PACS adoption has reached ‘mature stage,’

PACS adoption has reached ‘mature stage, so say this article at HealthcareITNews.

DES PLAINES, IL – A new report from the research firm IMV has found the market for electronic picture archiving and communication systems (PACS) is largely in “replacement mode.”

According to “The PACS/IT Continuum: Present Access and Future Integration Strategies, 2010-2012,” released by the IMV Medical Information Division, replacement has become the primary motivation for purchasing new systems in 2010, with 85 percent of the planned purchases of complete systems being replacement systems, compared to 15 percent for first buyers.

“In hospitals with 100+ beds, the adoption of PACS has clearly reached the mature stage, with very few ‘first buyers’ of PACS systems,” said Lorna Young, IMV’s senior director of market research. “Moreover, the purchase of first buyer and replacement systems is a small portion of future PACS investments, comprising only 13 percent of the planned expenditures from now through 2012, while 73 percent of the expenditures are for expanding and upgrading their present PACS systems (with an additional 14 percent of expenditures potentially spent by hospitals whose respondents did not explicitly specify their PACS investment plans).”

IMV’s report provides insight into current and future PACS implementation strategies across the digital continuum, including archive strategies, access to advanced visualization software on the PACS desktop, radiology information systems (RIS), cardiology PACS and plans to interface related information systems and other “-ologies” with radiology PACS. The report provides a current snapshot on the vendor market shares for the PACS, RIS, and CPACS installed base.

“PACS has become an essential tool for hospitals and their served community,” said Young. “The increased need for image processing has placed demands on the speed and capabilities needed for image storage and visualization by the hospital enterprise, with image processing utilization expanding beyond radiology. The top planned PACS investments are to expand image storage capacity, additional PACS workstations and flat screen monitors, expanding network/bandwidth infrastructure, advanced visualization software and wireless networking.

“Initially viewed as an efficiency tool just for radiology,” she added, “PACS has become a cornerstone of communicating diagnostic results across healthcare systems, and is increasingly being integrated with other healthcare enterprise systems such as EMR/EHR and HIS. Some facilities are developing enterprise-wide solutions that integrate PACS with cardiology PACS, as well as data from other specialties.”

Other highlights from the report:

  • For the 100+ bed hospitals with PACS, 84 percent have it implemented in multiple locations outside of their hospital, and 16 percent are single hospital PACS implementations.
  • Overall, 93 percent of hospitals with 100+ beds have a radiology information system, made up of integrated RIS/PACS systems, department-based RIS systems, and integrated RIS/HIS systems.
  • The top clinical applications software types accessible from PACS desktops include CT angiography, MR angiography, mammography breast CAD and CT calcium mapping.
  • Overall, 9 percent of the hospitals have their own dedicated 3D lab outside of radiology.
  • Overall, 59 percent of the 100+ bed hospitals have a cardiology PACS (CPACS).

IMV’s PACS/IT Continuum report is based on the responses from 314 PACS and radiology administrators/managers nationwide, whose primary hospital is a short-term general, non-federal hospital with 100+ beds. Their responses have been projected to the universe of 2,420 short-term general hospitals that have 100+ beds.

Wi-Fi adoption in healthcare up 60% in past year

I got this off

Deployment of Wi-Fi in healthcare environments has grown by more than 60 percent worldwide during the past 12 months, according to ABI Research. High double-digit growth is expected to continue for both wireless local area network (WLAN) and Wi-Fi RTLS (Real-Time Locations Systems) deployments, the London-based market research firm said.

Other wireless technologies experiencing significant growth in the healthcare area in the past year include cellular machine-to-machine systems and body-area networks, wearable wireless sensors that transmit a patient’s condition to monitoring applications, ABI reported.

“Wi-Fi adoption has helped overcome initial concerns about complexity and reliability of wireless within healthcare,” said ABI Research Principal Analyst Jonathan Collins. “The growing number of wireless technologies and wireless applications being developed, piloted and deployed within healthcare further underline the level of interest in using wireless to improve the flexibility and efficiency of healthcare services around the world.”

Technologies tracked by ABI Research’s Wireless Healthcare Research Service included Wi-Fi, Bluetooth, Low-Energy Bluetooth, ZigBee, 802.15.4 and proprietary low-power RF offerings across applications such as WLAN, personal monitoring, disease management, assisted living and telepresence.

GPS not just for driving but can be tool for crowd management and medical follow-up

This article off Alphagalileo examines the use of GPS in public health!

