4 ms·

1,000 characters? What, are they paying for storage by the byte? Was this system designed in 1960? For that matter, were any doctors involved in the design of t

by drinian 16y ago

1,000 characters? What, are they paying for storage by the byte? Was this system designed in 1960? For that matter, were any doctors involved in the design of the system? How on earth do they store medical imaging, compress it down to 128x128 GIFs?

akavlie 16y ago
Medical imaging is probably in systems and hard copies completely disconnected from (and inaccessible by) the database.
- drinian 16y ago
  You're probably right, although that's another problem. I've heard (this is not my area) that most of the big, expensive machines all use their own proprietary image formats. Although I once had some emergency dental work done in New Zealand, and they were able to give me a laser-printed copy of their digital X-ray along with a printout of my EMR as I was walking out the door.
  - rdl 16y ago
    Actually, I unfortunately know a fair bit about medical imaging (since I supported radiology systems for a couple years). There's a ~1980s protocol called DICOM which is largely used to transport images around. It is quite complex for what it actually, has lots of vendor and device inconsistencies, and because medical imaging devices are expensive and have a long duty cycle, you can have a 10-20 year spread of equipment on your network. Some of the actual imaging technologies (MRI, CT, US) are inherently low resolution per image in a study (due to the limits of physics), but a study can be composed of a bunch of images, and it can end up 5-10GB. The high-resolution individual images tend to be x-ray, especially digital mammography.
- rdl 16y ago
  Right -- the medical images go into something called a "Picture Archive and Control System", or PACS, which is separate but should be linked to the EHR/EMR. The PACS is basically a file server with some metadata which speaks a stupid old protocol (DICOM) to the x-ray, and which also speaks to expensive computers with FDA-certified high-res (WUXGA or higher) B&W or color monitors (like, $10-20k for a monitor, and 2-3 monitors per workstation). Absolutely none of it is that difficult from the perspective of a green field software development effort, but there is huge complexity in making the PACS or EHR operate correctly with ~every idiosyncratic device, other EHR or PACS, or configuration request at every site in the world. Because the IT systems are often sold with a lot of consulting services to implement, and with medical imaging devices (for PACS), there isn't a lot of incentive to make everything plug and play. I think the best solution would be for a very large healthcare organization to actually require a standardized system at a low price, and make it available to everyone. (an organization like Kaiser or Sutter Health would probably have enough scale). Develop something which works with entirely comforming devices, has much lower configuration, and is user friendly and cheap, at the cost of customization. In the long run, it would be cheaper -- it's just that the people in the medical IT purchasing industry don't think like product people, they want consulting and services and handholding. There have been plenty of people killed or seriously injured by errors directly related to medical IT systems. Just in radiology, just recently, http://www.nytimes.com/2010/01/24/health/24radiation.html?pagewanted=all http://www.nytimes.com/2010/01/24/health/24radiation.html?pa...
yummyfajitas 16y ago
An MRI of my abdomen only outputs 256x512 images. Medical images suck.
- dedward 16y ago
  An MRI maybe - but a digitized X-ray is much, much higher than that.
pmorici 16y ago
A 1000 caracter limit is pretty common for a long form text field in PeopleSoft applications and for what ever reason PeopleSoft is really popular for building horrendous HR, business process and other records keeping business software.

by drinian 16y ago

akavlie 16y ago

Medical imaging is probably in systems and hard copies completely disconnected from (and inaccessible by) the database.

drinian 16y ago
You're probably right, although that's another problem. I've heard (this is not my area) that most of the big, expensive machines all use their own proprietary image formats. Although I once had some emergency dental work done in New Zealand, and they were able to give me a laser-printed copy of their digital X-ray along with a printout of my EMR as I was walking out the door.
- rdl 16y ago
  Actually, I unfortunately know a fair bit about medical imaging (since I supported radiology systems for a couple years). There's a ~1980s protocol called DICOM which is largely used to transport images around. It is quite complex for what it actually, has lots of vendor and device inconsistencies, and because medical imaging devices are expensive and have a long duty cycle, you can have a 10-20 year spread of equipment on your network. Some of the actual imaging technologies (MRI, CT, US) are inherently low resolution per image in a study (due to the limits of physics), but a study can be composed of a bunch of images, and it can end up 5-10GB. The high-resolution individual images tend to be x-ray, especially digital mammography.
rdl 16y ago
Right -- the medical images go into something called a "Picture Archive and Control System", or PACS, which is separate but should be linked to the EHR/EMR. The PACS is basically a file server with some metadata which speaks a stupid old protocol (DICOM) to the x-ray, and which also speaks to expensive computers with FDA-certified high-res (WUXGA or higher) B&W or color monitors (like, $10-20k for a monitor, and 2-3 monitors per workstation). Absolutely none of it is that difficult from the perspective of a green field software development effort, but there is huge complexity in making the PACS or EHR operate correctly with ~every idiosyncratic device, other EHR or PACS, or configuration request at every site in the world. Because the IT systems are often sold with a lot of consulting services to implement, and with medical imaging devices (for PACS), there isn't a lot of incentive to make everything plug and play. I think the best solution would be for a very large healthcare organization to actually require a standardized system at a low price, and make it available to everyone. (an organization like Kaiser or Sutter Health would probably have enough scale). Develop something which works with entirely comforming devices, has much lower configuration, and is user friendly and cheap, at the cost of customization. In the long run, it would be cheaper -- it's just that the people in the medical IT purchasing industry don't think like product people, they want consulting and services and handholding. There have been plenty of people killed or seriously injured by errors directly related to medical IT systems. Just in radiology, just recently, http://www.nytimes.com/2010/01/24/health/24radiation.html?pagewanted=all http://www.nytimes.com/2010/01/24/health/24radiation.html?pa...

yummyfajitas 16y ago

An MRI of my abdomen only outputs 256x512 images. Medical images suck.

dedward 16y ago
An MRI maybe - but a digitized X-ray is much, much higher than that.

pmorici 16y ago

A 1000 caracter limit is pretty common for a long form text field in PeopleSoft applications and for what ever reason PeopleSoft is really popular for building horrendous HR, business process and other records keeping business software.