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20 It & coMMunIcAtIons Hospital Post <strong>Europe</strong> 04/08 Innovation in healthcare doesn’t always come in the form of a powerful new drug or even through improvements in the way physicians provide care. New developments in information technology can drive innovative projects that can help physicians save lives. IT and business management have become tightly intertwined in hospitals, as in other industries. Because of this important relationship, IT executives in the medical industry can make significant contributions by helping hospital managers implement automated systems to monitor patient care. But first, IT executives and their teams need a vision of how medical information is communicated, controlled, and integrated. Their IT infrastructure must support that vision. Failure to share critical information with the systems and people who need access to it may result in unnecessary deaths. The clock is ticking. Here is an example to illustrate this point: a patient underwent a medical test about 14 months before he was diagnosed with terminal cancer. The initial report gave him a relatively clean bill of health. Yet there was also a second report, which indicated a spot on his liver, and recommended an ultrasound for further evaluation. The patient was discharged from the hospital based on information from his first report, which did not highlight the problem or the recommended test. Unfortunately, the second report was filed away without ever reaching the patient or his healthcare providers. The patient didn’t have the information he needed, and went about the remainder of his life wondering why he continued to have medical problems when there was “nothing seriously wrong” with him. He was unaware of the existence of the second report until after he was diagnosed with cancer over a year later, and asked to see his file to compare it against his latest CT scan. By then, the cancer had already spread, and it was too late to save his life. This case illustrates the need for automation in reporting medical test results. Apparently, this patient’s healthcare facility did not have automated workflow notifications or automated escalation processes in place. There were no automatic alerts to the patient’s physicians, or the patient himself, advising them of the need for further screening. Failure to have these processes in place – and enforced – prevented the patient and his physicians from acting upon critical information in a timely manner. “Do You Understand Me?!” The new translation technique facilitates daily work in hospitals. (Photo courtesy of Cristina Torres) Translating 42 official languages, 24 hours of the day: hospitals in the province of Albacete – part of the autonomous community Castilla de la Mancha in Spain – use a new simultaneous translation technique. A lot of the patients who visit hospitals in Spain do not speak Spanish. Therefore, a lot of communication difficulties between doctors and patients occur. For four hospitals in the province of Albacete, this problem is now a matter of the past: six months ago, a new translation technique was introduced there. Via a mobile and headsets, doctors and patients have the possibility Austrian-based Philips Speech Recognition Systems announced the launch of its services portfolio which enables its global network of Speech- Magic partners to access the company’s know-how and expertise in the field of healthcare documentation. The aim is to facilitate the integration, deployment, and support of the Speech- Can Software Save Lives? Automation in Reporting Medical Test Results to get in touch with a professional translator. This person immediately translates the conversation of the interlocutors. The new service is used to make communication easier – and it works: The users are very satisfied. Arabic, Chinese, And Romanian During the six-month test period, it became clear that Arabic and Chinese are the languages that are mostly requested (60 % of demands) – Romanian ranks third. Therefore, the translation for these three languages is immediate – without the need to feed a code in the mobile. The rest of the languages supplied, up to a total of 42, is translated with a delay of 10 to 30 minutes. The new translation technique is introduced to reduce social difficulties in the medical sector. CK IT organizations, especially those in the healthcare industry, cannot afford to underestimate the vital, strategic role integrated systems and communications play in their success. With the strategic use of technology, it’s possible to improve and transform business processes and react quickly to real-time data changes. Failure to take this approach can cause IT organizations to operate in a vacuum – disconnected from their businesses’ primary objectives and processes, and lacking consistent goals, procedures, controls, and best-practice guidelines. The Need For Automation Emergency rooms are very busy places. It is increasingly difficult for ER personnel to rely on manual data-sharing processes in this environment, especially as the number of patients continues to increase and more demands are put on the hospital staff. The example cited earlier might have ended differently had an integrated and automated process been in place. With integrated workflows, notifications, and escalations, a fully enabled service automation process could have engaged the appropriate people (doctors, administrators, etc.) with the data contained in the second report. The policy-driven attention and actions could have alerted the patient and his healthcare team of the recommendations for further testing. The physicians might have been able to diagnose the patient’s illness in