Top 10 Myths in Health IT

A talk given during Kuwait eHealth camp Dec. 2011

When viruses attack ICU

Intensive Care Units (ICU) are places in hospitals where people with special care are placed. Those people need continuous monitoring for there condition. These units are normally equipped with high tech patient monitor machines, ECGs, and ventilators.

Furthermore, ICU's normally keep higher standard of infection control to make them invulnerable to all kinds of infections due to the critical condition of it's patients.

e-Infection !

Last, week I was in Al-Amiri hospital, Kuwait. I was doing maintenance to a portable xray machine. There, I was struck with a view on all PC screens. Those PC's were running Critical Care Information system. In fact, all screens where showing a Mcfee Virus Alert. The list; as you see above, is showing multiple virus infections.

Even though ICU was equipped with high-tech patient monitors, ventilators and looked very clean and dis-infected, but it was; actually, infected with a special infections. These infection have no direct harm to the patient but they eventually do a harm !

How does a computer virus threatens life?

In these days, patient monitoring is not done at each bed. Each patient is monitored centrally by nurses & medical staff; i.e., at the nurse station. Thus, interruption in flow of clinical data between patient monitors and central monitoring system will definitely interrupt monitoring the vital signs of critically ill patient's .

Second; at critical care stations, physicians make electronic requests; i.e., for lab or imaging procedures. Virus infections can make those PC's slow or make them completely down by corrupting some files. In fact, delay in exam requests is definitely a life threatening .

Third, at critical care stations, physicians write there reports, notes or prescribe patient's medication. Virus threats on those stations; again, will delay the whole process at the ICU. Delay is not a good sign of a good ICU.

On the ground..

Frankly speaking, this ICU was not the only place in Ministry of Health where I have seen such virus attacks. Many places like neonatal ICUs, Radiology Departments, Cardiology, and Nuclear Medicine had the same issue.

In 2008, one year after world-wide attacks of a well know electronic warm(special viruses). the warm(or Trojan) with different names such as (DownaDop, Conficker, etc...) have hit most of ministry's information systems in a mater of a week. Moreover, xray and ultrasound machines were also hit by this warm specially those with MS-Windows XP were badly hit. Around 6 Xray machines went totally down due to network problems.

Finally, we have to admit that hospitals in Kuwait are in trouble ! In near Future we might see a crisis due to the fact that the no. of medical equipment getting connected using TCP/IP networks is exponentially growing.

Problem and Solution !

The problem is not actually the "virus attacks", virus attacks happen every day and everywhere, the problem is lack of network security , and maintaining that ! In fact, If you are connected to the outside world then you are at risk ! you don't have to be connected to the internet, allowing use of removable storage devices (i.e. USB sticks) is the biggest source of invulnerability.

The solution is not easy but affordable and better to start now than never.Effort to set standards for security in eHealth and for medical devices is going on. HIPAA is one example of such standards. HIPAA is a governmental act in USA to assure security and privacy of patient's health records. Some of these requirements are securing health records from viruses.

Moreover, and effort was taken by U.S department of veteran affairs to design a model for secure network of medical devices. See Excellent readings. Another effort was taken by Society of Hospital Information Mangament Systems (HiMSS) to encourage a medical device security disclosure like DICOM conformance statement. See Excellent Reading below.

In Kuwait, the gap is very huge. We should immediatly start some where. Niether we have IT team in hospital nor Biomedical Engineering departments have experience or a say in this.

Thus a very rough plan should be divided into three stages.

• Stage 1. Putting IT security standards on our list of priorities.

• Stage 2. Forming an independent IT support team in the hospital independent from medical device vendor. If MOH claims that they don't have enough resources, IT team doesn't have to be through local staff, IT can be outsourced just like electrical maintenance or waste Management .

• Stage 3. To Include IT support, Network management , and network security in medical device RFP, and the service contract (service level agreement.)

Excellent Readings..

1. When medical-device gets sick. Ellen Messmer, NetworkWorld.com, 2004
2. Medical Device Isolation Architicture Guide, Department of Veterain Affairs, USA. 2004
3. Trends in Medical Device Security. HiMSS.org (Bibliography)
4. Cybersecurity for Medical Devices.Scott Bolte, GE Healthcare, 2005

Big names make big mistakes

Did you recently login to Q8PACS Blog ??
Did you notice the FDA IT recall list ??



