Ideas in Hospital-Based Imaging

Cross-Country Hospitals Enjoy fMRI System Installs
Siemens Upgrades Health IT System
Getting ROI from IT

An fMRI system is an invaluable tool for hospitals with dedicated neuroscience institutes.

Cross-Country Hospitals Enjoy fMRI System Installs

Cathy Elsinger, PhD, is aware that within a busy radiology department, it is difficult to integrate fMRI capabilities into the existing workflow.

“A lot of work has to be done by the MR technologist in the room, and there aren’t the components for measuring patient responses in a way that’s standardized,” said Elsinger, who works as the vice president of research and clinical operations at Milwaukee-based Neurognostics. “So we provide that standardization via some workflow software for the tech.”

Focusing on the standardization of fMRI exams, the software works independently from the scanner to walk the tech through all the patient instructions and training, Elsinger said. “It’s all synchronized,” she explained. “It gives real-time feedback on how the patient is responding, and that verification is great for lowering your risks. So it really does help. We spend about 4 to 8 hours training the techs, and then they’re good to go to administer these exams.”

In late 2007, Neurognostics announced two new installations of its fMRI system: one at Hoag Memorial Hospital, Newport Beach, Calif, and another at North Shore-LIJ Health System, New York. Neurognostics will provide the data acquisition hardware and workflow software, as well as the company’s library of stimulation paradigms designed to map an array of cognitive and motor functions. Both institutions boast dedicated neuroscience institutes focusing on brain tumors, epilepsy, stroke, and neurodegenerative disorders.

At Hoag, radiologists will work with Neurognostics to research further paradigms. “By forming a collaborative relationship to develop disorder-specific tasks for our research use, we plan on taking full advantage of our advanced fMRI capabilities,” said Michael Brant-Zawadzki, MD, medical director of radiology. “We hope to replace Wada testing in our patients’ work-up for temporal lobe resection, and better guide brain tumor resection.”

The Neurognostics fMRI system also allows clinicians to integrate processed fMRI images into neuronavigation systems, enabling viewing of functional brain images both before surgery and in the operating room. North Shore University Hospital will be looking into clinical applications of Neurognostics’ current paradigms, according to Michael Schulder, MD, director of the Harvey Cushing Brain Tumor Institute and vice-chairman of neurosurgery at North Shore.

“Neurognostics’ fMRI system will standardize our ability to identify areas of functional activity prior to performing surgical resections,” he said. “Their ability to import fMRI images into our neuronavigation systems, including intraoperative MRI, is essential when applying fMRI to the clinical setting. We plan to study the clinical application of these paradigms and compare them to other, more labor-intensive methods of acquiring fMRI.”

Elsinger also cites the system’s expanded library of paradigms as a key benefit.

“We’re very forward-thinking in that we understand that presurgical mapping is where you’re seeing a lot of reimbursement now,” said Elsinger. “But this is a technology that’s growing, so we’ve been developing paradigms to test for disorders like ADHD. We think a lot of these applications will be used in a more widespread way in the future.”

Next up, Elsinger said, Neurognostics will focus on developing a solution for data processing. Currently, the company offers a data-processing service, with a turnaround time of 24 to 48 hours, but as institutions begin performing more and more fMRI studies, in-house processing will be more economically viable.

“We’re trying to understand who’s going to be doing the data processing from a workflow perspective,” said Elsinger. “We’re still gathering a lot of feedback on that. But this is a very exciting time for this technology. We’re only touching the tip of the iceberg now. A lot of new applications will arise.”

—E. Sanchez and C. Vasko

Siemens Upgrades Health IT System

Fueled by the business and clinical requirement to support an updated version of its vendor partner’s medication data, Siemens Medical Solutions announced in December the release of its latest INVISION health information system.

INVISION 27 contains platform, database, and application enhancements designed to help health care organizations streamline information across clinical, financial, and administrative functions throughout their enterprises. The upgrade took place after First DataBank came out with its new Drug Allergy Module, which improves clinical checking by providing additional allergen information.

“With an increased focus on patient safety, this new version of medication data supports the medication ordering and allergy collection processes, which enables a higher granularity of clinical checking,” said Kim Dastalfo, product manager, health services, Siemens Medical Solutions USA. “In order to take on this new support, our INVISION platform required a database expansion.”

