Friday, February 27, 2015

A Case Of MergDR...Merge Buys DR Systems

I guess my fingers are not quite as firmly placed on the pulse of PACS as I might have thought. I was completely blindsided by today's announcement of the acquisition of DR Systems by Merge. Oh, well, life is full of surprises.

From AuntMinnie.com:
February 27, 2015 -- One of the oldest names in imaging informatics is going by the wayside as PACS firm DR Systems has been acquired by Merge Healthcare. While the DR Systems name will be retired as part of the deal, founder and CEO Dr. Murray Reicher has been named chief medical officer (CMO) of Merge.

The deal unites two midlevel PACS providers and gives Merge additional scale to compete with larger multinational firms in the imaging informatics space. It also expands Merge's geographic footprint to DR Systems' core market in the Western U.S., while broadening the combined company's portfolio of intellectual property.

The deal was finalized on February 25, according to Michael Klozotsky, vice president of marketing at Merge.

Founded in 1992

DR Systems was founded in 1992 by neuroradiologist Reicher along with another brain imaging specialist, Dr. Evan Fram. Reicher and Fram said they founded the company out of dissatisfaction with existing PACS software available at the time.

The closely held company charted its own course over the years, remaining fiercely independent even as the rest of the radiology industry consolidated. The company gained a reputation for high levels of customer satisfaction, as evidenced by a string of top rankings in KLAS reports, as well as for its aggressive defense of its patents for PACS software.

Through the years, Reicher maintained his active role with the San Diego firm, serving as a frequent speaker at industry events and publishing peer-reviewed articles on imaging informatics. He assumed the position of CEO again earlier this year after the retirement of longtime chief executive Rick Porritt.

In announcing the acquisition, Merge cited the broad array of healthcare information technology software that will be offered by the combined firm, including DR Systems' eMix image-sharing service, RIS software, and cardiology and pathology offerings. Both companies also offer traditional PACS and RIS/PACS software and, indeed, have long been competitors in the acute care and ambulatory markets, Klozotsky said.

Merge cited the high customer satisfaction ratings of the combined entity, with No. 1 ratings according to KLAS surveys for cardiovascular information systems, hemodynamic monitoring software, and RIS software. Merge also plans to offer its iConnect Network services, including exam preauthorization, through DR Systems' installed base.

In addition to adding Reicher as CMO, Merge said it plans to keep DR Systems' San Diego headquarters open as its West Coast regional office. DR Systems employs some 180 people, according to Wikipedia. Merge will also maintain support for DR Systems' core software platform, continue with current implementations, and support and advance all product lines, the company said.

Merge expects the deal to be accretive to earnings per share under nongenerally accepted accounting principles (GAAP) in 2015 and future years. Merge financed the deal through a combination of $20 million in cash on hand and $50 million in cash raised from the sale of shares of recently issued preferred stock.

The deal is the latest in a long string of acquisitions that Merge has made over the years as it grew from a niche firm offering data connectivity software to perhaps the largest independent PACS firm. Other acquisitions have included Amicas, Cedara Software, Confirma, RIS Logic, and eFilm Medical.

Merge's most recent acquisition is designed to give the combined entity the heft to move forward in a healthcare industry where size increasingly matters.

"As healthcare continues to consolidate, scale is very, very important," Klozotsky. "This allows Merge to really operate on an entirely different level of scale."
I've met Dr. Reicher one one occasion, and he is a perfect choice for CMO. He is very well spoken, and truly a pioneer in this business.  In fact, DR holds quite a few core patents in PACS, as some other companies have painfully discovered.

It remains to be seen just how the DR products will be incorporated into the Merge palate. Will Merge PACS have a Catapult for the techs? We shall see...

Live Long and Prosper...And Boldly Go Where All Men Someday Will...

Leonard Nimoy, Star Trek's Mr. Spock to generations of fans, died today at age 83. Nimoy died peacefully at home from complications of COPD, chronic obstructive pulmonary disease, caused by cigarette smoking in his younger years. How illogical.

I think the eulogy given by William Shatner as Captain Kirk in the second Star Trek movie, The Wrath of Khan, says it all:
We are assembled here today to pay final respects to our honored dead. And yet it should be noted that in the midst of our sorrow, this death takes place in the shadow of new life, the sunrise of a new world; a world that our beloved comrade gave his life to protect and nourish. He did not feel this sacrifice a vain or empty one, and we will not debate his profound wisdom at these proceedings. Of my friend, I can only say this: of all the souls I have encountered in my travels, his was the most... human.
Star Trek gave us hope of new worlds, of new ideas, in the midst of the strife of the 1960's. We need this encouragement even more today.