the earliest stages. The patient could have had the information available to take a more active role in seeking the best treatment for his medical condition as soon as possible. At the very least, he could have had a fighting chance. This patient’s example is indicative of the types of problems that can plague hospitals and other medical facilities that do not have the processes, systems, and infrastructure in place to prevent a similar gap in critical communications. This example demonstrates an important lesson: by leveraging IT and business automation, medical teams can have real-time visibility into any critical information and changes related to a patient’s health. Hospitals and their staffs are in the business of saving lives, and their systems should enable that effort. Staff members, departmental teams, and the third parties that work with them (i.e., the outside radiology labs, pharmacies, doctors, and others) need to collaborate and communicate. And although each of these groups may provide specialty functions, they need to share patient data with each other within the HIPAA guidelines. Without alignment, healthcare specialists do their jobs in a vacuum and may unknowingly risk their patients’ lives; lifesaving information can fall through the cracks. With the right management vision, processes, and technologies in place, additional deaths may be prevented. This vision is based on an approach for managing IT based on business priorities, an approach known as Business Service Management. Ideally, hospitals and doctors should have fully implemented systems and processes in place to share critical data using this holistic approach. Unfortunately, this is not always the case. It’s also important for patients to be actively involved in securing their own data. They should ask whether the systems their healthcare providers use are working together effectively. Patients should also follow up with their doctors and hospitals after a critical medical test has been taken, and ask if any additional information or reports might be available. They should secure copies of their reports to discuss and review with their healthcare providers. These actions are vital and could make the difference between life … and death. Linda Donovan BMC Software www.bmc.com Speech Recognition “in the Fast Lane” A new report by market analyst Datamonitor discusses speech recognition and its use in the medical industry for transcription and dictation. It reveals that healthcare automation is driving growth in speech technology and the leading vendors, Nuance and Philips, are providing specialized solutions. The report, “Automating and Enhancing Processes through Voice in Desktop and Back Office Environments”, explains that although adoption of PC-based speech recognition is not widespread, the technology has found its niche in the healthcare market, where automation and cost savings are key drivers. Changes are taking place in the healthcare industry as issues over budgets and the accuracy of patient information arise. In order to reduce the error rate in diagnosis and ensure information is recorded efficiently, healthcare providers are adopting electronic health records (EHRs). Using speech recognition with digital dictation systems, to dictate notes directly into EHRs, means that doctors can update information faster and with lower error rates. “Patient information is gradually becoming digitized in order to address issues with delivering records and test results faster,” said Aphrodite Brinsmead, analyst at Datamonitor and author of the report. “By reducing the number of illegible handwritten documents and simplifying processes, providers can eradicate errors in diagnosis.” Speech recognition is also being used for medical transcription, easing pressure Speech Recognition to Capture Healthcare Information Magic platform as well as provide expert consultancy on productive medical reporting. The launch of its service portfolio is part of the companys’ strategy to grow from a technology provider into a team of globally recognized experts on information capturing in healthcare. “Philips has acquired a unique wealth of knowledge and proficiency while working with the world’s largest healthcare speech recognition sites which stretch across city-, region-, and even country-wide health systems,” commented Marcel Wassink, CEO of Philips Speech Recognition Systems. “The service offering now enables our SpeechMagic partners to apply this knowledge and experience directly to their IT applications. Our technicians, developers and consultants will help them design optimal solutions that boost productivity in hospitals and provide physicians with better information.” The company offers four key services: First, Philips helps define and integrate the optimal set of SpeechMagic features; Dictation Management the new Premium Kits from Grundig Business systems provide packaged solutions for use in the office, for mobile dictation, and for external transcription services and are suited for both professional users and secretaries. www.grundig-gbs.com this includes input channels and the ability to deploy in Citrix Access infrastructures or on Windows Terminal Servers. Next, deployment services prepare for fast system roll-out with the aim of facilitating user acceptance and minimizing downtime during implementation and set-up. Support services also provide the knowledge and tools for optimal system maintenance and fast resolution of technical issues, including training and workshops as well as standby and third-line support. on transcriptionists and allowing healthcare providers to save on staffing costs. Medical transcription is estimated to be a multi-billion dollar market and speech recognition