There is a lot of buzzes and there is a lot of emerging hype on Big Data, and I like to begin a series of posts on everything, well almost everything that I can capture, store, search, share, analyse and visualise there is to know about Big Data. I think I will by no means have discussed everything there is to know about Big Data in a running series of posts in this blog as I think Big Data is so huge that I can start an entire blog devoted to just this.
As this blog is about healthcare data and information issues, the issue of Big Data in healthcare is that there’s a tremendous amount of data and information about the patient. I wish to think it is organised, but the real issue is, that it isn’t organised as well as it should be and all that data is a mixture of structured and unstructured data. Here is when I like to agree with Joe Petro, senior vice president of healthcare research and development at Nuance Communications who sums up the current state of big data. Petro believes that there’s a tremendous amount of information when you’re in the institution – it is a big data problem, you’re trying to figure out what’s going on and how to report on something and you’re dying of thirst in a sea of information, and the issue is how to tap into that to make sense of what’s going on.
Big Data is everywhere, not just in healthcare but as well in as many other sectors of the global economy.
WHERE HAS BIG DATA IN HEALTHCARE COME FROM?
The separation of data among hospital systems – clinical components, laboratories, and radiology are all separate repositories for information. The main issue is with leveraging all of these data. Their use is to provide clinical care or provide scheduling information or operational information. Often there is a problem if we want systems to talk to each other. An organisation can also end up with redundant information due to a legacy system, a system we may continue to use, sometimes well past its vendor-supported lifetime, resulting in support and maintenance challenges. It may be that the system still provides for the users’ needs, even though newer technology or more efficient methods of performing a task are now available.
WHAT IS BIG DATA, IN A NUTSHELL?
Big Data thus refers to sets of data that are so large, that they become awkward and complex that traditional database management tools struggle to capture, store, analyse and share this information. Difficulties include capture, storage, search, sharing, analytics, and visualizing.
IBM (IBM 2012) claims that “every day, we create 2.5 quintillion bytes of data — so much that 90% of the data in the world today has been created in the last two years alone. This data comes from everywhere: sensors used to gather climate information, posts to social media sites, digital pictures and videos, purchase transaction records, and cell phone GPS signals to name a few.” IBM adds that “This data is big data.”
Big data spans three dimensions, sometimes referred to as the 3 “Vs”: Volume, Velocity, and Variety. But IBM says Big Data spans four dimensions: Volume, Velocity, Variety, and Veracity.
Image credit : : http://www.asigra.com
I shall leave this post for now with this infographic(Click on the image above to view the image in a new tab of your current window and in order to obtain a larger image or a closer view of the image in this new tab, zoom in) and continue with the “Vs” and Big Data Basics in the next post on Big Data.
I fist read about – from reading the September issue of CHIP Malaysia, an IT magazine I purchase from time to time, a move to streamline medical records into a centralised system utilising virtualisation technology supplied by VMware, the market leader in virtualisation at the University of Malaya Specialist Centre (UMSC). This article was too short and hard for me to understand about ‘virtualisation’. I decided to find out more, prepare a post on this blog, and here is what I like to share with you readers. In this post I shall focus a little on virtualisation techonlogy – hoping you and I can understand it better, and how UMSC hopes to decentralise medical records, and its benefits.
The UMSC is a private medical centre within a publicly funded, 1,300-bed teaching hospital called the University of Malaya Medical Centre (UMMC), both operated by the University of Malaya. UMSC provides the public access to world-class specialist clinical services with the support from about 200 clinicians and another 250 nursing and support staff.
Image credit : http://sprouti.com/
The VMware website explains that virtualisation is about how “today’s x86 computer hardware was designed to run a single operating system and a single application, leaving most machines vastly underutilized. Virtualization lets you running multiple virtual machines on a single physical machine, with each virtual machine sharing the resources of that one physical computer across multiple environments. Different virtual machines can run different operating systems and multiple applications on the same physical computer. “
You can watch this video and learn how virtualisation works.
