Multimedia

Recent advances in the application of multimedia technology in the fields of medical care have made it possible to digitize a very broad range of medical information and treat it in a uniform way. With these technical advances in the background, the concept of an” electronic patient chart", which has so far contained only a very restricted range of patient medical (digital) information, such as clinical laboratory test results and disease names, is going to have a substantial meaning in medicine. [1].

In the field of Radiology alone, images and diagnostic tools are complex, accurate and performed in LIVE real time. A pregnancy ultrasound 28 years ago did not even exist. Today, we can perform an ultrasound and literally see a 3-D image in color of a developing fetus week by week. (Example: http://0.tqn.com/d/pregnancy/1/0/o/Y/3/07armstrong3d29.jpg) Multimedia imaging is exactly that and can be best described as using many techniques to arrive at an outcome. Not only can a pregnancy ultrasound create 3-D images for viewing, but it also allows for hearing a fetal heartbeat, write an EKG tracing of the same heartbeat and, with the use of Artificial Intelligence,(Ability of a machine to perform tasks thought to require human intelligence. [2]) interpret the EKG by detecting abnormalities and create, write and print a report accordingly.

Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. [3] It does not use radiation (x-rays) as you would expect. This painless test obtains images as “slices” from the top - down of any internal organ or structure. The images are so accurate and detailed that at very early stages, many illnesses can be discovered that a conventional x-ray would not pick up. Improvement in Breast Cancer detection or Cardiac Disease management and outcomes stemming from the results are all occurring due to technology advances and the increasing use of this platform. Oftentimes under this guided imagery, tumors can be surgically removed, cardiac anomalies ablated and abnormal bleeding cauterized.

With the onset of telecommunications through DSL lines,cable, fiberoptics, fax lines and through the internet, images can be sent all over the world for rapid interpretation, consultation or diagnosis as well. Advances in mulitmedia in the healthcare profession is to blame for cures for diseases, early diagnosis, and illness treatment plans.

[1] Rapid Progress of Multimedia in Medicine and the Increasing Importance of Color: http://biocolor.umin.ac.jp/book200102/din01022801.pdf

[2] http://www.answers.com/topic/artificial-intelligence

[3] http://www.webmd.com/a-to-z-guides/magnetic-resonance-imaging-mri

Clinical DSS

The main focus of MIS vs. DSS in research, on the internet and in textbooks is all about business and finance. Another major aspect of a DDS is the clinical system. Clinical DSSs are typically designed to integrate a medical knowledge base, patient data and an inference engine to generate case specific advice. [1]

Today, with healthcare issues in the forefront and meaningful use being a financial incentive force for hospitals to go electronic, choosing the correct Hospital Information System (HIS) is key for the success of the implementation and meeting the deadlines to qualify for the government stimulus money. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs (Electronic Health Record) in meaningful ways to help our nation to improve the quality, safety, and efficiency of patient health care [2]

These implementations have to meet calendar deadlines to qualify for quite possibly large sums of money all in the effort to standardize healthcare and promote evidence based practice. Choosing the right clinical DSS is vital to the success of a facility, can increase patient satisfaction and can improve productivity and workflow in the healthcare environment. These systems are customized according to each individual facility’s policy and procedures, state and federal guidelines and proper medical practice. A clinical DSS is data driven and can assist in rapid decision making, can provide input from both patient and physician and can provide reporting services based on the data input.

Computerized clinical decision support systems directly assist the clinician in making decisions about a specific patient. [3] Pharmaceutical decisions can be made directly upon ordering just by having a drug-to-drug interaction warning, allergy warnings, or over/under dose warnings built into the system. Parameters can be set on drugs according to heart rate or blood pressure and when the clinician enters the data, the interactions are viewed immediately. Many systems can be set up with “hard stops” to avoid medication errors and increase patient safety. The reporting services of a DSS can provide a plethora of information regarding all aspects of a patient’s care. Drug Interaction reports, medication error reports, nursing documentation reports and the like can provide information on the compliance of health care workers as well as identify problem areas early on so appropriate action can be taken to avoid incidents.

In every aspect of medicine, Clinical DSSs are used throughout the healthcare continuum. Physicians are able to review charts and be able to document those findings reviewed in the patient’s medical record in real time called Point of Care (POC). 

