Ramblings: Recent Guest Lecture at Parkway College

I recently had the privilege to present as a guest lecturer on “Medical Imaging Informatics” for students of the Graduate Diploma in Healthcare Management conducted by Parkway College Singapore and it was very heartening to witness the high level interest in the subject even though the audience are not undertaking the course to become health informatics professional.

I usually lecture / present to health informatics professionals who are interested in deepening their knowledge the session was  definitely a refreshing change.

I have posted the slides I developed for the guest lecture here,  I welcome the students who participated in the lecture to contact me should they have any questions (even beyond medical imaging informatics) and if you are an educational institute who needs help, feel free to contact me (I adjunct at several institutes of higher learning around Asia-Pacific).

Cellphones reveal emerging disease outbreaks

Public health Informatics is one area I am relatively interested in and although I have not written any whitepapers on the topic (yet), I do have a lot of ‘draft materials’ on hand (well, I have bills to pay so I need to cater to my day job first).

This article from NewScientist.com discuss how the use of mobile phones / cellphones can help in public heath.


YOUR cellphone could be a key tool in the fight against disease by relaying a telltale signature of illness to doctors and agencies monitoring new outbreaks.

“This technology is an early warning system,” says Anmol Madan of the Massachusetts Institute of Technology, whose team concluded that you can spot cases of flu by looking for changes in the movement and communication patterns of infected people.

Epidemiologists know that disease outbreaks change mobility patterns, but until now have been unable to track these patterns in any detail. So Madan and colleagues gave cellphones to 70 students in an undergraduate dormitory. The phones came with software that supplied the team with anonymous data on the students’ movements, phone calls and text messages. The students also completed daily surveys on their mental and physical health.

A characteristic signature of illness emerged from the data, which was gathered over a 10-week period in early 2009. Students who came down with a fever or full-blown flu tended to move around less and make fewer calls late at night and early in the morning. When Madan trained software to hunt for this signature in the cellphone data, a daily check correctly identified flu victims 90 per cent of the time.

The technique could be used to monitor the health status of individuals who live alone. Madan is developing a smartphone app that will alert a named contact, perhaps a relative or doctor, when a person’s communication and movement patterns suggest that they are ill.

Public health officials could also use the technique to spot emerging outbreaks of illness ahead of conventional detection systems, which today rely on reports from doctors and virus-testing labs. Similar experiments in larger groups and in different communities will have to be done first though.

Leon Danon at the University of Warwick, UK, is negotiating with the ministry of health of a northern European nation about a project that would combine the anonymous cellphone records of around 10,000 people with their health records to produce signatures of disease from a larger population.

Researchers will need to think hard about the causes of the changes they see in the cellphone data, says Nathan Eagle at MIT, who is working with Danon. Eagle looked at cellular data from a series of cholera outbreaks in Rwanda between 2006 and 2009. He saw a clear reduction in people’s movement, which may have been due to the disease. But the outbreak was caused by floods, which also limited mobility. Distinguishing between the two possible causes on the basis of phone data alone was impossible, he says.

Madan presented his paper last month at the International Conference on Ubiquitous Computing in Copenhagen, Denmark.

Five key features of tomorrow’s EHR

This is an article from HealthCareITNews.com,

As electronic health records become more prevalent, it becomes more difficult to choose an EHR that will remain relevant and usable well into the future. Jerry Buchanan of eMids Technologies, Inc., an IT consulting firm, shares the following five key components of the EHR of tomorrow.

1. “Liquidity of data is an absolute necessity,” said Buchanan, who cited interoperability and integration as important elements. The ability to share data amongst many different platforms will be a crucial component of tomorrow’s EHR.

2. Assuming those providers who want to adopt EHRs have already begun to do so, scalability is essential. A scalable, web-delivered solution with a low financial barrier will ensure further market penetration, said Buchanan.

3. Tomorrow’s EHR should be easily maintainable. Hospitals require a massive amount of maintenance for their  varied IT systems.  An overly complex EHR will not survive.

4. Mobile computing is a big trend in healthcare IT. EHRs that utilize mobility will hold greater appeal for physicians who want the convenience and efficiency of mobile technology.

5. User-friendly design and interface are critical to tomorrow’s EHR. “Today’s users demand context-sensitive applications capable of predicting their next move and streamlining workflow,” Buchanan said.