Under the module, allergy codes possess a new structure, based on drug names, groups, and ingredients. Using Siemens Pharmacy and Soarian Clinicals, these codes can be interfaced to various systems.

“Making a significant investment in enhancing our INVISION platform, which is one of the most widely deployed systems in the United States, was a top priority for us, as we remain committed to supporting all customers across our multiple product lines in delivering the best level of patient care,” said Janet Dillione, president, health services, Siemens.

While it benefits a whole host of facilities, from big medical centers to small clinics, the software specifically is of assistance to those who perform online allergy collection and medication order processing. For example, the Denver Health and Hospital Authority, which operates a 500-bed main hospital, a 911 medical response system, a network of family and school-based health centers, and a level I trauma center, recently experienced a seamless transition to the new system.

“The upgrade was nearly flawless, and the support we received from our partners at Siemens was outstanding,” said Gregory Veltri, chief information officer at Denver Health. “Siemens finished ahead of schedule and actually caught us in the middle of completing maintenance on gateways. The feedback we received from our staff members and physicians after the upgrade was all positive.”

Dastalfo said that over a period of 4 years, the company homed in on two specific areas, “the research and development of the database and clinical workflow to support the new medication module, and the infrastructure to upgrade the platform and convert the data.” During the final 4 months of the project, Dastalfo continued, Siemens performed an upgrade and conversion on behalf of customers who host their system in the data center, located in Malvern, Pa.

Although the INVISION 27 was not particularly designed to reduce costs, saving money could be an added side bonus.

“This release was not primarily focused on decreasing costs; however, when the medication data integrity is consistently improved, the clinical workflow is optimized, which can help to drive down overall costs,” Dastalfo said.

—E. Sanchez and C. Vasko

Channen Smith, vice president and manager

Getting ROI from IT

McKesson Corp, Alpharetta, Ga, recently announced the launch of Horizon Managed Services, a new portfolio of services designed to help hospitals implement and rapidly achieve return on investment from their health care IT investments. The continuum of managed services will initially include accelerator services for implementation and upgrades, ongoing operation support, and remote hosting with database and security management.

“We have many customers today who really struggle with finding enough resources to ramp up and deploy their IT solutions,” said Channen Smith, vice president and manager for Outsourcing and Managed Services at McKesson. “If you’re in a big city, it’s not too hard to find those resources, but in a lot of rural communities it’s very difficult. As community hospitals start progressing in advanced IT solutions, finding capable resources is a real challenge.”

McKesson’s new remote hosting services are designed to help organizations sidestep the up-front capital outlay and ongoing maintenance of large-scale data centers. “We’ve consolidated down to two main data centers,” said Smith. “We plan to have an east-west data center strategy. From a cost standpoint, it’s a value-add proposition. It’s not more than what people are going to pay to buy the hardware and start up their own data center. Most hospitals can provide tier one, which is guaranteed 98% of the time; we offer tier four, which is guaranteed 99.9% of the time. The discrepancy sounds small, but no clinical department is going to accept that much downtime.”

Horizon Managed Services also offers accelerated implementation and upgrade work by handling both sides of installation and configuration. “A traditional methodology would be to assign an implementation team to come in and help build requirements, teach the hospital’s team how to configure, and so on,” said Smith. “We deploy a team to do all that testing and configuration on behalf of the client. The customer provides the requirements, and in conjunction with our implementation teams, we do all of that as a service.”

Smith notes that this approach can lead to significant time reductions in implementation. “We can do it more predictably and more quickly, so in many cases the cost of outsourcing is less than the cost of hiring their own teams,” he said. “What we sell from an outcome standpoint is predictable ROI, which is really what the CEO and CFO want to know.” Ongoing operational support is also a key feature, especially for remote or rural hospitals. “One of our new clients is 80 miles outside LA,” he said. “It’s tough to get anybody out there.”

In its initial phases, Horizon Managed Services is applicable only to McKesson products and solutions, but Smith says this is likely to change as the offering evolves. “We have a multigeneration plan,” he said. “Out of the gate we’re offering services just for McKesson, but we may expand over time. We’re also looking toward business continuity and disaster recovery strategies.”

And the Horizon Managed Services team is working with McKesson’s medical imaging team as part of phase 2. “In the first phase, we don’t have a PACS solution,” said Smith. “But that’s part of our phase 2 evaluation, along with image vaults.”

—C. Vasko