Raymond D. Aller, MD
Michael Weilert, MD
JCAHO removes bar-code mandate from safety goals
The Joint Commission on Accreditation of Healthcare Organizations has removed from its final 2005 patient safety goals the mandate that bar-code technology be implemented by 2007 for positive patient matching with medications, lab work, and other procedures.
The American Hospital Association had encouraged the JCAHO to remove the bar-code mandate, arguing that such technology is only one of many options for matching patients and medications.
The Joint Commission included in the patient safety goals several hospital laboratory-specific safety initiatives that could be implemented using information technology, but IT usage is not specifically stated in the goals.
The goal to improve the accuracy of patient identification says to use at least two patient identifiers (neither to be the patient’s location) whenever collecting laboratory samples or administering medications or blood products. Use two identifiers to label sample collection containers in the presence of the patient.
Furthermore, immediately prior to the start of any invasive procedure, conduct a final verification process to confirm the correct patient, procedure, site, and availability of appropriate documents.
The goal to improve the effectiveness of communication among caregivers says to measure, assess, and, if appropriate, take action to improve the timeliness of reporting and the timeliness of receipt by the responsible licensed caregiver of critical test results and values.
A more detailed explanation of the Joint Commission’s 2005 patient safety goals
is available on the JCAHO Web site, www.jcaho.com.
The ’nitty-griddy’ on super computing
First came the Internet, then the World Wide Web and e-mail. Next up: grid computing.
A form of super computing, grid computing evolved from high-performance, or scientific, computing that entails manipulating large amounts of data. With grid computing, the resources of underutilized computers are harnessed so that processing power, storage, data, and applications can be shared no matter where the computers are located. And, just as common protocol standards allowed the Internet to flourish, so too are open standards that are in development expected to bolster the progress of grid computing.
The long-term goal is to make the technology readily available and easy to use with any PC, but in the mean time, such areas as medical and scientific research are reaping rewards.
Sun Microsystems has been working with grid-like technology for about a decade, says Peter Ffoulkes, group manager of high-performance and technical computing marketing. Ffoulkes says that to reduce the cost and time involved in developing drugs, pharmaceutical companies are using grid systems in computer simulation to do as much testing as possible on computers before the drugs go to clinical trials. The computing power of grids, he adds, also allowed military researchers to understand the SARS virus and treat the disease in a much shorter period of time than they would have been able to do otherwise.
"What the grid technology essentially delivers is increased utilization and access to more computer resources," says Ffoulkes, adding that this means many projects that weren’t possible before grid computing can now be done, and those that were possible can be completed faster.
In May, IBM, another of the many technology firms investing millions of dollars in the technology, issued a report, "Pharma 2010: Silicon Reality," which lists grid computing as one of seven technologies that will have the most impact on pharmaceutical research in the next several years. The study reports that grid computing will be part of the technology that will ultimately allow pharmaceutical companies to reduce the cost of drug development to as little as $200 million and cut the average lead time of 12 to 14 years to between three and five years.
Grid computing’s less common function, information management, has been tapped by the National Digital Mammographic Archive, formerly the University of Pennsylvania Grid. Using IBMDB2 Universal Database technology and open standards, the University of Pennsylvania built a grid that delivers computing resources as a utility-like service over the Internet for thousands of hospitals. IBM’s database technology allows users to store and access mammograms in digital form while the grid provides analytical tools that help physicians make diagnoses.
Likewise, Aventis Pharmaceuticals is using IBM’s DB2 Information Integrator technology to give researchers a single window onto many databases in different physical locations.
"The information management side of grid is an underrecognized aspect of grid that’s really important and, I believe, in the medical industry it’s going to be possibly a more powerful use of the technology in terms of assisting end users and companies," says Al Bunshaft, vice president of grid sales for IBM.
Pathologist and computer scientist Joel Saltz, MD, PhD, believes grid computing eventually will allow pathologists to routinely review slides over the Internet. Information in slides will be converted to digital form and placed on storage devices.
"Grid computing will make it increasingly feasible to implement algorithms that systematically classify and quantify the contents of slides," says Dr. Saltz, chairman of the Department of Biomedical Informatics, Ohio State University, and a pioneer in virtual slide technology. "My view, at least, is that computer-assisted slide classification is an adjunct to pathologist slide interpretation, but it’s something that will be increasingly used to help pathologists standardize and quantify [data]."
