Virtualization for "dummies"

Have you heard that one of the hottest IPO lately is VMware ? What does this company do ? "Virtualization". Whats that ? May be a concept that is hard to grasp initially, but it is an area with great potential to simplify and minimize IT infrastructure. As someone involved in building a RHIO, IT infrastructure costs are a hugh issue and can be a barrier in forming RHIOs and HIEs.
Check this Dell blog item (complete with a video presentation) for a good introduction on Virtualization. Basically, from the dell website on virtualization (not meant to be an advertisement for Dell BTW),

"Virtualization allows you to run multiple applications and operating
systems independently on a single server. Administrators can quickly move
workloads from one virtual workspace to another - easily prioritizing business
needs while maximizing server resources"

EMR Video clip: VistA Integrated Health Care IT

This is an interesting clip with some real life EMR screenshots. Good demonstration of how a patient's electronic medical record is integrated with colonoscopy images and videos, EKG images. Also demonstrates CPOE (computerized physician order entry) for radiology order entry.

Telemedicine Wound Care Video Clip

Wound care is a really neat application of telemedicine. Here is a video clip on the use of telemedicine for wound care. Notice the use of Microsoft's new Ribbon style user interface (Office 2007) in the wound care application.
I wonder if they are using an Office 2007 based application (Infopath or Access) or have developed their own application from "ground-up" ?



A Wound Medicine Project document. Good detailed technical discussion on the design of a wound management application. Allows for on screen measurement of wounds using laser pointers.

Telemedicine Video clips

Here are a few good video clips on Telemedicine:
Clip #1: A real-life story on the use of Telemedicine consultation in an emergency room where the onsite ER physician was instructed on how to perform a surgical procedure on a critically ill pediatric patient who had just minutes.


Clip #2: Real demo of a Patient's experience with a tele-consultation. This patient presented to a clinic with an ear ache. A nurse used an otoscope connected to the telemedicine equipment (cool) and consulted with a remote Ear Nose and Throat doctor who was able to see the image from the patient's ear.

Telemedicine Resources

Telemedicine is another area in health IT that interests me. Being a practicing physician with patients in multiple settings such as nursing homes and hospitals, I believe that telemedicine shows great promise and has yet to reach its potential in transforming how we practice healthcare . It's the combination clinical medicine and cutting edge healthcare IT that is really appealing to a techie physician. Telemedicine technology in many ways is about moving data around between patients and physicians, similar to a RHIO or an HIE.

To me, an HIE (Healthcare Information Exchange) is about moving and aggregating actionable clinical data from multiple data sources to a physician (or other healthcare provider) in order to provider patient care. Telemedicine is just another type of data that must be moved from the source (the patient from the remote location) to the physician.

I will be putting together a list of useful Telemedicine resources. please let me know if I should include anything else.

Telemedicine and Delaying Hospitalization: Interesting item on how telemedicine can reduce hospitalization of nursing home patients from a blog on senior care.

Some interesting points from the blog item:

• "...many doctors have skilled nursing facilities third on their to-do lists"


• “37 percent of the hospitalizations of long-term residents at urban nursing homes nationwide were potentially avoidable.”
• "A doctor can teleconference with a patient, see them via a monitor and make a decision as to what the patient needs."
  " Many nursing homes have found this reduces the need for unnecessary hospitalizations.."

More links related to Telemedicine and Hospitalizations:

• Treating Acute Infections by Telemedicine in the Home PDF
• New telemedicine program pairs comfort of home with heart care
• Treating Acute Infections at Home with Telemedicine Presentation on real implementation of telemedicine. Has pictures of the equipment used, list of costs for the equipment and benefits of the program: Shows the reduction in hospital days, costs savings, patient satisfaction etc.
• Telemedicine Information Exchange (TIE) website : Great resource with a wealth of information on Telemedicine.
• Boston Globe article on Nursing home deficiencies and cutting unneeded hospitalizations. How Telemedicine is being used to address these challenges.