Spock was at once of us and foreign to us, half-human and half-Vulcan. Similarly, Nimoy, growing up an Orthodox Jew in Boston, probably felt something of the same dichotomy. When a Star Trek script called for Spock to make an "alien gesture," Nimoy reached back into his Jewish heritage, and used the Orthodox priestly blessing as the "Live Long and Prosper" sign we know so well:


I spent about 10 seconds in the presence of Messrs. Nimoy and Shatner at the Star Trek convention in 2004. We were not quite on a first-name basis, although at one point I was one of William Shatner's 5,000 Facebook friends. Still, like millions of fans today, I feel like I've lost a close friend; these actors and their characters have been part of our lives, well, for most of our lives.

But as DeForrest Kelley's Dr. McCoy said at the end of The Wrath of Khan, "He's not really gone as long as we find a way to remember him." Perhaps not completely logical, but true nonetheless.

Godspeed, Leonard.

I have to add one little thing on this, the day of Mr. Nimoy's funeral. I was searching the Official Leonard Nimoy Online Shop (shopLLAP.com) for something he had touched or otherwise autographed. I came upon his signed self-portraits in the photography section, housed by R. Michelson Galleries, and ultimately found this one for sale:


It's called "Self-Portrait with MRI".  Well, even Spock made a mistake here and there... The signed versions may be a little pricey, but this is priceless. I'm waiting on a quote...

Tuesday, February 24, 2015

Pebble's (Bad) Time(ing)?


The folks who brought us the Pebble Watch are at it again, today announcing the new Pebble Time, a
"Color e-paper smart watch with up to 7 days of battery and a new timeline interface that highlights what's important in your day," on Kickstarter. Features include:
  • We're announcing a new watch called Pebble Time with a new timeline interface.
  • Pebble Time features a new (64) color e-paper display and microphone for responding to notifications.
  • No compromises on what you love about Pebble: up to 7 days of battery life, water resistance and customizability.
  • Pebble Time is fully compatible with all 6,500+ existing Pebble apps and watchfaces.
  • Three colors available exclusively on Kickstarter. Pebble Time starts shipping in May.
  • Extra special engraving for our original Kickstarter backers who support us again ♥♥♥
The first thing we notice is, of course, the color screen. Nice touch, but it is not a touch screen. The Time is still button-driven. It does have a microphone built in to allow some level of voice control or response (although for iOS, this is so far limited to Gmail notifications, but no doubt this will improve. The presence of the tiny hole for the microphone renders the Time water resistant, but not water proof like its elder siblings.

The OS is redone with WebOS underpinnings. It's nice that the now defunct revamped Palm platform has landed somewhere useful.


It's a little cartoonish, but it should be useful, customizable, and still run all the old Pebble apps (and I suppose watch faces too.)
As with all Pebble software, we’ve built an open platform. You can allow apps and developers to add ‘pins’ to your timeline, so you can keep track of things like upcoming events, sports, weather, traffic, travel plans, pizza specials and more.

The Pebble operating system has been re-imagined with a new visual style. While all existing Pebble apps will still work great, we’re inviting developers to upgrade their apps to support color. More details coming soon!
Had you been on the stick, you could have had one of the first 10,000 watches for $159, but they went fast. Pebble has raised $4 Million within hours (minutes?) of the Time's debut. You can still get in at $179 if you act fast. The retail price will be $199.

So why haven't I jumped on this? Two words...Apple Watch. In some ways, this is an apples and oranges (pun intended) comparison. The cheapest Apple Watch will be the aluminum sports version, at about $350, or so the pundits say. The stainless steel model will be $500, and the Gold Elite Apple Fan Boy edition will be $5,000.  But the AW is a whole 'nother animal. Its build quality is likely to be a step beyond the Pebble's, the functionality will be far greater, at least for iPhone owners, the screen will be better and touchable, there will be heart rate sensors (maybe not active initially), and so on. On the other hand, the Pebble Time will be cheaper and supposedly will go 7 days between charges. The Apple Watch apparently will barely make it through the day with moderate use.

I love my original Pebble, which works very well within its parameters. The Time will most likely do so as well. I have high hopes for the Apple Watch, which should be in my hands sometime in April, just before the Time ships. Time will tell, eh?

Dalai's (Ad)Sense
or lack thereof...

