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A team of researchers at the Eindhoven University of Technology has developed a software tool that physicians can use to easily study the wiring of the brains of their patients. The tool converts MRI scans using special techniques to three-dimensional images.

This now makes it possible to view a total picture of the winding roads and their contacts without having to operate. Doctors can virtually browse along the spaghetti-like "wiring" of the brain, with this new tool. Researcher Vesna Prčkovska defended her PhD thesis on this subject last week.

To know accurately where the main nerve bundles in the brain are located is of immense importance for neurosurgeons, explains Bart ter Haar Romenij (professor of Biomedical Image Analysis, at the Department of Biomedical Engineering). As an example he cites ‘deep brain stimulation’, with which vibration seizures in patients with Parkinson’s disease can be suppressed. "With this new tool, you can determine exactly where to place the stimulation electrode in the brain. The guiding map has been improved: because we now see the roads on the map, we know better where to stick the needle." The technique may also yield many new insights into neurological and psychiatric disorders. And it is important for brain surgeons to know in advance where the critical nerve bundles are, to avoid damaging them.

The accuracy of the tool is a great step forward. Especially intersections of nerve bundles were difficult to identify till now. Ter Haar Romenij: "You can now see for the first time the spaghetti-like structures and their connections." We are far from seeing all brain connections; there are many more smaller compounds in the brains, who are not seen by the new tool. A microscope observed them. "But you cannot, of course, dissect a live patient into slices for under a microscope," the professor smiles.

The tool was developed by TU/e researcher Anna Vilanova, with her PhD students Vesna Prčkovska, Tim Peeters and Paulo Rodrigues.

High angular resolution diffusion imaging (HARDI) is a diffusion weighted MRI technique that overcomes some of the decisive limitations of its predecessor diffusion tensor imaging (DTI) in the areas of composite nerve fiber structure. Despite the advantages, HARDI raises several issues: complex modeling of the data, non-intuitive and computationally demanding visualization, inability to interactively explore and transform the data etc. To overcome these drawbacks, we present a novel, multi-field visualization framework that adopts the benefits of both DTI and HARDI. By applying a classification scheme based on HARDI anisotropy measures, the most suitable model per imaging voxel is automatically chosen. This classification allows simplification of the data in areas with single fiber bundle coherence. To accomplish fast and interactive visualization for both HARDI and DTI modalities, we exploit the capabilities of modern GPUs for glyph rendering and adopt DTI fiber tracking in suitable regions. The resulting framework, allows user-friendly data exploration of fused HARDI and DTI data. Many incorporated features like sharpening, normalization, maxima enhancement and different types of color coding of the HARDI glyphs, simplify the data and enhance its features. The tool is based on a recently developed technology called HARDI (High Angular Resolution Diffusion Imaging). The MRI measuring technique for HARDI was already there, the research team took care of the processing, interpretation and interactive visualization of these very complex data, so that doctors can get to work.

Bart ter Haar Romenij expects that the tool can be ready at relatively short notice for use in the hospital within a few years. "We need to validate the package. We now need to prove that the images match reality." Also, there is still work to do on the speed of the corresponding MRI scan. For a detailed view, a patient needs to be one hour in the scanner, which is too long. Moreover, the tool is already widely in use by other scientists, says the professor.

The research was supported by NWO (Dutch Organization for Scientific Research). The thesis of Vesna Prčkovska is titled: High Angular Resolution Diffusion Imaging, Processing & Visualization. She graduated last Wednesday, October 20, 2010.

via w3.tue.nl

 

 

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Surescripts announced that it will expand its nationwide e-prescribing network to accelerate the digital transformation of the nation’s health care system by supporting and enabling the electronic exchange of all types of clinical information.

With this announcement, Surescripts is leveraging the success of its e-prescribing experience and its open, neutral network to enable the nationwide exchange of clinical messages, including up-to-date summaries of patients’ recent visits with their health care providers. Moving beyond e-prescribing, Surescripts will build on its established and trusted network by making available to its network participants and electronic health record partners new secure messaging tools through a strategic investment in Kryptiq, a proven technology leader. The move is further supported by two years worth of technology pilot work at Minute Clinic, the pioneer and largest provider of retail medical clinics in the United States. The announcement and new clinical message sharing capability was widely hailed by health care and health IT experts who agree that it will serve to accelerate the efforts of federal, state and industry leaders to improve outcomes and reduce the cost of health care for all.

The Surescripts network is used by the nation’s pharmacies, pharmacy benefit managers, payers, by 200,000 e-prescribing physicians and by more than 200 different electronic health record vendors to send electronic prescriptions and share prescription information across all 50 states. E-prescribing has improved patient safety and convenience and significantly reduced the cost of processing a prescription.

“It’s a new day for Surescripts and a new day for the nation’s health care system,” said Harry Totonis, president and CEO of Surescripts. “Today’s announcement is consistent with our mission of improving how health care is delivered in our country. And while there is still more work to be done in e-prescribing, we have the expertise and capability to do so much more. We are proud to support the federal government’s efforts to encourage doctors to use electronic health record systems to improve quality and safety, and to reduce the cost of care.”

