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Medical software - Trends, Standards & Future


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Medical software - Trends, Standards & Future

  1. 1. Medical software Trends, Standards & Future SREEDHAR KODLAHALLI BANGALORE, INDIA 10 OCTOBER 2011 A sand-box of all things Medical…
  2. 2. Medical software - Medical Device : Definition <ul><li>&quot;Medical device&quot; means any instrument, apparatus, appliance, material or other article, whether used alone or in combination, including the software necessary for its proper application intended by the manufacturer to be used for human beings for the purpose of: </li></ul><ul><li>diagnosis, prevention, monitoring, treatment or alleviation of disease, </li></ul><ul><li>diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap, </li></ul><ul><li>investigation, replacement or modification of the anatomy or of a physiological process, </li></ul><ul><li>control of conception </li></ul><ul><li>and which does not achieve its principal intended action in or on the human body by pharmacological, immunological or metabolic means, but which may be assisted in its function by such means. </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  3. 3. Medical software - Lexicon <ul><li>HIS - Hospital Information System </li></ul><ul><li>CIS - Cardiology Information System </li></ul><ul><li>RIS - Radiology Information System </li></ul><ul><li>PACS - Picture Archiving and Communication System </li></ul><ul><li>Modality - Image acquisition hardware (CT / MR / US / X-ray) </li></ul><ul><li>Workstation - Image viewing/processing entity </li></ul><ul><li>LTS - Long-term storage </li></ul><ul><li>STS - Short-term storage </li></ul><ul><li>ADT - Admission/Discharge/Transfer </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  4. 4. Medical software - Healthcare segments <ul><li>Imaging (e.g., CT, MRI, US …) </li></ul><ul><li>Information systems (e.g., clinical, operational, financial) </li></ul><ul><li>Non-invasive therapy </li></ul><ul><li>Invasive therapy </li></ul><ul><li>Medical implants (e.g., heart valve) </li></ul><ul><li>Home/Personal care </li></ul><ul><li>Pharma/Labs </li></ul><ul><li>Referring physician, billing, insurance </li></ul><ul><li>Medical transcriptions </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  5. 5. Medical software - Traditional medical ‘ologies’ <ul><li>Radiology - Diagnose and treatment of diseases using medical imaging technologies (radiant energy and radioactive substances) </li></ul><ul><li>Oncology - Diagnose and treatment of tumors </li></ul><ul><li>Cardiology - Diagnose and treatment of heart and its diseases </li></ul><ul><li>Angiology - study of blood vessels and lymph (a clear, watery, sometimes faintly yellowish fluid derived from body tissues that contains white blood cells) vessels </li></ul><ul><li>Ophthalmology - study of anatomy, physiology and pathology of the eye </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  6. 6. Medical software - Current trends <ul><li>Workflow enabled </li></ul><ul><ul><ul><li>Establishes a seamless flow of information that supports efficient patient care workflow in a typical imaging encounter maintaining the consistency of patient information </li></ul></ul></ul><ul><li>Context aware </li></ul><ul><ul><ul><li>Process of using particular &quot;subjects&quot; of interest (e.g., user, patient, clinical encounter etc.) to 'virtually' link disparate applications so that the end-user sees them operate in a unified, cohesive way </li></ul></ul></ul><ul><li>Data driven / Role based </li></ul><ul><ul><ul><li>Appropriate selection of tools and processes based on the selected data and the role executing the data </li></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  7. 7. Medical software - Statutory regulations/ Certifications <ul><li>Medical standards </li></ul><ul><ul><ul><li>ISO 14971 - Application of risk management to medical devices </li></ul></ul></ul><ul><ul><ul><li>ISO 13485 - Quality management standard for medical devices </li></ul></ul></ul><ul><ul><li>Hardware </li></ul></ul><ul><ul><ul><li>CE 0413 marking </li></ul></ul></ul><ul><ul><li>Regulatory approvals </li></ul></ul><ul><ul><ul><li>FDA - Food & Drug Administration, USA </li></ul></ul></ul><ul><ul><ul><li>TÜV - Technische Überwachungs-Verein, European Union </li></ul></ul></ul><ul><ul><ul><li>CFIA - Canadian Food Inspection Agency, Canada </li></ul></ul></ul><ul><ul><ul><li>JPAL - Japanese Pharmaceutical Affairs Law, Japan </li></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  8. 8. Medical software - Systems & information flow Medicare Provider Inventory Admission/Discharge/Transfer RIS PACS Workstation HIS Modality Master Patient Index Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  9. 9. Medical software - Typical Workflow Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  10. 