My good friend Mike Cannavo, the One and Only PACSMan, called me this morning, quite concerned with something he saw on my blog. No, he's used to the juvenile writing and other foolishness rampant on these pages. But when the PACSMan brought up the blog this morning, he saw this:


Funny, because when I opened the page, I got this:


If you didn't already know, many blogs on Google's Blogger/Blogspot platform use AdSense, which adds a little interest to the process, if you know what I mean.

AdSense is a free, simple way to earn money by displaying targeted ads next to your online content. With AdSense, you can show relevant and engaging ads to your site visitors and even customize the look and feel of ads to match your website.
Watch the video to find out why over two million publishers of all sizes are using AdSense.

Every time you click an ad, I get a fraction of a cent. And I do mean a fraction. In the 10 years this blog has been up and running, I think I've made about $200.00 or so. But it is Google that determines which ads run on the page, based on YOUR browser's cookies. In other words, if you've looked at Dell, or RamSoft, you'll be seeing their ad on an AdSense site.

The AdSense ads thus DO NOT REPRESENT AN ENDORSEMENT OF ANY KIND. If this should reflect on my credibility, meager though it is, I'll turn off the AdSense and you can all put a penny in the mail for my retirement-home-Jello fund instead.

Make sense?

Thursday, February 19, 2015

GE Quench: FDA Issues Class 1 Device RECALL For 13,000 Scanners!



AuntMinnie.com reports an FDA recall of about a zillion GE MRI's and other brands with GE components (well, actually, it's only 13,000 of them):
The U.S. Food and Drug Administration (FDA) has ordered a recall of thousands of MRI scanners manufactured by GE Healthcare to correct a problem that could "result in life-threatening injuries" if magnet shutdown modules are disconnected, according to an FDA notice.

In the notice, dated February 18, the FDA announced that it has ordered a class I device recall of all GE MRI scanners using superconducting magnets. The recall covers some 33 brand names of scanners and thousands of systems distributed throughout the world, manufactured from 1985 to today.

The notice describes the problem as pertaining to the systems' magnet rundown units (MRUs), which are designed to initiate a controlled quench and turn off the magnetic field in the event of certain problems with the scanner, such as a ferromagnetic object introduced into the MRI suite. Such shutdowns are only intended for extreme emergencies and can put an MRI magnet out of commission for a week or more and cost up to $30,000 to replace lost helium, according to the website MRIQuestions.com.

In GE's case, a scanner's magnetic rundown unit may not actually be connected to the scanner, according to the FDA recall notice. In an emergency, a disconnected MRU "could delay removal of a ferrous object from the magnet, potentially resulting in life-threatening injuries," the notice said.
You can find the FDA notice HERE. You'll have to scroll through thousands of serial numbers to get to the meat of the notice:

Manufacturer Reason
for Recall
At certain sites, the MRU may not be connected to the magnet. In emergency situations, a disconnected MRU could delay removal of a ferrous object from the magnet, potentially resulting in life-threatening injuries. The MRU must be connected to the magnet at all times.
FDA Determined
Cause 2
TRAINING: Employee Error
ActionGE Healthcare sent an "Urgent Medical Device Correction" letter GEHC Ref# 60876 dated January 6, 2015 to affected consignees. The letter was addressed to Hospital Administrators / Risk Managers, Radiology Department Managers, & Radiologists. The letter described the Safety Issue, Safety Instructions, Affected Product Details, Product Correction & Contact Information. Customers were instructed to do the following: As a preventative measure, confirm that MRU is connected to the magnet by performing the following four step test on the MRU.

1. Verify the green CHARGER POWER LED is lit.


2. Depress and hold the TEST BATTERY switch for 15 seconds. The green BATTERY TEST LED should light and remain lit while the TEST BATTERY switch is depressed.


3. Place the TEST HEATER toggle switch in the A position. The green HEATER TEST LED should light. If it does not light, depress TEST HEATER LED switch to verify that the LED is functioning.


4. Place the TEST HEATER toggle switch in the B position. Green HEATER TEST LED should light. If it does not light, depress TEST HEATER LED switch to verify that the LED is functioning.