Drivers around the world use the global positioning system (GPS) to figure out how to get from point A to point B. But a young Hebrew University of Jerusalem researcher has shown that GPS can also be applied commercially to better deal with crowd or shopper management and even to evaluating patient recovery following surgery.


Michal Isaacson, a doctoral student working with Dr. Noam Shoval of the Geography Department at the Hebrew University, has been involved in developing new approaches to the use of advanced tracking technologies in order to provide valuable data collection and analysis for later study and application or even for on-the-spot, real-time application.

Her work has implications for understanding the activity of people in different settings, such as urban areas, shopping malls, theme parks, national parks and other tourist attractions. It has already been tested to evaluate crowd activity and flow at the Port Aventura theme park in Spain.

For her research, Isaacson has been named the first prize winner among students in this year’s competition for the Kaye Innovation Awards at the Hebrew University. The prizes were presented on June 9 at the university’s Board of Governors meeting. Her work in this field has resulted in a book that she coauthored together with Dr. Shoval and in several articles published in leading geographic journals. The first article she coauthored and that was published in The Professional Geographer was noted by the journal as one of the top five most cited articles in 2006-2007.

The system she and Shoval have developed uses GPS technology to record the location of people for a designated period of time. During this period, participants are required to carry a small GPS unit with them. The tracking data is then analyzed, using a computerized, time/space analysis engine, to derive maps that indicate the volumes of activity throughout the location and charts that indicate how different types of populations spent their time in the location.

The data obtained using tracking technologies can also be analyzed in real time, creating virtual “radar” of the activity of visitors throughout a destination. Real time analysis can lead to dynamic management of attractions in a more efficient way, both enlarging the number of people that can visit an attraction within a given time frame and controlling their flow in a way that allows for the growth of sales and enlarged revenues. The analysis of this data can also change the way attractions are planned and can enable effective planning of future additions to an attraction.

The technology also has far-reaching medical applications. In collaboration with Dr. Yair Barzilay of the Hebrew University-Hadassah Medical School and the Orthopedic Surgery Unit at Hadassah University Hospital, a method was developed for detecting the mobility of patients after surgery as an objective measure for their follow-up recovery and well-being. The patients carry a GPS unit with them after the operation, tracking their movements, which are then analyzed. Future development will integrate additional sensors that will allow the combination of GPS data with physiological data, such as heart rate and blood pressure.

Healthcare Taking Computing To The Cloud

Marianne Kolbasuk McGee wrote this article on the Health IT and Cloud Computing for InformationWeek

While the healthcare sector has long been an IT laggard, the industry appears to be embracing cloud computing comparably to many other sectors.

Nearly one-third of healthcare sector decision makers said they are using cloud applications, and 73% said they are planning to move more applications to the cloud, according to a recent report by Accenture. Those figures fall in line with findings about cloud adoption plans in other industries, according to the report.

he Accenture report statistics were compiled from a study released in February by unified e-mail management services provider Mimecast which last fall surveyed 565 IT decision makers across several industries in the United States and Canada about their cloud plans.

The 32% of respondents in the healthcare sector using cloud applications were most similar to those in industries such as manufacturing, in which 32% of respondents in that sector also said they were using cloud applications; followed by respondents in education (29%) and retail (35%).

The 73% of healthcare industry respondents planning to move applications to the cloud were most similar to the 75% of respondents in the technology and government sectors who also intended to expand their use of the cloud.

There are several key reasons why healthcare sector IT leaders are moving applications into the cloud, said Dadong Wan, a senior research scientist at Accenture studying digital health trends and a co-author of the recent Accenture report examining cloud computing in healthcare.

Many of those reasons boil down to cost advantages and flexibility that cloud computing offers healthcare organizations, especially as they implement plans to meet the federal government’s $20 billion-plus HITECH financial incentive programs for the meaningful use of IT.

“Cloud computing is a newer technology and compared to existing IT is newer and more cost advantageous” especially for the nation’s thousands of small medical offices looking to deploy health IT, said Wan in an interview with InformationWeek.

Cloud models — in which third parties host applications, storage, and access to computing power via the web — provides “economies of scale,” often giving two to 10 times the cost advantages of other computing models that would otherwise require healthcare providers to host servers onsite or hire in-house technical support to keep systems running, said Wan.

The cost advantages also reflect cloud computing models’ ability to provide “raw computing resources, raw CPU cycles, and other capabilities” that aren’t usually easily available or affordable for onsite computing configurations.

