Category: Healthcare IT Blog

Context of IT

Influential CIO and blogger Dr. Halamka published an excellent post today on the role of CIO titled Job of CIO – Content versus Context.  Dr. Halamka and Healthcare IT is not alone on this and IT organizations across all sectors face similar challenges to deliver more with less and little or no wiggle room for innovation.  Compliance, technology refresh, security and operations ends up taking the entire budget with no room for innovation.  That is the real picture in almost every IT organization and more often the role of CIO and the entire IT organization gets valued by how the expectations are set and managed, yes the context compared to the content on latest technologies and buzz.

Unfortunately there is no Silver Bullet solution for all the problems that Dr. Halamka highlighted in his post. However, there are several learnings for IT organizations, enterprise solution vendors and service providers to IT organizations. I am eager to see his next post about on his speculation on the IT organizational model for the future that improves the context of the work.

Now coming back to the learnings,  IT organizations can take cues from startups, from lean principles like lean IT or lean startup to try to squeeze innovation out of existing operations budgets.  As a person who has straddled between the startup and IT organization worlds, I also see the challenges associated with it introducing lean / agile methodologies in a traditional IT organization, which is mostly organizational and cultural and has to be overcome first.

For enterprise vendors and services providers, IT organizations will love you when you provide capability to enable IT to charge back for the service business is using. Though charge back for IT services may not happen soon, at the least it will enable IT organizations to track who is using what and use as a leverage for budget increase.

If you are not already tuned into Dr. Halamka’s blog, here is the link

Saravana Rajan


Thursday afternoon reads

1. China’s fake Apple Stores:  (Bird Abroad)

– the facade can be imitated but not the culture and every detail of a brand like Apple cannot be imitated.  Still this could have faked more than few customers.

2. No New Social Networks Launched Today (Borowitz Report)

– A friend of mine told me that in Silicon Valley every business plan thats being hatched up now is about a social network of some kind – are we in another tech bubble?

3. Tale of two countries: The Growing Divide Between Silicon Valley And Unemployed America (Tech Crunch)

4. Clinician to Clinician Communication (Healthcare Informatics)

– In this world of social networks, paying using your smart phone, come to healthcare world you will find FAX and Phone as the greatest thing since sliced bread.  There are numerours reasons for that, lets not get into what’s wrong with Healthcare, that’s another conversation over a beer.

Nhin Direct project is taking a think small and simple approach to connecting the physicians with other physicians using existing applications,  communication protocols(SMTP and XDR) and what not.  Simple direct to direct communication is key for healthcare technology adoption among providers.

5. The DNA–People, Processes, And Philosophies–Of Innovative Companies (Fast Company)
– innovation starts from within a person, who believes that a world can be a better place and the system (organization or country or any entity) they are in has to foster a culture of innovation.  If the system doesn’t foster, its just one more barrier to bring down for the innovator and create a new system.

Health Informatics insights: remote health monitoring

I just got better from a month long ordeal with an infection, which required daily visits to a care provider to assess the state and provide care. Though, the care was exemplary by Ontario CCAC, there are areas of improvement needed in care coordination among providers and remote health monitoring to increase efficiencies.

Remote health monitoring, means different things to different people.  The following report from California Health Foundation offers the current state of the market with a clear definition on the terms and the state of the market.

The Connected Patient: Charting the signs of remote health monitoring

Image Source: California Health Foundation – The connected patient: charting the vital signs of remote health monitoring.

Key insights: little has changed in the last four years with mixed results from pilot projects

Why little has changed when the economic benefits offer several millions and billions of dollars in savings and efficiencies ?   The author of the report points to the structural issues of the US health care system, which tends to be fragmented and focused on episodic care.  I believe that this is not just a US problem and is a common issue between the publicly funded Canadian healthcare& and friends south of the 49th parallel.  By far the biggest barrier to more pervasive adoption of DM has been the continued fragmentation of operations and information technology across health systems.

That is a well known problem with the providers paid on a fee for service basis.   In the US there are recent developments with the introduction of HITECT act and Accountable Care Organizations towards an outcomes based system.  In Canada, from my view the change appears even slower and the outcomes based model is being discussed at the provincial level, who are essentially payors of the service.