If the MRU test does not perform as described in each of the 4 steps above, GEHC strongly recommends that you stop using the system, and immediately call your GEHC representative. Customers with questions may contact their local service representative. For questions regarding this recall call 262-513-4122.
Quantity in Commerce12,968 (5,708 US, 7,260 OUS).
DistributionWorldwide Distribution - US Nationwide in all states in continental USA including DC, PR, GU, and the countries of ALBANIA, ALGERIA, ARGENTINA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHRAIN, BELARUS, BELGIUM, BOLIVIA, BOSNIA & HERZEGOVINA, BRAZIL, BULGARIA, CANADA, CHILE, CHINA, COLOMBIA, COSTA RICA, CROATIA, CYPRUS, CZECH REPUBLIC, DENMARK, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR,K ESTONIA, FINLAND, FRANCE, FRENCH POLYNESIA, GEORGIA, GERMANY, GREECE, GUADELOUPE, GUATEMALA, GUYANA, HONDURAS, HONG KONG, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA, REPUBLIC OF KOREA, KUWAIT, LATVIA, LEBANON, LIBYAN ARAB JAMAHIRIYA, LITHUANIA, LUXEMBOURG, MACEDONIA, MALAYSIA, MALTA, MARTINIQUE, MAURITIUS, MEXICO, MOROCCO, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA, NIGERIA, NORWAY, OMAN, PAKISTAN, PANAMA, PARAGUAY, PERU, PHILIPPINES, POLAND, PORTUGAL, QATAR, REUNION, ROMANIA, RUSSIA, SAUDI ARABIA, SERBIA, SINGAPORE, SLOVAKIA, SLOVENIA, SOUTH AFRICA, SPAIN, SUDAN, SWEDEN, SWITZERLAND, SYRIA, TAIWAN, THAILAND, TUNISIA, TURKEY, UKRAINE , UNITED ARAB EMIRATES, UNITED KINGDOM, URUGUAY, UZBEKISTAN, VENEZUELA, VIETNAM, ZAMBIA.
Oops. Did I see employee error listed as the problem? AuntMinnie's Brian Casey notes:
The company said it learned of the problem after discovering that some MRI scanners in India had been modified by service personnel or by equipment users to disable the magnet rundown unit. In addition to alerting customers to the problem, GE noted that the red magnet rundown button should only be pressed in an emergency situation.
Now why, one might ask, would anyone want to disable the MRU? Inquiring minds want to know. And did we really need the reminder that the big red button that says, "PRESS IN CASE OF EMERGENCY" should be pressed only in an emergency? Perhaps that tells us something about GE's opinion of its customers.

Mobile MRI services take note...business awaits!

ADDENDUM.....

My sources around the world are telling me this issue is the fault of GE and NOT the Indian fellows they were blaming. Here's one report:
It (the MRU) was never connected or properly installed. We can't disconnect it. So it was a GE issue. Big problem though.
More to come...This is pretty scary.

Wednesday, February 18, 2015

Beautiful Images from Fovia


I'm a little late with this entry, but...

I have a friend who works for Fovia, a supplier of rendering software and more. I've blogged about them in the past, and I've always been impressed with their stuff.  

Anyway, here are some of their latest renderings of PET/CT images:



Think how much easier it would be to explain to the surgeons (or the patients) where the lesion actually lies if we could show them something like this! Should have been Image of the Year, in my book, but then the RSNA appears to be reading a different book altogether...

Sunday, February 15, 2015

"Please Choose One"

A short story by Phillip Allen Green. Read this and be afraid. It describes my worst IT nightmares..
Please choose one:
The three words blink in front of me on the computer screen.
Please choose one:
Patient is-

