The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Secure Integration of Information Systems in Radiology

Medical Imaging is an industry where distinctive imaging protocols such as Digital Communications in Medicine (DICOM) and Health Level 7 (HL7) are used to transmit patient data across multiple information systems relaying possible life-saving data their providers. These information systems, unique to radiology departments require proper integration and workflow to achieve the CIA triad of confidentiality, integrity, and availability. This paper discusses the challenges of integrating disparate healthcare radiology information system with particular emphasis on protocol security

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector

Future developments and trends in use of picture archiving and communication systems

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University London.Objectives: This study identifies modern information technologies that can improve the clinical practice of Picture Archiving and Communication Systems (PACS) and determines the approaches that are needed to improve the functionality of current PACS to provide better next generation PACS and to improve the future of radiology practices and workflow with future PACS generations. Method: A parallel mixed method approach was adopted including qualitative method (semi-structured interviews), quantitative method (questionnaire survey) and observation of online discussion groups on PACS. Five databases were searched to find salient literature, including Science Direct, Springer Link, Scopus, CINAHL Plus and Google Scholar. Six radiologists were interviewed and questionnaires were collected from 120 radiologists. Four online discussion groups related to PACS were monitored via LinkedIn. The data were analysed thematically using the thematic analysis method. Finally, a focus group was held with a separate group of radiologists to validate the findings. Results: Eight themes emerged from the thematic analysis of the data: (1) limitations of traditional PACS; (2) user needs and requirements that can increase PACS functionality; (3) Web based solutions of PACS; (4) PACS on mobile phones; (5) Vendor Neutral Archive (VNA); (6) full integration of voice recognition in PACS; (7) backup solutions for the system and (8) continuous training for PACS users. Discussion: With the development of healthcare information and communication technology (ICT) and with the increased demands of the radiologists to expand PACS usability, traditional PACS must be updated to follow the changes. Modern technologies can provide better solutions to enhance the functionality of current PACS. The next generation of PACS can fulfil the future requirements of users. This study considers the issues between the needs and requirements of the users of a PACS system in the future and the developing solutions in ICT and the PACS industry. Moreover, highly developed PACS systems with advanced features will have a direct impact in changing and improving radiology workflow. Accordingly, a model has been developed that proposes new features for the next generation PACS system, which may be applied to the next generation radiology practice. The model was validated with the focus group and, by using a separate group of radiologists in another country, was determined to be generalisable. Conclusion: It is widely recognised that traditional PACS must be updated to adopt recent advances in ICT. This research has identified themes that, when incorporated, will enhance the functionality of PACS and radiology workflow and provide better quality clinical practice. The findings from this empirical research can be used: as recommendations to vendors; for technology development; and by medical institutes to consider aspects when undertaking implementation of PACS and training future radiologists. Keywords: 'Picture archiving and communication system’, PACS, Future trends, next generation, Organisational efficiency, Productivity, Clinical practice, Ubiquitous.Ministry of Health, Government of Kuwai

Open-source software in medical imaging: development of OsiriX

Purpose Open source software (oss) development for medical imaging enables collaboration of individuals and groups to produce high-quality tools that meet user needs. This process is reviewed and illustrated with OsiriX, a fast DICOM viewer program for the Apple Macintosh. Materials and methods OsiriX is an oss for the Apple Macintosh under Mac OS X v10.4 or higher specifically designed for navigation and visualization of multimodality and multidimensional images: 2D Viewer, 3D Viewer, 4D Viewer (3D series with temporal dimension, for example: Cardiac-CT) and 5D Viewer (3D series with temporal and functional dimensions, for example: Cardiac-PET-CT). The 3D Viewer offers all modern rendering modes: multiplanar reconstruction, surface rendering, volume rendering and maximum Intensity projection. All these modes support 4D data and are able to produce image fusion between two different series (for example: PET-CT). OsiriX was developed using the Apple Xcode development environment and Cocoa framework as both a DICOM PACS workstation for medical imaging and an image processing software package for medical research (radiology and nuclear imaging), functional imaging, 3D imaging, confocal microscopy and molecular imaging. Results OsiriX is an open source program by Antoine Rosset, a radiologist and software developer, was designed specifically for the needs of advanced imaging modalities. The software program turns an Apple Macintosh into a DICOM PACS workstation for medical imaging and image processing. OsiriX is distributed free of charge under the GNU General Public License and its source code is available to anyone. This system illustrates how open software development for medical imaging tools can be successfully designed, implemented and disseminated. Conclusion oss development can provide useful cost effective tools tailored to specific needs and clinical tasks. The integrity and quality assurance of open software developed by a community of users does not follow the traditional conformance and certification required for commercial medical software programs. However, open software can lead to innovative solutions designed by users better suited for specific task

Business model and strategy analysis for radiologists to use electronic health records (EHR)

Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 90-94).Radiology is a medical specialty that employs imaging to diagnose and treat disease. It has long been an advance user of technology to capture, store, share, and use images electronically. In 2009, President Obama signed into law a measure, the HITECH Act (part of the stimulus package), that incentivizes healthcare providers to use electronic health records (EHR) in care delivery to improve quality, efficiency, safety, and reduce cost. The meaningful use (MU) program's Stage 1 requirements (part of HITECH Act) did not include imaging requirements, leading to confusion among radiologists and other specialties with regard to what MU offers to and requires of them. This thesis attempts to clarify the contribution radiology can make to MU by understanding radiology as a system, including its surrounding issues and its drivers, using Stage 1 MU requirements, data from qualitative research, and results from analysis. It answers the following question: Should Radiologists be considered part of the care team, leveraging EHR for meaningful use and hence eligible for incentive payments? It does so via the following methods: a) Discussing in detail current issues surrounding radiology systems from quality, safety, efficiency, and cost perspectives; b) Discussing MU in the context of radiology and reviewing what is missing in it for radiologists; c) Providing deeper systems analysis of current behaviors and why they have this form at this time; and d) Explaining how MU objectives can help to overcome many current issues and ultimately help to improve health outcomes. Specific changes to MU criteria to achieve these benefits are recommended. This thesis employs systems concepts and tools including system architecture and system dynamics for research and analysis to understand the system and derive hypotheses. A system dynamics model is used to analyze current drivers in imaging and to clarify the impact MU can have on these drivers. Thesis conclusions are supported by the analysis performed using the model as well as information gathered through industry interviews, online articles, academic and industry journals, and blogs.by Palani Perumal.S.M.in Engineering and Managemen

Factors affecting the acceptance and meaningful use of picture archive and communication systems by referring clinicians in private practice

A Picture Archive and Communication System (PACS) is a health information technology that facilitates the electronic storage, transmission, presentation and processing of digital medical-imaging datasets. The benefits of PACS have been well-documented. It provides a means to replace traditional film-based workflows and their inherent limitations. Referring clinicians’ acceptance is a critical factor in the overall success of a PACS implementation; and given the financial implications of project failure, research into physician acceptance and meaningful use is crucial. Very few PACS acceptance studies have focused on the referring clinicians, and even less in the context of the private sector. Therefore, the problem that this research aims to address is: There is a lack of understanding on which factors influence PACS acceptance and the meaningful use thereof by referring clinicians in private practice. This explorative study follows an embedded mixed methodology approach in order to meet the research objectives, favouring a qualitative method of inquiry with the support of a quantitative strand. Electronic questionnaires were distributed to private practice referring clinicians to probe the aspects related to PACS acceptance and its meaningful use. The conceptual framework, as devised by Paré and Trudel (2007), was used as a theoretical lens to categorize and discuss the research results in terms of Project, Technological, Organizational and Behavioural factors that affect PACS acceptance and its meaningful use. The findings showed good acceptance rates, which is in line with other research conducted in this field, including research done in the public sector. Technical and Organizational factors were the most prevalent. An extension of the above-mentioned theoretical framework was proposed to assist in maintaining positive results after the project Implementation phase has been completed. This research expands the Information Technology PACS body of knowledge – by identifying both the technical and the non-technical factors that are crucial in private practice referring doctor acceptance and meaningful use. By addressing these factors, institutions can improve the likelihood of PACS project success in private practice settings. Maximising referring doctor acceptance and meaningful use could also give private practices a competitive advantage over their competitors

Assessing hospital physicians' acceptance of clinical information systems : a review of the relevant literature

In view, of the tremendous potential benefits of clinical information systems (CIS) for the quality of patient care; it is hard to understand why not every CIS is embraced by its targeted users, the physicians. The aim of this study is to propose a framework for assessing hospital physicians' CIS-acceptance that can serve as a guidance for future research into this area. Hereto, a review of the relevant literature was performed in the ISI Web-of-Science database. Eleven studies were withheld from an initial dataset of 797 articles. Results show that just as in business settings, there are four core groups of variables that influence physicians' acceptance of a CIS: its usefulness and ease of use social norms, and factors in the working environment that facilitate use of the CIS (such as providing computers/workstations, compatibility between the new and existing system...). We also identified some additional variables as predictors of CIS-acceptance

Data warehousing through multi-agent systems in the medical arena

Comunicação apresentada na International Conference on Knowledge Engineering and Decision Support, 1, Porto, 2004.In this paper it is presented AIDA, an Agency for Integration, Archive and Diffusion of Medical Information. It configures a data warehouse, developed using Multi-Agent technology, that integrates and archives information from heterogeneous sources of a health care unit. AIDA is like a symbiont, with a close association with core applications at any health care facility, namely the Picture Archive Communication System, the Radiological Information System and the Electronic Medical Record Information System, that are built upon pro-active agents and communicate with the AIDA’s ones

Value of Health Information Sharing in Reducing Healthcare Waste: An analysis of duplicate testing across hospitals

Recent healthcare reform has focused on reducing excessive waste in the US healthcare system, with duplicate testing being one of the main culprits. We explore the factors associated with duplication of radiology tests when information sharing across healthcare providers is fragmented, and patients switch from one hospital to another. We hypothesize that patients’ switching behavior across hospitals is associated with a higher levels of duplicate testing, and argue that implementation of intra- and inter-hospital information sharing technologies will help to reduce duplicate tests. We utilize a panel data set consisting of 39,600 patient visits across outpatient clinics of 68 hospitals from 2005 to 2012. Our results indicate that hospital switching is associated with greater duplicate testing and usage of inter-hospital information systems is associated with lower duplication. Our results support the need for implementation of health information exchanges as a potential solution to reduce the incidence of duplicate tests