Also, cloud computing models have an “exoskeleton nature” that makes it easier to connect disparate systems from multiple organizations as well as multiple processes “end to end,” such as e-prescribing, claims processing, and eligibility checks, which “cut across multiple stakeholders,” said Wan.

Finally, while privacy and security are often among the concerns that healthcare providers express when discussing cloud-based models, typically cloud providers offer more robust security “than is available in-house,” said Wan.

“Cloud players’ livelihood is protecting data,” he said.

Mobile baby

I got this off UNSW.

IVF patients will soon be able to track their test results through their mobile phones, using technology developed by UNSW researchers.

The interactive electronic system, HealthyMe, allows patients to self-manage medical records, log test results and communicate with others – from doctors to fellow patients.

IVF Australia will offer the service to patients within a year, after a successful trial with 17 patients. The results were presented at an e-health symposium at UNSW this week.

“The women wanted an e-health system that was more deeply integrated with their care, accessible through their Blackberries and iPhones,” says Professor Enrico Coiera, Director of the Centre for Health Informatics at UNSW, which is marking its 10th anniversary.

“We picked IVF for the trial because it’s a very demanding two months that the patients go through. They need a lot of support,” he says. “The women often used it to help remember what they needed to do. That meant when they went back to the clinic they were armed with important questions and information.”

In future doctors will be able to see if a patient has taken a medication or actually undergone a requested test and what the results are.

The trial of the program is also being rolled out to other parts of the population.

“The system is controlled by the patient, so the privacy issues are kept to a minimum,” says Professor Coiera. “While it is interactive like a social networking site, our system would provide a much tighter community. You might share information only with people who have the same condition as you.”

People with multiple conditions stand to benefit the most, according to Professor Coiera: “Often information is not shared between different treating doctors and the medications they prescribe in isolation, may together affect each other. This way, all the records are kept in the one place for the first time. It’s a way that the patient can help glue the care system together.”

In this year’s Federal budget, the government earmarked half-a-billion dollars for e-health.

Ramblings: HospitalBuildAsia 2010, FutureHealth ASEAN and CLMM

Alright, this blog post is a combination of 3 different ‘ramblings’ topics;

  • HospitalBuild Asia 2010
  • FutureHealth ASEAN Forum 2010
  • A site visit to a local hospital on their CLMM (Closed Loop Medication Management) implementation.

I’ll do a ‘summarize version’ and first thing first (order by sequence of events) will be HospitalBuild Asia 2010.

As mentioned previously, its my second year presenting at HospitalBuild Asia and for this year, I ‘served’ as the Congress Chair for the Medical Imaging track,  presented on 2 topics and hosted the panel discussion.

Sounds like a hectic schedule? Well it sure was!

I’d be uploading the slides for the 2 topics later so keep an eye out for it.

Now for FutureHealth ASEAN 2010, I must first congratulate the organizers – FutureGov, for an excellent job. Well Done!

The topics were well-chosen and the speakers were fabulous. The delegates were also the right mix, I attended this event representing my ‘day-job employer’ as an ‘vendor’ and I throughly enjoyed myself from both professional and personal capacity.

Both HospitalBuild Asia and FutureHealth served as an excellent avenue for me to catchup with old friends (and making new ones) as well as  discovering new aspects/perspective of health informatics (that is why I LOVE attending conferences).

Last on the list would be the site visit I made to a local hospital on their CLMM (Closed Loop Medication Management) implementation. This particular hospital happens to be my previous employer – yes, the one where I worked as a Imaging Informatics Administrator and started my career in health informatics.

Now CLMM is one of the latest buzzword in the world of health informatics and there is a good reason for it – Patient Safety and higher Quality of Care.

I’m not going to dwell too much into the details of CLMM (else this blog post will be 5 pages long) but the site visit did inspired me to write an article on how to utilize bar-code technologies.

I gave free consultancy to the Pharmacy department after the site visit as I noticed many areas that can be improved – easily and cost-free, many of them on bar-code technologies.

So there you have it, 3 of the most important events that took place to me (related to health informatics)  that I want to share with you.


New Article: Enterprise Imaging Informatics – PACS in Radiology and Beyond

I wrote a new article titled : “Enterprise Imaging Informatics – PACS in Radiology and Beyond”.

This article examines the increasing demands for medical imaging services and how progress in medical imaging technologies, their impact across different clinic disciplines and  how it redefines Enterprise Imaging Informatics and the potential market growth in Asia.

Enjoy the article here.