Male     Female 
I click FEMALE.
I watch as the auto-template feature fills in the paragraph for me based on my choices.
Patient #879302045
Patient is: 38-year-old female status post motor vehicle accident. Please acknowledge you have reviewed her allergiesmedications, and past medical history.
I click YES.
Have you counseled her about smoking cessation?
I click NO.
A little animated icon of a doctor pops up on the screen. His mouth begins to move as if speaking. A speech bubble from a comic strip appears next to it.
“Tip of the day: smoking cessation is important for both the patient’s health and part of a complete billing record.” 
The animated doctor smiles and swings his stethoscope like a lasso.
I click ACKNOWLEDGE.
A new screen appears.
Please choose one:
The patient’s current emotional state is best described as-
☐ Distraught     Calm      Agitated
I turn away from the computer to look at the patient. She lies curled in a ball on her side. Her bare feet stick out below the sheets halfway off the gurney. I notice she has a turquoise blue toe ring. She stares straight ahead. She plays with her patient ID band, twisting it round and round with her other hand. Makeup is smeared around small brown eyes. She stares blankly at the wall behind me. I clear my throat. She doesn’t blink. I clear it louder. Still nothing.
I look back to the computer. The same screen is still there.
Please choose one:
The patient’s current emotional state is best described as- 
☐ Distraught     Calm      Agitated
I turn back around.
Blonde hair is matted to the right side of her face where tears have dried it to her skin. A thick strand of it hangs across her eyes and I wonder if it annoys her. I watch as tears reform in her eyes and run sideways across her face. A teardrop starts to grow on the side of her cheek. More tears are added until finally it falls from her face onto her tear soaked pillow.
Her chest rises and falls at a rapid pace. She is breathing fast, almost panting. It is a raspy sound. I bet if she spoke right now her voice would sound raw, the kind of scratchy raw that comes after too much screaming. But she doesn’t speak. She just lies there breathing with a thousand yard stare fixed to her face.
The computer dings.
Please choose one.
I click DISTRAUGHT.
The computer takes me to a new screen.
Please choose one:
Patient’s primary reason for being distraught-
Emotional     Physical     Other
The patient starts moaning. I look over. A guttural sound that is part wail, part cry spills out of her just loud enough for me to hear.
I click EMOTIONAL.
That selection triggers a new screen for me with new choices:
Please choose one:
What is the reason for patient’s emotional problem?
Intoxication   ☐Psychiatric   ☐Neurologic
Hmm, I look at her trying to decide which to choose. She is in a hospital gown. Her clothes were cut off with the trauma shears when she came in. She still smells like gasoline and blood and burnt plastic smoke. It burns my nose sitting this close to her and makes my eyes water.
There’s dried blood mixed with car oil and dirt on her chest. There is a lot of it. It covers her shoulders and the top of her breasts like a red patchy shawl, yet she is not injured. She has been examined and x-rayed and CAT scanned from head to toe. Her body is fine.
The computer dings again impatiently, prompting me to choose one.
Please choose one:
What is the reason for patient’s emotional problem?
Intoxication   ☐Psychiatric   ☐Neurologic
I click the Next arrow at the bottom of the screen to try and advance the page without choosing one.
PAGE INCOMPLETE- YOU MUST CHOOSE ONE pops up.
My mouse circles the screen hesitantly. I guess I will click… PSYCHIATRIC. In a way emotions are psychiatric, I tell myself.
Choosing psychiatric has opened a new screen.
The patient shifts on the bed. A glimmer on her head, reflecting the fluorescent lights above, attracts my attention. I lean in closer. There are shards of broken up windshield glass scattered throughout her hair. Some are brown from dirt from where she lay on the ground, some are stuck to her head from blood, and some are scattered on the sheet below her. The shards twinkle on the bed like little stars.
I frown, the nurse was supposed to clean her up. I wheel backwards on my doctor stool across the trauma room to the door. I lean my head out through the curtain.
I look around. I spot the patient’s nurse. She is sitting on the other side of the ER, working at a computer. I know she is trying to enter data from the patient’s visit to get her charting done. Well, I think, maybe someone else can help us.
I scan the ER. There are doctors and nurses everywhere down here, yet every single one that I see sits at a computer with their eyes chained to the screens and a scowl on their faces while they click and type, click and type. I bet the hospital could burn down around them and they wouldn’t notice.
“Hey!” I yell.
No one even looks up. The clicking and typing continue.
An old man standing in the doorway of another patient room makes eye contact with me. He scowls as he surveys our ER. He shakes his head in disgust. I blush and duck back into the room behind the curtain.
The computer dings twice now, prompting me to hurry up. I remember my patient throughput time is monitored and reported and compared to the national average. A timer has appeared on the bottom of the screen, letting me know that I am four minutes twenty-eight seconds past the average ER doctor throughput time.
The numbers keep climbing. If I spend too much time on one patient, I will get a letter from administration for not meeting my throughput quota. I wheel back up to the computer.
Please choose one:
Because you chose Psychiatric, patient was offered-
Counseling     ☐Medications     ☐Inpatient Care
A sob wracks my patient’s body interrupting me again. She shifts in the bed, leaving clumps of brown dirt crumbling on white sheets. She is absolutely filthy. I wonder how long she lay in that field before someone found her. She still stares at the wall, unresponsive.
I look back at the computer. I didn’t offer her any of these things. Maybe I should lie and click counseling so that I can finish her chart.
I click Next.