Source of the video above : http://www.vmware.com/virtualization/
I am sure many of you readers out there will feel intimidated watching and understanding all the IT jargon in this video.
Allow me to describe a little about virtualisation, and tell you how servers we know about can be transformed into virtual machines, which is what basically virtualisation is all about.
Most of you will know and surely heard of servers and networks. A server is a physical computer dedicated to running one or more services to serve the needs of the users of other computers on the network, the “clients”. Servers usually run a single operating system and a single application. You would have heard the IT guy talking about a database server, file server, mail server, print server, web server, gaming server. Each of these kind of named serves run a single operating system and a single application, depending on the computing service that each of these servers offer. This is the traditional way servers are managed, in a simple way of understanding You would have noticed several servers (computers) all located in a server room. Since servers are designed to run a single operating system and a single application, these leaves most of such computers (machines) vastly underutilised. This is when the virtualisation technology steps in.
Virtualisation converts any one server which is a single physical machine, into mutliple virtual machines inside it, with each virtual machine sharing the resources – including the CPU, RAM, hard disk and network controller of that one physical computer across multiple environments. Different virtual machines inside any one server can run different operating systems including Windows, Linux and more and multiple applications, for example Oracle, Exchange, SQL Server, Sharepoint and SAP, on the same physical computer. Thus, the old “one server, one application” model is eliminated. This frees IT admins from spending so much time managing servers.
Healthcare IT infrastructure in healthcare settings in many places as it was at UMSC, is a very traditional environment of complex, device-centric computing made up of autonomous content factories or “silos” with inherently incompatible technologies, product-specific workflows, uncoordinated content development, efforts resulting in overlapping content, linear workflows to produce multiple deliverables from each product’s content.
Medical records in most hospitals in Malaysia are still not centralised, scattered across departments often keeping their own documents making it diffiucult to collate them. This often leads to long delays in patients getting treatment.
In the pursuit of a new strategy for content ubiquity (that is to say the state or capacity of the contents of medical records being everywhere, especially at the same time), UMSC seeked solutions to change its fragmented, legacy IT systems of a decentralised medical records system into cost-effective, agile computing infrastructure environments. UMSC wanted to concentrate the data and make it readily available for their medical personnel to access.
According to Leon Jackson, Head of IT, UMSC, in the past doctors could end up using as many as three terminals simultaneously to access the necessary information to treat a patient. Jackson was hired in 2009 to help develop UMSC’s IT system for its new premises in 2016. He started the hospital on a journey which would see the digitisation of existing workflow and adopting virtualisation to drive efficiency and making a move toward a unified virtualised IT environment. Jackson believes this is one of the easiest ways to gain a competitive edge in the medical industry.
The solution process faced a specialised set of infrastructure and end-user requirements to support the digitisation of biomedical imaging and other medical information, to enable/ease basic clinical processes via electronic workflows, and to provide personal desktop environments that could be accessed on mobile devices, and via terminals throughout UMSC including in sterile and electronically sensitive areas such as operating theaters which allow for more “sterile” equipment through the deployment of thin-client touchscreens with washable mice and keyboard.
UMSC wanted to deliver a more user-centric (that is to say in which the needs, wants, and limitations of end users of a product are given extensive attention) connected care computing infrastructure environment to boost the availability of systems needed to treat patients effectively, the encouragement of clinicians to embrace digitisation, and meet demand for new medical services applications.
After evaluating options, UMSC decided on VMware. VMware claims that VMware virtualisation solutions have been chosen by over 250,000 customers, including 100% of the Fortune 100.
VMware’s solution to UMSC was for a more user-centric computing infrastructure environment which enables higher quality on-demand experience which allows new ways for clinicians to collaborate across applications and data from any device, where and when they need. In this way, more clinicians and healthcare consumers were expected to leverage hybrid cloud resources, while maintaining a managed, secure environment to use their applications and services, through which healthcare providers will be able to deliver better services at lower costs.
