April 2007

WORLD

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ICT deployment in hospitals can cut operating costs

Once hospitals exceed a certain tipping point in its IT investments, they see a reduction in operating costs, improved efficiencies, and a slight drop in patient mortality rates, according to a new report by PricewaterhouseCoopers.

The study of 2,000 US acute care hospitals found that about 60 percent so far are near or have reached the tipping point, in which investments in IT have begun to pay off. In total, there are about 6,000 acute care hospitals in the US. The tipping point is slightly different for forprofit versus non-profit hospitals. However, to reach the tipping point, a hospital needed to make pretty significant investments in IT, based on the complex scoring system PwC, used to evaluate the hospitals. The scoring system rated hospitals on their investments, in about 40 different applications.  

Involving patient in healthcare through IT

On 12 March 2007 The Scarborough Hospital (TSH) and Canada Health Infoway (Infoway) have announced a new initiative to improve emergency room service. Through kiosks in the emergency waiting rooms at both hospital campuses, patients will be able to enter information in seven different languages, thereby facilitating more effective triage.

Here it deserves a mention The Scarborough Hospital is Canada's largest urban community hospital, involved in delivering innovative, high quality patient care. It advocates community's health and wellness issues, and is a leader in research, teaching and learning. Affiliated with the University of Toronto, TSH is also a referral centre for vascular surgery, pacemakers and corneal implants. Canada Health Infoway is an independent not-for-profit  rganization
that invests with public sector partners across Canada to implement and reuse compatible health information systems,which support a safer, more efficient healthcare system.

Coming back to this joint initiative, which is Called Enhancing Emergency Services: A Patient- Centred Approach (EES), it aims to better support nurses and physicians with smart tools so that they can work more efficiently and effectively to enhance patient flow and improve patient care.

These patient-centric information systems will assist patients in communicating their status to ER staff and physicians as they wait in emergency waiting rooms. An alert will pop-up on the nurses' screen each time a patient updates information. According to Dr. Hugh Scott, President and CEO, TSH, “Patients now have the option to play even more of an active role in their care process during unavoidable waiting time.” Also, the new e-triage tool will assist staff with the patient reassessment process and reprioritization of care as needed.” The system is designed to enhance various aspects of ER service for patients without increasing staff or enlarging facilities.

The user-friendly kiosks are available in English, but will also feature interfaces in seven different languages including English, French, Chinese (Cantonese and Mandarin), Tamil, Punjabi, Farsi, Hindi and Urdu. Patients are asked a number of questions in their native language and can choose answers from a comprehensive list. The system then translates the information into English for use by the care providers.

Infoway is investing $1.5 million dollars in this pilot project, approximately half of the project's total cost. The new technology will capture more detailed data from patients, process that information and provide it to the nurses and physicians. The Centre for Global e-Health Innovation, University of Toronto Healthcare Resource Modelling Laboratory, the University of Alberta  TRIAGE Solution and Medisolve, are also partners in this project.  

Boost for electronic health records

A bill introduced on 1 March 2007 by the US Representative Patrik Kennedy, a Democrat based in Rhode Island, will give US doctors an incentive to sign patients to use electronic health record systems. According to the terms of this bill, titled Personalised Health Information Act, US doctors will get US$3 for every patient that they sign up to use electronic health record, over a period of next three years. The bill entails US Secretary of Health and Human Services to create an incentive program for doctors, to encourage their patients to use an electronic health record system.

The bill is a proactive step to facilitate USA's adoption of electronic health records, which in turn can contribute greatly towards reduction of healthcare costs, and elimination of medical errors. The successful passing and execution of this proposed bill is estimated to save to the tune of $70-$80 billion a year for the healthcare industry, in terms of efficiency alone. The e-health records would allow healthcare providers to send important messages to patients, such as reminders about a check-up or the due date of vaccination, etc. According to Kennedy, the bill would empower patients by making them better informed and would also improve communication exchange between patients and their healthcare providers. Several companies, which include Microsoft, e-health record vendor Allscripts and the American Heart Association, have endorsed this bill, which endows it with an added corporate muscle.  

Investment in Middle-East Healthcare to Triple

The Mideast is set for a substantial increase in spending on its healthcare infrastructure, according to virtually all local news sources. In the UAE alone, estimates suggest that there is shortage of over 2,000 hospital beds. As a result, numerous private hospital development groups have been drawn to the region, explained Ottmar Schmidt, Director of Marketing at Welcare World. The change is expected, among other things, to reverse the trend of affluent Middle Easterners seeking healthcare abroad in such places as the U.S. or Europe.

The forecast predicts that the Middle East will be one of the four emerging markets, along with China, Russia and India, whose healthcare investment will rise from $1 billion to $3 billion.  

Telemedicine in the sub-Saharan Africa

A European task force on telemedicine, which met at Gaborone, Botswana, on 1 March 2007, reviewed the ICT applications for health in the sub-Saharan region. The task force concluded that ICT through satellite solutions could facilitate the improvement of health in sub-Saharan Africa. To translate this idea into reality, some shortterm actions have been chalked out in a pilot projects proposal.

