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Dr. Joseph Connolly, a neurologist at Everett Clinic in Everett, Wash., was recently preparing to give an urgent consultation on treatment for a 20-year-old man who had been diagnosed with an inoperable, malignant brain tumor. But the patient's condition quickly took a turn for the worse, so his parents rushed him to the emergency room of a local community hospital miles away from Connolly.

"The hospital wanted to know whether they should just let him go [die] or if there was something that could be done," Connolly recalls.

But before Connolly could give this critical opinion, he needed to see images of the patient's brain. Typically, that requires hard-copy films, but it was late in the day and the Everett Clinic's radiology department was closed. Fortunately, a couple of days earlier, the patient had had a brain scan performed by a cancer doctor who, like Connolly, uses a new digital-imaging system that enables high-quality images from CT scans, MRIs, and X-rays to be viewed on a PC via the Internet. Using this technology to examine the brain scan, Connolly quickly determined that the patient also had a cystic brain lesion that was causing complications.

"We admitted the kid into the hospital right away," says Connolly, who advised that the cyst be drained immediately. He printed out the brain-scan image and faxed it to the community hospital's emergency room, which then rushed the young man into surgery. "We gave him more time," Connolly says.

The distributed digital-imaging system, from medical-device manufacturer Stentor Inc., lets Connolly collaborate with other physicians on urgent cases such as the brain-tumor patient, as well as on less-critical situations. "A major bane in a physician's life is not being able to look at films because someone else has them," Connolly says. On top of that, "I can be backed up for weeks for a consultation appointment. This technology helps me determine whether or not a patient needs to be seen, and how soon."

Businesses and organizations have long used IT as a tool to save time and money. But in health care, some of the most exciting applications of medical informatics are being used to save lives and, at the very least, improve patient care. Medical informatics is defined as the scientific field that deals with the storage, retrieval, sharing, and optimal use of biomedical information, data, and knowledge for problem solving and decision making, says Dr. Edward Shortliffe, professor and chair of the department of medical informatics at the College of Physicians and Surgeons at Columbia University in New York. "It touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies, notably in the areas of computing and communication," he says.

Medical informatics can be broken down into four areas of application: bioinformatics (molecular and cellular level), imaging (tissues and organs), clinical (patients and individuals), and public health (populations). Among the latest and most promising developments are technologies that improve medical devices and other tools used to help doctors diagnose, monitor, and treat patients, as well as collaborate.

One of the most useful advances is Internet-enabled digital imaging, such as the technology from Stentor. Stentor's product is based on iSyntax technology that was developed by and is licensed from the University of Pittsburgh Medical Center Health System (see "Diagnostic Tools Take Aim at Terrorism," Feb. 4, p. 31; information week.com/874/tools.htm). Typically, medical images involve huge amounts of data--an average of 50 to 100 Mbytes per image--requiring a lot of bandwidth and storage capability. ISyntax uses mathematical representations of images called wavelets that distribute these huge amounts of data to PCs instantly via the Internet or intranets, without the need for special high-bandwidth lines or viewing equipment. Health-care providers access the images stored by Stentor via an application service provider model.

The Internet is playing an important role in other medical devices as well. New technologies let physicians remotely monitor the performance of heart devices such as defibrillators implanted in patients' chests. In the near future, tiny microchips implanted nonsurgically into a patient's heart or other body part could monitor blood pressure and provide other important information via a PC or PDA, allowing doctors to alter treatment quickly without the need for invasive procedures (see story, p. 50). Other technologies, such as improved digital imaging akin to spell-check tools in word-processing software, help radiologists better detect early signs of diseases, including breast cancer.

"Medical devices and diagnostic tools certainly have a lot of potential for improving care," says Noel Williams, CIO of HCA, a Nashville, Tenn., operator of 200 hospitals and health facilities throughout the country. Any technology that lets doctors and other clinicians quickly access or share pertinent information about a patient can ultimately reduce the chance of treatment mistakes and improve the level of care, Williams says.

At Magee-Women's Hospital, part of the University of Pittsburgh Medical Center Health System, computer-aided detection technology helps radiologists find the slightest suspicious or abnormal feature on mammography screenings to better diagnose possible breast cancer. "The technology picks up features such as possible calcifications, architecture distortions, and masses that might otherwise get passed over by a radiologist because they're not easily visible," says Dr. Jules Sumkin, chief of radiology at Magee-Women's Hospital and professor of radiology at the University of Pittsburgh School of Medicine. Magee-Women's Hospital has been using the technology since last March in a system called ImageChecker, developed by R2 Technology Inc.

Computer-aided detection technology doesn't replace radiologists' analysis of mammograms. Instead, it provides radiologists with a second look, after they examine the actual mammogram films. "We don't want the radiologist to be biased at the initial look," Sumkin says. The technology performs objective algorithms on the film to look for suspicious features and then marks those areas with triangular cues.

Most computer-aided detection mammograms--even normal ones--will end up featuring at least two of these cues, which the radiologist then re-examines more closely to determine if they're false positives, an indication of possible cancer, or another problem, Sumkin says.