A radiology system (RIS) is an example of another way the clinical DSS is used. Imbedding x-ray images into the patient’s medical record upon completion with interpretations all assist in diagnosis and treatment. The same holds true with a Cardiology system. An electrocardiogram can be performed, posted and reviewed in real time at the POC, which is timely, accurate and could very well be life-saving.

Of course, nothing will take the place of “hands on” medicine, but the technology now has not only improved patient care and outcomes but has increased the efficiency of the health care provider.

There is growing recognition that CDS, (Clinical Decision System) when well-designed and implemented, holds great potential to improve health care quality and possibly even increase efficiency and reduce health care costs. [4]

1. http://www.openclinical.org/dss.html

2. https://ehrincentives.cms.gov/hitech/login.action

3. http://www.accessmedicine.com/content.aspx?aID=779210

4. http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

eBusiness

E-business (electronic business), derived from such terms as "e-mail" and "e-commerce," is the conduct of business on the Internet, not only buying and selling but also servicing customers and collaborating with business partners. One of the first to use the term was IBM, when, in October, 1997, it launched a thematic campaign built around the term. Today, major corporations are rethinking their businesses in terms of the Internet and its new culture and capabilities. Companies are using the Web to buy parts and supplies from other companies, to collaborate on sales promotions, and to do joint research. Exploiting the convenience, availability, and world-wide reach of the Internet, many companies, such as Amazon.com, the book sellers, have already discovered how to use the Internet successfully [1]
eBusiness is here whether we like it or not. We can use the internet for every aspect of our lives, be it sharing personal experiences, shopping online or using documents for business use. With businesses watching our every move and marketing according to likes and dislikes, eBusiness can become, quite possibly, the answer to our economy’s poor state of affairs. Businesses can offer the convenience of shopping and paying online, as well as comparison shopping for best prices and consumer best choices as a one-stop-shopping internet site. Companies buy from others and offer the consumer the best of everything. On an increasing basis, consumers turn to the Internet to purchase and research items like dishwashers, cars, stocks, travel and even clothing. According to a September 2007 Pew Internet & American Life Project survey, 49 percent of Americans have bought a product online and 60 percent rely on the Internet to conduct product-related research.[2] The benefits of eBusiness to the consumer is vast. Businesses can reach virtually every part of the world for the best product and offer it to the buyer at competitive prices on a single site. The rapid growth of the internet commerce in recent years presents established small businesses with a serious dilemma. On the one hand, they can stick with the business model that has worked for them for the last number of years. On the other hand, they can make the shift to serious eBusiness. Choosing to stand pat is usually much easier in the short term. But in the longer term this almost certainly means they will be left behind by technology, and lose many of their most important clients to more aggressive competitors. [3]
As a consumer, utilizing an eBusiness is the most economical way of shopping and decision making. Comparison shopping, best prices and best products all can be researched and we can now make a true educated decision on our purchases. Returns and receipts are kept in databases making the process simpler as well. With the choice of free shipping and online specials and the convenience of shopping at home, an eBusiness is lucrative both for the consumer and the company.

1 http://searchcio.techtarget.com/definition/e-business

2 http://communication.howstuffworks.com/advantages-e-commerce.htm

3. http://www.enetsc.com/EBusinessArticles.htm

Conferencing

Web conferencing is innovative and cost-saving for those large companies who need to reach out to clients across the world. Over the years, technology has expanded from conference calls via telephone to webinars. What is web conferencing? Simply stated, it is a solution that brings people together from multiple locations to share information in an interactive environment with other users over the Internet. From multi-million dollar corporations to home offices, web conferencing increases productivity by having decision makers all present in a single setting to discuss budgets, logos, campaigns, and other strategic topics.
During these conferences, ideas are generated through shared applications, such as polling and virtual whiteboards, and the web conferences usually include real-time VoIP (voice over IP) to accompany presentations with audio. Web conferencing also includes the ability to display and interpret PowerPoint slides and documents, send text messages, and it can record a meeting session offline as well as online. [1]

“The internet has made it possible for those involved in teleconferences to share computer desktops, Using services such as WebEx or GoToMeeting, conference Participants log into common software that allows them to broadcast their computer display to the group” [2]

Webinars and online video are today's fastest growing information distribution platforms. Its little wonder when you consider the value provided to the producers, participants, and viewers by such a convenient, robust communication venue. [3]

In my experience, I have found webinars to be both a help and a hindrance. For educational purposes, I find them to be convenient and cost-effective. There are opportunities for asking questions, immediate feedback and group participation. Attendance can be accessed from anywhere (home, work or even vacation) and it also allows for saving the program for viewing at another time. In nursing, many of them are free and offer CEUs. Webinars and conferencing is priceless when it comes to education and also in the workplace for conferencing with clients all over however they can also be a hindrance with great limitations.