Though there are several drivers for remote health monitoring including communication technology advancements, mobile data standards, the chronic care tsunami we are facing as a society,  there are some significant challenges in adoption at the physician office,  consumer engagement and payment models for this service.

In spite of the challenges there are significant economic benefits and prospects to remote health monitoring both in US and Canada.

& Rethinking Our Approach to Disease Management: Technology and Information Flow Considerations

IHE International meeting in Toronto

Keith Boone presented about CDA and CCD history at the IHE dinner in Toronto last night.

Highlights from Keith’s presentation:

– Interesting to know that CCD came from Vancouver Island Health Authority Electronic Medical Summaries project.

– Schematron for message conformance over XSD and it’s an ISO standard. Good to know.

– What is the difference between a document and a message?

Whenever you go back and ask for Information and if you get the same thing back then it’s a document. It is persistent compared to a message, if you are caught up in document vs messages.

– Where in the world is XDS ?

– Checkout CDA Tools

– Keith also has a new book coming out in May 2011 on CDA.

And here is Keith’s post on his speech if you are looking for meat.


Great to hang out with the standards geeks from IHE and meet great people and catch with up with old friends who are involved in improving healthcare and healthcare standards.

Thanks to HIMSS for the wine.

Saravana Rajan

Ontario EMR Specification v4.0 FINAL version released

Ontario  EMR version 4.0 specification(final) was released couple of days ago by Ontario MD for EMR vendors to apply for funding offering and comply with version 4.0 requirements.


Here is the link to the schedule and version 4.0 requirements.

Version 4.0 has some key requirements from a jurisdictional EHR or document exchange between healthcare provider point of view.  One of the key requirement is the requirement for EMR vendors to implement Hospital Report Manager specification to enable transfer of clinical documents like discharge summaries, transcribed reports (radiology, lab and others) from healthcare providers (mainly acute care hospitals) to primary care physicians(PCP) using an EMR.

This is great first step forward to enable the family doc to receive discharge summary from the hospital before the patient shows at the doc’s office and EHR.  Though at a provincial level this standard (Hospital Report Manager) doesn’t seem to align with the Ontario Clinical Document Specification, which is currently under public review as well.

Friends at eHealth, kindly take a note of this.  I am reviewing the CDS and will be submitting my comments through the public review forum as well.

Saravana Rajan

Medical Imaging on the Cloud

As Cloud Computing is making its waves at the peak of the technology hype cycle (source:Gartner), last week at Radiological Society of North America (RSNA), one of the largest healthcare technology trade shows in the world,  Cloud Computing made its entry into medical imaging technology.

DICOM Grid, a Phoenix based company made headlines last week at RSNA 2010 as they launched their cloud based platform for enabling secure exchange of medical images among physicians, hospitals and imaging facilities.

If you have been in healthcare and especially medical imaging, this is a well known and common problem for physicians, patients and image producers, where diagnostic imaging and results cannot be shared among healthcare providers other than by burning and sending a CD or DVD or faxing the patient’s image to the requesting physicians or specialists for referral.

This is mainly due to information silos created by care providers and insufficient technology means to share information beyond the care provider’s firewall.

In Canada, this problem is being addressed by building centralised diagnostic imaging repositories funded by Canada Health Infoway, an arms length government entity for enabling EHR in Canada.  South of the 49th parrellel in US, invisible hand plays a role and market takes over resulting in innovations like DICOM Grid, who has an untapped blue ocean market ahead of them.

DICOM Grid is bringing cloud computing and medical imaging technology together to solve this problem and are becoming a centralized diagnostic imaging repository for their customers – physicians, patients and image producers.

At a high level Dicom Grid‘s solution seems to solve the problem of accessing patient’s images in a seamless fashion, and their success remains in their customer’s hand as there are some barriers to adoption from a physians perspective.

Also to note that Dicom Grid is not the only player, eMix,  a spin off from a successful medical imaging technology company DR systems is also in the play and probably one of the first to enter this market.

Saravana Rajan