YOU MUST CHOOSE ONE pops up again.
Please choose one:
Because you chose Psychiatric, patient was offered-
Counseling    ☐Medications   ☐Inpatient Services
I try alt tab. No luck.
YOU MUST CHOOSE ONE.
I give up and click COUNSELING.
Another screen.
Please choose one:
Patient responded to counseling with:
Excellent Improvement Some Improvement No Improvement 
I click NO IMPROVEMENT.
The little doctor figure reappears on the screen. He’s holding up his index finger and a light bulb appears over his head as if he’s just had a fantastic idea he can’t wait to share with me.
“Dr. Tom Tip reminds you: Did you try offering a drink of water or a tissue? Surveys show that sometimes it’s the little things that make patients feel better.”
I look over at her. I can’t bring myself to offer her water. Her knuckles are blanched white from the death grip she has on the side rail. She’s mouthing the word NO over and over to herself and shaking her head back and forth. Her eyes are wide with terror and do not see me. The skin of her face is pulled taut with fear.
I know that look. She is seeing the moment. I know she is going to see it again and again for the rest of her life. It will come in nightmares, it will come in dreams, it will come at the worst possible moment of what should be happy occasions, more likely than not it will even come at the moment just before her own death no matter how long she lives. She will never escape it. Sixty-eight minutes ago her brain burned an image into the inside of her skull that she will never be able to unsee.
I click SKIP.
The doctor icon disappears, replaced by text.
Please choose one:
Did you offer the patient water?
Yes     No
I click NO.
The little figure pops up again this time with a stern look on his face and his arms crossed.
“Surveys show patients like it when their doctors offer them water or a tissue. Patient satisfaction scores go up. Try it, you might be surprised.” He uncrosses his arms and holds out a little of glass of water.
For a brief second I imagine punching my fist through the computer screen. It would feel so good to climb the stairs to the top floor of the hospital with the computer stuck on my arm. I imagine spinning in a circle and launching it as hard as I can off the roof of the hospital towards the pavement below. I would give anything to see it smashed and destroyed and ruined, just as it has done to this profession I once loved.
But I know they would just replace it with another computer and just as quickly with another doctor.
I sigh and look around the room.
There is a cup on the counter.
I frown, it is awfully dirty.
I pick it up and turn it over.
A child’s tiny, bloody shoe falls out onto the counter.
The woman cries out, Oh God Oh God Oh God and grabs the child’s shoe before I can pick it up.
She holds it next to her face. She’s sobbing now and starting to scream. Oh God Oh God Oh God Oh God Oh God. She clenches the shoe to her chest. The blood on the shoe matches the blood on her chest.
The computer dings.
“Did you give the patient a cup of water?”
I lie and click YES.
“Good job!” The computer trumpets out a happy horn sound. It’s hard to hear over the patient’s screaming. The little doctor gives me a thumbs up and high fives a hand that appears on the screen next to him.
“Sometimes it’s the little things that make people feel better.” The doctor says.
I click NEXT.
The Patient Disposition Screen loads.
Please choose one:
Where is the patient going after the ER?
Home     ☐Admitted     ☐Transferred
I hover the mouse on the screen for a second, trying to decide.
I click HOME.
Please choose one:
How is the patient doing after your care for her?
Improved      ☐Not Improved     ☐Other
I look at her again.
I click NOT IMPROVED.
*WARNING*
This time the whole screen flashes. The little doctor is back, hands on his hips. His face is stern as the speech bubble appears next to his head. The letters are in red this time.
“Patients who are NOT improved should NOT be sent home. You clicked Psychiatric as her primary issue. Perhaps some medications would help the Healthcare Consumer. Would you like me to recommend some choices available on the hospital formulary?”
I ponder the question. Is there a drug for this? Something that will make her feel better? Something that doesn’t wear off like, ever?
I click NO.
Are you sure? The computer asks again.
I click YES.
A big red flag now pops up on screen and the computer buzzes like a half time buzzer in a sports game that I have just lost.
A note of this patient encounter has been sent to your Hospital Administrator for chart review of this patient. It is the goal of our healthcare facility to make patients feel better before they are discharged. You have acknowledged that you failed to do so. You will likely receive a lower patient satisfaction score for this.
Please acknowledge.
I click NO.
It flashes again.
Please acknowledge.
I click NO.
Please acknowledge.
I click NO.
A box pops up.
I am sorry, Valued Healthcare Provider, do you not understand the question? Would you like to fill out a service ticket?
Yes   No
Please choose one.
The words blink at me on the screen.
I look over at the patient. She is on her side again, sobbing as she cradles the tiny shoe to her chest. Her eyes are squeezed shut and she’s rocking back and forth so hard the whole gurney is shaking.
I look back at the computer.
Please choose one.
I look back at my patient.
Please choose one.
Suddenly I get it. I choose.
I reach down and unplug the computer. The screen goes black.
Without the noise of the computer fan whirring, the room is suddenly silent- save for her quiet sobs.
A strange feeling comes over me, one I almost forgot existed after so many years.
I remember who I am and why I am here.
I stand up and take a deep breath. I step towards the patient and begin the long and tedious process of gently picking out the shards of bloody glass stuck throughout her hair. As I start to work she opens her eyes and blinks.
She sees me.
The terror filling them fades just a tiny bit.
For once the computer stays quiet.
I pick through the strands of her hair. The three words blink in my mind over and over.
Please choose one…
Please choose one…
Please choose one…