We are in the process of implementing an EMR. Due to time constraints, travel costs and lack of personnel the company we are currently involved with has taken to webinars in place of their site visits. They have also included other sites conferenced in on the same calls. At times, we could have up to 2-3 different facilities across the country participating. In healthcare, regulations vary from state to state and questions presented during the conference at times have no bearing on what others are doing. This can drag on the webinar and decrease the attention span of the participants.

Time constraint is another downfall. All issues may not be answered or material may not be covered, which results in an additional webinar. The main disadvantage is the lack of interaction between the participators and the presenter as the entire seminar is conducted online. The presenter is little more than a voice on the other end, so the instructor cannot gauge the level of understanding among the participants. Brainstorming and sharing of thoughts are particularly minimal. The level of synergy is lost. It proves to be a handicap when it comes to reinforcing the subject as it limits the ability to practice and refine new skills. Also in webinars, the different learning styles of people cannot be addressed properly. [4]

In healthcare, this platform, although convenient, will never replace an actual site visit from the vendors. Companies need to get a real “feel” of a facility, understand workflow and interview staff about the applications they are implementing. The company implementing our program also offers webinars for an exorbitant fee and recommends purchasing them in a series grouped in a “package” in order to fully understand their software. Although it may be cost-effective and lucrative for the company offering the service, it is a financial burden and at times inconvenience for those participating. What may be cost-effective for the company using this platform may not be so efficient and productive for those dependent on knowledge transfer.

[1] http://www.web-conferencing-zone.com/what-is-web-conferencing.htm

[2] Stair, Ralph & Reynolds, George (Sixth Edition) Fundamentals of Information Systems p.194

[3] http://www.technology-webinar.com/

[4] http://lifestyle.iloveindia.com/lounge/what-is-a-webinar-8487.html

Reply

Web 2.0

Web 2.0 is the term given to describe a second generation of the World Wide Web that is focused on the ability for people to collaborate and share information online. Web 2.0 basically refers to the transition from static HTML Web pages to a more dynamic Web that is more organized and is based on serving Web applications to users. Other improved functionality of Web 2.0 includes open communication with an emphasis on Web-based communities of users, and more open sharing of information. Over time Web 2.0 has been used more as a marketing term than a computer-science-based term. Blogs, wikis, and Web services are all seen as components of Web 2.0. [1]

The concept of "Web 2.0" began with a conference brainstorming session between O'Reilly and MediaLive International. Dale Dougherty, web pioneer and O'Reilly VP, noted that far from having "crashed", the web was more important than ever, with exciting new applications and sites popping up with surprising regularity. What's more, the companies that had survived the collapse seemed to have some things in common. Could it be that the dot-com collapse marked some kind of turning point for the web, such that a call to action such as "Web 2.0" might make sense?[2]

Early on, the internet, or World Wide Web was infantile compared to the vast tools available now. With this second generation web, it has not only brought the world together in business but in social life itself.

We are in the midst of developing concepts. Social media alone is a vast and changing environment. It is a business marketing haven for up coming companies targeting audiences. Blogging, instant messaging, telecommunications, interactive websites all make up the new generation Web 2.0. Yet, through all the media blitz and business frenzy, is it all really “good”? For fear of sounding “dated” I will risk to say not all that glitters here is gold. We fight for the right of privacy. In one quick click of the mouse it’s gone. We are opening ourselves up to uncharted territories. Companies are watching what we eat, buy, browse even read. I shouldn’t say watching...the proper term here is “stalking”. It is, however, our fault.

