No longer does Dr Ravi Kasliwal need to make separate rounds of the six operating theaters of the hospital. Thanks to Echo information Management System (EIMS), the Senior Cardiologist Consultant, Escorts Heart Institute and Research Center (EHIRC), can now view the activities of these operation theaters from his room itself.
EHIRC, one of the reputed names in the field of cardiac surgery, covering a range of heart treatment for all age groups. Established in 1988, the hospital boasts of a vast computer network of over 130 nodes linked through an ethernet LAN network. Right from the time a patient enters the hospital till he steps out, all the big and small details about his treatment get recorded in this system.
EHIRC has been one of the early birds to have deployed informatics for health care. The hospital has always believed in utilizing the latest IT tools to improve quality and effectiveness of the care and reduce its cost. The newly installed EIMS, called EnConcert, from Hewlett-Packard (HP), is a move in the same direction. Before the installation of EIMS, the echo images of the patients were recorded in analog and video format. However, video images are generally not very clear and the quality deteriorates with time. Storage of data is another problem. It is difficult for the consultants to compare the previous images with the latest ones. Says Dr Kasliwal, "The images are clearer in digitized format which makes the diagnosis more accurate. In color, the difference in digital format highlights the different valves of the heart making our job easier and accurate." Similarly, storage too is no longer an issue, as EnConcert has a huge storage system called Juke Box with a space of 600GB which stores the recorded images as well as the history of the patients. Moreover, as the data gets stored in digitized format, there are also no chances of data loss. So, even if a patient comes after many years, the doctors can access his previous reports and comparing them with the present one can decide whether his condition has improved or deteriorated, or whether he needs surgery or not. Again, as digital means direct storing of original data to disk, instead of digitizing from video, the original image quality is preserved. This enhances a sonographer’s ability to document the abnormalities present in multiple beat loops instead of long video runs.
As part of EnConcert implementation at EHIRC, the main building of the hospital was connected to the rehabilitation building with a state-of-the-art fiber optic cable, enabling consultants to view a patient’s report while sitting in another building. The system enables the doctors to view the same picture at several places simultaneously. Says Dr Kasliwal, "The most important advantage of this system is that you can view and analyze the live images from anywhere in the hospital. For example, there is a consultant doing echo cardiogram in one room. And I, sitting in another room, can have access to the first-hand images of the patients heart from all the labs. And even before he gets ready to dress up he can have the report ready, verified by senior consultant."
EnConcert is a combination of standard computer hardware and software which streamlines the collection, analysis reporting, archiving and maintenance of a laboratory’s echo data. The software developed by HP for this system handles primarily four functions: administration, acquiring images, image display and reporting. The hardware consists of HP’s high-end Kayak range of workstations with a configuration of 350Mhz processor speed and 128MB RAM, LH3 server and a Juke Box. The latest LH3 server from HP has Hot Swap Hard Disks with a capacity of 24GB with a dual processor of 300Mhz and 256MB SDRAM.
A smooth sail
EIMS manages a network of color images, both in the form of single frames and continuous loops of 10 seconds. There are six color Doppler echo cardiography systems and 10 workstations, installed at various locations in EHIRC for accessing the information by consultants. Though the number of workstations installed is 10, the cabling has been laid down for security 22 workstations. Suvendra Das, Sales Development Manager, Medical Products Group, HP, says, "If we complete 22 sites it will be one of the largest installation of EIMS in the world." The installation of EnConcert, including both hardware and software trial, took a total of 18 days. Adds P Ramakrishna, System Engineering Consultant, HP Medical Products, "We didn’t face any major problem during installation since we chose NetWare 4.0 as a platform. The server is Windows NT 4.0 and the database is SQL server. However, the hooking on to the server and testing the fiber optic bandwidth which connects the main building to the rehabilitation center gave us some problem because of the gap between the two buildings, but we got over it in about a day."
"The most important thing is that you can analyze live images from anywhere in the hospital."
Dr Ravi Kasliwal, Senior Consultant Cardiologist,
How is EIMS going to help the patients?
