Monday, November 4, 2013

The quest to train professionals with in-depth hands-on DICOM and HL7 experience.

Students from our June PACS class
The current penetration of EMR’s for physicians is already exceeding 50% and for hospitals it is more than 70%. One of the most common issues that are brought up by CIO’s about their implementation challenges is the lack of available expertise to integrate these systems with their order entry systems, lab, pharmacy, and the numerous other connections. A typical institution has about 150 computer systems ranging from surgery to blood bank, all of them typically exchanging this information using the HL7 standard, and many of them needing to be connected to the new EMR’s. In addition to the much sought after HL7 expertise, as these systems are going to be increasingly “image enabled”, the need for professionals with detailed DICOM knowledge, especially for the integration and troubleshooting, will also undoubtedly increase significantly.

If you are looking for an opportunity to strengthen your skills, here is your opportunity as OTech offers its next DICOM/HL7 seminar (see schedule) in the second week of December, following our popular PACS administration certification class in the Dallas Metroplex. The HL7 training covers a comprehensive discussion on the Version 2 standard, including a hands-on section which allows students to create and test HL7 messaging from a variety of applications. The DICOM training covers not only the DICOM protocol and data format specifications in great detail, but also provides students with numerous tools and test images to be able to implement and troubleshoot integration projects.
Especially for those living in the Northeast and Midwest, this seminar in the Dallas area will be a nice break from the cold while having the opportunity to eat some local BBQ and steaks (and yes, if you are a vegetarian, we have lots of choices as well). Looking forward to see you in Texas!

Herman Oosterwijk

President OTech Inc.

Reach to the top part II

Looking up to the mountain
at about 13,000 ft (day 3 of the hike)
It is 11 0’clock at night when Francisco, one of our porters, wakes us up. We are camping out at the base camp of Mount Kilimanjaro in Tanzania, Africa, which is at an altitude of 4662m or 15,295ft (higher than any of the mountains in Colorado). It is freezing cold, we slept in our down sleeping bags with extra clothes, and chemical hand warmers in our double pair of socks and some of us even have a hat on, leaving only our mouths and noses in the air to breathe. There are six of us, my spouse Johanna and I, another couple who we have traveled with many times before, our team leader, and his buddy. We dress quickly in the dark, get a couple of snacks and hot tea in our “dining tent,” which had been carried up to the base camp by one of our 27 porters.

One of our porters;
they carry about 20 kg (40lbs)
of food, supplies,
water, tents, and our luggage
Going up and down a mountain in 6 days is quite an expedition; we had two assistant guides in addition to the trek leader, a cook, and 23 porters who carried the food, water, tents and our luggage from 1800 meters or 6000 ft at the entrance gate to the camps. At exactly midnight we are ready to hike up our last stretch to the peak. We have little headlights strapped to our heads that show the terrain for about 6 feet ahead of us. On a typical night, there are 50-100 people who attempt to make the ascent to the top. More than 50 percent of those who start the trek don’t make it to the peak. The fortunate who do must be able to withstand the cold and high altitude.

A common misconception is that there is less oxygen at high altitude, actually there is the same amount of oxygen in the air as at sea level, however, the difference in air pressure makes only 50 percent of that available to our lungs at that altitude, which the body compensates for with a higher pulse rate and deeper breaths to increase the number of red blood cells carrying oxygen.

Three guides and two porters, one of them carrying an emergency oxygen tank, “just in case” accompany us on our last stretch. Our lead guide, Charles, is setting the pace with tiny steps going up the mountain. It gives the term “slow walking,” or as it is called in Swahili, “pole, pole” a completely new meaning. Looking up, we see that several teams have left before us, providing an almost surreal view, like a procession of lights winding up the mountain.

Our Kilimanjaro"expedition": team of six,
3 guides and 27 porters
I am carrying only the bare minimum in my backpack, a “camel-back,” which is a plastic bladder filled with about 1.5 liters of water and two water bottles. The water was carried up by our porters from our last camp, the last spot on the mountain where water was available, which after being filtered and boiled to kill all of the bacteria, is needed to prevent dehydration, one of the major causes of failing to make it to the top.

After a few hundred yards of hiking, I am already out of breath and have to stop after every couple of steps. At this point, I doubt that I am able to make it up. Passing an emergency stretcher alongside the path, used to evacuate those who are struck with a severe case of altitude sickness, does not help mentally. Nicholas, the youngest of our three guides notices that I am having difficulty and takes over my carry-on in addition to his own pack, which is a major relief. I am at the back of the pack, and have no clue how everyone else is doing as the only thing you can see is their lights. After the fact, I learned that our female climbers in the front were having a hard time as well, but they managed by taking five steps at a time, and then pausing for three counts as they take deep breaths. It is all about finding the right rhythm:  one step at a time for the next six or seven hours. My guide’s releasing me from my backpack, which was only a couple of pounds, gave me the physical and mental boost to keep on going.
Camping out
at 4000 m (13,000 ft)
on day 3

As long at the incline is not too bad, I can keep on going, but I do have trouble keeping myself balanced after I have to take big steps such as to master a high rock or step. Nicholas, my guide is there always to correct me or give me a little push. We stop only for a few minutes every half hour or so, because it is below freezing at 10 degrees, with the icy wind making it feel like we are at the North Pole. Despite the fact that each one of us has at least five layers of clothing on top, three pair of pants, several pairs of socks and mittens, the temperature is still just bearable. The hardest part to keep warm is our hands. They are quite exposed, as we need our trekking poles to balance and pull us up.

