Pictures of the Future    Fall 2007

Data that’s Always There

Walter Bauer suddenly feels a sharp pain in his chest. It’s Saturday evening and Bauer’s wife calls for a paramedic, who is quickly on the scene. Having performed an ECG, the paramedic instructs Bauer to go to a hospital. This is the first time Bauer has been to this particular hospital, which is why he’s given a second examination and re-diagnosed. All of the resulting data is then entered into the hospital’s information system.

That’s today’s status quo. But in just a few years, Germany will have an integrated healthcare system that will link doctors, pharmacies, and hospitals in a network. When this happens, patients like Bauer will be treated more rapidly, and fewer examinations will be required. Here’s a scenario of how things will change:

The paramedic can view patient information that Bauer’s family doctor entered into his office administration system six months earlier, and which is now contained in a centralized patient file. He can access this information because Bauer would have signed a release beforehand. The doctor at the hospital can also access relevant data from this centralized file, including ultrasound images, X-rays, and lab results, thereby enabling a more rapid diagnosis. The diagnosis will then be entered into the hospital information system and Bauer’s patient file, ensuring that other authorized users can access the data. In order to exploit the benefits of electronically supported integrated healthcare, doctors and patients will first have to be registered in a telematics infrastructure system.

This can be done with a special healthcare card currently being tested in pilot projects in Germany (see Pictures of the Future, Spring 2005,  Personalization—Healthcare). "An important element in this system is the connector, which is an electronic component that ensures secure data transfer and the automatic launch of additional data processing applications," says Dr. Michael Meyer from Siemens Medical Solutions (Med). The connector makes it possible to transfer data from healthcare providers (for example, doctors and hospitals) to the telematics infrastructure in encrypted form.

Among other things, the electronic patient file simplifies cooperation between the out-patient and in-patient segments of the healthcare sector.

"We’ve entered into strategic partnerships with leading providers of medical office software such as DOCexpert in order to create an interface for linking doctors and hospitals to our Web-based Soarian Integrated Care e-health solution," says Dr. Volker Wetekam, head of Med’s Global Solutions division, who is also responsible for electronic patient files. "Just how well this kind of seamless communication can work," he adds, "is exemplified by a project with Rhön-Klinikum AG in which we will introduce an electronic patient file system to 46 of the company’s clinics." With over one million patients per year, Rhön-Klinikum AG is Germany’s largest private hospital company.

Total Data Availability. In our scenario, Walter Bauer’s family doctor might use his PC to enter an appointment for a catheter examination into the local hospital’s electronic calendar.

"Cardiologists used to get a referral from the patient’s doctor saying that, for instance, a coronary angiography examination should be performed—and that was it. There was no further information," says cardiologist Friedrich Fuchs, who works at Siemens Medical Solutions (Med). With an electronic referral, on the other hand, a family doctor can enter detailed information on the patient’s medical history into a digital document, and can also use his or her office administration system to add relevant lab results or images to a patient’s file—information that is in turn forwarded to the hospital.

In our scenario, Bauer’s preliminary tests turn out to be inconclusive. As a result, he is sent to radiology for a CT scan. There, a software development from Med known as Fast Data Link enables the layered images of Bauer’s heart to be sent in special DICOM format from the CT scanner to a server at a speed of up to 40 individual pictures per second—or practically in real time. That’s like transmitting the content of a full CD every second. By comparison, current procedures that work with the DICOM standard can transmit only four images per second.

Only seconds after Bauer’s scan, syngo WebSpace software installed in the hospital’s central server automatically generates a three-dimensional depiction of his heart. Bauer’s attending physician can call up this 3D model from practically any PC in the facility, and can also obtain an opinion from a colleague who is authorized to access the data. "Developing this solution involved taking advantage of the opportunities our latest client-server software offers for storing complex 3D images at a central server. Once in the server, the images can be accessed from PCs and notebooks," says Dr. Louise McKenna, head of Global Marketing for CT Oncology at Med.

Many doctors can already receive CT images via a wireless network as well. Werner Reinhold, a Healthcare Solutions manager at Siemens Enterprise Communications, believes that 80 to 90 percent of all German hospitals will be equipped with a WLAN (wireless local area network) within five years.

Medical staff at facilities such as Leipzig Hospital now use tablet PCs from Fujitsu Siemens Computers (FSC) to document treatment and care right at the patient’s bedside. The PCs are in such demand that Med is working on a version that can be disinfected, thereby enabling it to be used in sterilized areas.

The data recorded on such PCs is transferred via WLAN to the hospital information system. Conversely, nurses can call up relevant treatment information from a patient’s bedside, thus avoiding potential medication errors. At the clinic of the University of Munich, all of the operating rooms have been equipped with WLAN. the clinic decided to do so because expanding the existing network infrastructure in operating rooms would have been too expensive due to fire protection considerations. "Our experience with WLAN in operating rooms has been very positive," says Dr. Bernhard Pollwein, head of Anesthesia. "Challenges have been limited to factors such as metal walls and doors and to the large number of people in the OR."

But with so much information available at portable terminals, doctors need special assessment software to ensure that they recognize interrelationships and maintain a clear overview of each patient’s status. One such software package is called Soarian Quality Measures. The package utilizes artificial intelligence to extract relevant medical information on a patient from numerous independent data sources in a hospital. The software is based on REMIND technology (Reliable Extraction and Meaningful Interference from Non-Structured Data), which can read and interpret all image and text information regardless of data format. The program operates in a manner similar to a CAD (computer-aided diagnostics) system, which autonomously assesses image data sets and generates a diagnosis (see Pictures of the Future, Fall 2005,  Digital Health—Trends). "CAD systems are now accepted in the U.S. as a second opinion for certain examinations, such as mammographies," says Fuchs. "That’s because studies have shown that the use of such systems enhances diagnostic quality." Soarian Quality Measures can similarly help improve the quality of medical care.

Medical Care via Television. Walter Bauer has now been released from the hospital, and his family doctor gets right to work on follow-up care measures. All of the important information from Bauer’s hospital visit has been entered into his electronic patient file.

But if Bauer lived in the Madrid metropolitan area, he’d have even better chances of staying well. That’s because a telemedicine pilot project called AmIVital is developing procedures for remote monitoring of patients and elderly persons in need of care.

Among other things, the project has given patients sensors that monitor their vital functions. "Our goal is to enable such patients to live on their own in normal surroundings, regardless of which type of illness they may have," says Luis Reigosa, who is managing the project for Med in Spain. Medical data is sent via mobile phone to a hospital or care provider. Consultations, on the other hand, take place on the patient’s television set. For example, a doctor can send the patient a form that he or she fills out on a TV using a special remote control unit. Such seamless communication between doctors and patients will one day constitute an important element of integrated healthcare.
                                                                                                                  Michael Lang