Telemedicine in Wound Care

Wound care practice, Woundcare Consultants

Wound care in long term setting from Ostomy Wound Management

Telemedicine Wound care using cell phones

WoundMatrix, wound care EMR

Smith & Nephew's has a Device to measure Wound area. See their website for more information.

Laser device to measure wounds.

Telemedicine Liability: Unfortunately, liability and malpractice are issues that must also be considered even in telemedicine. Here are a few resources:

Blog item on Telemedicine Liability: contains a link to potential liability issues in teleradiology.

Telemedicine Risk makes the following points:

• "...while remote medical practice can bring efficiency and cost savings... it can increase liability."
• "Malpractice insurance is merely the first step in risk management for telemedicine, since local laws may be different on each end of the link..."

Regional Telemedicine Issues

A map of Telemedicine and Telehealth State-by-State: A map with links to each state's telemedicine related issues such as existing programs, reimbursement policies etc.

Arizona's Telemedicine Program, equipment description

Telemedicine in Dermatology

TeleDerm Guidelines

Study using TeleDerm. A comparison of TeleDerm with conventional dermatology.

Telemedicine in Nursing Home

Here is a 2006 presentation on the use telemedicine for nursing home care in the state of Maine.

Employing a Wireless Mobile Solution to Bring
Telemedicine to the Nursing Home Bedside
This is proposal to link three rural Michigan nursing homes via telemedicine.

Telehealth Wound Protocol

Northeast Telehealth Resource Center , Partners Healthcare Telemedicine, ME and VT state.

There is a set of document links on their resource page. I have provided them here for convenience.

Informed Consent Reimbursement Policy and Procedures Tele-mental health Protocol for Correctional Inmates Protocol for Medical ASL Interpretation for the Deaf--Video Relay Interpreting Tele-Wound Care Protocol for Nursing Home Residents Tele-Pain management Protocol Tele-pharmacy Protocol

Wound care in long term setting from Ostomy Wound Management

Telemedicine Solution Vendors

REACH Remote Stroke Care

The use a 100% web enabled solution using webs cams, telemedicine carts to deliver reote stroke care to hospital emergency rooms.

InteractiveCare Provides a complete solution for telemedicine. Focus is presently on hospitals but the solution can be deployed in multiple clinical settings. They have a good demo here.

Healthcare Vision Inc

ExhibitOne This company does high definition video conferencing for multiple applications including healthcare.

HealthPia America, Medical Device company. Their flagship product is the "All-in-One Diabetes phone, a cell phone with a built-in glucose monitor that essentially functions as a full-time nurse"

Second Opinion Telemedicine Software: A complete solution for telemedicine consultations.

Telemedicine Radiology:

Team Health is a Tele-Radiology group: "TeamHealth Teleradiology (THTR) was founded in 1991, in Durham, North Carolina, by a group of physicians from Duke University. At that time, the centralized interpretative services group offered reading expertise in MRI and CT for rural physicians who lacked access or experience in these modalities. The group provided 24-hour-a-day coverage, including nights and weekends. THTR was the first and the largest teleradiology company of its kind."

Telemedicine Presentations

TeleHealth and EMRs (5/2007) Makes a good case for telemedicine and its integration with EMRs. Also has a great set of EMR screenshots.

A. Hasan Sapci, M.D at the Telemedicine Resource Center at the University of Michigan Health System has included a comprehensive set of interesting telemedicine technical presentations on his online resume.

Telemedicine for developing countries, MIT developed solution

Telemedicine in Disease Management

Telemedicine in Diabetes

Diabetes Telemedicine/EMR product. Describes the benefits of telemedicine in diabetic care.

Comprehensive discussion of Telemedicine in Diabetes, and the endocrinologist's role

IDEATel- Informatics for Diabetes Education and Telemedicine

Home Telemedicine- A Practical Guide Addresses a number of issues: HIPAA, implementation, nurse case management, provider issues

Telemedicine RHIO

RHIOs, Telehealth & Interop (HIMSS Architects of Change 3/2006) Lists several RHIOs with Telehealth components

Telemedicine Technical Resources:

Store and Forward Technology

ICU Telemedicine

ICU Medical Service company using Visicu's technology

Article on Inova Health System, North Dakota adoption of Visicu.