When resting, other teams pass us, while greeting us with the familiar term “Jambo,” which means “hello” in Swahili. The terrain is hard to cover as most of the path is covered with loose gravel, which is not only hard to walk on, but every step up is about two thirds effective as you automatically slide down a little. It is like walking up a sand dune with loose sand but worse as we have trouble getting oxygen in our system.

After about two hours, most of our water becomes inaccessible as it starts to freeze up. Our female friend’s camelback supply line was nicely protected by an expensive REI enclosure with a zipper that also froze, which made it useless. I found that the best solution for carrying up our water was to take a water bottle and put it in the backpack rolled into two woolen socks, something we learned from Charles our guide, not from our guidebook, which we read back and forth several times during our preparation.

At about two-thirds of the way to the top, I have increasing difficulty keeping my balance anytime I have to break my rhythm to take a large step, and I am again starting to doubt whether I will be able to make it. Looking back, this was probably either due to dehydration, as I had not been drinking on a regular basis because of my guide carrying my water, or due to exhaustion. We had hiked for eight hours the day before and had only three hours of rest prior to this last part. Nicholas, my lifesaver notices my balance problem and takes me by the arm. He forces me to keep my rhythm even though I am thinking I am at the max. It is interesting how much more your body can do if you just set your mind to it and have the right support.

Sunrise on Kilimanjaro
In the meantime, the sun is rising, providing us with an incredible view. The only thing I can compare it to is when I have watched the sun rise from the window of an airplane when making a trans-continental flight. It is truly like being on top of the world as the sky turns orange and we can see the clouds far below us in the valley.

Nicholas is pushing me as he probably knows that this is the only way I will be able to make it, so we pass the other team members in the front by keeping a regular rhythm, one step at the time, not allowing me to rest or stop. When the sun is coming up, I can see the rim of the mountain far ahead of me. In the meantime, we have finished the stretch of “switch-backs,” which are needed to master the steep ascent before reaching a relatively gradual incline. I let go of my guide’s arm and walk the last few hundred yards only supported by my walking sticks, almost like a last sprint to the finish line.

When I arrived at the rim, I sat down under the sign of what is called “Stella Point” at 5745 meters (18,848 feet). After another 5 or 10 minutes, the rest of our team arrives, joyful that we came that far. I had made up my mind that I was going to stop right there, but just in case, I asked our main guide, Charles, how the terrain is going to be for the last kilometer, ascending another 100 meters of elevation. He assured me that this was going to be “easy,” so after taking a short rest, I decided to go for it. And Charles was right, the last part was not as steep, in addition to the fact that it was light so we could see the peak in front of us, and the sun was also warming us up. 

At the top, with two of our guides
(in case you don't recognize me,
I am at the far right)
On our left we can see the glacier, a fraction of the original size due to the effect of global warming.  Finally we arrived at what is called Uhuru peak, at 5895 meters or 19,341 feet, at 7:20 a.m., the culmination of four days and one night of hiking. We all hugged each other and took a short time for pictures, not too long as it is really cold at that high altitude.

The last segment had taken a heavy toll on our team. Our leader’s friend did not feel well at all and took off almost immediately to get back down with our two porters. Our friend had started wheezing, probably caused by combination of the reduced air pressure and the dust we got in our lungs during the ascent, so he had to take it easy coming down accompanied by our chief guide, Charles. I was still exhausted and had to lean on Nicholas, our assistant guide, for a big part of the way coming down. Except for our team leader, who was the only one who had any high altitude hiking experience, our ladies had the least difficulty.  Interesting how the women outdid the men on this trip.

Visiting one of the Care Highway projects;
All kids are the same:
they want to be held and hugged
Hiking up to the top of the highest free-standing mountain in the world is definitely not for the faint-hearted, you have to be fit, adventurous, and be willing to test your physical and mental boundaries. If you are not comfortable expanding beyond your comfort zone, it is not for you. I am glad we did it, in addition to the fact that we served a good cause as it was part of a fund-raising effort (

It is also not for “control-freaks” as you have no control of what the weather conditions are going to be, or how your body is going to react. It is like going into space for the first time, there is no true training ground. We saw experienced hikers who could not make it to the top, and on the other hand, we also met a 69-year-old gentleman who made it (albeit with help of an oxygen tank). So, even if you are not into hiking, I suggest you do something crazy that forces you to expand your boundaries. This adventure truly changed my life, and I am sure doing something similar will impact you as well in a positive manner.