Why not check in with 465 friends and let them know what you are doing every moment, or tell the world every step you take with a change in status. Or how about an update on location and let the world know exactly where you are at any given second. The Web is no longer a collection of static pages of HTML that describe something in the world. Increasingly, the Web is the world – everything and everyone in the world casts an "information shadow," an aura of data which, when captured and processed intelligently, offers extraordinary opportunity and mind bending implications. Web Squared is our way of exploring this phenomenon and giving it a name. [3]

[1] http://www.webopedia.com/TERM/W/Web_2_point_0.html

[2] http://oreilly.com/pub/a/web2/archive/what-is-web-20.html?page=1

[3] http://www.web2summit.com/web2009/public/schedule/detail/10194

For further interest watch: http://www.youtube.com/watch?v=nsa5ZTRJQ5w

Database Research

[1] “One of the technology terms that most people have become accustomed to hearing either at work or while surfing the Internet is the database. The database used to be an extremely technical term, however with the rise of computer systems and information technology throughout our culture, the database has become a household term.

The definition of a database is a structured collection of records or data that is stored in a computer system. In order for a database to be truly functional, it must not only store large amounts of records well, but be accessed easily. In addition, new information and changes should also be fairly easy to input. In order to have a highly efficient database system, you need to incorporate a program that manages the queries and information stored on the system. This is usually referred to as DBMS or a Database Management System. Besides these features, all databases that are created should be built with high data integrity and the ability to recover data if hardware fails.” 

[2] “In simple terms, a single database system is great for individual needs such as organizing files for the home, documenting doctor’s or dentist’s visits, creating a daily schedule to keep track of everything on your To-Do list, remembering special occasions, etc.” [3] “The generation, collection management and reporting of data are the primary function so of each information system within the HIS. Each function is addressed by the organizations integrated information system. For example, to meet the billing and regulatory requirements for an outpatient visits, the following data are captured and communicated. To accomplish these functions, and HIS includes components that support patient registration, scheduling, charge capture, clinical documentation and billing. In some cases, manual forms track patients through portions of their visit and then data are subjected to batch data entry at a later time to complete a database.”

The paragon McKesson HIS system contains these components. The advantages of the registration system includes the ability of the system to retain historic information and allow the fields to be manipulated with changes in demographic information, etc.

The major disadvantage is the search function. Exact information must be entered or the patient’s information will not be found . This causes a major duplication of records. Also, the registration application is not fully integrated with the other components of the system. An enhancement would certainly be to have all the applications that make up the Paragon HIS “talk” to each other. The company is trying to improve their competitive edge by applying these enhancements to their software, however with the onset of “meaningful use”, all production to the HIS has been on hold and their concentration lies with Computerized Physician Order Entry (CPOE).

[1] “Database” http://www.tech-faq.com/what-is-a-database.html

[2] “Database” http://www.databaseguides.com/what-is-a-database

[3] Englebardt, Sheila P & Nelson, Ramona (2004) Health Care Informatics: An Interdisciplinary Approach , 151

Hardware and Software

n a 328 bed hospital, the administration of 25,000 doses of medication per month was streamlined through information systems. The hardware purchased was: desktop computers, mobile workstations on wheels that are thin clients, blue tooth wireless technology; access point’s communication devices, portable handheld devices (Tablet) and barcode scanners.

The proprietary software package is McKesson’s Paragon, which is integrated health care software that is a certified, electronic health record and comprehensive hospital information system, whereby clinicians can input data that is processed and functions as a communication between practitioners and departments as well as across health care disciplines and insurance companies. This is rated the #1 community HIS by KLAS in 2006-2010. The system is on a Microsoft platform.

The workflow/role for medication administration includes: the Doctor placing an order in his HP Tablet over a secure (VPN) network utilizing wireless technology (Blue Tooth & Access Point). This order flows into the ‘Pharmacy Connect’ software system through the Paragon software. Once this communication is reviewed, the pharmacist coordinates the flow of data to the automated medication dispensing cabinets (ADCs). The nurse logs into the ADC and chooses the patient, the medication for the patient and removes it from the secured locked draw. 

Prior to administration of the medication, the nurse use the barcode scanner to scan her identification badge, medication and patient’s identification badge to ensure the right route, dose, medication, time, and patient. The last right is documentation, which is done through the electronic signature.

HIPPA & privacy laws, as well as potential for viruses have eliminated the use of personal flash drives at work. Encrypted flash drives are provided to those individuals who need to give external presentations. In preparation for bedside medication administration, the institution purchased laptops, WOWs (workstation on wheels) and hand-held scanners.

The use of hardware and software technology in the healthcare environment has shown to decrease medication errors and improve the communication across providers.