Buchanan noted that EHRs demonstrating interoperability, scalability, and maintainability used to have a strong advantage in the market. Today, however, those factors have become all but required for EHRs. Mobility and usability are emerging as aspects that will distinguish tomorrow’s EHR from the rest.


Personally, I feel that the points above can be applied to many facets within health informatics.

Food for thought?

Ramblings: “So You Want To Be a PACS Administrator” is released for sale

Ladies and Gentlemen,

It is my pleasure to announce the official release of my first book – “So You Want To Be a PACS Administrator”.

As mentioned in the previous blog entries,  “October 2010 holds many new ‘first’ for me“, there are three  new ‘first’ for me and this is the third ‘first’ – my first book.

“So You Want To Be a PACS Administrator” is written as a companion guide for introductory courses in the domain of Imaging Informatics developed by myself  for institutes of higher learning (mostly based in Asia Pacific). It also serve as a guide for the novice PACS Administrator and (hopefully) as a reference for the experienced.

To find out more, please kindly visit http://www.SoYouWantToBeAPACSAdmin.com

If you would like to purchase “So You Want To Be a PACS Administrator”, please kindly visit the online store here.
(I found a discount code for 20% off books – Enter code BOOKTOBER at checkout – Offer ends 10/31/10)

P.S. In line with binaryHealthCare’s commitment to the environment,  arrangements have been made with Eco-libris to have a tree planted for every book printed. To see the total numbers of trees planted, please click here.

Going Green: A Texas recycling company strives to lessen environmental harm from healthcare waste

In my humble opinion, we need more of these companies around to ensure sustainability, in fact, I think the manufacturers / equipment providers should play a bigger role in  recycling these equipment. Original story can be accessed from here.

It is an inevitable part of the patient treatment process that some procedures generate toxic materials, and healthcare staffs are responsible for proper disposal. Obsolete medical equipment, radiation, mercury, pharmaceuticals, and biomedical waste all must be managed carefully to protect people and the environment.

To clear the confusion, waste management companies that cater to healthcare facilities are ready to step in and fill the void.

“Healthcare facilities should have waste management protocols in place to minimize potential harm, not only to patients and staff, but also downstream to the environment and the safety of those who may handle or come into contact with it once it leaves the facility,” says Louis Okon, president and CEO of Okon Metals in Dallas.

Okon is a fourth-generation leader of Okon Metals. For nearly 100 years the company has specialized in recycling, and for the last 25 years Okon has worked in MRI magnet recycling on national and international projects.

“We are the direct recycling contact for hospitals, imaging centers, medical networks, OEMs, insurance companies, and finance companies when an MRI magnet is in need of disposal,” Okon says.

Replaced, damaged and aged magnets, insolvent MRI operations, MRI systems being returned to finance companies, or even upgraded MRI systems all require recycling. With their specific training for handling and processing MRI magnets, Okon and his staff can decommission and dismantle a magnet on-site when there is no other way to remove it from a building.

They have the necessary environmental permits to decommission magnets properly and conduct regular visits to downstream metals consumers to be sure the waste is being handled appropriately once it leaves their facility. They also provide transportation from all 50 states and internationally. Okon Metals tries to make waste removal and disposal a relatively easy process for facilities.

“Without a strict waste management protocol,” Okon says, “there is no way to ensure your patients and staff, or even the individual people and businesses who come into contact with the waste once it leaves your facility, [that everyone is] properly trained, insured, certified, or qualified to handle the materials. Without knowing where the waste may end up, facilities can face potential environmental and safety hazards, as well as legal claims and liability.

“It is often plaintiffs’ attorneys who open a facility’s eyes to the need for a waste management protocol, usually soon after environmental damage or personal injury has occurred,” says Okon.

Okon does find that, because of laws and insurance, healthcare centers usually maintain appropriate protocols. “While some struggle to do the bare minimum…others have a full program and team to identify and implement an internal, as well as downstream, protocol for each by-product and waste item it produces, from needles to 90,000 pound MRI magnets,” he says.

Okon maintains that correct disposal is more cost-effective in the long run. While healthcare staff may balk at the expense, recycling companies provide incentives to make the process more appealing and accessible. For instance, Okon Metals does not charge for transportation or for most of its services, says Okon.

In addition, “we also, in most cases, pay our customers for the MRI magnets based on the intrinsic metallic value of its components,” he says.

