Traditionally, physicians order imaging exams based largely on their own experience and an individual patient's symptoms. The goal of the Evidence-Based Medicine System is to provide physicians with the unprecedented ability to compare a single patient's symptoms with thousands of other relevant patient histories, additional pertinent medical literature, and best practice guidelines to select the most appropriate diagnostic imaging test. Once the appropriate test is performed, physicians caring for the patient will be immediately notified on the availability of images and text reports, so important clinical decisions can be made in a timely fashion.
GE Medical Systems, Brigham and Women's Hospital, and Medicalis Corporation, a company that was formed to commercialise innovative evidence-based decision support solutions initially developed at Brigham and Women's Hospital, collaborated on the system which is being rolled out in phases. "The future of health care and clinical decision-making will rely heavily on the practice of evidence-based medicine, a notion supported by national organisations such as the Institute of Medicine", stated Dr. Ramin Khorasani, Vice Chairman, Department of Radiology and Director, Center for Evidence-Based Imaging, Brigham and Women's Hospital.
"Imaging technology is a critical tool, though recent data suggests that between 10-30 percent of imaging studies ordered for patients may be inappropriate, which could lead to increased costs, misdiagnosis and sub-optimal care", stated Matthew Van Vranken, chief operating officer, Brigham and Women's Hospital. "Evidence-Based Medicine solutions, including those involving imaging, are a significant step in helping doctors have the right information in real time to determine the best tests for their patients."
As part of its ongoing commitment to improved patient care, GE, in collaboration with Medicalis and Brigham and Women's Hospital, has led the integration of databases including imaging files, patient data, and other relevant medical information at the hospital, giving doctors the precise information they need from seemingly endless amounts of data. Brigham and Women's Hospital alone generates nearly two terabytes of imaging data each month, which is stored and protected with highly reliable networked storage systems from EMC Corporation, specialised in information storage. This is equivalent to one billion pages of single-spaced text. Laid end-to-end, those pages would encircle the earth four times.
"GE Medical Systems and Brigham and Women's Hospital believe the new system will enable physicians to function in a filmless and paperless environment, improve the efficiency and quality of care, and result in faster and more accurate diagnoses, while ultimately reducing medical errors", stated Gary Gottlieb, MD, MBA, Chief Executive Officer, Brigham and Women's Hospital.
Prior to the installation of the Evidence-Based Medicine System, doctors would either simply call in a request for an imaging test or, less frequently, consult a radiologist to determine what test to order. In a busy physician's practice, it is generally impractical to search for and retrieve the best information about appropriate testing from the ever-growing volume of information, especially when a decision needs to be made quickly. As a result, doctors rarely have the opportunity to learn what tests have been effective for patients with similar symptoms, other than through consulting with colleagues with similar experience.
Following is an example of how the Brigham and Women's Hospital system will work when all phases are completed. A doctor sees a patient with certain symptoms, such as generalised abdominal pain. The doctor enters the symptoms in a Web-based application developed by Medicalis, using a desktop computer, or a wireless device such as a tablet PC. The system will analyse the symptoms and simultaneously compare them against many thousands of patient records with similar symptoms; relevant data published in medical literature; best practice guidelines, as well as crosscheck for potential problems such as contra-indications.
The system then offers the doctor a suggestion, such as: "Dr. Smith, the last 10.000 MRIs done for these symptoms were normal; you should consider a CT exam which, in patients with similar symptoms, has yielded positive results in 10 percent of cases." The physician then decides whether or not to follow that suggestion based on other information that she has at her fingertips. If she chooses to order that specific exam, she or her supporting staff schedule the test electronically using a secured site on the Internet that protects patient confidentiality.
The patient undergoes the imaging test at Brigham and Women's Hospital. The digital images are provided to the radiologist and stored and protected with networked storage systems from EMC. Finally, the requesting physician is notified on her preferred device that the multimedia report, including the text and images, is available for review. The data from the imaging test is then added into the growing evidence-based database and stored for use with subsequent patients.
Brigham and Women's Hospital is a 721-bed non-profit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. The hospital's pre-eminence in all aspects of clinical care is coupled with its strength in medical research. A recipient of research grants from the National Institutes of Health, Brigham and Women's Hospital conducts internationally acclaimed clinical, basic and epidemiological studies. The Center for Evidence-Based Imaging, launched in the fall of 2002 with a gift from EMC Corporation, allows world class scientists to use innovative information technology solutions to help improve quality of care by generating and delivering knowledge at the point of care.
Medicalis Corporation focuses on Evidenced-Based Medicine and the enterprise-integration that inserts real time decision support into clinical work flows, Providing Knowledge for Life. The company's solutions strengthen the tie between the physicians who order diagnostic tests and therapies, and the hospitals and ancillary facilities that deliver them. Closing the clinical work flow loop of the ordering/scheduling/notification/results-distribution/follow-up cycle, Medicalis helps health care institutions to decrease unnecessary variability of care and reduce medical errors, while monitoring the improvement of resource utilisation and the optimisation of revenues and costs.
GE Medical Systems is specialised in medical imaging, interventional procedures, health care services, and information technology. Its offerings include networking and productivity tools, clinical information systems, patient monitoring systems, surgery and vascular imaging, conventional and digital X-ray, computed tomography, electron beam tomography, magnetic resonance, ultrasound and bone mineral densitometry, positron emission tomography, nuclear medicine, and a comprehensive portfolio of clinical and business services.