Pictured to the right is the typical method of file storage for doctor offices, especially in rural areas. A current objective and focus of government health officials is to see that this ancient and inefficient method of information storage be replaced with modern computer based Information Technology. I see this process occurring in two distinct steps. First, local doctor offices need to adopt and become comfortable with simple file server technology. This means that doctors will replace pencil and paper with light weight laptop PC's or room dedicated PC's when seeing patients in his/her office. A follow on second step will be the establishment of Internet based centralized patient database storage including a full complement of encryption and file locking technologies. These technologies are, of course, required to limit access to and protect the privacy of patient records.

This network, of course, belongs to the military and serves the millions of service personnel in the military. Unfortunately, it is currently steeped in Microsoft technology. Generally hated by doctors, and costing many billions of dollars, it appears to be a total debacle of the past Bush administration. In contrast, the Veterans Administrations has it's own health care system called VistA. Information on this friendly and open source system can be found here. Once again, taxpayers foot the bill for a largely hated, proprietary system when a perfectly good, award winning, solution is available largely for free. Amazing! See the links to the right for details.

This space use to detail the local "Quality Health Care Network" often used as a poster child of how medical I.T. should be done. Based on my recent research, however, this organization along with many others are about to be steam rollered by major corporate interests. I highly advise viewing the Igenix video that details what is currently happening (link near bottom of page). I also recommend reviewing the work group listing and sites involved in health care information exchange (medical I.T.) development. Many of these organizations carry the Internet .org tag in their URL's but are little more than fronts for corporate interests. I have bad feeling that the average patient will be left in the garbage dump relative to corporate bottom line profits and interests. It's the American way I guess.

The efforts by the State of Colorado relative to digitizing medical records can be found here. Senate Bill 07-196 which is now law can be viewed here. As I read the bill, there is no effort to standardize any of the file formats. In fact, a slide show on the efforts and progress of the State's Office of Information Technology has been posted on the Internet in the form of the proprietary Microsoft PowerPoint® slide show. Thankfully Linux and OpenOffice provides a simple, fast and totally free way to convert the proprietary Microsoft file formats to something standardized and that common people can view and read. The PDF version can be viewed here. The world standard Open Document version can be viewed here.. It appears that the Barrack Obama policy of Government transparency does not extend to the State of Colorado.

Sad to say, some hospitals/doctors think they both own and control your medical records. They do not of course and you have Federal law on your side in obtaining your records. Check out pages 776 and 777 of the CFR for the information and rules needed in obtaining your records. I live in Western Colorado and between two hospitals here and a west coast doctors office I soon found that none of the medical electronic record systems effectively communicated. Out of desperation to keep information from all three sources coordinated and current, I moved my basic and relevant medical records out from under HIPAA and to my own file server. The records are now current, correct, controlled by me and accessible nearly instantly on a world wide basis.

Doctor's offices I've visited that use file server technology typically use some flavor of the Windows operating system. A major potential problem with this is the lack of world wide, clearly defined, file formats. Tissue samples, for example, are routinely routed all over the planet in order to get an expert read or medical opinion relative to the sample. It obviously would be a great help if doctors and equipment makers, world wide, had access to a common set of I.T. standards, preferably in the public domain, to use or build equipment against. Another area in dire need of reform and standardization is the basic information every doctor needs before treating a patient. This includes but is not limited to such simple things such as contact information, billing information, simple medical history, allergies, current medications etc. As an example, an excellent file format standard for use with this information would be the universal XML standard. A 2nd file standard example that could be used with graphic or scanned information is the DjVu file standard first developed by AT&T Labs in 1996. Current proprietary Microsoft based solutions are expensive to purchase now and will be even more expensive in the future to phase out or change to needed or desired universal worldwide standard(s).

Dragon Voice is a speech to text software package that is either central server based or runs on the Windows operating system. I recently had the opportunity to visit a wrist and hand specialist on the West Coast. Dr. Ross Nathan either uses Dragon Voice or an application that is very similar. He was able to do an examination of my hand while verbally dictating his finding into the voice to text application. While I asked about treatment options and prognosis, Dr. Nathan verbally dictated his answers into the computer. The end result was a fully formatted report that I was able to take with me. All of the above took only a few minutes and, of course, provided him with a permanent electronic record of his diagnosis and treatment. The report also included the necessary diagnostic ICD-9 and treatment CPT codes necessary for billing. All in all, my visit to this doctor's office was very impressive and efficient. In my opinion, his systems and methods are what the medical profession is coming to.

The radiologic image to the right is an example of what I feel will become the norm rather than the exception. It was produced by an InSight Fluoroscan unit. This unit produces instantaneous high resolution images on a display monitor instead of on film. The direct to digital imaging technology results in a very low radiation dose to the patient while producing an image output that can be captured, printed and stored much like any other computer data. In this case and on a daily basis neither the doctor nor his assistants wear any protective equipment. They do, however, wear a radiation monitoring badge as a precaution against excessive radiation exposure. Needless to say, such images can be easily transmitted to any place on the planet via the Internet. The only requirement is that receiving and display systems be compatible with what is being transmitted. Links to radiologic direct digital imaging technology can be found in the links section to the right. This technology is used in several other fields of medicine.

This page should not necessarily be interpreted as an endorsement of the above mentioned doctor's medical qualifications or expertise. You and only you are able to make such a personal decision. This page is about the use of Information Technology in the medical field. The Hand & Wrist Center is one of the best I have visited in this regard.

The application of well organized and standardized Information Technology principles to the medical field have to potential to revolutionize record keeping, diagnostics, bill paying among other functions. In my view, the sooner the revolution happens the better it will be for everyone.

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• Veterans VistA System
• VistA Home Page
• VistA Described
• VistA Described II
• VistA In Depth
• AHLTA A Failure?
• Military Medical Health
• Military ALHTA System
• Military Health Slide Show

• National Systems Integrator
• Ingenix/Axxolotl Video
• IT Workgroups List
• Sys.Certification Commission
• Standards Group
• Gov. Health Info. Net
• Another Info Exchange Org.
• Natioinal Organization Listing
• Another Standards Group
• Yet Another Solution?
• Interoperability Issues Site
• Financial Management Org.
• The Challenge

• Damned Data
• Relevant CFR Rules
• Medicare Electronic Filing
• HIPAA Rules Summary
• The XML Standard
• DjVu File Standard
• Wrist & Hand Center
• Hologic Corporation
• Direct Digital Imaging

• Colorado Health Infor. Technology
• HIT News Bulletins
• Colorado Regional Health
• Patient Bill of Rights - Records
• QHN Slide Show
• QHN History
• Health Forum Site
• Most Wired Site