Lab Soft News

Colonoscopy Demonstrating a Live Ascaris lumbricoides Roundworm

This is a link for pathologists who don't like to go to the movies but will certainly like this one. Click on the "view video" link at the NEJM web site to see a live Ascaris lumbricoides roundworm viewed through a colonoscope. The video is a supplement to the following article: Jang MK and Lee KS. Ascariasis. N Engl J Med 2008;358:e16. I hate to spoil the ending of the flick for you, but the critter gets snared with a loop.

Last Chance to Register fo the Lab InfoTech Summit

Lab InfoTech Summit, a unique three-day conference for laboratory and hospital professionals designed to provide up-to-date information about clinical lab software and pathology informatics, will begin next Wednesday, April 9, at the Venetian Hotel in Las Vegas. This is your last chance to register. The conference brochure is available on-line. On-line registration is also available. The list of the 41 participating exhibitors is available here.

Phillips Buys "Specialized" Hospital Information System

I have posted a number of previous blog notes about Philips Healthcare, a major multinational player in the medical imaging field as well as many other areas. Now comes the news that Philips will acquire Tomcat Systems, a Northern Ireland-based supplier of cardiovascular information systems (see: Philips Buys Tomcat Systems). Philips has been keeping to the sidelines while rivals GE Healthcare and Siemens Diagnostics have acquired companies in the healthcare IT sector. However, Philips has now made its move into what is being referred to by John at the Chillmark Research blog as a specialty-specific "CVIS" software company (see: Philips Picks Up Niche CVIS Software Company). The Chillmark blog focuses on healthcare IT issues and is well worth reading. Below is an excerpt from the note (boldface emphasis mine):

Yesterday, Phillips announced that it will acquire Irish-based healthcare software provider TOMCAT Systems....TOMCAT offers a well-regarded cardiovascular information system (CVIS) software package that should fit nicely in the existing Philips cardiovascular portfolio. What I find particularly intriguing though is that TOMCAT is a specialty specific EMR/PM software package and to date, Philips has been reluctant to get into the EMR market. Could this signal a change at Philips? Will other EMR acquisitions by Philips be forthcoming?...When one looks at the TOMCAT model, it is easy to see why a cardiologist may like it, but why a hospital CIO may roll their eyes. This is a cardio-specific EMR/PM platform. Such department specific solutions often are difficult to support over time and can become another information silo if they are not full integrated with the host EMR system that a hospital may be using. But today, it is the doctors and surgeons who rule the roost and most often a CIO must accept and adapt to the adoption of disparate solutions such as this. Philips undoubtedly understands this and may be looking to take this approach in doing an end run around large monolithic EMR solutions, such as those from their big competitors, Siemens and GE Medical. Time will tell.

As readers of Lab Soft News will fully understand, "specialized" hospital systems such as the LIS provide optimal functionality for the departments that select them such as pathology/lab medicine, in the case of the LIS, and radiology with the RIS/PACS. You can now add cardiovascular information systems (CVIS) to this growing list. Couple this trend with the repetitive failures of EMRs and CIOs may well roll their eyes at the challenges facing them. This trend toward more and more specialized systems will continue unabated because of the silo mentality in hospitals. Also, our increasingly specialized physicians will demand equally specialized information systems and high level system support. EMRs cannot fulfill this promise.

Finally, John raises the most important question of all. He asks to what extent GE and Siemens will continue to support their monolithic EMR solutions, Centricity and Sorian. For me, the answer to this question is crystal clear. GE and Siemens are in business to make a profit and will continue to sell their hospital EMRs as long as CIOs continue to buy them. However, both of these companies clearly are in the medical diagnostics business and EMRs are largely conduits for the transfer of diagnostic information from the "specialized information systems" to the treating physicians. Strategically and in the long run, they will be the most enthused about the information systems that directly enhance the diagnostic enterprise. And this is exactly where Philips has decide to launch its own IT initiative.

A New Model for Medical Conferences: Broad Choices and No Waiting

David Carr, in a very insightful article in the New York Times (see: We Want It, and Waiting Is No Option), makes a number of interesting observations about the behavior of mainly younger consumers. He describes his visit to a large record store and remarks that most of the customers were "trading headphones at listening posts as they riffled their way through songs that they would no doubt go home and download later." In the article, he quotes extensively from the ideas contained in a new book entitled "Here Comes Everybody: The Power of Organizing Without Organizations" by Clay Shirky. He goes on to make the following observations about the web and consumer behavior:

...[T]he Web is not competition for traditional media, but a completely different system that empowers both groups and individuals, a place where choice is not only an option, but an imperative....[C]onsumers expect exactly what they want, when and how they want it. Music sellers, networks and movie studios are adjusting to a new paradigm where the customer is not only always right, but expects to be able to exercise that judgment with a flick of a finger....[C]onsumers increasingly live in “the cloud,” a wireless universe of always-on content.