Okon has realized that many facilities are still unaware of the low-cost, free, or even profitable services associated with waste disposal. Clearly, more information can be circulated on how to implement efficient, cost-effective waste management protocols, he says.

The goal for Okon and his staff is to reduce and eventually eliminate environmental, health, and financial disasters related to improper waste removal. If the company’s long-standing track record is any indication, they are on the right path.

IBM, Nuance Collaborate on Speech Recognition for EHRs

This is something of interest (at least to me).

It also explains why data captured in EMR/EHR should be structured, which is important but not many physician get its (or rather, they choose not to get it).

The original article can be access from Eweek.com.

IBM Research will contribute its expertise in medical-dictation processing to Nuance Communications with the goal of using speech recognition to incorporate structured data into electronic health records.

IBM and Nuance Communications have announced a partnership in speech recognition to direct physician-dictated text into the structured fields of an EHR (electronic health record).

Nuance is the maker of the Dragon speech-recognition software, which in addition to health care and other industries is used in the White House and Defense Department.

According to Peter Durlach, Nuance Communications’ senior vice president of marketing and product strategy for health care, the collaboration between IBM and Nuance will use IBM’s research in NLP (natural language processing) to enhance Nuance’s CLU (Clinical Language Understanding) software products.

Nuance’s CLU technology is a health-care-specific type of NLP that involves extracting specific data about a patient’s condition from the narrative text dictated by a physician or nurse. CLU is a core element of EHR workflows, according to Nuance.

“It will combine some of the work IBM has done in the natural language processing area with the work we’re already doing at Nuance to tackle that big problem in health care, which is, How do you get structured data out of the narrative part of the dictation?” Durlach explained to eWEEK.

“This new partnership will enable IBM Research to develop improved technology where the information extraction system can benefit from structured knowledge such as a medical ontology of symptoms to develop an understanding of the dictated text,” Salim Roukos, IBM’s senior manager of NLP Technologies, wrote in an e-mail to eWEEK.

According to Roukos, IBM has been developing new ways to extract discrete information from dictated material using advanced text mining.

The narrative part of a doctor’s dictation involves an unformatted, or unstructured, section of text that an EHR is unable to process into separate fields. “If you don’t get that structured data, all that narrative is just there as a blob of text in the database,” Durlach said. “It’s very hard to do decision making after the fact because you don’t have structured field level data.”

Durlach said the collaboration with IBM will allow the CLU application to “parse [data] out of that narrative blob of text and populate EHR fields so you can do data mining.” Physicians will not have to key in data to the EHR fields themselves.

He compared the use of CLU to being able to extract mentions of specific companies from a radio or television broadcast on financial trends.

Nuance has posted a video demonstration of a doctor using CLU technology to dictate a patient’s diagnosis and treatment plan into an EHR.

Of the approximately 2 billion medical reports dictated per year in the United States, most are dictated by physicians using this narrative process, Durlach noted.

Physicians still need to use the narrative format and have the CLU technology format it, he explained.

“These EHRs, they require physicians to point and click through multiple screens. The physicians can’t stand it because it slows them down—they’re very awkward,” Durlach added.

“EMRs [electronic medical records, or EHRs] have a significant amount of freely dictated/written unstructured doctors’ notes and comments,” Roukos explained. “The CLU analyzes this unstructured text and extracts facts into structured tables such as any allergies a patient might have. The structured data can be used to automate any checks to improve on health care services.”

CLU can identify and pull data on medical problems, social history, allergies and medications from the narrative text, according to Nuance.

The CLU technology can also alert health care providers to previous information about a patient, Roukos said.

Companies such as 3M Health also offer dictation apps for health care

New Article: The DICOM Conformance Black Paper – What Your Vendors Don’t Want You To Know

Dear fellow readers,

I would like to share with you a freshly minted whitepaper blackpaper on DICOM Conformance – What your vendor don’t want you to know.

Sounds like a serious topic? You bet!

In this whitepaper blackpaper, we will take a look at the role of DICOM,  the reasons why (and on how many levels) DICOM non-conformance takes place as well as the resolution options to DICOM non-conformance.

This whitepaper blackpaper is part of the Vendor Neutral Archive (VNA) series (first whitepaper can be accessed here) and serves  as an introduction/teaser to an upcoming Ebook  – “Vendor Neutral Archive & How it will change the World (of Medical Imaging Informatics)”, estimated launch date : Mid-December 2010

“The DICOM Conformance Black Paper – What Your Vendor Don’t Want You To Know” can be accessed here.