While the technology has its benefits, it takes time for radiologists to become experienced in using it. When Magee-Women's Hospital first began using computer-aided detection technology, there was an increase in the number of recalls, asking women to come back for second mammograms to double-check the spots. But now that the hospital's radiologists are more accustomed to the technology, callbacks have decreased.

A research study, appearing in the medical journal Radiology 2001, of 1,000 patients shows that of 115 cancer cases missed by conventional mammogram readings, 77% were identified later by computer-aided detection technology, Sumkin says. Another study in the journal indicates that a community breast-care center using the technology reported a 20% increase in the number of breast-cancer patients it treated, mainly because more cancers were detected earlier.

During the next decade, digital imaging featuring embedded computer-aided detection for mammography and possibly for other testing, including lung scans, will become mainstream, Sumkin predicts. "This is here to stay," he says. Still, the technology isn't cheap. Magee-Women's Hospital spent about $30,000 on the computer-aided detection system, plus the cost of hiring three employees who scan the conventional mammogram films of each patient into the digital system, Sumkin says.

Although advanced medical technologies such as these may become mainstream, much of their acceptance depends on cost effectiveness, says Dr. Octo Barnett, professor of medical informatics at Harvard Medical School and director of the laboratory of computer science at Massachusetts General Hospital in Boston. "A major problem in health-care technologies is that when spending resources are limited, you have to ask, how often will we use a technology, how many false positives will we get, and what are the improved outcomes?" Barnett says. "How many lives will we actually save?"

Indeed, when a hospital considers buying advanced medical systems, those purchases face competition from other capital expenditures, including more traditional information-management purchases such as new electronic medical-record software or bedside PCs, says Columbia University's Shortliffe. "Some technology improves care--but it also increases the cost of care, so that's a big consideration," he says.

In the case of mammograms, the health-care industry overall has faced reductions in reimbursements from insurance companies and federal programs such as Medicare. So the decision to buy new, advanced mammography equipment, even if it can potentially detect cancer earlier, is a difficult one, Sumkin says.

Other times, technologies seem to be in search of problems to solve. "Do you use an MRI for a sprained ankle?" Massachusetts General's Barnett asks rhetorically, to illustrate how some technologies might be overused in order to prove their cost-effectiveness from an investment standpoint or because a patient demands an unnecessary test. "It's like patients who request antibiotics for a cold," Shortliffe says. "It won't help, but some doctors will give in."

While imaging technology helps doctors more accurately detect cancer and other ailments, Internet technology is playing a bigger role in doctors' ability to monitor patients' progress. Among the latest advances are Internet capabilities that let cardiologists and other specialists remotely monitor heart patients.

Last month, Medtronic Inc., maker of medical devices for patients with chronic illnesses, received Food and Drug Administration approval to sell its Medtronic CareLink Monitor and software, which let doctors monitor and evaluate over the Internet patients with implantable defibrillators from their homes.

"This is a major improvement for defibrillator patients, who are typically very focused on their devices," says Dr. George Crossley, director of electrophysiology at Baptist Hospital in Nashville. Defibrillators help regulate the heartbeats of patients with arrhythmia, or irregularly fast heartbeats. "If you or I are sleeping at night and our foot jumps, we won't really pay attention to it. But a patient with a defibrillator will immediately assume it was the device, thinking there's a problem with their heart."

This sort of ultrasensitivity usually results in anxious calls and needless visits to the doctor, who checks the patient and the defibrillator with special equipment in the office. "Nine out of 10 times, we end up patting the patient on the back and telling them to go home, everything is OK," Crossley says. Using Medtronic CareLink Monitor, patients transmit data from their defibrillators by placing a handheld device over their chest. Information from the defibrillator is transmitted into the handheld device, which is plugged into a telephone jack, and sent securely via a standard phone line to a Medtronic database. Doctors retrieve the information from the database via the Internet from their offices, hospitals, or homes.

With this data in hand, doctors can instruct patients on whether they need to be seen, or they can prescribe other treatment such as medication. And there's another benefit: The reduction of unnecessary office visits by defibrillator patients indirectly helps patients in need of immediate appointments, Crossley says. Physicians can also use the Medtronic CareLink Monitor for regular periodic checks to see how well patients' defibrillators are functioning. The CareLink Monitor works with an existing Medtronic defibrillator model. The manufacturer is seeking FDA approval for the monitor to be used with other Medtronic defibrillator models, as well as with Medtronic pacemakers and heart-failure devices.

Baptist Hospital is conducting a pilot of about a dozen patients with the CareLink Monitor, Crossley says. Medtronic plans to make the device widely available by midyear; it also plans to offer CareLink patients access to their own secure Web pages to view the performance of their heart devices. Health-care providers using the CareLink Monitor network will pay a fee, which hasn't yet been determined. Medtronic is negotiating with health-care insurers about a co-payment arrangement in which patients would pay part of the cost, with the rest covered by insurance companies and health-care providers.

The biggest benefit of the CareLink network to the health-care industry is cost-savings through the elimination of unnecessary doctor visits, Crossley says. That alone could stand to tantalize the industry into supporting the widespread use of medical-informatics technology.