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Can CDs Be Eliminated From the Image-Sharing Process?

April 5, 2018
by David Raths
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‘The concept that we provide people with CDs is ludicrous,’ says one imaging informatics exec
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The dream of imaging informatics executives is to get CD-ROMs out of the workflow. But they are stubbornly persistent — like fax machines in physician offices.

During a recent webinar put on by the Society for Imaging Informatics in Medicine (SIIM), two executives described their strategies for handling images arriving from other organizations.

Alexander Towbin, M.D., associate chief of radiology informatics at Cincinnati Children’s Hospital, said the hospital gets medical images from around the world because it is a center of excellence for many conditions. Historically those came via CD, but that is changing.

Putting it bluntly, Towbin said, “CDs suck!” There are so many opportunities for error to be introduced. Some institutions put passwords on them and don’t share them. Some forget to burn them. Some CDs arrive with the label on the readable side. “They do everything they can to screw it up and then they do it over again,” he said.

As Cincinnati Children’s has moved to cloud solutions for image sharing, there are still problems they have to deal with, such as accession numbers that are too long and can’t be ingested into the PACS. But automation tools allow them to fix those problems across all a patient’s files. “That has been huge,” Towbin said. “The decrease in the number of problems from CDs has been huge for us.”


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In its own region, the healthcare organizations previously were on one image-sharing platform, but the vendor went out of business. Now the provider organizations are on multiple cloud-based solutions, and Cincinnati Children has created a hub-and-spoke gateway, which sends imaging studies into its PACS. “That works well for ones we have relationship with,” Towbin said.

Putting images on CDs is also bad for patient engagement, Towbin stressed. “The concept that we provide people with CDs is ludicrous. We are asking them to act as delivery people. Apple got rid of them six or seven years ago. Most computers don’t have them. Even in radiology, we have to buy add-ons for computers.”

Kevin McEnery, M.D., director of innovation in imaging informatics at the University of Texas MD Anderson Cancer Center, said, “We see the cloud as indispensable for moving forward. We see it decreasing complexities of image transfers. It simplifies the logistics of moving images between institutions without sacrificing security.” His organization is migrating away from CD-ROMs as well. But with 16,000 to 18,000 studies processed per month, there is still a lot of investment in employee time in getting images into the PACS. “We could use a lot more automation than exists with the current infrastructure,” he said.

Rather than having patients shuffle CDs to other providers, MD Anderson has hired a third-party company. Once someone is an MD Anderson patient, the vendor calls and asks where they have had imaging and takes care of it from there. “It decreases stress and increases the number of studies available to get a more complete picture of the patient’s condition,” McEnery said.

Towbin said the hub-and-spoke approach with other institutions has had its challenges in terms of project management. The other organizations might not necessarily see working on this as a high priority. “It is a way for them to send images to us — an above-and-beyond thing we are asking them to do. It is a huge stressor on our informatics team — getting external providers interested in using our solution,” he said. There is a lot of trial and error to get it working, and understand work flows. The experts on our teamwork to understand the best work flow for each institution. It was and continues to be a challenge to roll this out to everyone else.”

Beyond getting images into the PACS, another issue is getting access to prior imaging reports, McEnery said. “They are coming through a different pathway — on that fax pathway. We are putting a bigger emphasis on not just improving how we get images but also how we get reports from the institution the image is coming from on their understanding of the disease process.”

On Cincinnati Children’s roadmap is image-enabling its patient portal to allow patients to push images elsewhere or download them. “It is doable and where we need to move. It is difficult to image-enable the patient portal, but not impossible.”




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Microsoft Healthcare Rolls Out FHIR Server for Azure

November 13, 2018
by David Raths, Contributing Editor
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Developers could use the server to quickly ingest and manage FHIR datasets in the cloud

Microsoft Healthcare has announced the release of an open source project, FHIR Server for Azure, to offer developers access to software that supports the exchange and management of data in the cloud via the FHIR specification.

FHIR Server for Azure on GitHub provides support infrastructure for immediate provisioning in the cloud, including mapping to Azure Active Directory (Azure AD), and the ability to enable role-based access controls (RBAC), the company said. Developers can save time when they need to integrate a FHIR server into an application or use it as a foundation to customize a unique FHIR service.

In a blog post, Heather Jordan Cartwright, general manager of Microsoft Healthcare, said the company “is contributing this open source project to make it easier for all organizations working with healthcare data to leverage the power of the cloud for clinical data processing and machine learning workloads.”

In August 2018, Microsoft joined with Amazon, Google, IBM and other companies in a commitment to remove barriers for the adoption of technologies that support healthcare interoperability, particularly those that are enabled through the cloud and AI and especially FHIR.

Among the points the companies agreed to was: “We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation.” 

As an example of how FHIR Server for Azure will work, Microsoft said developers can use the server to quickly ingest and manage FHIR datasets in a cloud environment, track and manage data access, and begin to normalize data for machine-learning workloads.

