Sunday, January 1, 2012

Tips from a Road Warrior (19): Abort a Landing if the Conditions are Unsafe!

Being part of an aborted plane landing is a strange experience. Everyone is ready, the wheels of the plane were out, the flight attendants are seated in their bulkhead seats, and suddenly you feel a very strong acceleration as the plane takes off again and flies straight over the runway, ready to circle around and try again. The first few seconds are somewhat worrisome till the captain comes over the speaker and announces the reason for the aborted landing. I recall one case where he noticed that there was a problem with timely clearing of the airstrip by another plane. I agree that in this case it is to be better safe than sorry and make sure that the next try is better prepared. 

A similar experience of an aborted procedure happened recently to the dad of one of my good friends. He was scheduled for back surgery, and ready to go. He was admitted, prepped with all the IV's and monitors already connected and surrounded with his family till the surgeon came in for a latest check of his files. He noticed that the patient had been taking a blood thinner each morning to take care of a heart condition, prescribed by his cardiologist. Fortunately, the surgeon noticed this and canceled the procedure right away as the patient might have bled to death during the procedure. Everyone went home and was told to come back in a week, after the patient being off the medication for a week. The good news is that this was caught just in time, the bad news is that resources were scheduled and everyone was ready to go. 

There is a lot of talk about implementing electronic health records and how universal access by every healthcare practitioner who can review preconditions, allergies, and definitely medications will provide a safer and more efficient healthcare delivery. Here was a good example that hit home very close to me. Our regional hospital is implementing an Electronic Health record right now. I am sure that the available incentives provided by the American Recovery Act to implement Health Records in a Meaningful Use manner has a lot to do with it. However, their first implementation is only to level 4 of the HIMSS US EMR adoption model (see , which excludes closed loop medication administration, another essential component of electronic health records. The latter would prevent potential drug interactions, inappropriate dosages and drug-allergy interactions. In my opinion, implementing these solutions cannot go fast enough. Imagine the number of unfortunate events that would be prevented or lives saved if this would be available.

Like aborting a plane landing, aborting a medical procedure if it is not deemed safe is a good thing. It would have been better if one could have prevented the conditions causing the cancelation to start with so as not to potential create dangerous situations which could impact the live of one of more people. 

2012, It’s All About Image Enabling

As we are entering the new year, one might wonder what this upcoming year will bring in the healthcare imaging and IT field. After the foundation that was laid in the 1990 of solid and reliable standards such as DICOM and HL7, the first decade of the 21st century was dominated by digital imaging and PACS system installations. There are still a couple of departments in a hospital that are holding on to analogue technologies and non-DICOM encapsulation of their data such as pathology and endoscopy which generates MPEG clips, but that will gradually convert over the next few years. Most US based healthcare institutions are already at their second or even third generation of PACS installations. Migration has become a major issue as unexpected costs have become associated with changing vendors and loosing essential information such as image annotations, key images, and other presentation state information. This is one of the major reasons that people are considering Vendor Neutral Archives or archiving images in the "cloud". However, these VNA cloud solutions have created quite some confusion as there is no true definition about what a true VNA storage solution would encompass. 

One of the major components in my definition of a true VNA is the capability to provide image access by a stand-alone viewer or through an Electronic Medical Record in a non-proprietary manner. Each vendor has its own plug-in and/or web access which allows for image access to their own images, but the challenge is to provide this capability to different vendors from different systems. IHE has defined a way to do this using the so-called XDS-I profile, which is based on a Dicomized version of a web protocol, called WADO, or Web Access to DICOM Objects. However, the problem with defining standards is that it always includes a certain level of crystal bowl gazing, i.e. one does not quite know whether this will take off and be widely implemented as there might be more pragmatic and readily available solutions that might become a de-facto standard. Therefore, time will tell whether WADO will become the widely accepted standard, but it is clear that image enabling has to happen, through whatever means. This is where we as health care imaging professionals will have to spend our next time and energy. Most of the problems distributing and managing images in an enterprise have been successfully solved, it is now all about ubiquitous availability if imaging and corresponding access. This is also where I feel that our profession will grow into: supporting the infrastructure and products and services to facilitate this. The only thing missing is to make this a “meaningful use” requirement so that it will get more attention of the people distributing resources and funds. Time will tell.