Tuesday, July 20, 2010

Optimizing the Management of Digital Images for Sick Children

After almost a week of in depth meetings with people about pediatric medical issues, computing-medical infrastructure innovations and other related topics, all interspersed with a bit too much coffee and pastries, I am very happy with how welcoming and helpful everyone here in Philadelphia and beyond has been.

Trying to decide what to write about has been a challenge because there are so many interesting computing projects that The Children's Hospital of Philadelphia (CHOP) is involved in. The decision for today's post topic was cinched yesterday, by a personal memory that surfaced in my meeting with  Chris Tomlinson  the Administrative Director of Radiology. We had been discussing Vendor Neutral Archives (VNA), a state of the art process for managing digital images and their associated metadata that Chris has successfully championed at the hospital.

My insight came while we were discussing how patient care has been improved by installation of the VNA system. A large hospital, especially a large children's hospital, will often have years worth of digital image data for each patient. For example, data collection may start when the child is born prematurely and continue as the child grows older and is monitored developmentally; or if a child acquires a life-threatening condition that requires ongoing interventions, the volume of digital imaging data can grow exponentially as well. When a patient comes to the hospital for any reason, it is logical to want to pull all historical image data as part of that child's current assessment.

In a non VNA environment, digital image data may be stored on servers in different departments (opthamology, radiology, etc) on incompatible systems,  or archived offsite somewhere secure but difficult to access rapidly. As a result, when a patient walks in the door for an appointment, their prior history may not be fully available to the doctor they are seeing that day.

As Chris and I were speaking I flashed back to the times I have gone in for a medical appointment and been told that my "file has not arrived". I also remembered the times I have had to tell a care provider that I will fail a standard tuberculosis (TB) test because I received the BCG vaccine as a child. Yet because this information seems to periodically vanish from my records I submit to taking (and failing) another TB test. Three office visits typically result:  Trip 1: get poked for the TB test; Trip 2: return to have the failed test examined and watch the staff get very very nervous; Trip 3: come in for a chest x-ray. Wait for the doctor to receive the x-ray and report to me that I am healthy.

Frustrating. Time consuming. Expensive. Excess radiation.

Imagine the effect of these inefficiencies upon a sick child and their family.

Chris Tomlinson and his computing team at CHOP are working very hard to ensure optimal and full availability of patient imaging data at any time of day or night. It is hard to describe how real and non academic this effort becomes when you walk the hallways  in Radiology or the Neonatal Intensive Care Unit and observe room after room of state of the art digital imaging equipment in constant use helping sick children.

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