vendors are taking advantage of this. Healthcare currently represents 85 % of the PC- and server-based speech recognition market. Datamonitor estimates that the market for speech recognition in healthcare globally is worth an estimated US-$170 million in 2008. Between 2008 and 2013, the market will more than double in size. One area where speech recognition has seen a significant uptake is for imaging where a number of radiologists are using the technology to dictate reports. Radiologists work in controlled environments using specialized vocabularies to dictate reports that often use repeated language and are therefore an ideal target for speech recognition vendors. Healthcare will remain the largest market for speech recognition through 2013. www.datamonitor.com Finally, the productivity services round up the service package, as Philips experts analyze end users’ working methods, evaluate results and user satisfaction, and provide recommendations to optimize workflows and processes. www.philips.com/speechrecognition
Hospital Post <strong>Europe</strong> 04/08 Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), Switzerland, encompasses the hospitals of St. Gallen, Ror- schach, and Flawil, and provides essential medical care for eastern Switzerland. For seven years, the hospital’s computer workstation infrastructure was based on the Windows 2000 operating system and Microsoft Office 2000 desktop applications. The client software was increasingly reaching the limits of its performance, however, and becoming unstable in some areas. In order to retain high service levels at a reasonable cost, Kantonsspital St. Gallen chose to deploy the Windows Vista Enterprise operating system and the 2007 Microsoft Office system on 2,000 computers across the organization. This powerful new IT infrastructure will also support the hospital in introducing further valueadded services such as a clinical workstation portal for its employees that will be built using Microsoft Office Share- Point Server 2007. Situation “One company, three hospitals”: Under this motto, Kantonsspital St. Gallen – with approximately 3,000 employees – provides basic and specialist medical care for the population of east Switzerland, making it the sixth largest hospital in the country. In addition, Kantonsspital St. Gallen conducts research, performs educational activities, and offers accredited university-level training in its specialist disciplines. Until recently, the hospital’s 2,000 computer workstations ran desktop software based on the Windows 2000 operating system and Microsoft Office 2000 programs. These programs had been in use for seven years, and were repeatedly reaching the limits of their performance in day-to-day business. “The platform was beginning to become unstable. When we purchased new computers, we didn’t have the necessary drivers, and not all applications were supported,” explains Stephan Schläpfer, Project Manager at Kantonsspital St. Gallen. For example, employees had problems synchronizing their notebook computers via Microsoft ActiveSync technology, and mobile access to specialist applications using Windows 2000 was problematic. On top of this, Microsoft had ceased to provide mainstream support for the outdated operating system. “We urgently needed a powerful new basic IT infrastructure,” says Schläpfer. Kantonsspital St. Gallen also needed software that could support a new clinical workstation portal for its employees. The organization wanted to set up a dashboard page from which employees could access all required information and programs from their notebook computers. The portal would enable employees to locate information more quickly and improve their communication with one another. “Our aim is to turn IT into an easy-to-use everyday tool for users,” says Schläpfer. “At the same time, new tools would reduce administrative work for IT employees, increasing their productivity.” Solution The hospital chose to continue using Microsoft solutions to fulfill its software requirements. Employees work around the clock, using approximately 400 different specialist medical applications, and many of these already have interfaces to Microsoft Office applications. To support the software upgrade, Kantonsspital St. Gallen also upgraded its hardware, purchasing 2,000 new computers: 1,750 desktop PCs and 250 notebooks. With Microsoft Office SharePoint Server 2007 collaboration software, Microsoft was able to offer a solution for the planned portal that fully met the expectations of the IT managers. “The focus here is on employees and their needs. The company’s ‘people-ready’ philosophy corresponds exactly to our planned clinical workstation portal,” explains Jürg Lindenmann, Head of IT at Kantonsspital St. Gallen. Project planning for the implementation of the Windows Vista operating system and 2007 Microsoft Office was undertaken by department and external service providers. By participating in the Microsoft Technology Adoption Program (TAP), the project team was able to extensively test Windows Vista long before its market launch and ensure compatibility with special medical applications. In line with the people-ready philosophy, users were involved in the project right from the start. The project team mapped various user scenarios using the pre-release versions of Windows Vista and 2007 Microsoft Office programs. In this way, users learned, for example, how meet- It & coMMunIcAtIons 21 Upgraded Desktop Infrastructure New Operating System for Swiss Hospitals Essential medical care providers for east Switzerland: Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), Switzerland, combines the hospitals of St. Gallen, Rorschach, and Flawil. ings could be managed using the Microsoft