First, of course, the data has to make it into the computer, and Dr. Saltz says that will take a while. The technology, he adds, initially will be rolled out to academic centers and then high-end reference labs, and, in about 15 years, or perhaps less, to private labs.
"So the ability to use anything like grid computing, at least in anatomic pathology, until recently wasn’t there because the data wasn’t in the computer," he says. "And my point is the data will be in the computer, and it will be possible to do a variety of very interesting sorts of things."
Eventually, on the commercial side, grid computing will be delivered as a service in much the same way that electricity or telephone service is delivered, says Sun’s Ffoulkes. Users will define how much computing power they want, and companies that offer that power will determine the price. Ffoulks adds, "It’s basically going to become the dominant way in which computing is done."
Cerner purchases Gajema Software
Cerner Corp. has acquired Gajema Software, a developer of desktop and mobile computing applications for the laboratory market.
This transaction allows Cerner to offer its clients such outreach laboratory solutions as point-to-point tracking of specimens, dispatching, and supply and fleet management capabilities.
"Adding Gajema to our already solid Cerner Millennium PathNet solution allows
us to deliver a unified outreach laboratory solution for our existing and future
clients," says J.P. Fingado, enterprise vice president and general manager of
clinical centers at Cerner.
ASTMmarketing standards for dictation and speech recognition technology
ASTM International, formerly the American Society for Testing and Materials, has introduced two data-capture standards: one pertaining to dictation and one for speech-recognition technology.
The standards were developed over the last two years and were sparked by growing concern in the medical community over errors in health care records, says Brenda Hurley, CMT, FAAMT, chair of ASTM Subcommittee E31.22 on Health Information Transcription and Documentation, which oversees the standards. The standards are intended to help health care transcriptionists generate reports more quickly and accurately, adds Hurley.
Standard E2344, "Guide for Data Capture Through the Dictation Process," presents ways for health care workers giving dictation to improve the quality of their recordings and thereby the quality of transcribed reports. "This has been one of those issues medical transcriptionists have known about forever," Hurley says. Too often, she explains, transcriptionists have to spend time "trying to fill in trouble spots because of background noise or interruption."
The standard, which was introduced in February, addresses appropriate physical settings for dictation, formal dictation training, use of abbreviations while dictating, feedback systems for mechanical and technical problems, and optimal dictating technique, and it offers guidance on the handling, storage, and security of common dictation devices.
Standard E2364, "Guide to Speech Recognition Products in Health Care," introduced in July, provides an overview of the capabilities and limitations of speech-recognition technology in creating health care records. "More and more institutions are starting to evaluate [speech-recognition] products," Hurley says, "and salesmen make promises that are sometimes not realistic. Speech recognition is not going to overcome disorganized dictation."
The standard describes the functionality that should be included in speech-recognition systems used in health care; summarizes the workflow for front-end, back-end, stand-alone, and networked speech-recognition systems; offers typical scenarios in which speech-recognition technology can be used; outlines points that should be covered in training; and delineates the limitations of the technology-for example, users with heavy guttural accents or who make grammar or punctuation errors may have difficulty. The standard does not recommend specific speech-recognition technology vendors, products, or services.
For more information about the standards, call ASTM customer service at 610-832-9585
or access the ASTMWeb site, www.astm.org.
ASTM charges $27 for the dictation standard (E2344) and $32 for the speech-recognition
Software tackles discounts for the uninsured
SearchAmerica is offering hospitals a new tool that handles discounts for the uninsured.
The program helps hospitals and medical groups assess the financial situation of a patient to determine up-front if they qualify for various charity care or financial aid programs.
SearchAmerica’s New Matrix discount for the uninsured program is based on existing Payment Advisor architecture. The technology allows hospitals to automate their process based on the charity or uninsured discount program in place.
PMDsoft has installed its PMDsoft hand-held data-capture system at Huntington (NY)Hospital, part of the North Shore Long Island Jewish Health System.
The product allows doctors to schedule cardiac patients for outpatient procedures, record visit transactions, and send billable transactions directly to the hospital’s billing services.
Sysmex America has implemented its MOLISlaboratory information system for Esoterix Inc.
The implementation was completed in less than two years in seven laboratories across the United States and Europe.