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Enterprise Archive: Standards and SOA - A Mount Everest?Posted on: 5.30.2008 6:09:04 PM Posted by Joe Marion

From my involvement in a couple of current engagements, a key dilemma facing anyone considering an enterprise image archive is the question of architecture, and is it possible to “reach the pinnacle” of a truly vendor-neutral, patient centric solution that can receive input from multiple service areas, and provide accessibility to a number of applications?

I am reminded of some recent computer technology battles that might well be bell weathers for healthcare image archiving. One example is the 802.11 N Wireless standard. In the words of Wikipedia, “…market demand has led the Wi-Fi Alliance to begin certifying products before amendments to the 802.11 standard are completed.” In other words, in the zeal for faster net-working, people are willing to gamble on hardware in the hope that it can meet the eventual final standard.

Another good example is the Blu-Ray versus HD DVD format war. Some elements of consumers were willing to pluck down large sums of money to be pioneers before one or the other became the de facto standard. In this case, Blu-Ray won. And what about all those who bet on HD DVD? At least one retailer is capitalizing on it — Best Buy is offering gift cards to help clear out HD DVD inventory, and trade-ins to convert to Blu-Ray. Smart retailing!

The “lesson-learned” for healthcare imaging: Is there a horse race brewing in terms of enterprise image archival? A lot is made over industry standards efforts such as HL7, DICOM, and IHE as the answer to an enterprise archive. In a perfect world, everyone will interpret the standard and vendor A's device will easily interoperate with vendor B's device. Unfortunately, it's not a perfect world, and vendors still strive for some competitive advantage. Hence, in DICOM there are fields that can support proprietary data! So, is the industry really behind the standards, or merely giving lip service to them, and looking for any chance they can to gain a competitive advantage? In the case of an enterprise archive, there are those that would propose force-fitting everything into DICOM, so a non-DICOM object would be handled by enveloping it in a DICOM wrapper.

At the opposite end of the spectrum are those who subscribe to patient-centric service oriented architecture (SOA). The SOA concept has broad IT appeal in terms of interoperability, and might be considered as a mechanism to supplant standards, and enable different services to cope within the environment. Those that would subscribe to this approach argue that the objective is to create a “vendor-neutral” solution that can interoperate in multiple services. This sounds like a great answer, but, where is the incentive to make it work? Is it market pressure alone that will force vendors toward solutions that interoperate? Will competitiveness get in the way such that proprietary hooks preclude true interoperability?

What is the answer? I am sure there are multiple viewpoints. Having raised this issue, I would like to propose this as a forum for sharing ideas — from both users and vendors, with the objective of educating those for whom this is a concern. I welcome your comments. What do you think? Should the enterprise archive wait and be driven by standards? Or, is SOA an alternative that will win out from market pressure just as Blu-Ray has?

The Dashboard from HellPosted on: 6.2.2008 10:54:25 AM Posted by Daphne Lawrence

Before I came to Healthcare Informatics, I worked in a hospital network where, like everybody else, I wore many hats. One of those hats was making a finance performance dashboard. It tracked about 30 indicators. We had no IT system for the dashboard, no software, no reports fed from anywhere. It was me, Excel, PowerPoint, and walking up to the third floor to get the open visit reports on the last day of the month. It was me, gathering reports from… everywhere. Reports on department usage, managed care payments, Medicare, Medicaid — reports that in most cases were not apples to apples, and had to be manipulated so that they were.

And God help me if the secretary in any department was on vacation.

I lost my mind.

But the execs loved the clear and detailed information on the dashboards. It really was useful to them for strategic planning. Yesterday, my replacement at the hospital called me and we started dishing about the dashboard, which got me thinking about sharing some dashboard best practices in our next issue of Healthcare informatics.

So, are you using dashboards?

A lot of systems bought by hospitals in the recent past have performance dashboard capability. But I suspect many of you did not play with that capability right away (having a hospital to run and all.) Did you get around to using the dashboard function yet?

Five things you should know about Universal Healthcare coverage and the Impact on InformaticsPosted on: 6.11.2008 10:25:57 AM Posted by Pete Rivera

5. Indigent care, write offs and grants will be severely limited. “Charity care,” community clinics, and community hospitals will need to become leaner and more efficient as they compete with other hospitals now accessible by their patient base. Translates to improved Electronic Health Records, improved front end processes, and streamlined reimbursement processes for these organizations.

4. Most reimbursement levels will follow Universal coverage rules. But, there may also be additional compensation for Preventive Medicine procedures, decrease patient wait times and other government metrics. Translates to a need for improved links between Electronic Health Records and claims submission.

3. New federal standards and centralized payer centers will reduce or eliminate state level programs. Translates to new EDI requirements and interfaces.

2. Benefits eligibility will be tied to Universal Patient Identifiers which means requiring accurate, reportable demographic information in order to obtain government reimbursement. Translates to improved eligibility verification at point of care.

1. The need for Private Medical Insurance (PMI) will rise similar to the model. Translates to new contracts, EDI, and the need to keep multiple insurance payer tables within Hospital Information Systems.