In August, Josh Mandel, chief architect of Microsoft Healthcare, noted that the company had added support for FHIR to the Dynamics Business Application Platform through the Dynamics 365 Healthcare Accelerator, and developed an open source Azure Security and Compliance Blueprint for Health Data and AI for deploying a FHIR-enabled, HIPAA/HITRUST environment in Azure.


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Wednesday, December 19, 2018 | 1:00 p.m. ET, 12:00 p.m. CT

By 2019, the volume of data generated by genomic sequencing will be greater than the amount of data on YouTube. Due to that, enormous data management challenges await healthcare organizations as they look to better integrate genomic data into personalized care plans for their patients.

In this latest Healthcare Informatics webinar, attendees will learn about these challenges in much greater detail and will also develop a deeper understanding of the opportunities that lie in front of them as genomic data becomes more actively used for rare disease diagnosis; for cancer detection; for the tracking of mutations; and for medication selection for patients.

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IBM Buys Red Hat for $34B, Boosting its Position in the Cloud Market

October 29, 2018
by Heather Landi, Associate Editor
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The organizations plan to accelerate hybrid multi-cloud adoption

Armonk, New York-based IBM announced Sunday plans to acquire Raleigh, N.C.-based Red Hat, a provider of open source cloud software, for approximately $34 billion.

The acquisition is by far IBM's largest deal ever, and the third-biggest in the history of U.S. tech. As a result of the deal, IBM one of the largest hybrid cloud providers in an emerging $1 trillion growth market.

Under the agreement, IBM will buy all of the issued and common shares of Red Hat for $190 in cash. Shares in Red Hat closed at $116.68 on Friday before the deal was announced. The deal is expected to close in the latter half of 2019.

Red Hat to operate as a distinct unit within IBM's Hybrid Cloud team.

“The acquisition of Red Hat is a game-changer. It changes everything about the cloud market,” Ginni Rometty, IBM chairman, president and CEO, said in a statement. “IBM will become the world's #1 hybrid cloud provider, offering companies the only open cloud solution that will unlock the full value of the cloud for their businesses.

Rometty noted that most companies today are only 20 percent along their cloud journey, renting compute power to cut costs. "The next 80 percent is about unlocking real business value and driving growth. This is the next chapter of the cloud. It requires shifting business applications to hybrid cloud, extracting more data and optimizing every part of the business, from supply chains to sales," she said.

"Open source is the default choice for modern IT solutions, and I'm incredibly proud of the role Red Hat has played in making that a reality in the enterprise," Jim Whitehurst, president and CEO, Red Hat, said in a statement. "Joining forces with IBM will provide us with a greater level of scale, resources and capabilities to accelerate the impact of open source as the basis for digital transformation and bring Red Hat to an even wider audience –  all while preserving our unique culture and unwavering commitment to open source innovation."

Companies today are already using multiple clouds. However, research shows that 80 percent of business workloads have yet to move to the cloud, held back by the proprietary nature of today's cloud market. This prevents portability of data and applications across multiple clouds, data security in a multi-cloud environment and consistent cloud management, the organizations said.

With the acquisition, IBM plans to accelerate hybrid multi-cloud adoption. “Together, they will help clients create cloud-native business applications faster, drive greater portability and security of data and applications across multiple public and private clouds, all with consistent cloud management. In doing so, they will draw on their shared leadership in key technologies, such as Linux, containers, Kubernetes, multi-cloud management, and cloud management and automation,” the companies said in a press release.

IBM's and Red Hat's partnership has spanned 20 years, with IBM serving as an early supporter of Linux, collaborating with Red Hat to help develop and grow enterprise-grade Linux and more recently to bring enterprise Kubernetes and hybrid cloud solutions to customers. These innovations have become core technologies within IBM's $19 billion hybrid cloud business. Between them, IBM and Red Hat have contributed more to the open source community than any other organization.

With the acquisition, IBM said it would remain committed to Red Hat's open governance, open source contributions, participation in the open source community and development model, and fostering its widespread developer ecosystem. In addition, IBM and Red Hat will remain committed to the continued freedom of open source, via such efforts as Patent Promise, GPL Cooperation Commitment, the Open Invention Network and the LOT Network.

IBM and Red Hat also will continue to build and enhance Red Hat partnerships, including those with major cloud providers, such as Amazon Web Services, Microsoft Azure, Google Cloud, Alibaba and more, in addition to the IBM Cloud. At the same time, Red Hat will benefit from IBM's hybrid cloud and enterprise IT scale in helping expand their open source technology portfolio to businesses globally, the companies said.

Upon closing of the acquisition, Red Hat will join IBM's Hybrid Cloud team as a distinct unit. Red Hat will continue to be led by Jim Whitehurst and Red Hat's current management team. Jim Whitehurst also will join IBM's senior management team and report to Rometty.


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