Today, I have loged in to Q8PACS Blog and; as usual, I was checking FDA IT recall list.

This time I noticed some thing special in the list. This time in that list we had products from all BIG names (see image on top)

This observation can bring many lessons to our imaging community. Some of these lessons are:

Big names can also make mistakes ..
Some times their mistakes are as big as their name.

PACS recalls: wrong measurement.
Majority of PACS Recalls are due to wrong measurnment by medical software. Those wrong measurment will definitely affect a diagnosis or a treatment plan. It's time to start QC program for PACS Workstations.

PACS is a medical devices ..
Medical IT software are medical devices that are governed by medical device regulations. If you don't have those regulations.. make them !t are governed by medical device regulations.

Majority recalls are class 2.
Class 2 recalls are due to deficts which can have potential to cause serious injuries.

Take the effort and watch recalls.
Take the effort to improve safety of your patients by watching FDA recalls.


Share your thoughts with us by writting a comment !

Virtual Conferences..

"PACS In Age of Change.." was the title of the first virtual conference by Auntminnie.com. The event was held online on November 17, 2010 at 11 a.m. USA Eastern Time.


This was my second time to attend a conference. My first chance was during SIIM 2009.


At that time I have logged-in to website. Logging in was much easier than reaching the Charlotte Convention center during SIIM2009. In Charlotte, I had to pay for car parking lot .. i got ticket on first day :).. and I was lost in down town Charlotte .. but this time loggin in was in a minute (of course I had to give my kids some candy to keep them away from me) !!

After logging in was the menu page, which is similar to SIIM2009 lobby floor. From there I had the choice to go to different sections of the event (i.e, lounge, auditorium, helpdesk, exhibit hall, etc..) 

Thereafter, I wanted to catch the first talk by my favorite speaker:  Eliot Siegel Chief of Imaging services at University of Maryland Medical Center and Professor; Vice Chair, University of Maryland School of Medicine Department of Diagnostic Radiology. The title of his talk was "Redesigning Your Radiology Department to Save Body and Mind"

Mr. Siegel's talk was about design of radiology reading rooms and design elements which insures proper reading of digital images and improve productivity in service. He started with design of reading room in old days (analogue) and from there he compared to reading rooms in digital era. 

Dr. Siegel pin-pointed at several issues; i.e, effect of ambient light on reading productivity, Room temperature, integration with information system, acoustics (i.e, noise due to MR machine)

Affect of ambient light on fatigue

Effect of monitor brightness on reading time

Later I have attended the exhibit hall where I found medical software/hardware vendors. See below. In the exhibit hall I had the chance to chat with representatives of those vendors specially McKesson and Barco. McKesson is a very well known Healthcare, and Imaging IT vendor in NorthAmerica. Barco is top manufacturer of medical grade monitors. Barco representative gave his view on Q8PACS case study about monitors in Kuwait.

Exhibit Hall

Chatting at the exhibit hall.

Later, I decided to take a virtual beverage; so, I had to visit the lounge. At the lounge I met many participants who were chatting like real lounge. I exchanged my views about the virtual conference and about the talks..

Chatting with other participants at the lounge

My overall impression was great about this event and hope that Auntminnie will repeat this experience again.

This event was organized by Auntminnie.com and virtual service provided by InXpo.com 

This experience was very good that we in Kuwait should think about organizing such event which (I'm sure) saves a lot of money which normally goes for the venue and Catering :(  .. Hope we can see Kuwait Imaging Informatics events in virtual world on 2012.

Happy new year !! Many hands...

PACS Club members during seminar in Dubai 2008
Suad, Iman, xxx,  Haifa, Saud, Zaheer, xxx, Mutairi,  Al-Seyeed, Ossama, Hashir, AbdulMuqeet, Hamad, Al-Eidan, Herman, Bader, xxx

If we get together,

We can do the impossible !!

If we stick together,

No body can break our unity !!

If we dream together,

Our dream can become true !!

If we think together,

Our imagination becomes reality !!

If we pray together,

Allah accepts from one to all !!

If we put hands together,

We can lift as much weigh as many hands are there !!

If we focus together,

All power will go into one direction !!

If we do "PACS" together,

Our imaging systems will have high "utilization rates" !!

If we grasp above together,

We all will have a "Happy new year" !!