By adhering to its existing principles and operating procedures, Surescripts will extend its existing collaboration with electronic health record vendors and all network participants to facilitate the movement of clinical information when and to where it is needed by a patient’s health care providers — be they a physician, nurse practitioner, physician assistant or pharmacist. The Surescripts network will remain complementary to current EHR, HIE and health system networks by allowing them to connect to a national backbone that, in turn, can connect them with any other network.

“The services will be new, but the approach will not,” said Totonis. “Surescripts will adhere to the same set of principles that propelled e-prescribing adoption in the U.S. to 200,000 physicians in less than a decade: privacy, security, neutrality, physician and patient choice, transparency, collaboration and quality. We will continue to work with and enable our EHR partners. These are the principles that brought together more health care organizations for the purpose of electronically sharing information than ever before and these are the principles we will keep. Our network will be open and neutral and we see it as complementary to other healthcare networks and to local exchanges.”

New Tools to Access New Services

In addition to using its network to enable the secure electronic exchange of clinical messages, Surescripts will provide tools to electronic health record systems and all network participants to access these new services. The new services are supported by Surescripts’ strategic investment in Kryptiq, one of the nation’s leading developers of technology that enables providers, their colleagues and patients to securely share clinical information. Kryptiq technology facilitates first-of-its-kind, open collaborative messaging connectivity among more than 40,000 physicians nationwide by connecting electronic health record systems, health information exchanges and health systems located throughout the country. Working with Kryptiq, Surescripts will make a selection of secure messaging tools broadly available to network participants.

All of these services will be fully compatible with the federal government’s standards for clinical interoperability and security, including those currently being developed through the Nationwide Health Information Network (NHIN) Direct Project, where the Surescripts exchange will operate as a Health Information Service Provider (HISP).

MinuteClinic Sharing Thousands of Clinical Messages A Month Over the Surescripts Network

Surescripts is already linked with over 500 CVS Caremark MinuteClinic sites across 26 states. Launched in November of 2008, the service has grown to where MinuteClinic nurse practitioners are today using the Surescripts network to share thousands of patient summaries with their patient’s physicians each month.

“Patients receive care in different settings and, as a result, their information must be able to follow them wherever they go,” said Troy Brennan, M.D., chief medical officer of CVS Caremark. “Each and every time that MinuteClinic shares information via the Surescripts network with a patient’s medical home, it improves the continuity of care.”

Connecting Pharmacy for More Coordinated Care

By expanding Surescripts’ focus to enable the sharing of all types of clinical information, the nation’s retail pharmacies and PBMs aim to realize further gains efficiencies while improving outcomes and reducing the cost of health care for all.

This move is also part of a long-term commitment by Surescripts to enable the pharmacist as a critical component of a patient’s coordinated care. There are key trends occurring in healthcare right now with technology being deployed and electronic connections being established to the point of care that promise to redefine patient care. In this environment, Surescripts’ role as the nation’s network for clinical interoperability supports and enhances pharmacists’ ability to connect with physicians, patients and their information for more coordinated care.

Announcement Hailed by Nation’s Health IT Experts

By enabling e-prescribing as well as the secure electronic exchange of clinical information, Surescripts offers broad support for the meaningful use of electronic health records. Taken together, these capabilities help improve health care quality and safety while reducing the cost of care. Importantly, Surescripts supports all federal and state policies and standards for health information exchange — including privacy and security standards (such as HIPAA and state law), technology interoperability standards (such as NHIN Exchange) and message types such as HL7, CCR and CCD. In addition, Surescripts is also following the recommendations adopted by the HIT Policy Committee and the standards being developed by the NHIN Direct Project. As such, the announcement was recognized by experts throughout the nation’s health care system.

“The Surescripts initiative is consistent with plans of the Department of Veterans Affairs to add implementation of the Nationwide Health Information Network Direct capability, to the Virtual Lifetime Electronic Record portfolio,” said Roger Baker, assistant secretary for information and technology for the Department of Veterans Affairs. “Our intention is to facilitate secure, standards-based health information exchanges between the VA and the private sector. A large number of Veterans receive some portion of their care from community providers and this initiative will assist us in improving the continuity of care for our Veterans.”

“Healthcare information exchange enables clinicians to coordinate care, improving quality, safety, and efficiency,” said Dr. John Halamka, chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center. “Surescripts is accelerating connectivity by leveraging its existing e-prescribing network to provide novel data exchanges among providers.”

“Secure, low cost, easy to use transport of relevant health information is vital to physicians who wish to take advantage of the EHR incentive programs under Medicare or Medicaid,” said Dr. David C. Kibbe, senior adviser at the American Academy of Family Physicians. “What this subscription messaging service promises is an affordable pathway for doctors to meet several of the criteria for Meaningful Use without disruption of office workflows and with assurance of reliability equal to that which they already expect with e-prescribing exchanges. It is a natural extension of what Surescripts has established in the field of clinical data exchange with medications, and which offers additional types of data exchange services without ‘locking in’ subscribers to a proprietary network that they can’t get out of.”