10. Medical software - Workflow steps <ul><ul><li>Registration </li></ul></ul><ul><ul><li>Order </li></ul></ul><ul><ul><li>Scheduling </li></ul></ul><ul><ul><li>Image acquisition </li></ul></ul><ul><ul><li>Pre-processing / QC </li></ul></ul><ul><ul><li>Image archival </li></ul></ul><ul><ul><li>Post-processing / measurements / QC </li></ul></ul><ul><ul><li>Reading / reporting / billing </li></ul></ul><ul><ul><li>Referring physician </li></ul></ul><ul><ul><li>Therapy / out-patient care / follow-up </li></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  11. 11. Medical software - IHE Radiology Workflow *Picture Ref: IHE – Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland * Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  12. 12. Medical software - Systems / Roles <ul><li>To ensure </li></ul><ul><li>Data availability </li></ul><ul><li>Consistency </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  13. 13. Medical software - Worklists <ul><ul><li>Essence of workflow-enabled, context-aware, data-driven systems </li></ul></ul><ul><ul><li>Consists of Workitems - a unit of action/process to be followed </li></ul></ul><ul><ul><li>Lists provided for each human/machine actor based on the role and rules </li></ul></ul><ul><ul><li>Rule based : Set of filters based on actors preferences, organizational processes and patient priorities </li></ul></ul><ul><ul><li>Actors can choose to sort & search the worklists and override the presented order of work items (human factor) </li></ul></ul><ul><ul><li>Examples of Worklists </li></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  14. 14. Medical software - Industry inter-operability standards <ul><li>HIPAA - Health Insurance Portability and Accountability Act </li></ul><ul><ul><ul><ul><li>Encourages the widespread use of electronic data exchange in the US health care system to improve the efficiency and effectiveness </li></ul></ul></ul></ul><ul><li>DICOM - Digital Imaging and Communications in Medicine </li></ul><ul><ul><ul><ul><li>Standard for handling, storing, printing, and transmitting information in medical systems </li></ul></ul></ul></ul><ul><li>HL7 - Health Level 7 </li></ul><ul><ul><ul><ul><li>Standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer. Based on short messages </li></ul></ul></ul></ul><ul><ul><ul><ul><li>IHE - Integrating the Healthcare Enterprise </li></ul></ul></ul></ul><ul><ul><ul><ul><li>An initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information </li></ul></ul></ul></ul><ul><li>CCOW - Clinical Context Object Workgroup </li></ul><ul><ul><ul><ul><li>An HL7 standard protocol designed to enable disparate applications to synchronize in real-time, and at the user-interface level. Facilitates &quot;Context Management” </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  15. 15. Medical software - Standard : HIPAA Privacy & Security <ul><li>The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information </li></ul><ul><ul><ul><ul><li>The HIPAA Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes (read insurance) </li></ul></ul></ul></ul><ul><li>The HIPAA Security Rule requires that healthcare organizations implement audit controls. The five steps to meeting this requirement include </li></ul><ul><ul><ul><ul><li>Determine systems or activities to be tracked or audited </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Select the tools that will be deployed for auditing and system activity reviews </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Develop and deploy the Information System Activity Review and Audit Policy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Develop appropriate standard operating procedures </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Implement the audit/system activity review process </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  16. 16. Medical software - Standard : DICOM <ul><li>Hierarchy </li></ul><ul><ul><ul><li>Patient </li></ul></ul></ul><ul><ul><ul><li> Study </li></ul></ul></ul><ul><ul><ul><li> Series </li></ul></ul></ul><ul><ul><ul><li> Image </li></ul></ul></ul><ul><ul><ul><li>Procedure - One or more Series from one or more Studies </li></ul></ul></ul><ul><li>DICOM Service Object Pair (SOP) - Classes and the roles of Service Class User (SCU) and Service Class Provider (SCP) </li></ul><ul><li>Verification service class SCP/SCU roles </li></ul><ul><li>Storage service class SCP/SCU roles </li></ul><ul><li>Query/Retrieve service class SCP/SCU roles </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  17. 