Thursday, December 1, 2011

Tips from a Road Warrior (18): What’s in a Name?

I was in the departure lounge of an international airport waiting for a delayed flight when I heard a familiar name over the intercom. It sounded vaguely as if it could have been my last name, but it was not quite as I was used to it being pronounced. Just to make sure, I went to the desk and asked whether they called my name and they told me that they indeed had done so several times. It turned out they wanted to notify me that they had put me on another flight because I would have missed my connection otherwise. 

The incident serves as a reminder of the challenge names pose for healthcare imaging and IT systems. How we identify people, obviously plays a pivitol role in the integrity of the information managed by healthcare imaging and IT systems. First of all, they might be entered incorrectly. A common error is that a data-entry person inputs the last and first name in a single field, which either should contain only the last or first name. Another common problem is a name change due to changes in marital status. At worst, the impact could be that a previous record, result or image might not be available or, at best case has to be merged. The standard actually allows for a special "merge" or “update” transaction to take care of this. 

Other name issues occur with truncations. Not that the connectivity standard does not support sufficient characters, but because an input device has certain limits. I have seen a simple data entry device using a small handheld that only had 16 characters maximum as input. Many foreign names can be longer than that. Some cultures also have double last names, for example, Hispanics typically carry their mother's and father’s names. In my native country, the Netherlands, it is common that a woman maintains both her own and her husband’s name. As a matter of fact, my spouse has been stopped at several international security posts because of the difference between her names in her European passport and how it commonly is entered on airline tickets. 

An additional complication with several European names is the presence of “prefixes,” such as “de la” in French, “von” in German, and “van de” or “van 't” in Dutch with several variations. Many US generated healthcare IT systems do not know how to handle this, or require special configuration options to deal with this. A recent post on a user-group highlighted this issue with a popular CT system that could not match names with these prefixes in its worklist. 

A problem also occurs when people have names in a language and corresponding character set that does not have a exact mapping into English. This is the case with several Asian languages as well as Middle Eastern languages such as Arabic and Hebrew. The name Abraham can be spelled Abrahim and there are many spellings of Mohammed. With medical care becoming increasingly global, it is not uncommon for a patient to be screened initially in a clinic in Dubai, for example, and then treated in a US institution. The international name issue could be easier if the software processing the patient information supports multiple international character sets. This is relatively easy to check in the interface specification. In some cases the name is the only differentiator, as can be the case with identical twins who have the same sex, and birth date, as well as address. 

In conclusion, names are tricky and can cause problems with identification and matching of the right patient records, especially in countries that lack a universal patient identifier (such as the US), making patients identification an ongoing challenge. 

RSNA 2011, What?s New?

As I strolled the giant exhibition halls of McCormick Place at this year's RSNA 2011, it felt less busy. There didn’t seem to be any "buzz," there were no new gadgets or applications generating the interest and excitement of years past. When I asked others about this, there was no clear consensus as to why this should be, but a number of people suggested that the requirement to implement “meaningful use” of Electronic Medical Records has taken up a lot of energy, and investment. It will be interesting to find out at the upcoming HIMSS meeting this spring in Vegas whether this is true or not.

I also found the scientific exhibits disappointing; here is where you can get a peek into what is happening in the research laboratories. The most fascinating demonstration this year was the use of manual gestures through standard gaming technology to operate a radiology workstation. 

Another interesting development is the use of Kiosks for allowing patients to enter their personal information into their electronic medical record electronically, instead of having them fill out pages of forms, consents, HIPAA statements and other paperwork, which seems to be necessary every time one makes a physician appointment. 

Decision support for order entry, which checks appropriateness of specific orders against a specific complaint, also seems to be taking off. Exchanging images in an “ad-hoc” manner through subscription services also seems to be growing exponentially to address the need for images to be shared within an institution and between physicians. Images are typically uploaded onto a “cloud” server and are than shared with those physicians who are authorized to do so. Display technology is also improving rapidly, with better of-axis viewing, offering the capability to follow fast changes such as displaying slices that are generated by the new tomographically generated digital mammography systems in a CINE mode. One of the vendors was able to increase the output of its monitor to such a degree that it became a virtual light box and allowed the comparison display of a film on one display with the digital image on the other. 

Of course, the term “meaningful use” was on almost every booth promising a to help conference attendees tap into the US federal incentive programs. And finally, dose reporting also seemed to be on the top of every list, especially for CT vendors. There was a very well done demonstration about the IHE organization on how to do this according to the new standards using DICOM structured reporting. As with many new standard extensions, however, the industry always seems to lag a few years behind, so that in many cases, one still needs to rely on burned-in text that is captured as a DICOM image, which requires screen scraping to get it in an electronic format. 

So, in conclusion, I found RSNA 2011 to be a subdued conference, quiet, not many new things, just another year in Chicago. The good news was that the weather was perfect, I have memories of previous years when I could not get home because of snow and ice, but the weather cooperated very well. This allowed many to visit the company receptions and dinners in the evening and stroll back to the hotel leisurely without having to take a taxi.