Here's a link to a video of Shirky lecturing about some of the ideas contained in his book if you want more details. Here is a link to a video of Shirky discussing new media and the development of a protest culture.

Based on the above observations, it occurred to me that our standard live medical conferences are outdated and need to be modified. The problem, as I now understand it, is that not enough choice and flexibility are being offered to conference registrants. The standard schedule of longish formal lectures by faculty members is analogous to the rigid TV programming that is becoming obsolete because of technology like Tivo and digital video recording. Following are some of my thoughts about how medical conferences could be better organized, taking advantage of the web and the popularity of short-form videos:

• The major advantages of medical conference are the following: (1) faculty panels and Q and A sessions for spontaneous discussion of ideas and opinions; (2) informal networking with other registrants who have similar problems and challenges; (3) interaction with vendor representatives and the ability to view their product demonstrations.
• Let's get rid of the typical 45-minute live-lecture format. Instead we will substitute a set of three or four short-form digital videos by the same faculty, each of them about 10 to 15 minutes long. Time will be allocated during the conference for attendees to browse these on-line videos at their discretion. Live panel discussions by the faculty would be interspersed throughout the conference, allowing them to field questions and defend their positions.
• Companies exhibiting at these new type of conference would also have the opportunity to post on-line their own videos showing their products in the best light. Having viewed these videos, registrants would be able to engage company representatives in a more sophisticated manner in the conference exhibit area.
• A major role of the conference organizers would be, first, to select faculty members based, in part, on the content and quality of the videos that they will have made available for review prior to the conference. Conference organizers could also "commission" new videos specifically for the conference.
• Conference organizers would also develop conference knowledge navigation maps that would organize both the faculty and exhibitor videos by topic, providing guidance about which to browse based on the interests and needs of the viewers. The Q and A sessions would be recorded during the conference and integrated into these knowledge navigation maps at its conclusion for later review.
  

President of eClinicalWorks Discusses PHRs and Patient Portals

I have been following the progress of eClinicalWorks (eCW) for some time, posting a number of notes about the company (see as an example: More on eClinicalWorks: A Successful PMS for Office Practices). eCW has developed and sells one of the leading  office EMRs that can also be called an ambulatory EMR or EMR/PMS. The president of the company, Girish Kumar Navani, is refreshingly candid and always has interesting insights about his company and the larger HIT industry. A recent interview of him by Mr. HIStalk is no exception to this rule (see: HIStalk Interviews Girish Kumar Navani, President of eClinicalWorks). Below is an excerpt from the interview in Q and A format with boldface emphasis mine. The portion selected focuses on patient portals and personal health records (PHRs).

Q: You mentioned Google. What did you think of the Google and Microsoft PHR announcements at HIMSS?

A: There is definitely a big buzz in the industry that something needs to be done regarding personal health records and employer health records. We definitely have a perspective. As it’s been written, although we haven’t written a press release, Wal-Mart has selected eClinicalWorks. We will be integrating with employer-based records there as well. In the coming months and years, PHRs will have a purpose. What mode they take or which company operates them is anybody’s guess right now.

You’ve got EMR companies that are doing patient portals and there’s a value proposition there for the EMR companies and the physician to do it and their patients can have access to their personal health records. Then, the portal can deposit that health record in any PHR system of their liking to share it with the proper entity. I think there will be intermediaries that will help – it could be Google it could be Microsoft,  it could be Dossia, it could be any of the ones that will eventually interoperate around a personal health records system.

I believe, with Navani, that most of the value of PHRs will be based on their ability to interoperate (i.e., share data) with hospital EMRs and ambulatory EMRs, referred to by eCW as an EMR/PMS. I made mention of this in a previous note (see: Cerner's Winona Health Project Featured on the PBS News Hour). I thus favor the idea of a consumer-controlled PHR with interfaces to both hospital EMRs and ambulatory EMRs. These interfaces can be developed as components of patient portals. Here is how eClinicalWorks defines its own patient portal product:

eClinicalWorks Web-based Patient Portal lets patients and doctors communicate easily, safely and securely over the Internet. Patients are given secure passwords that allow them to log into their physician’s system to see their own private set of documents including labs, diagnostics, statements and messages. Doctors can automatically remind patients for their health maintenance reminders, procedure due dates and also send them patient statements and lab results electronically—minimizing the need for patients to call the office.

So in summary, I believe that PHRs will only flourish if and when they are capable of accessing and exchanging data from hospital and ambulatory EMRs. This will require the development of agnostic patient portals that can establish bi-directional links between the hospital, office, and home/PHR data domains. By my use of the term agnostic, I refer to the ability of the patient portal to interoperate with the large variety of heterogeneous EMR/PHR products that have been installed in the HIT market.