The Value of Provider-to-Provider Telehealth Technologies, CITL

TeleHealth Technologies Report

Reducing emergency department transfers

Reducing transfers from correctional facilities to emergency departments and physician offices

Reducing transfers from nursing home facilities to emergency departments and physician offices

Replacing in-person consults with virtual consults

Reducing redundant and unnecessary laboratory tests

Telemedicine Market Article is a little dated, 2004, but does have an excellent market analysis.

Video Conferencing Solutions Vendors

New and Pre-owned equipment , Video Conference Store

Carries Sony Video Conferencing products

LifeSize, High Definition Video solution. This company has their own product which looks pretty slick. They have several excellent video demos of their product in action. Here is a review of their system.

Telemedicine Programs

MTN Missouri Telehealth Network

University of Iowa , Dept of Family Medicine: Samsung SDS of Korea, a development team at the University of Iowa has developed a Nursing Home Telemedicine system, Colonial Manor in Amana, Iowa. See their system diagram.

Karishma Telemedicine: Program based in India, their brochures are here.

Maine Telemedidine Services

Policies and Procedures for providing telemedicine services in Maine

Telemedicine Equipment

Alaska's AFHCAN user manuals

EMR - Clinical User Interfaces

Medcin from Medicomp has long been a leader in this area with their clinical Medcin terminology. Here is an example of their user input screen. I learned a lot about clinical user interfaces by reading Medicomp's materials. Some EMR vendor web sites include good screenshots of their user interfaces. I have noticed a lot of vendors have utilized a "Medcin-like "clinical observation documenting style.

Microsoft has just released a Guidance document for clinical terminology matching for a clinical user interface, which is part of their CUI project: http://www.mscui.net/

They have put together some nice guidance documentation on clinical user controls. I have done a lot of reseach in this area and it is hard to find any comprehensive guidance information regarding clinical user interface development.

Although Medicomp has some good information on their website which includes some nice powerpoint presentations with good screenshots, Microsoft has taken it to the next level. They have made a significant contribution to the clinical IT open-source community by releasing this set of comprehensive clinical user interface guidance documents.

Microsoft's CUI Terminology Matching Guidance Document

I came across this today:

Mark Hagland is a contributing writer based in Chicago
Sidebar
RHIO Steps to Success—A Sarcastic Look
Are the real RHIO keys to success more about hot air than about healthcare?
The following comes from Mr. HIStalk's blog, http://www.histalk.com/.

Guide to RHIOs for CIOs, in easy steps:
Participate eagerly in meetings
with your competitors as they talk about sharing data, making sure to speak in
generalities and offering no participation beyond attending more meetings.
Go
back to your co-workers and sneer at how stupid your competitors are and how
backward their systems are compared to yours.
Report back to your fellow VPs
that there's really nothing in it for your organization, but that you'll listen
politely and avoid all commitments just so no one gets mad.
Respond to latest
of 100 surveys asking about RHIOs, making sure to wax poetic about the wonderful
possibilities that will result from the electronic hand-holding that RHIOs will
bring, knowing full well it won't happen until benefits are offered to those
involved.
Go back to your co-workers and make fun of all the folks who've
forgotten CHINs and therefore are doomed to repeat history.
Ignore sales
pitches from vendor RHIO participants who got involved only to troll for new
business.
Go back to your co-workers and make fun of the IT organization of
the local IPA or medical society, consisting of one doctor's brother-in-law
armed with an AA degree and an A-Plus certificate.
Prioritize your IT shop's
involvement in RHIO work somewhere between “get rid of all the cubes and give
everyone an office” and “seriously consider moving all desktops and servers to
open source operating systems.”
Go back to your co-workers and explain to the
bright-eyed among them who ask about RHIOs that it's “no margin, no mission” and
that it will be a cold day in hell when you voluntarily share your exquisitely
created and managed information with the clueless barbarians across town with
their pathetic IT systems.
Get on the speaking circuit and HIMSS advocacy
groups to make sure your attendance at RHIO meetings is rewarded with industry
visibility as a RHIO thought leader.