We know for a fact that patient care happens everywhere – bedsides, remote offices, homes, labs and these days in the cloud. These varied locations require providers to manage a variety of unique desktop environments, ranging from workstations on wheels to high-traffic nursing stations to inpatient room computers.
UMSC hopes to benefit from this automated and efficient ubiquitous IT system in the following ways:
speeding up clinicians’ access to various clinical information systems across different devices, including mobile and fixed terminals providing the continuous availability necessary to clinicians delivering tertiary care, and to all delivery units using IT to improve patient management.
provides better decision support to clinicians and increases efficiency that will lead to reduced waiting times and UMSC being able to see more patients
cutting server hardware and infrastructure spending to 60 percent of the cost of an all-physical infrastructure; vendors that could not adapt to its new infrastructure were gradually phased out
a system that responds quickly to clinicians’ requirements and helps provide a better service to patients; minimising unplanned downtime; and redirects IT spending to support new application delivery
deploy new virtual machines in minutes to support staff requirements, rather than waiting weeks or months to procure and implement new physical servers
VMware View desktop virtualisation provides the surgical team with a ”follow-me desktop’ that helps them access the same data from multiple devices within the private network; surgical work is considered to be typically not conducive to carrying mobile devices, so for surgeons a ‘follow me’ desktop accessible from fixed terminals anywhere within the UMSC buildings is ideal
clinicians will be able to consume and contribute information to and from the patients records at the point of care, improving efficiency, reducing errors and the need for clerical support plus time wasted treasure hunting for information; for example, that if a doctor was giving a lecture on campus and received a call from a nurse, he would be able to remotely access his files and provide the required information for a particular patient
For your information, UMSC is currently running about 100 VMware View desktops, and expects to increase this over the following year to 300 concurrent users. Jackson revealed that to support this migration, UMSC had invested up to 4 percent of its revenue each year for the last three years on IT.
Also on the pipeline by the end of Q3 2012, is when all clinicans will use iPads to access a virtual Windows 7 desktop incorporating legacy thick-client (thick-client meaning, “intelligent” regular Windows applications installed on the local machine i.e the client machine, capable to processing more data locally on the client) applications together with new mobile applications for its hospital information systems.
References:
Avanti, K 2012, How VMware is helping to ‘free’ Malaysian healthcare, Computerworld Malaysia, viewed 22 September 2012, <http://www.computerworld.com.my/resource/applications/how-vmware-is-helping-to-free-malaysian-healthcare/>
CHIP Malaysia, Making Sense of Medicine, September 2012, Online Dynamics (M) Sdn. Bhd., Petaling Jaya, Selangor Malaysia
Farhan, G 2012, 01/08/2012, Cloud medicine at UMSC, PC.com Malaysia, viewed 25 September 2012, < https://www.liveatpc.com/cloud-medicine-at-umsc>
Ryan, H 2012, M’sia hospital prescribes virtualization for healthcare sector, ZDNet, viewed 25 September 2012, <http://www.zdnet.com/my/msia-hospital-prescribes-virtualization-for-healthcare-sector-7000002976/>
VMware, viewed 22 September 2012, <http://www.vmware.com/>
VMware Customer Case Study, Medical Center’s Virtualization Journey Boosts Patient Care and Transforms Medical Systems, VMware, viewed 26 September 2012,<http://www.vmware.com/files/pdf/customers/
VMware_University_Malaya_Specialist_Centre_12Q2_EN_Case_Study.pdf>
Diabetes mellitus is a common disease causing significant mortality and morbidity. It is a serious debilitating and deadly disease, but you can control it and you can learn to live with it as once you are a diabetic, it’s very difficult to reverse it.
In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the Second National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The third National Health and Morbidity Survey (NHMS III) was conducted between April to July 2006 and showed a dramatic increase in the prevalence of diabetes for adults aged 30 years and above to 14.9% – an increase of 80% over a period of just 10 years (8.3% in NHMS II vs 14.9% in NHMS III ) representing an average 8% rise per year.