Surescripts: Going Beyond E-Prescriptions

Surescripts’ new Clinical Interoperability Services will leverage the nation’s largest network of physicians and the secure, private, reliable and scalable Surescripts network. When combined with Kryptiq’s best-in-class clinical messaging technology, the new services enable Surescripts to offer several options to electronic health record vendors, health systems, health information exchanges and the physicians they serve. All options are designed to address the specific needs and current capabilities of Surescripts’ network participants and be complementary to existing investments in electronic health record systems while offering varied levels of functionality and integration.

• Extended Network Connectivity – As a network of networks, Surescripts will support and enable the exchange of all types of clinical messages between EHRs, HIEs and health systems that, today, are not connected with each other.
• Net2Net Connect – Allows health systems and technology vendors that already support clinical information sharing within their network to connect to Surescripts in order to receive and send clinical information outside their network. This new service will be available in December 2010.
• Message Stream – Secure messaging tools for health systems and technology vendors to enable their physicians to electronically exchange clinical information. This new service will be available in December 2010.
• Clinical Message Portal – Simple connectivity tools intended for providers that, today, do not have an EHR system to send and receive clinical messages. The new service will be available in January 2011.

Surescripts’ e-prescribing services will continue to be offered without charge to physicians. Existing users of Surescripts’ e-prescribing services would not be obligated to use the services being announced today. To establish a connection for clinical information sharing over the Surescripts network, users will be able to choose how they want to connect and which services they use.

Those interested in learning more about and acquiring these tools and services can receive updates about our introduction plans by visiting www.surescripts.com/transform and completing a short form.

 

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Canada’s investments in drug information systems (DIS) will generate $436 million in cost savings and efficiencies in 2010, announced Richard Alvarez, President and CEO, Canada Health Infoway (Infoway). The findings are outlined in an independent study commissioned by Infoway, released today.

Drug information systems are part of an electronic health record. Authorized pharmacists, doctors, nurses and other care providers can use them to securely view a patient’s medications. They also help health care providers to obtain a full and accurate medication history and to catch potential drug interactions before they harm patients. By early 2010, about one in three community pharmacists in Canada used DIS. So did half of hospital emergency departments. Some doctors also used e-prescribing to send or print prescriptions for their patients. Some of the gains identified in the study come from these early adopters.

“Drug Information Systems in place today are already generating significant value across Canada, and that value will increase as adoption of the technology increases,” said Alvarez. “Through access to a comprehensive patient medication profile, DIS enable health care providers to improve care for patients and to save time.”

The study found that drug information systems generated patient care benefits and productivity gains valued at $436 million in 2010. These include:

• Increased medication compliance: In a national survey conducted for the study, pharmacists said that DIS helped them to work with patients so that medications were more likely to be taken as prescribed (valued at 21% of total benefits).
• Reduced adverse drug events: Fewer drug interactions and other problems means better quality of care. This helps patients and saved health care costs, accounting for 20% of the overall financial benefit from current use of DIS in Canada.
• Reduced medication abuse (16%).
• Increased pharmacist and prescriber productivity (32%), e.g. because pharmacists had to call doctors and other prescribers less often to check prescriptions
• Improved drug cost management (10%).

“Pharmacists are seeing technology and their drug therapy expertise working in concert to transform the delivery of patient care,” stated Ruth Ackerman, President of the Canadian Pharmacists Association. “By providing health care professionals with the information they need to support their clinical decisions, Drug Information Systems are improving medication safety and effectiveness.”

The findings are outlined in the National Impact of Generation 2 Drug Information Systems Report. The study drew on a national survey of pharmacists, information from provincial DIS implementations, interviews with health care leaders, a comprehensive scan of related research studies from Canada and other countries, and economic statistics. An independent panel of experts reviewed and validated the results. Stronger improvements in productivity and in medication compliance were reported in provinces with more established DIS.

In the national survey, pharmacists rated improved access to patient information, increased patient safety, and reductions in fraudulent medication use as the top benefits from a drug information system. More than 9 in 10 of those who responded reported that patient, physician, and pharmacist/pharmacy technician satisfaction had improved since implementing a DIS. In addition, about 7 in 10 pharmacists said that DIS had improved their ability to detect and prevent fraudulent medication use. Many also indicated that DIS support pharmacists in undertaking clinical roles, such as checking to make sure that patients who move from one point of care to another (e.g. hospital to home) have the right medications or helping patients with chronic disease to manage their condition.

“When health providers have access to the right information at the right time, quality of care and efficiency improves, ” said Alvarez. “We expect these benefits to grow over time as more of Canada’s clinicians begin to use increasingly advanced drug information systems to help them care for patients.”

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

For more information, please see the Backgrounder.

 

Dan Strasbourg
Director, Media Relations
Canada Health Infoway
Tel.: (416) 595-3424
dstrasbourg@infoway-inforoute.ca