The suggested actions focuses on increasing the numbers, improving performance and quality of the health workforce of sub-Saharan Africa, increasing the coverage of health services in the area, by reaching remote, isolated areas, and strengthening the intelligence gathering capacity of the area's health systems and their ability to use information for decision making.

All total three pilot projects were proposed under the eHealth initiative, as part of a European Union's strategy to enhance interconnectivity in Africa through ICT. According to Telemedicine Task Force, by complementing terrestrial infrastructure with satellite communications, better communications coverage for the sub-Saharan region can be achieved. However, the proposed pilot projects should concretely demonstrate the feasibility of this approach. These demonstration projects will be used to inform and to help develop a framework for extending e- Health. One of the key goals of this European task force is to develop a complete scenario of telemedicine opportunities in the sub-Saharan region, and to formulate recommendations for future action.

Here it deserves a mention that this was the third meeting of the telemedicine task force, which is composed of the main relevant African organisations, the World Health Organization, the European Commission and the European Space Agency. This task force is constituted after a Brussels workshop in January 2006, that highlighted the potential of satellite telecommunication technology to support health systems in Africa. The task force has been set up to define a framework of appropriate actions for a telemedicine programme in the sub-Saharan Africa to support the definition of a cost-benefit study; to evaluate the relevance of a pan-African network for telemedicine.  

Using bioinformatics to tackle avian flu

Researchers at the University of California, San Diego (UCSD) and the University of Hawaii will use bioinformatics, grid computing and networking infrastructure, as well as collaborative ties with the Asian institutions to learn more about avian flu.

“We will use modern highthroughput biology to annotate the biological structures of different subtypes of the avian influenza virus, at the same time as we study their variations,” said Principal Investigator Peter Arzberger, Director of Life Science Initiatives at UCSD. “We will also construct a grid infrastructure to support avian flu research – an infrastructure that could one day handle research on other infectious diseases as well,” he added. According to him, “Fighting a pandemic will also be easier if we put in place the infrastructure to replicate data, support medical informatics, and even assist in remote diagnosis.”

University of California, San Diego will lead the one-year project, with more than $350,000 in funding from the Telemedicine and Advanced Technology Research Center (TATRC), a part of the U.S. Army Medical Research and Material Command (USAMRMC). TATRC invests in telemedicine and advanced medical technologies in order to deliver world-class healthcare to military personnel.

Institutions in three Asian nations will leverage TATRC's investment by funding their own researchers to work with their counterparts in California and Hawaii, as part of their ongoing collaboration in the National Science Foundation-funded Pacific Rim Applications and Grid Middleware Assembly (PRAGMA). Pacific Rim institutions collaborate in PRAGMA to develop grid-enabled applications and coordinate deployment of the needed infrastructure throughout the Pacific region to allow data, computing, and other resource sharing.

Five non-U.S. partners have pledged to fund collaboration on the avian flu virus project. They are Japan's National Institute for Advanced Industrial Science and Technology (AIST); China's Jilin University (JLU) and Computer Network Information Center (CNIC); as well as the Korea Institute for Science and Technology Information (KISTI) and Konkuk University (KU). Significantly, Malaysia's Universiti Sains Malaysia (USM) has pledged new funding for the collaborative project at the PRAGMA 12 workshop.

The focus of this research is on the use of reverse genetics techniques to combat emerging bird flu pandemic threats. The researchers intend to characterize the function of the influenza viruses using a structure-based approach, develop simulations of the molecular dynamics involving interactions among major factors that may determine the virulence of a virus, and test whether the multinational collaboration can establish a successful, largescale, distributed computational data grid.  

Fight against Aids in Africa gets mobile power

The recently held 3GSM World Congress in Barcelona was the platform for announcing a significant inroad in the e-Health sector. Here it was announced that the mobile phones could be used to combat the prevalence of HIV/AIDS, which is threatening to take epidemic proportions in the African continent.

A public-private alliance between the US government and five member groups from the mobile phone industry has taken an initiative called 'Phone for Health' for this purpose. The $10 Million 'Phone for Health' project aims to use mobile phone to cater to health systems in ten African countries. Firms working on this project include the US President's Emergency Plan for AIDS Relief, Motorola, the GSM Association, Voxiva, and Accenture.

The scheme expedites the real time collection of data from healthcare staff and field workers and holds structured two-way intercommunication to enhance supervision and feedback. According to Paul Meyer, Chairman, Voxiva, “Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information.”

Presently, more than 60 percent of the African populace lives in regions where there is mobile phone coverage. This is projected to escalate to 85 percent by 2010.  

Singapore to consolidate its patient medical records

The Singapore government is endeavouring to consolidate patient medical records in a common IT system so as to enable sharing of health information between doctors in Singapore, coming from both the public and private sectors, in a secured manner.