Can electronic health records (EHRs) serve to help patients manage their health and to provide treatment to patients with chronic diseases, such as diabetics?
EHR systems widely implemented in Wisconsin, USA are improving coordination and making health care more efficient, lowering costs and identifying and treating at-risk patients to improve their health.
Image credit : JSOnline, Milwaukee, Wisconsin, USA. Eida Berrios, a registered nurse and certified diabetes educator, leads a discussion in early July during a class for patients with insulin pumps at the Sixteenth Street Community Health Center in Milwaukee.
Here is how it works in diabetes management using EHRs for patients at the Sixteenth Street Community Health Centers in Milwaukee, Wisconsin as reported from the July 16, 2012 JSOnline, the online version of The Milwaukee Journal Sentinel – the primary newspaper and the largest newspaper in Milwaukee :
patients who may have a three-month average blood sugar level higher than the recommended 7% may be flagged by the systems to receive extra help to manage their chronic disease
doctors can run reports of patients who missed their cholesterol panel check last year and, in that way, focus on patients out of range and get them in for an appointment sooner
graphics generated from data of individual patient history reports received since 2010 allow doctors compare their patients against national trends and other doctors’ patients
doctors look at treatment plans and the most recent test results, while providers use the data to create intervention plans, to identify which screenings are getting missed and to refer patients to diabetic educators to help them manage their chronic illness
the coordinated care and testing that a patient receives when doctors and diabetic educators monitor their patients using the EHR systems provides a holistic view of care, and it can also be shared by doctors to avoid retesting
doctors become more proactive in providing care by identifying patients who are far away from their health care goals, even if the patient hasn’t been in the clinic for a while, and the patient becomes more informed and they tend not to fall out of care, preventing costly emergency hospitalisations
the EHR systems remind doctors to address certain screenings and lab tests with their patients
the EHR systems sends out reminder calls for example about a missed appointment or a missed flu shot
data in the EHRs system help to document statistics for example, 74% of the 1,895 patients that saw their doctors twice last year have an average blood-sugar level under 8%; it also shows 70% of their diabetic patients have a blood pressure of less than 130/80
providing monthly reports for example of regular neuropathy exams – to see if diabetics had loss of sensation in their feet, could highlight that too many patients weren’t getting a documented foot exam, and remind doctors to keep up with testing
information from in-house reports divided by blood-sugar controls, blood-pressure management, cholesterol level and screenings of neuropathy foot exams and retinal exams allows for specific follow-up to target areas patients are struggling with, such as exercise, nutrition, emotional support and diabetes education classes
researchers use the information from the the EHR systems to identify at-risk groups that live within specific geographic areas by linking clinical information in the EHR system to public health data to identify and map the prevalence of diabetes compared with levels of economic hardships
This is one good example how EHRs serve as a platform to manage health education, to help patients manage their health and to provide treatment.
Abridged by R. Vijayan, from the original article “Diabetes management using electronic medical records” by By Aisha Qidwae of the Journal Sentinel, July 16, 2012.
I stumbled upon the post “Improving Patient Care through EMRs” from the Plus91 blog by Pooja Raval who used to work for Plus91, a healthcare Technology firm developing Innovative High Quality Solutions for the Indian Healthcare Industry based in Pune. Maharashtra, India.
In her post she offers a list of reasons why Electronic Medical Records (EMRs) is a modern revolution in the field of healthcare with all its numerous benefits to doctors that eventually can improve patient care. She listed twelve good reasons. I thought her post was pretty interesting and decided to expand on it, so it would seem a little more comprehensive. So here I have reproduced her thoughts, and expanded on her post what I think from my literature search are the extra EMR benefits.
Now I have seventeen (17) reasons!
This list (as below) has no particular order of importance, nonetheless I have retained her order in writing the 12 reasons and added on the five (5) more reasons. Click on any thumbnail image to view the presentation in the same tab of your current browser window, press Esc key to continue reading the article).