Office Outlook 2007 messaging and collaboration client. “This approach went down very well, and we received a great deal of positive feedback from employees,” says Schläpfer. The project team also built a prototype of the clinical workstation portal using Office SharePoint Server 2007. “In rolling out Windows Vista, Microsoft Office 2007, and Microsoft Office SharePoint Server 2007, we are taking the first big step towards establishing a clinical workstation portal, which is to be implemented in phase three, by the end of 2009,” states Schläpfer. Thanks to the smooth interaction between Microsoft products, employees will have central access to office applications, specialist functions, appointments, and meeting management. Forms, archives, and the Intranet are also incorporated. All this will make it easier for employees to locate cross-clinical information. Preparations for the broad deployment continued up to March 2007. In September, the pilot rollout took place in the IT department and in three clinics: Cardiology, Infectious Diseases, and Ear, Nose and, Throat. Those involved in the project had one month to make any necessary modifications. The full rollout then began, building by building, in mid-November. “We were not able to carry out the rollout clinic by clinic, as many departments are spread across several locations,” Schläpfer explains. “During the rollout, we took measures to ensure that employees could access their data as usual, both on the old platform and on the new platform.” As planned, the team was able to conclude the rollout on all 2,000 computers by the end of February. In order to prepare employees for the new system, Kantonsspital St. Gallen began providing appropriate training seminars months before the actual rollout using a learning approach that combines face-toface instruction with flexible online training. “We provide one-and-a-half-hour seminars to teach employees the basics. They can then familiarize themselves with the new software at home and learn on their own,” Schläpfer continues. The Home Use Program included in the Microsoft Enterprise license agreement supports this option. The Home Use Program allows the hospital to issue Office 2007 licenses for home use. Benefits – Modern and Stable Working Environment Various users, from doctors and physiotherapists to nursing staff, use the new system and can access their specialist applications just as before. Plus, users are finding that the system starts up quicker and it’s easier for them to find documents and files. “Windows Vista and the 2007 Microsoft Office system are being very well received by employees, both experienced and occasional PC users,” maintains Schläpfer. “They are all particularly impressed by the efficient Instant Search function in Windows Vista. Thanks to the online learning program, they can independently expand their knowledge and thus complete their work on the PC more efficiently. As for IT employees, the analysis tools in Windows Vista make their jobs easier.” Equipped For Future Projects The Microsoft solutions lay the foundation for future projects. “Windows Vista and the 2007 Microsoft Office system are not just new products for us, but also core elements of our long-term IT strategy,” emphasizes Lindenmann. www.microsoft.com www.kssg.ch New Head of Healthcare IT Agfa HealthCare, provider of IT-enabled clinical workflow and diagnostic imaging solutions, announces today that it has hired Dr. Volker Wetekam as its new Executive Vice President for its global HealthCare IT division. Dr. Wetekam will head up an operation of around 3,000 staff members and report directly to Christian Reinaudo, President of Agfa HealthCare. He will take up his new position mid-September. In his new role, company speakers explained, Dr. Wetekam – who comes from a top position with Siemens Healthcare – will define and implement the overall strategic positioning and roadmap for Agfa US: Huge Step Forward for Telemedicine At the end of June, the U.S. House of Representatives passed the bill H.R. 6331 by a landslide vote of 355-59. It contains provisions adding skilled nursing facilities, hospital-bases dialysis centres, and community mental health centres as originating sites for Medicare telehealth reimbursement. Shortly afterwards, Sens. Max Baucus and Charles Grassley, the Chairman and Ranking Republican on the Senate Finance Committee, announced that they had reached a compromise in their negotiations on the Medicare legislation. While a written copy of this compromise has not been released, American Telemedicine Association (ATA) has learned from sources HealthCare’s IT division, which manages both the company’s Imaging Informatics and its Enterprise IT business, covering solutions from Picture Archiving and Communications Systems (PACS) over Cardiovascular Information Systems (CVIS) to Hospital and Clinical Information Systems (HIS/CIS). He will be responsible for driving the division’s overall profitable growth. Dr. Wetekam will also become a permanent member of the HealthCare organization’s Executive Committee. www.agfa.com/healthcare on Capitol Hill that at least the skilled nursing facility provision and the hospital-based dialysis provision are in the compromise bill. ATA has indications that the community mental health centers provision is also in the compromise bill, but we have yet to confirm this. Inclusion of the telemedicine language in both the House and Senate versions of the Medicare bill makes its inclusion in the final legislation likely. “Passage of this legislation represents a huge step forward for telemedicine and a major victory for ATA,” the organization underlined. www.americantelemed.org
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