The Belated, Limited RSNA 2012 PACS Post I: lifeIMAGE and HealthFortis

My sincerest apologies to my readers, some of whom have nicely pointed out that I've been lax in my Post-RSNA posts. In years past, I've been very diligent about posting my RSNA observations immediately, never letting even a day go by without putting something down on virtual paper for my loyal fans, all three of you. I guess this is what happens when I violate the rules set out by Dr. Bruce Hillman in a recent JACR editorial: "The key to a happy career is being low enough on the totem pole to escape notice. Even better is to be so far down the hierarchy as to be beneath contempt."

But like the kid with the dog-chewed homework, I've got several excuses.

First, when you go to RSNA with wife and family, your time must be devoted to...wife and family. Instead of hanging around McCormick with my laptop as the sun set on Chicago, pounding away at a pithy post, I was compelled to high-tail it back to the hotel to meet up with the boss. Yes, it's Mrs. Dalai's fault, but PLEASE don't tell her I said so!

Second, I've been battling a light case of the flu. No, I haven't taken the confirmatory test, but the pharmacist at Rite-Aide, whom I trust more than most physicians, tells me she's seen a lot of this among those of us who took the flu vaccine. Those who didn't have the shot are getting REALLY sick. But I'm doing better.

Third, in anticipation of changing tax laws, especially those concerning non-cash contributions and deductions, I've been going through the house and donating everything not nailed down. (The dogs have been hiding under the bed.) A collection of 300 Beanie Babies (remember those damnable things?) went to our local Children's Hospital. My collection of every transistorized version of Zenith Trans-Oceanic shortwave radios, 30 miniature transistor radios, and 7 Minox spy-cameras and dozens of accessories all went to our State Museum. And finally, and most painfully, my beloved collection of 19 huge classroom-sized slide rules and 70 more normal-sized and projection slide rules went to MIT. And let me tell you, sending a bunch of 8-foot long objects to Massachusetts is not an easy task.  Watch for the Dalai Memorial Slide-Rule exhibit at the MIT Museum sometime in the next year or so.

Finally, not so much in anticipation of any change in the law, but more in reaction to our neighbor's house being burglarized at high noon last week, I bought a gun and started to learn how to use it. For those who are interested in such things, it is a Heckler and Koch P7M8 with Robar NP3 coating.

This is an old model, no longer made by H&K, which was designed for the German police. It has no safety per se; to cock the weapon, one squeezes the handle. Without the squeeze, the gun cannot fire, PERIOD, making it one of the safest firearms out there. I went to the local firing range, and with a lesson (having not fired a gun in 30 years) I shot 50 rounds with fairly good accuracy:

I'm not a huge gun advocate, but I think it is self-evident that had someone at the Sandy Hook School in Connecticut been armed, 26 innocent children and their protectors would more likely be alive today. And that's all I'm going to say about that. (Don't even bother to comment.)

Right. Let's get on to business.

From my earliest, infantile postings, I've been bemoaning the problem of the "portable patient," the fellow whose imaging studies are spread about the land like a virus. My friends at lifeIMAGE, including CEO Hamid Tabatabaie many other wise folks from the old AMICAS days, continue to lead the charge in solving this particular bane of my existence. There has certainly been progress in digitizing even the smaller hospitals, but the free-standing PACS therein create what lifeIMAGE terms "information silos".  A new (well, evolutionary, anyway) service called Connections™eases the communication between these silos, the patients whose information they contain, and the medical personnel that staff them.

lifeIMAGE Connections employs simple and social workflow to connect people in real-time to send or receive imaging information. Physicians, patients and imaging service providers can connect to sources of imaging data on CDs, remote PACS networks, scanners or electronic health records. This will drive better, less expensive patient care by preventing unnecessary imaging exams, and will also foster a new level of collaboration on imaging that will escalate the value and scope of radiology in healthcare delivery.

Accountable Imaging™ is a commitment to bridge silos of medical imaging information to avoid unnecessary exams, delays in care and medical errors. lifeIMAGE Connections facilitates the seamless exchange of studies between institutions, physicians and patients anywhere, supporting radiology practices that pledge to be accountable.

For those whose path will force them into an Accountable Care Organization (ACO):

In the coming year, Connections will evolve to support new models of provider collaboration. To help hospitals involved in ACOs meet quality and cost containment goals, lifeIMAGE will provide imaging duplication detection through integration with clinical decision support and EMR applications. This will connect physicians who are part of at-risk models to relevant prior imaging, no matter where it is stored. lifeIMAGE is demonstrating its early integration with HealthFortis, a leading decision support system, at RSNA.

lifeIMAGE had at RSNA-time approximately 300,000,000 images under management. Not bad. Clearly, the market agrees that their solution works: customer list reads like a Who's Who of radiology:

Yes, there are other ways to skin the silos, so to speak, and many PACS companies tout them. But I firmly believe lifeIMAGE has solved this problem in the most vendor-neutral and HIPAA compliant manner possible. I have but one regret: I'm not yet a customer. But I'm working on it!

On a tangential issue, I got to hear as well about the continued evolution of HealthFortis, mentioned above and described in one my RSNA 2011 posts. Kang Wang, another of the software geniuses (and I do not use that term flippantly) has taken the approach to CPOE that would never occur to a megalithic company:  BE the piece of paper the surgeons and clinicians really want! Never slow down the docs, but add decision support to the format they already know. The interface is simple, intuitive, EMR integrated, cloud based, it actually works. Initial placements have demonstrated that compliance with the system increases rapidly with use, with fewer and fewer incorrect orders. While the average "decision support" software simply second-guesses the user, HealthFortis HELPS select the recommended procedure, following a search and display algorithm reminiscent of Google.  Appropriateness of radiological procedure selections are graded by the ACR Appropriateness Criteria, with 9 for the best and 1 for the worst choices given the particular setting.

Sitting on the periphery of the CPOE committee of one of our hospitals which is trying to rework 20-year-old MediTech software, and hearing the shrieks of pain and agony from the other which is trying to make Cerner user-friendly, I can tell you first hand that Kang's approach is light-years ahead of the old-fashioned ways.

lifeIMAGE and HealthFortis have, through simple interfaces and effective software, solved some of the most troublesome problems we face in the "Information Tsunami". I urge you to have a look for yourself.