Note: This article is Researched and Prepared for ClearState and also published at

Radiology Images and MU: Vital, but Not in the EMR…Yet

This article from talks about 2 of my favorite topics in health informatics and their co-relation (I share very similar viewpoints, especially on the part where medical imaging is not only radiology).


A diagnostic picture is often worth more than a thousand words. But whether—and how—to include images in the EMR as a requirement for meaningful use is an ongoing discussion. Thus far, images have been excluded from federal discussions of the criteria for meaningful use. At the grassroots level, however, the debate over images and meaningful use is lively to say the least. Many physicians claim images are a vital tool for accurate and timely diagnosis and should be at least considered in the scenarios for meaningful use. Others believe healthcare providers have too many other requirements on their plates right now.

As advances in imaging continue to show greater detail, often in real time, images in the EMR could provide a more complete patient record than text-based notes and lab results alone. But meaningful use isn’t the only issue for images—even if images are eventually required for demonstration of meaningful use, vendors, healthcare facilities and users will still have to address image storage and management.

Images overlooked
Janice Honeyman-Buck, PhD, FSIIM, believes the inclusion of images in the EMR is critically important, and was surprised the proposed meaningful use criteria for 2013 did not address the integration of medical images into patient records. “The referring physician needs to see the radiologist saw,” says Buck, editor in chief of the Journal of Digital Imaging and associate professor and director of informatics in the Department of Radiology at the University of Florida. While the physician may not need access to the entire study, key images would better help to illustrate the patient’s condition.

“It’s a matter of setting priorities, but what I’m afraid of is that hospitals will be going for the [MU] criteria now, and then in about 2015, they won’t have the infrastructure necessary to handle the images because they are so big,” she opines.

Why the omission? Honeyman-Buck says a “rift” between radiology and health IT may be one of the reasons images were excluded from MU criteria. “There has always been sort of a separation between radiology, which handles the images, and health IT, which integrates all the information about the patients,” she says.

Better communication is one way to alleviate that separation, says Honeyman-Buck. There is a need for “more of a collaborative effort between the people [in radiology who] really know how to handle the images, bandwidth requirements and the huge storage requirements, working along with people [it IT] who are really in charge of all the information in the EMR.”

When and if radiology images do become a requirement for meaningful use, Honeyman-Buck believes storage and display issues will be the largest barriers that facilities and practices must overcome.

For display, she says, “radiology works hard to make sure their displays are in a quality-controlled environment. They have the power it takes to navigate through huge studies, and this is not something that [is] easily transferable to other locations.

“In current operating systems and computers, there are limitations to the file system for how many individual files can be stored in one place, so radiology has been working with this problem,” she says. “It’s not insurmountable, but it is a challenge.”

Inclusion caveats
Including images in the context of an EMR has its limitations, says Gregory A. Spencer, MD, FACP, CMO, of Crystal Run Healthcare, a multi-site healthcare system based in Middletown, N.Y. Spencer cites the screen size and resolution limitations of today’s computers as restrictions: “Typically, people are working from desktops or even laptops, if they are taking the EMR into the room with them,” he says. “You are not going to spend thousands of dollars on a monitor if 99 percent of the time you’re looking at a [physician] note. I think from a diagnostic perspective, it’s very limited in the utility and the quality.”

Spencer notes that the inclusion of images in the EMR is a “convenience” rather than a “show-stopper.” With regard to MU discussions, “I think the demand isn’t quite there for it yet,” he says. However, when the demand for image capability does grow, “there would be a lot of retrofitting and vendors scrambling to incorporate that in their next version.”

Crystal Run Healthcare uses a NextGen EMR interfaced with its Carestream RIS/PACS. Within the EMR, “you have to enter the patient demographics again [once a report is brought up] to actually view the images, and we are working on embedding a URL for an image. It’s just a matter of the demand for that,” Spencer explains, noting that the URL will launch a browser to a non-diagnostic quality image, which would suffice for the primary use of patient education. He says demand from physicians thus far for viewing images in the EMR has been limited.

Integrating images in the EMR would not provide a great benefit for many specialties when measured against the amount of work required to make it happen, he says. However, EMRs that accommodate integrated images would provide significant value to some physicians—including orthopedic and oncology practices.

Seeing is believing
Bradley Erickson, MD, PhD, of the Department of Radiology at the Mayo Clinic in Rochester, Minn., and the Society for Imaging Informatics (SIIM) chair, says inclusion of images in the EMR is “critical.”

“One of the greatest advances of medicine in the past 30 years is that basically images have replaced a lot of much more invasive procedures, like exploratory laparoscopy, so I think having images available to physicians is critical,” he explains.