I am sure Health Information Management (HIM) / Medical Records (MR) practitioners reading this post working in an EMR workplace, will know if these 17 reasons hold water. If these reasons justify a shift to EMRs, then HIM/MR practitioners at non-EMR workplaces who still practice on paper-based medical records could view these reasons as a reason to propose a planned cut back on paper-based medical records quickly and make the swift transition to EMRs.
However, I am certain It is common for individuals to have anxiety about the transition as it represents a change in their very comfortable routine. Others may be simply “technophobic” and deplore the idea of spending any more time interacting with technology than they already have to.
One way to address these issues creating buy-in from doctors and staff is to highlight the ways in which the EMR implementation may save time and make life easier.
There is no process in the office that will not be affected – and hopefully improved – by the EMR. Communicating this in a way that emphasises the positive aspects of the change, while carefully addressing employee fears and concerns, can build excitement for the transition and ultimately ensure its success.
References :
Carolyn, KS & Laura LSO, ‘Usability: Patient–Physician Interactions and the Electronic Medical Record’, in J Stephan & MG Frank (eds) 2012, Information and Communication Technologies in Healthcare, Boca Raton, FL, USA, pp. 123-144
Neil, SS (ed.) 2011, Electronic Medical Records A Practical Guide for Primary Care, Humana Press, New York, USA
Pooja, R 2011, Improving Patient Care Through EMRs, viewed 22 August 2012, <http://technology4doctors.blogspot.com/2011/03/improving-patient-care-through-emrs.html>
Prathibha, V (ed.) 2010, Medical quality management : theory and practice, 2nd edn, Jones and Bartlett Publishers, Sudbury, MA, USA
I am sure many Health Information Management (HIM) practitioners in the U.S. and HIM practitioners from the U.S. who are following this blog already know about an innovative tool for charting their promotional pathways. I had kept away this article after reading a news feed about it a few days ago, and wanted to toy around with this interactive tool before I could blog about it today.
In the U.S., the U.S. Bureau of Labor Statistics expects employment in the medical record and Health information Management (HIM) field to increase 21 percent by 2020.
Any white dot in any square of the grid represents each HIM job title while a yellow diamond in any square of the grid represents an emerging HIM job title. Clicking on a white dot displays a rounded rectangle box pointing to the chosen HIM job title white dot. This box shows a description and details on the skills required, job responsibilities, education and work experience needed for success, and promotional pathways. More detailed description on this HIM job title can be viewed by clicking on the yellow box labeled ‘FULL DESCRIPTION’ at the bottom of the rounded rectangle box. Simultaneously, line(s) radiate from this white dot to other white dots or yellow diamonds representing promotional HIM job title(s) in neihbouring squares of the grid .
The following screenshots show three (3) views of this map. A larger view of each screen shot opens in a new tab of your current browser window.
introduction screen
Grid showing skill levels on the left, broad job families on top row,white dots for existing HIM titles and yellow diamonds for emerging HIM titles
HIM job title box and radiating lines to adjacent HIM job titles
AHIMA hopes that the map will help students, recent graduates and HIM professionals looking for new opportunities to plan a path to success through the promotional and transitional career paths associated with them.
AHIMA plans to add emerging roles to the map as needed to reflect the current reality of HIM roles, pathways between the roles and connections to the direction in which the profession is moving.
I think this tool is simple yet a clever plan to graphically display HIM job titles and career pathways in a grid, and qualifies as a one-stop quick resource center and reference portal to check on HIM opportunities in the U.S.
References:
Career Step, viewed 5 July 2012 <http://www.careerstep.com/about-us>
Health Information Careers – Career Mapping, viewed 5 July 2012 <http://hicareers.com/CareerMap/>
There is a lot of buzzes and there is a lot of emerging hype on Big Data, and I like to begin a series of posts on everything, well almost everything that I can capture, store, search, share, analyse and visualise there is to know about Big Data. I think I will by no means have discussed everything there is to know about Big Data in a running series of posts in this blog as I think Big Data is so huge that I can start an entire blog devoted to just this.
