many ways.

Because it is vendor-neutral, it overcomes incompatibilities between different facilities' IT systems –not just in underserved communities but also in the common scenarios where a rural facility is transferring patients with complex conditions to better-equipped institutions outside the community. Here is an example of just such a set-up in the San Diego area, where eMix has made a big difference.

The modest, per-usage fee for using a service like eMix also makes it affordable and scalable for underserved communities. No software or hardware purchase is required. Nor is there a maintenance contract because maintenance is the service provider's responsibility.

Cloud services reduce costs in other ways, too – by avoiding the substantial labor associated with virtual private networks and the labor, postage, and courier costs associated with burning and sending files on CDs.

Cloud-based medical information exchange improves care, as well, because it is a much faster way of getting medical files in the hands of the physicians who need to see them. This is especially true for emergency cases.

Finally, cloud-based exchange inspires confidence and trust in health IT because it ends the frustration that until recently characterized most efforts to exchange files between IT systems. Until recently, sharing files between systems that didn't talk to each other was labor-intensive, expensive, and loaded with breakdown potential.

Those days are over – but only for the institutions that are taking advantage of the technology. If the ONC is serious about its goals, then it should be promoting this simple-to-adopt, simple-to-use solution in its strategic plan.

eMix Helps Young English Boy Get Emergency Consultation in U.S.

Mittwoch, den 17. August 2011 um 18:26 Uhr

Fighting a rare and life-threatening cancer, seven-year old Timmy Mason faces a situation where in the words of his father, “Lost days can mean a lost life.”

But thanks to eMix, the Masons now have a valuable tool to help them beat the clock of Timmy's fast-growing tumor.

Timmy, who lives with his family in the Cotswolds hills of west-central England, has a rare form of cancer called Nasopharyngeal Rhabdomyosarcoma (RMS).

After the disease was diagnosed in 2008, Timmy was treated with chemotherapy and radiation and went into remission. But he has relapsed twice since then, most recently in May. Some of his situation is chronicled on the family’s blog here and on Twitter here.

The urgency to find a cure grew in early August when the family learned the cancer had spread to Timmy's brain stem.

Through online research, Timmy's parents identified a treatment team in Minnesota whose published paper suggested their endoscopic surgical procedure might be able to help Timmy. The Masons contacted team member James Sidman, M.D., who requested Timmy's latest MRI so he could assess the case.

But given the tumor's rapidly advancing state, how could they get the MRI to him in time?

Clinical Data-Sharing 20 Years Ago – and Today

Montag, den 08. August 2011 um 23:00 Uhr

A recent edition of HIStalk, an online blog about healthcare IT, tells

an inspiring story about the ability of IT to prevent catastrophic health

outcomes. But it is also a cautionary tale about the primitive state of clinical

data sharing today – except where cloud-based sharing is used.

The story, which took place in 1993, concerns the daughter of Ed and Julie

Marx. Ed is currently CIO at Texas Health Resources in Dallas/Ft. Worth

but at the time, he was working as the physical relations coordinator at a

hospital where Julie had just given birth. The newborn, Talitha, suffered

from pneumonia and a hole in her stomach from a Strep B infection. The

attending physicians predicted, to the Marxes' dismay, that the problems

would leave their daughter physically and mentally impaired.

Talitha's best chance, the Marxes were told, was to be seen by specialists at

the region's Level 1 NICU. The hospital was 90 minutes away, however, and

the trip was risky for Talitha in her condition. Alternatively, the specialists

were willing to consult at a distance, but only if they could access her

records remotely.

Fortunately, during the previous year, the IT department had implemented

technology that allowed doctors to dial in on a modem and get real-

time access to clinical data. Ed worked on the project, too. Now, with his

daughter's health on the line, he suddenly saw a new use for the system:

Giving the specialists from the Level 1 hospital access to Talitha's records.

With Ed's urging, the proper wheels were set in motion. Access was

accomplished in about two hours, beginning the clinical collaboration

between the Level 1 specialists and Talitha's doctors. Treatment was so

successful that the predicted impairment was averted. Today Talitha is a

healthy, bright child unmarked by the near-tragedy of her first days.

That's the good news. Here's the cautionary note: Even though this drama

took place nearly 20 years ago when IT was less advanced, most hospitals

still have no efficient way to share clinical data if their IT systems don't talk

to each other. In fact, at many hospitals, the options are far worse than

what the Marxes faced. The files would have to be burned to CD and sent

with the patient, which means the patient would have to take that risky trip

to the Level 1 center instead of physicians collaborating remotely.

The primary exceptions are hospitals that have implemented cloud-based

systems such as eMix. Today, Talitha's records could be accessed in a few

minutes, not hours, via the cloud. Now that cloud-based data-sharing has

arrived, hospitals everywhere have the ability to immediately share

patient data in emergency situations. There is no longer an excuse for doing

otherwise.

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Network with eMix

RSNA Project: Patients Like Cloud-Based Medical Information Exchange, Too

The Patient-Centered Medical Home: A Home for Cloud-Based Info Exchange, Too

Virtual HIMSS12 on Cloud-Based Data Exchange

Joint Commission Sentinel Event Alert: Cloud Computing As One of the Solutions

eMix Connects the World

eMix Connects the World

Imaging Studies on CDs – Why They Fail

ONC Plan Misses Obvious Strategy: Cloud-based Medical Information Exchange

eMix Helps Young English Boy Get Emergency Consultation in U.S.

Clinical Data-Sharing 20 Years Ago – and Today

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