  
©Philip Allen Green
philipallengreen@hotmail.com

Saturday, February 14, 2015

IT Laments From An ER Doc
The 10th Anniversary Post on DoctorDalai.com

Fellow blogger and ER physician Edwin Leap, M.D. has apparently discovered the joys of poorly written software I've been bemoaning for so long.

In a December entry, Dr. Leap opens with an apology for the behavior of some less-than-tech-savvy physicians:

I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system crashes and we call because the voice recognition doesn’t work and we curse the screen and shake our collective fists at things that slow us every day. I get it.

He's a bit more conciliatory in this than I've been, but he's right. There are some docs for whom the acronym P.B.K.A.C. (Problem Between Keyboard and Chair) is 100% applicable. These unfortunate folks are the inspiration for Dalai's XIIth Law
XII. The PACS needs to be operable by the least technically-savvy radiologist on staff.

That being established, Dr. Leap takes the gloves off, and picks up my battle-flag, starting with his disgust with his EMR.
However, there are some things that you and those who develop your systems need to understand. Allow me to elucidate.

We didn’t ask for EMR in its current incarnation. It is now a gargantuan billing and data collection industry, with precious little utility in our day to day practices. As such, your bosses love it because it squeezes the last gasping penny out of every chart. They write your checks, we don’t. Nevertheless, we have difficulty being excited about ever more fields to fill out, ever more time-stamps, ever more screening exams, and the caucophanous symphony of key-strokes and mouse clicks that echo through the modern hospital and threaten to muffle the sound of suffering and human interaction.
The vast majority of EMR's, CPOE's, etc., are unwieldy, unusable pieces of convoluted trash, which add to the hours of the already full day of a busy physician. More on this in a moment.
Next, passwords and security make a lot of sense to you. You dwell in a world of hackers and identity theft and you worship at the silicon altar of HIPAA. We, however, are busily seeing patients and trying to do it as quickly as possible in hospitals, clinics and especially ER’s that have no ‘off’ switch but which do track our ‘quality’ in part by tracking our speed and efficiency. Thus, we have little time to spend logging on. And when we step away to, say, intubate a dying patient, the last thing we want to do is log back on to 1) the computer 2) the hospital EMR system and 3) the particular department system and 4) the radiology viewing system. But here’s the really, really important part: nobody is busily stalking behind us trying to look at medical records or interpret xrays on strangers so that they can violate their privacy. We’re watching; trust me.

It was a nice idea but now it’s a poison. It is the law of unintended consequences on steroids. It’s all redundant, irrelevant, obnoxious busy work that stands between us and efficiency. If you really insist on it, then make it all biometric with thumb prints. Because tracking usernames and passwords is starting to take up more of our fragile brains than drug doses and diagnoses. And that, my friends, is not good.
Yes, security. We all understand the importance of keeping hackers and other slime out of patient data. I wonder how many passwords Anthem had that didn't prevent 80 MILLION records from being compromised. Screw passwords. Let's try biometrics, wrist-worn RFID's, implanted chips, retina scans, anything that will get the job done painlessly (well, after the chip implant, anyway). We simply don't have the time to re-log in 35 times per day.

You might recall my tale of IT tyranny from the same Laws of PACS lecture wherein I used AutoHotKey to create a little macro script that pushed the button that kept my RIS active. IT at first banned the macro because "someone might use the program to bypass a password screen." Yeah, right. They knew quite well that I was the only radiologist in my group capable of even understanding how that might be done, and they knew me well enough to know that I wasn't going to do it. I did win out in the end, but as usual, it was a battle that really didn't need to be fought.