17. Medical software - Standard : DICOM salient features <ul><ul><li>Confirmation statement : A standardized way of identifying the specific DICOM capabilities of the equipment (supported SOP pairs - SCU/SCPs) </li></ul></ul><ul><ul><li>Self contained entity - Preamble, Header & Image(s) </li></ul></ul><ul><ul><li>Standard tags </li></ul></ul><ul><ul><li>Unique IDs for various tag values (e.g., SeriesInstanceUID, PatientUID) </li></ul></ul><ul><ul><li>Universal DICOM dictionaries for tags and custom tags </li></ul></ul><ul><ul><li>Ability to store single frame and multi frame medical images </li></ul></ul><ul><ul><li>Format extendable by design </li></ul></ul><ul><ul><ul><ul><li>Parts (e.g. Part10 - Media Storage and File Format for Media Interchange) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Supplements (e.g. Supplement 60 - Hanging Protocol) </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  18. 18. Medical software - Standard : HL7 <ul><ul><li>HL7 provides </li></ul></ul><ul><ul><li>Functional interoperability </li></ul></ul><ul><ul><li>Semantic interoperability </li></ul></ul><ul><ul><li>Based on messages </li></ul></ul><ul><ul><li>&quot;Level Seven&quot; refers to the top level of the seven-layer International Standards Organization's (ISO) communications model for Open Systems Interconnection (OSI) - the application layer </li></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli 7 Application 6 Presentation 5 Session 4 Transport 3 Network 1 Physical Function Communication
  19. 19. Medical software - Standard : IHE <ul><li>Definition </li></ul><ul><ul><ul><ul><li>A set of Actors cooperating through T ransaction s to perform a specific task </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Examples </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Scheduled WorkFlow (SWF) - Admit, order, schedule, acquire images, notify of completed steps </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Consistent Presentation of Images(CPI) - Hardcopy and softcopy grayscale presentation state </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Key Image Notes(KIN) - Flag significant images </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Describe the solution to a specific integration problem, and document the system roles (Actors), standards and design details </li></ul></ul></ul></ul></ul><ul><li>Defines integration capabilities by coordinated implementation of communication standards; such as DICOM, HL7, W3C and security standards </li></ul><ul><ul><ul><ul><li>Standards harmonization approach </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli HIS RIS PACS Modality HIS HL7 HL7 --- --- RIS HL7 HL7 HL7/DICOM --- PACS --- HL7/DICOM DICOM DICOM Modality --- DICOM DICOM DICOM
  20. 20. Medical software - Standard : IHE salient features <ul><li>Confirmation statement - Supported set of Integration Profiles, Actors, and Transactions </li></ul><ul><li>IHE Integration Statements - Simple documents prepared and published by a vendor to list the IHE Profiles supported by a specific release of a specific product </li></ul><ul><li>IHE Technical Frameworks - Detailed documents which specify the Integration Profiles and the associated actors (systems) and transactions </li></ul><ul><li>IHE Connectathons - Annual events where equipment vendors bring products with IHE Profiles and test them with other vendors </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  21. 21. Medical software - Standard : CCOW <ul><ul><li>The CCOW standard provides a mechanism for applications to share information so that they appear to behave as a single system. This shared information is known as the context </li></ul></ul><ul><ul><ul><ul><li>Patient context </li></ul></ul></ul></ul><ul><ul><ul><ul><li>User context </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Encounter context </li></ul></ul></ul></ul><ul><ul><li>Addresses following integration challenges </li></ul></ul><ul><ul><ul><ul><li>Multiple disparate applications - Labs, meds, cardiology, scheduling, billing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Users in need of easy access to data and tools - Physicians, nurses, therapists, administrators. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Kiosk as well as personal workstations - Hospitals, clinics, offices, homes </li></ul></ul></ul></ul><ul><ul><li>Context manager </li></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli Context Manager CCOW Mapping Agent Annotation Agent CCOW
  22. 22. Medical software - Standard : CCOW salient features <ul><ul><li>Subject hierarchy </li></ul></ul><ul><ul><li>Capabilities </li></ul></ul><ul><ul><ul><ul><li>Secure Subjects - Only applications with access privileges may set or get (e.g., User) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dependent Subjects - The value of a subject must be consistent with the value for another subject (e.g., Encounter depends on Patient) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Custom Subjects - May be defined by healthcare providers and/or vendors, distinct from HL7’s standard subjects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Annotation Subjects - Data that is in addition to a subject’s identity (e.g., a Certificate is an annotation for the User subject) </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli User* Patient Encounter Observation Certificate* * secure subject identity subject annotation subject