And if the availability of images for the physician is important, so too is image integration into the EMR, Erickson says. The implementation would promote efficiency, because physicians would be able to view an image or series of images, comment back and forth with one another regarding what they are seeing, which could reflect their decision-making process.

Like Honeyman-Buck, Erickson says he was disappointed that images were left out of the meaningful use requirements for 2013. “I think it reflects the fact the decision-makers are not aware of how influential or important images are in the practice of medicine, or they just have other interests that drove them to make the criteria rather than improving medicine,” he says. “Compared to some of the requirements that are in meaningful use, I think … the inclusion of images would be a small requirement.”

For example, one current requirement calls for documenting smokers down to age 13, which will be much more difficult to implement than requiring EMRs to include some level of imaging, according to Erickson.

Mayo’s Rochester facility uses a GE Centricity EMR, integrated with an internally built repository. All new images are automatically forwarded to the repository; the EMR can record user annotations and user-specific viewing preferences, Erickson explains. All new images are available, as well as archived images by way of an image storage and retrieval system. The clinical image viewing system interfaces to the enterprise image archive to achieve this, he notes.

Bracing for the future
The use of the EMR as a one-stop organizer for patient information—including images—is very compelling, says Spencer. Honeyman-Buck believes it is something that will become a requirement: “Images will be included at some point.”

Hospitals are gearing up to implement EMRs that meet the current meaningful use requirements, but this could make it more difficult to accommodate an image-enabled EMR in the future, because facilities may not have the appropriate bandwidth or storage when images become an EMR requirement, she says.

Erickson says inclusion of images is not just a radiology concern, and facilities should have a plan in place to include images for various specialties, such as cardiology, dermatology, pathology and ophthalmology. This will enable facilities to use “one standard user interface that the various physicians need to get used to,” he explains.

“I suspect it may be more than just ‘including’ them,” he notes. “I think there will be requirements to send and receive a certain percentage of studies from other facilities using electronic [not CD-based] mechanisms.”

“Plan from the beginning,” stresses Honeyman-Buck. “Make sure that whatever EMR system you are developing or putting in can grow and expand in five years so that the images can go into it.”

North Yorks spends £3.2m on telehealth

NHS North Yorkshire and York has announced that it will implement 2,000 telehealth systems from Tunstall following a successful pilot across the county.

The plans, which will see the primary care trust spend around £3.2m on the new systems, will create the largest telehealth programme in the UK, the PCT believes.

The decision follows an eight month pilot that was launched in October 2009.  One hundred and twenty machines were installed in patients’ homes to collect vital signs information, including temperature, blood pressure, and blood glucose and oxygen levels.

The readings were sent to a central monitoring centre via a phone. There, abnormalities were highlighted and a clinician asked to contact the patient if necessary.

Rosie Walker Smith, a case manager working in North Yorkshire, said: “Feedback from patients already using telehealth has been overwhelmingly positive.

“Not only does it reduce the risk of their condition deteriorating to the point they need hospital treatment, but also gives them the peace of mind that their condition is being monitored. It’s great that more patients will get to benefit from this technology.”

The PCT said the systems will enable it to identify and act on any deterioration in a patient’s condition and ultimately prevent them from being admitted to hospital. They should also support patients discharged from hospital.

The new scheme will focus on those patients that suffer from long term conditions such as chronic obstructive pulmonary disease, chronic heart failure and diabetes. In 2008-09 more than 6,000 patients in the area were admitted to hospital with respiratory and cardiac problems.

David Cockayne, director of strategy for NHS North Yorkshire and York, said: “We are delighted to announce this significant investment in telehealth which we, and local clinicians, believe will continue to make a huge difference for patients living with a long term health condition.

“As outlined in our recently published five-year strategy, we are committed to providing care closer to home and improving the quality of life for patients living with a long term health condition. We recognise telehealth as being a key enabler to us achieving our aspirations.”

Tunstall won the contract to provide the systems following a competitive tender process.

Jon Lowe, UK managing director at Tunstall Healthcare said: “We are delighted to be partnering with NHS North Yorkshire and York to reshape the way care is delivered closer to home, using innovative technology to support and sustain care delivery.

“One thing is clear, patients are at the heart of everything we do and telehealth can have an immediate and lasting positive impact on patient care and clinical quality.

“We very much look forward to working with NHS North Yorkshire and York to deliver a whole systems approach to care, allowing clinical teams to unlock the benefits for patients and carers.”