Note: Special acknowledgements to Mr Ravi Krishnan for advisory and proofreading on this whitepaper blackpaper (making it a better read).

Ramblings: So I am now Dr. Adam CHEE

As mentioned in the previous post “October 2010 holds many new ‘first’ for me“, there are two other new ‘first’ and this is one of it.

That’s right ladies and gentlemen, I have graduated from my doctorate program (about a week ago), henceforth, my official salutation will be ‘Dr.’

No, I did not go to Medical School (I did not get a MD – Medical Doctorate) nor did I do a Research Doctorate (PhD – Doctor of Philosophy), what I completed was a Professional Doctorate – a Doctor of Industrial Technology (D.I.T) which focus on the optimization theory, human factors, organizational behavior, industrial processes, industrial planning procedures, basically the effective application of technology into the industry. For the interested, my (applied) thesis is in Health Informatics 🙂

For the unaware, a professional doctorate is on the same level with a research doctorate (a.k.a PhD), it’s just that the focus is different

  • A professional doctorate is applied research to a profession  while a research doctorate is .. well.. more academia  in nature
  • The minimum entry requirement for a professional doctorate is a Master Degree with substantial working experience while the research doctorate is good honors with zero requirements on working experience

To understand more on this topic, read this article. (P.S. a Medical Doctorate is also a professional doctorate).

Now not many people knew that I was undertaking doctorate studies (for those whom I told, very few believed it to be true because I am always making jokes about it), the reason why I did not make it ‘public information’ is because I had previously embarked on a PhD program but it didn’t materialize, hence it would have been extremely embarrassing if I didn’t manage to complete my Doctor of Industrial Technology (thankfully I did).

Because I work in both higher education and in the healthcare industry, I get addressed as ‘Dr.’ on several occasions prior to this (especially when I present at conferences) and it was quite awkward having to correct people, so I am kind of glad that I have finally graduated.

So there you have it, the second ‘first’ for me in the month of October, there is a third ‘first’ so stay tune 🙂

~Dr. Adam CHEE

Ramblings: ‘The Book’ is published

Thats right ladies and gentlemen,

‘So You Want To Be a PACS Administrator” is officially published!

However, it is not released for sale yet.. the reason? Well I just order the first copy of the book for proof-reading purchases so for the eager readers, please bear with me for a little longer, I will release the book for sale once everything checkout ‘ok’.

In the meantime, allow me to share a review by Mr Phil Robson, a fellow friend and industry expert (those working in the medical informatics scene in ASEAN and Middle East would know him).

“With the publishing of “So You Want To Be a PACS Administrator” Adam has added to his already large volume of published material in the field of Imaging Informatics through binaryhealthcare.com, amongst other sources.

Adam’s book covers all aspects of procurement, implementation and ongoing management and maintenance of a PACS system. It is written in a style that will engage and interest readers across the range of interest and experience levels.

It will serve as an invaluable reference source to experienced RIS and PACS Administrators, Radiographers, Healthcare IT professionals, students and other healthcare professionals.

Of particular interest to me, as an ex-Radiographer was the Chapter on Applied Imaging Informatics. This chapter clearly explains, in non technical terms, the seemingly complex DICOM arena.

The sections related to future proofing any PACS purchase, and ensuring Vendor or PACS neutrality for an institution’s Image Data are of particular relevance as many facilities are entering into second generation PACS replacements for Radiology, or extending Imaging Archives into other clinical specialties.

Let us hope that PACS Administrators, in time, are fully recognized for their expertise in their chosen profession. That day has been brought closer with the publishing of this book”


Ramblings: October 2010 holds many new ‘first’ for me

Looking at the foreseeable events of things to come, it would appear that October  2010 holds many new ‘first’ for me.

For starters, I have started on a new job as Sales Director (although the job is relatively technical in nature), with an extremely innovative company that provides (and develops) vendor neutral enabling solutions in the  medical imaging informatics space.

Technically this is my first Director level job in a commercial entity (being the Chief Advocate/Director of a binaryHealthCare doesn’t technically count as it is a Social Enterprise).

In addition to the new job, there are two other new ‘first’ that will happen in October 2010 but I will keep in under warps for now as not to ‘jinx’ them but do stay tune for the exciting updates.

Cheers 🙂