  23. 23. Medical software - Development <ul><li>The plan - PMP/QMP </li></ul><ul><ul><ul><ul><li>Configuration management - Documentation & Protocol </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Quality assurance (SQA) - Project management </li></ul></ul></ul></ul><ul><ul><ul><ul><li>User expérience design - Project risk management </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Product risk management - Groups & Roles </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tools & 3rd party software validation - Charm handling </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Testing - Traceability </li></ul></ul></ul></ul><ul><li>The holy grail </li></ul><ul><ul><ul><ul><li>Risk analysis & mitigation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Quality </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Traceability </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Audit trails </li></ul></ul></ul></ul><ul><li>The Mantra </li></ul><ul><ul><ul><ul><li>Documentation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Reviews </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Testing </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  24. 24. Medical software - Typical development challenges <ul><li>Consistent patient / user identification </li></ul><ul><li>Patient safety / medical records safety </li></ul><ul><li>Statutory medical records retention for longer periods </li></ul><ul><li>Integration with multi-vendor systems (Modality/HIS/RIS/PACS) </li></ul><ul><li>Integration with multi-vendor applications </li></ul><ul><li>Patient medical history privacy issues (HIPAA) </li></ul><ul><li>Stringent quality standards (FDA, TÜV) </li></ul><ul><li>Multi-modality integration </li></ul><ul><li>ER workflow </li></ul><ul><li>Patient Information Reconciliation - Exception handling </li></ul><ul><ul><ul><ul><li>Example: Image acquisition completed for an unidentified patient </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Example: Same patient receiving service at a different location across the same health service provider </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  25. 25. Medical software - Future trends <ul><li>Zero-admin deployment </li></ul><ul><li>Smart clients, remote viewing, streaming </li></ul><ul><li>On demand – Application, Image & Performance </li></ul><ul><li>Night-hawk reading </li></ul><ul><li>Remote/collaborated/expert-assisted diagnosis/therapy </li></ul><ul><li>Distributed workflows </li></ul><ul><ul><li>Pre-fetch, parallel steps </li></ul></ul><ul><li>Distributed PACS </li></ul><ul><ul><li>Network Attached Storage (NAS) </li></ul></ul><ul><ul><li>Storage Area Network (SAN) </li></ul></ul><ul><ul><li>Data cloud </li></ul></ul><ul><li>Multi-modality workflow integration </li></ul><ul><ul><li>E.g. Multi-modality reader </li></ul></ul><ul><li>Consistent framework everywhere; modality, pre/post-processing, reporting stations… </li></ul><ul><li>Diagnosis Therapy to Preventive analysis Interventional healthcare </li></ul><ul><li>Multi-modality assisted full-bodied human physio-model construction & diagnosis </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  26. 26. Medical software - Microsoft initiative <ul><li>MICROSOFT HEALTH Common User Interface (CUI)* </li></ul><ul><ul><ul><ul><li>Support the delivery of safe patient care by providing detailed guidance for the standardization of clinical application user interfaces </li></ul></ul></ul></ul>*Ref: <ul><li>Microsoft HealthVault </li></ul><ul><ul><ul><ul><li>Simple end-user controlled health records that can be shared with health service providers and insurance agencies </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  27. 27. Medical software - Tools to play… for free! <ul><li>HL7 </li></ul><ul><ul><ul><ul><li>Browser, Simulator - </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Integration engine - </li></ul></ul></ul></ul><ul><li>DICOM/PACS </li></ul><ul><ul><ul><ul><li>DICOM toolkit - </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Viewer - </li></ul></ul></ul></ul><ul><ul><ul><ul><li> </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Archive & image manager - </li></ul></ul></ul></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  28. 28. Medical software - References <ul><li>DICOM - </li></ul><ul><li>HIPAA - </li></ul><ul><li>HL7 - </li></ul><ul><li>IHE - </li></ul><ul><li>CCOW - </li></ul><ul><li>ISO 14971:2007 - </li></ul><ul><li>ISO 13485:2003 - </li></ul><ul><li>FDA : Medical devices - </li></ul><ul><li>TÜV : Medical devices - </li></ul><ul><li>CFIA - </li></ul><ul><li>JPAL - </li></ul>Medical software - Trends, Standards & Future Sreedhar Kodlahalli
  29. 29. Thank YOU Medical software - Trends, Standards & Future Sreedhar Kodlahalli SREEDHAR KODLAHALLI BANGALORE, INDIA [email_address] [email_address]