Medical information visualisation; biomedical visualisation; proceedings.

Int’l conference on Medical Information Visualisation (3d) BioMedical Visual…(2005: London, England) Ed. by Gordon Clapworthy et al.

Computer Society Press

2005

83 pages

$157.00
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R859

In these proceedings from the July 2005 conference, contributors describe their work in bio-mechanical modeling and simulation, treatment planning, analytical visualization and multi-dimensional data visualization. Specific topics include patient-specific muscle models, the influence of bio-mechanical parameters on simulation of lung behavior, simplification of mesh models, complex pre-operative planning environments for total hip replacements and targeted radiation therapy, a simple method to show variations, 3D reconstruction of lymph nodes, statistical analysis for brain EIT images using SPM, a 3D visualization system of a cranium using x-ray images and visualization of biochemical results using SimWiz3D.

The American Hospital Association (AHA) in Chicago, the Association of American Medical Colleges, and the Federation of American Hospitals, along with accrediting organizations, government agencies, and quality and consumer groups have begun a new voluntary initiative that will collect and share with consumers standardized quality measures of patient care in hospitals.

At a press briefing in Washington, DC, AHA president Dick Davidson said that the initiative will begin by looking at 10 quality measures involving heart attacks, heart failure, and pneumonia. “Providing high-quality care demands that patients be informed partners in decisions about their care every step of the way,” he said in a prepared statement. “Providing helpful information can only enhance a patient experience.”

Imagine connecting medical records for millions of patients to billing, registration, and scheduling areas for a truly connected health information system. Imagine the efficiencies to be gained in patient care. Imagine the savings in operating costs and capital expenditures plus increased revenue due to improved efficiency. Although the magnitude of this vision may be daunting, it’s becoming a reality.

Kaiser Permanente, the nation’s largest not-for-profit integrated delivery system with more than 8 million members in nine states and the District of Columbia, is uniquely positioned to undertake the major clinical information system transformation now under way to improve healthcare quality, enhance the patient experience, and transform business processes. Kaiser Permanente’s health IT initiative is destined to become one of the nation’s largest private-sector clinical IT systems. Known as KP HealthConnect, the large scale effort will integrate all patient information in a single system linking medical information with billing, scheduling, and registration data. The size of the initiative is such that caregivers will be able to refer patients to specialists on the spot, send prescriptions to pharmacies electronically, and share information in real time with other physicians treating the same patient from different locations. It is a major undertaking. The IDS will invest more than $3 billion, including one-time investment and ongoing support, over an 11-year investment horizon.

Kaiser Permanente is one of a growing number of health systems implementing large-scale health IT initiatives. However, tight budgets and increasing scrutiny continue to challenge the organization and other adapters of health IT to justify costs and understand the ROI for such initiatives. Through it all, “benefits realization” is the mantra. To demonstrate and document the value of its technology, Kaiser Permanente has developed strategies, methodologies, and models to improve the deployment and financial management of its technology investments. Health IT implementation projects require a level of project and financial management on a par with a major industrial engineering or construction undertaking. Complex clinical IT projects can be risky propositions that can fail to deliver on their promise. The risks include technical failure, system obsolescence due to insufficient maintenance, and workforce or customer resistance.

With today’s rising healthcare costs, specialists are under the gun to save money wherever possible, while still providing top-notch care. Providers stagger under the weight of administrative loads generated by even small practices, while the demands of patients, affiliated health plans and referring providers grow each day.

By moving paper-, phone- and fax-based processes to the Web, healthcare organizations can help slash the high cost of administrative waste. One important element of successfully managing and streamlining the administrative flow of interacting with health plans is Web-based connectivity.

Health Plans Can Help

Not long ago, Orthopedic and Sports Medicine of Erie (OSM) was a prime example of an overburdened provider. With three physicians and 35,000 patients, the practice was overwhelmed with the paperwork required to correspond with its affiliated health plans. Finally, with no viable solution to help her staff as they struggled to stay on top of the workload, Practice Manager Charlene Kellerman began looking for a way to handle the day-to-day functions required to keep the practice running smoothly.