However, according to Singapore's Health Minister Khaw Boon Wan, some sensitive data pertaining to issues like HIV and sexual diseases will never be shared, and will be kept highly confidential. This centralized database has the potential to transform the healthcare of Singapore. With the advent of consolidated medical records, now a patient will not have to repeat his/her tests and scans, if he changes his/her doctor, or visits a different doctor than his/her usual one. This will lead to savings in his/her medical costs. Khaw also said that Singapore would “gradually” graduate to an EMR system. Already some progress has been made in this direction. Several issues, which include data protection, regulation and audit, need to be considered first before moving over to such a system, and Singapore government is naturally introspecting on these.  

A deserving award for Raytel and tele-health

Frost & Sullivan, a global growth consulting company, which has been partnering with its clients to support the development of innovative strategies for more than forty years, has selected Raytel Cardiac Services as the recipient of the 2007 U.S. Cardiovascular Enabling Technology of the Year Award for its dedicated efforts in the remote monitoring in cardiac rhythm diseases. Each year Frost & Sullivan presents this award to a company that has developed a technology that can benefit or revolutionize the industry.

“Any refinement of procedures or devices that are able to expedite the time a doctor is able to allot for a patient, without sacrificing accuracy or thoroughness, will be seen as a significant advancement,” said Frost & Sullivan's Research Analyst Venkat Rajan. “Raytel's advanced remote home monitoring technologies and reporting services are aiding this market,” he added.

Here it deserves a mention that Raytel is one of the most experienced telemedicine providers in the US healthcare industry. Its technicians and report data are available to patients and clinicians 24/7, all year round. The company's highly experienced technical staff supports the monitoring service, provides comprehensive and relevant test reports, supports physician emergency notification requirements, works with patients to ensure test compliance with their physician's prescribed frequency, and also offers guidance and training to both clinicians and patients. This comprehensive monitoring service allows the clinician to spend limited clinical resources on more acute patient needs without sacrificing quality of care. This remote monitoring system can greatly aid the patients who live in remote or rural locations, without immediate access to their cardiologist. Not only can the device alert the cardiologist of unstable arrhythmias, but they can also monitor device function, battery power, and identify if cardiac leads have become disconnected. “Raytel's technology and services also represent significant future savings for reimbursement payers. Being able to monitor patients on a frequent and consistent basis reduces the necessity of office visits, and even can pre-warn healthcare providers about delineating conditions that could lead to an acute emergency,” noted Rajan.  

NASA scientists to make inroads in the domain of space medicine

NASA scientists are studying ways to improve space medicine for tackling space travel's medical challenges. One effort is to develop 'image fusion.' In this process, clear, sharp x-rays and other high-resolution, scanned images of astronauts taken on earth will be combined with less sharp sonograms taken onboard spacecraft to enhance those images. These improved images will enable doctors to better see the condition of major organs in astronauts. Sonogram scanners use non-invasive sound waves to take pictures of organs and features inside the body. Doctors also use sonograms to view and monitor unborn babies. Because sonogram scanners often are lighter and use less power than other kinds of scanners, they are better suited for space travel.

“We want to be able to detect any changes (in astronaut) organ structure and function during spaceflight,” said Richard Boyle, a scientist and neurology expert at NASA Ames Research Center in California's Silicon Valley. He added, “This would allow us to provide early intervention to resolve medical problems before they become more serious. There will be very limited diagnostic tools available to the astronauts, and this image fusion may provide a way to help astronauts maintain their health.”

“In order to investigate any potential changes that may occur during long-term space travel, we have selected the human heart and kidneys as our initial study subjects,” Boyle observed. According to Xander Twombly, a colleague of Boyle's, “We're working on development of a digital model of the human heart and kidneys. This is a computer model of the heart that can be used to predict changes in heart function under different gravitational conditions.”

According to Twombly, computerized topography, which are commonly known as CT scans, will be used to “take pictures of the beating heart on earth prior to spaceflight.” These x-rays provide significantly higher-resolution pictures of the heart as compared to those provided by an ultrasound scanner. “We will take ultrasounds (of the heart) on the earth as well, before spaceflight, and then we'll combine the ultrasound and the CT images to make an enhanced picture of the heart,” Twombly explained. According to researchers, they are using the power of computers to tie x-ray details to lower-resolution ultrasound scans, so that when ultrasounds are taken during space travel, they will be sharper and show more detail.

NASA has teamed up with doctors to develop image fusion for sonograms. Collaborations also aid in the spin-off of new technologies, like image fusion. NASA has entered into a collaboration with Salinas Valley Memorial Healthcare System (SVMHS), with whom NASA has a Space Act Agreement.

“They provide all the imaging and medical expertise, and NASA provides the computer science know-how and systems to develop image fusion technology. Our group has had close interactions with SVMHS Sam Downing, President/CEO, the doctors and staff at Salinas for at least eight years to develop a wide variety of medical imaging technologies,” Boyle added. Dr. Richard Villalobos is the principal investigator at Salinas Valley Memorial Hospital, working with Boyle and Twombly.  

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