Dr. Leap continues his velvet-gloved attack, documenting another pet peeve of mine, the inability of IT to grasp the mission-criticality of what we physicians do, day in and day out.
Now, about tech support and system back-ups. We have to use these systems. There is no option. And we have to use them 24/7/365. Because that’s when people get sick and die. Therefore, every system needs to have a parallel back up system that kicks in whenever a data transfer or update or repair or anything else is happening. ‘We’ll be shutting down for four hours’ isn’t an option anymore. Since ‘we won’t see heart attacks for four hours’ isn’t an option either. Furthermore, when things are going badly, when we need a reset password or when the computers are locked up in some loop that looks like an alien language, we need help immediately. We don’t need ‘a ticket’ submitted. A round-the-clock job that requires EMR necessitates round-the-clock IT. No questions asked.
And finally, my new friend the ER doc rediscovers the travesties I've been bellowing about for just over 10 years on this very blog:
Finally, to those who design these monstrosities and those who buy them to the protests of clinicians, what are you thinking? Medicine is about caring for patients. And anything you create that makes it more difficult is an insult. Shame on you. You should do better, for your staff and for the patients who ultimately pay your salaries and fees.
Dr. Leap ends with a leap of niceness toward IT that I wish I could manifest as well...
And for you IT folks, I’m sorry. I’ll keep trying to do better. I generally know where to find ‘start’ when I’m talking to you and I can actually navigate the directions you give in a fairly efficient manner. I know that the disc drive isn’t a cup-holder and that I have PC, not a Mac. I’ve even been storing my passwords on my smart phone! I realize you have a tough job; made tougher for dealing with physicians and nurses.

All I’m saying is this: I understand your frustrations. Try to understand ours!
Yes, IT departments, and particularly software vendors...TRY to understand our frustrations. I have been blogging for TEN YEARS, saying basically the same thing. A significant plurality, if not the vast majority, of medical software is utter, complete, unmitigated GARBAGE. It is designed by engineers with no experience in healthcare and tuned to the specs of bean-counters, with no experience in healthcare. It is pitifully clear that absolutely NO thought has been given to the usability in the hands of those who need to make these abominations work in the process of treating patients and hopefully saving lives. It is nothing short of criminal, but it is no surprise. These Rube-Goldberg contraptions are NOT selected and purchased by the people that use them, but rather by those beholden to the bean-counters or other administrative influences, and those who wish to have the easiest time servicing the product.

Sadly, even after 10 years, I don't know the solution to this situation. CIO's and IT departments are not about to give up their influence over these huge expenditures, and I'm not sure how to take it away from them. Perhaps the only thing I can do is to slap the vendors in the face repeatedly with the fact that their software sucks, and hope that the subsequent embarrassment will prompt them to clean up their acts. I'm not holding my breath, and I have grave doubts that I've influenced anything much at all. Perhaps once I'm fully retired, I can turn my attention more fully toward this effort.

In the meantime, the frustration continues, with potentially deadly consequences.


Sunday, January 11, 2015

Je Suis Juif, Je Suis Charlie





50 world leaders, and tens, maybe hundreds of thousands, marched in solidarity with the French cartoonists and Jewish civilians, slaughtered by radical Islamists. You will notice that Israeli Prime Minister Benjamin Netanyahu, as well as Palestinian leader Abbas, marched to either side of French President Holland. Not present? Our own President, the so-called leader of the Free World. His lame-duck, racist Attorney General was supposed to be our representative, but he was nowhere to be seen in the very extensive coverage.

What message did we just deliver to the rest of the world? That we don't care, that we are above it all, that we don't perceive a threat? Or maybe that some in our leadership might even sympathize with the goals of the terrorists? Outrageous? Sure, but there aren't too many other interpretations to be applied to this appalling lack of solidarity displayed by our leadership.

Despite this dangerous embarrassment, the rally gives me more hope for the future than I've had in a long time. Presently, Europe is well on the path to become Eurabia, due to lax immigration and policing (not to mention individual firearm) policies. There is every chance of a recapitulation of the Holocaust under the brand of Radical Islam. But today, this very day, maybe, just maybe, Europe has awakened to its deadly trajectory, and along with the rest of the world, might just take steps to reverse the trend. Maybe, just maybe, those who died did not do so in vain, but gave their lives to awaken the world to the reality of these monsters:  they murder Jews because they are Jews, they murder cartoonists because they are "offensive," they wish to silence any dissent, they hope eventually to conquer and "fundamentally transform" the entire planet.

Maybe, just maybe, we will see a reversal of the "no-go" neighborhoods. Maybe we will see a denial of institution of Sharia law within these ghettos. Maybe we will see the realization that Israel is being demonized based on lies from those who would destroy her and her people. Maybe there will be an understanding that anti-Semitism is a harbinger of the anti-West, anti-Colonial, anti-freedom agenda of these vermin, which has been adopted by the aging Marxist revolutionary wannabes that make up much of the Left in this and other Western nations.

Maybe.

This is a war, not simply for territory or for treasure, but for our very souls.

There is only one response:

"Je Suis Juif, Je Suis Charlie"