With 30 percent of OSM’s patients covered by Highmark Inc., Kellerman went directly to the health plan to lobby for a better way to handle administrative transactions. “We asked Highmark to find a way to use the Internet for some of our paperwork and other manual processes,” she said. “The paper chase for referrals alone was unbelievably difficult, and our staff could barely keep up with the workflow. Highmark took our request seriously, and we were one of the health plan’s first providers to begin processing transactions via the Web.” That was in the fall of 2000, and Kellerman and her staff have been enjoying the benefits of Web-based connectivity ever since.

Pain-free Connectivity

Luckily for OSM, choosing the technology was painless. The practice did not have to endure the process of evaluating its needs, debating whether to buy or to build, choosing a technology vendor or integrating the technology into new and existing processes. Highmark had already done that homework and deployed the technology, NaviMedix’s NaviNet platform, offering it to OSM and the rest of its network providers free of charge.

Through patented technology and an innovative master franchising program, Medical Hair Solutions of South Florida offers Latin American investors and entrepreneurs a unique business opportunity to address one of the most common cosmetic concerns–the problem of hair loss.

“We offer a turnkey solution that allows physicians, health care professionals or entrepreneurs to help Latin Americans suffering from hair loss enjoy all the benefits of a younger, more vibrant appearance,” says C. Leo Smith, managing partner and COO of Medical Hair Solutions of South Florida. “This is an ideal way to build a successful business that caters to the cosmetic needs of tens of millions of Latin Americans.”

The market opportunity is enticing. According to the American Academy of Dermatology, two out of three men develop some form of baldness later in life. About half as many women suffer from hair loss, and children being treated for cancer often lose their hair, as well. Other candidates for treatment include men or women experiencing illness-associated hair loss or scalp conditions and women with post-partum hair loss. The technology also can be used to treat dermatitis, psoriasis, itchy scalp and other skin conditions, opening the door to additional revenue-producing diagnostic and treatment services.

The Medical Hair Solutions of South Florida system uses proven hair growth activators and a patented Swedish technology called Low Level Laser Therapy (LLLT) to treat baldness, thinning hair and scalp conditions. This noninvasive treatment stimulates the scalp and opens closed hair follicles. Health, moisture and nutrients are brought to the bottom of each hair follicle to stimulate hair growth.

LLLT was first used to treat diabetics with lower extremity ulcers due to poor blood supply. Researchers found that lasers improved blood flow, and body hair located within the radius of the laser beam grew thicker and longer than the surrounding hair.

Clinical studies in Europe have found that the use of low levels of laser light stops progression of hair loss in 85 percent of patients and encourages hair growth in almost 60 percent. The U.S. Food and Drug Administration (FDA) has approved Low Level Laser Therapy as safe for cosmetic use to make hair thicker and healthier.

According to a report, “A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors,” published in the July/August issue of Annals of Family Medicine, most medical errors in family medicine begin with miscommunication. Researchers analyzed 75 anonymous error reports from 18 U.S. family physicians and documented errors in 77 percent of incidents. About 80 percent of the errors involved some form of miscommunication, such as an error in medical record data or a communication breakdown between the physician and patients or colleagues. The project was a collaboration between authors in the Department of Family Medicine at Virginia Commonwealth University, Richmond, and the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington, D.C. More information is available online at http://www.aafp.org/x28597.xml. For the full article, go to http://www.annfammed.org/cgi/content/full/2/4/317.

Can new semiconductor packaging ploys cut health care costs?

Can flex and other advanced packaging materials and techniques now coming under scrutiny to cut costs as well as reduce IC size in next-generation cell phones and game machines wind up inside your anatomy some day in medical implant devices like pacemakers? If biotechnology advances match predictions, the human body could prove an explosive market for ICs and other componentry, providing the next frontier for the packaging community.