PACS Group of Kuwait 1st Meeting

PACS Professionals training. Courtesy of Q8PACS  (2008)

" Finally, an official group
for PACS Admins is formed..
It's a place were PACS
Admins can speak out."; PACS Admin said.




On Dec.27th 2010 the first meeting of the PACS group of Kuwait was held at Mubarak Hospital. The group is the official committee formed by Radiology Council. Dr. Salwa AlKanderi head of radiology council announced establishment of this group to re-organize the operation of PACS in Radiology departments and to hear from PACS admins. PACS Group of Kuwait is lead by Dr. Salwa Haidar, a pediatric radiologist at Mubarak hospital and consists of at least one member from each radiology department in MOH hospitals.


In their first meeting, two posts were selected. Saud AlSaif; Senior PACS Admin at Amiri hospital was announced as deputy of the group and Abeer Hajiya; Senior PACS admin at Mubarak hospital at Mubrak Hospital was announced as Group officer.


In that meeting, members introduced themselves to each other and shared some of the problems they are facing in their daily work. 


The discussion about problems was lengthy which shows the amount of issue they are facing. These problems ranged from issues like financial benefits to technical difficulties.For example, mobile phone bill which they have to pay from their own pocket and technical issues like patient image exchange using CD and difficulties referrals are facing to view those images. Moreover, during that meeting a member of the group  brought up a technical issue they are currently facing in their hospital which stunned every body !    That was an issue of a huge image loss in their archive. That hospital lost approximately 12000 images from their Short-term storage and more from their Tape-Library due to tape warn out !!


The meeting was concluded by Dr. Salwa by promising every body to work hard to pass their needs and voices to the radiology council which will eventually take the required action. 






Should you have any suggestion (or best wishes) to the PACS Group of Kuwait ? please write them down in below form.

Contest Winner Nov. 2010

THE WINNER of last month Dr. Salwa Hayder. Pediatric Radiologist , MubarakHospital. _________________________ Contest award: 160GB USB HDD. Mubarak Hospital (~800 bed hospital) is undergoing it’s third generation PACS. In the third time, radiology department realized that they cannot depend on vendor in setting their PACS/RIS requirements since they suffered a lot win their previous PACS Archive got full. They decided to help the vendor by putting their requirement in the form of an RFP. Even though this RFP contained fatal mistakes, but it was certainly better than leaving every thing up to the vendor. Their RFP writing process included PACS Storage calculation with help of their PACS Administrator Mr. Sadiq bin Hussein and Mrs. Abeer Hajiya.		َ Online contest Nov.2010 ..
		Dear All, After Long time, announcement of the winner of last month’s online contest is here. She is Dr. Salwa M. Hayder who is known for her care to patient and to her career. Quality at work was one of her motivation to fight for the best. On behalf of Q8PACS we send her our best wishes and hope that she can bring her qualities to people around her. · Interviewing the winner How do you find the contest in general ?     Dr. Salwa:  Very interesting and challenging. How hard was the contest questions ?     Dr. Salwa:  I believe it was hard especially it asked for some details which is out of my specialty, mainly  medical engineer will know it. Did you do little research to answer the contest questions ?    Dr. Salwa:   Yes Do you think that details about HL7 messages, Diagnostic Monitors or any other PACS/RIS option should be added to the Tender document (RFP) ? why ?   Dr. Salwa:   I think its better to cover all the details in the tender to make sure the system will work smooth with other hospital systems. Do hospitals in Kuwait verify if these requested options are delivered with PACS/RIS ?  Dr. Salwa:   I know that they mainly insist on having HL7 compatibility with no more details.          Thank you · Contest and Solutions Q1. What is the “eSec Login” option is ? A1. “eSec” is abbreviation of eSecurity.. which is a security option which allows radiologists to login to Centricity RIS using a magnetic card, which obviously requires a card reader Hardware. Q2. List three HL7 messages usedcommonly in Kuwait? a. ADT .. Patient admission and registeration. b. ORM .. order messages c. ORU .. Observation result (report) References : HL7 Messages | Corepoint Health Q3. List three requirements of Medical Diagnostic Monitors. A3. a. Spatial resolution (Mega Pixel) b. Contrast resolution (Bit/Pixel) c. Brightness (cd/m2) .. more .. References: Guidelines on the Specification of Diagnostic Display Devices Q8PACS Blog. http://q8pacs.blogspot.com
			This Month's .. Win 16GB/3G/Wifi	برعاية ..