The most important thing is that you can analyze live images from anywhere in the hospital. To give you an example, there is a doctor doing echo imaging in one room, and I can get access to the first-hand images of the patient from all the labs, and even before the patient dresses up, you have the report and which has already been verified by an expert. Then, suppose, someone has to show something to another consultant while he is in the operating theater or vice-versa, even that can be done. That’s the number two advantage. But, the biggest advantage is that we can simultaneously see the images of the patients heart as it was six weeks back and as it is now. It helps us in assessing his treatment, that is whether his condition is improving or is deteriorating further. And it is all in digitized format, which prevents any data loss. Moreover, the pictures can be opened at many places. That’s the beauty of it and, of course, it is a fantastic teaching aid.
What is the technical jump that you are talking about, if one compares the previous situation with the present one?
Previously, one got the images on video and you know, what video quality is. A digitized signal is a digitized signal and an analog signal an analog signal. But there is one big difference and that is you are able to monitor the reports and are able to make better reports. And you can compare the reports and, of course, it is a great teaching exercise. Now we have fellows sitting somewhere else who can access the echo images. Students no longer have to crowd in the laboratories.
So, what’s next? What kind of development can we expect?
Next will be online three dimensional echo, which we are developing but it will take time.
When can we expect that?
Online three dimensional echo is already available, but right now we catch the images in various planes and then they are reconstructed on computers. So it is not exactly online but the time is not far when it would become online. Apart from an improvement in the quality of images, the computer will also be able to take any plane echo-cardiography images.
What are the other future developments?
When you talk to me three months from now, I will show you the person’s coronary angiography and then in the next three months we will have the holter and DMT. So that in six month’s time on a click of a mouse, I will be able to show you the person’s angiography, holter monitoring and DMT and echo.
What will be the improvement from a common man’s perception?
From a common man’s perception, the biggest improvement is that he can understand for himself that not only is his heart’s valve leaking but his arteries are blocked and his DMT is also normal, so his valve needs to be replaced plus by-pass or his arteries are not so blocked and he can go on medical therapy. Times have changed, patients also want to know more details about the treatment they are getting and technology is also helping them to understand better.
Is there any other field of medical sciences which can utilize this technology?
Oh yes, the whole field of gastroenterology. Just see how clear this image is? In video it never comes out so clear.
The system also has a number of security measures, to present records from gelty tampered with. There are various levels of security, keeping in view the flow in the number of echo patients. First is the administrative level where the administrative assistant has the network right of typing the patient’s details and also printing the report. The next level is the physician or the clinician level. Their job is to diagnose the cases, make reports and then transfer them to the server which stores the data in the juke box. Next in the ladder are the specialists or the consultants who enjoy the maximum rights. They can amend the report as well as move the patient’s record from one folder to another. Consultants with lower network right cannot move images from one folder to another.
But all these benefits haven’t come without a cost. The total cost of installing this system at EHIRC amounted to around Rs2 crore. Says Das, "We were lucky to work on this project which was ideal in many ways. This hospital has a total of 10 color monitors, which is probably the highest in this part of the world." Though the company is working on various projects, nothing is concrete at this point in time.
HP’s medical group is also in the process of developing 3D online images. As of now, 3D online images are already available but the retrieval time for reconstruction is very high. Says Das, "We think that real 3D online images with more realistic reconstruction time, say, two or three minutes, should be available by the first quarter of 1999." This concept can be used in other medical fields as well. Adds Das, "The next development in this field is probably Cardiology Information Management System where the devices like the holter and ECG and CAT equipments can be tightly integrated. Then the next would be that you have PACS or Picture Archieval Communication System which can take care of the CT scanners, MRIs and other things in the radiology department. And logically, the next would be that all this information will get hooked to the HIMS or Hospital Information Management System where all the administrative data is stored."
With so many new developments on the way, the importance of IT in medicine is only going to increase further. "If you talk to me three months from now, I will show you the person’s coronary angiography, and then three months later holter and DMT," says Dr Kasliwal optimistically. So in the next six month’s time at the click of a mouse, we will be able to see a person’s angiography, holter monitoring and DMT, and echo. Who knows, by the next millennium, we might have digital hospitals too.
in New Delhi.
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