Ways to make the semiconductors inside medical implant devices less expensive are coming under scrutiny as the national drive to lower health care expenditures moves forward. Premium quality and reliability standards must still be maintained, however, in such life-and-death applications. Can cheaper IC packaging techniques such as use of flex and other materials as replacements for ceramic substrates meet the rigorous demands of medical electronics destined for the human body?

Yes, according to several researchers who will present their findings at this week’s High-Density Interconnect and Systems Packaging conference in Denver. Flex can successfully replace ceramics in medical electronics applications, just as it is currently doing in many other areas, they contend.

“Today, miniaturized electronic devices for medical applications cannot be considered as high-priced products in a secured market. Due to increasing competition and pressure on health expenses, cost for hardware is quickly gaining importance for successful marketing,” note Mike Stampanoni and Walter Schmidt of Dyconex Ltd., Zurich, Switzerland, in a paper. They will review “Modern Interconnect Solutions for Miniaturized Medical Electronic Devices” at the Denver meeting.

The paper discusses packaging options for implantable medical devices, analyzing the unique system challenges. Devices such as pacemakers, defibrillators, and hearing aids require long-term, reliable packaging in small volume with low weight, the paper states. Fortunately, the environment for such devices, the human body, is not very demanding in terms of temperature variations and mechanical shock.

Purpose: To check the accuracy of the Internet-derived medical information.

Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and

Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid.

Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities.

Healthcare organizations are no different than most large corporations. Running them efficiently means putting in place a financial information system (FIS) that operates effectively on all levels, from individual departments to the corporate office. When an organization grows, especially through acquisitions, coordinating these systems across the enterprise is crucial.

The problem in healthcare, however, is that the best-of-breed approach taken by many institutions has created a world of disparate systems that require interfacing with other hospital systems. This can be a daunting task within a single hospital, let alone among a dozen facilities owned or operated by a parent company.

But things are beginning to change. Large healthcare organizations, and some vendors, have realized that financial information systems can no longer be relegated to back-office status. Their importance in patient billing, claims processing, materials management and even strategic planning requires that standardized business applications be accessible to key personnel across the entire enterprise, whether that means one hospital or a dozen.

In the case of St. Vincent Health in Indianapolis, that meant a network of 16 hospitals. For Orlando Regional Healthcare in Orlando, Fla., a total of seven facilities needed to be linked. Each organization’s decision to choose a single, integrated FIS that could be rolled out at each institution not only improved overall efficiencies, but also provided the flexibility necessary to support future growth.

Medical practice is increasingly being computerised. In our offices we use our PCs to prescribe electronically with fewer errors, automatic recognition of potential drug interactions and allergies, and more legible scripts. Clinical decision support software offers the potential to add rigour to our decision making. Many of us use real time web access to support this functionality. How can these important developments be extended to our work in the emergency department, on home visits, while caring for patients in institutions, and other settings where the practitioner is away from the office and its resources?

It is possible, although impractical, to take a laptop along and access the internet either via standard or mobile telephone. However, use of a hand-held computing device offers a much more palatable solution. There are many devices on the market. For months now I have used a Palm Pilot Vx (www.palm.com) weighing just over 100g and fitting into my shirt pocket as diary, address book and notepad, and it synchronises with my office PC easily’ through a cradle or infrared port. Recently’ I have also started using it in my medical practice.

Firstly, I installed a comprehensive clinical drug information guide that I now regularly use to check my prescribing when out of the office. The database is automatically updated daily through the web when I synchronise the Palm with my office PC. Thus, using the Palm to support my prescribing is quicker, more accurate, and much more accessible than any paper-based resource. My Palm now also has, among others, programs to calculate cardiovascular risk, intravenous drug doses, and gestational age . This weekend I found the Merck Manual (one of my favourite resources) available for free download in Palm format and the entire manual now resides on my Palm.

I saw 56 patients while on duty at the local hospital yesterday. I used the Palm to check prescribing 10 times and to inform my therapeutic decision making six times. Access was simple, easy, quick and unobtrusive to the clinical encounter.

I feel that I have entered a new era in my medical practice. For the first time I have evidence in easily accessible format at my fingertips wherever I am.