Examine | PACS: A Conversation with . . . Matt McLenon

In this Q&A, the founder and CEO of Softek Solutions Inc. (www.softek-illuminate.com) tackles the problem of how to use the free-text information in electronic health records to drive clinical decisions using Illuminate, a PACS add-on product that works much like a Google search engine.


rt image: Why has it traditionally been difficult for radiologists to find previous cases, information, and images?

Matt McLenon: The primary reason for difficulty is that most, if not all, PAC systems have taken a traditional, structured approach to organizing information, typically using relational models. The problem is that these systems are optimized for collecting and storing data, with efficient access only along a few dimensions.

In many cases, it is computationally-prohibitive to find information along these other dimensions, and so, the data is effectively inaccessible. Illuminate augments these traditional designs by optimizing the retrieval of information that is virtually trapped by these systems.


image: What are some of the capabilities for searching, saving, alerting, and sharing information with Illuminate? 

McLenon: Illuminate brings many great benefits to clinicians that weren’t previously available from any other solution. First and foremost, Illuminate indexes the unstructured data within the PACS and makes it accessible in a matter of milliseconds, regardless of the size of the repository.

We also keep an unlimited history of searches, allowing us to improve the accuracy of the search engine over time by analyzing how people search for medical information. If you want to track specific patients prospectively through the care-delivery process, you can easily register interest in those patients using Illuminate.

You will be notified when future imaging studies have been completed or when changes to their existing studies occur. Doctors are excited about the “virtual community” that we have created, where they can share their thoughts and ideas collaboratively with the entire radiology team.

This can be done easily in several ways; first, with our interesting case libraries and second, our tagging capabilities. Tagging is a much more natural way for the clinician to arrange, organize, and track their ongoing work with noteworthy patient cases.


image: How does having instant access to free-text information in the electronic health record help drive clinical decisions? 

McLenon: Before now, information in the PACS was virtually trapped and could not be retrieved in a timeframe that allowed doctors to affect the clinical decision process. With Illuminate, now it can. The free-text in the body of radiological reports accounts for the majority of the clinical information.

With quick access to that information, clinicians can make informed decisions on care.
Safwan Halabi, MD, of Detroit-based Henry Ford Health Systems states, “From a clinician’s standpoint, the ability to quickly mine report data allows for myriad clinical improvement opportunities.

For instance, a urologist performing robotic prostatectomies wants to find out how many patients had surgical complications that require CT-guided abscess drainage. A quick search of the CT drainage procedure and the referring clinician that performed the procedure yielded 30 cases in the last five years. This data would be used to help identify what patients and surgical technique was used to prevent future complications.”


image: How does this product help researchers, educators, and hospital administrators?

McLenon: From an administrator’s standpoint, report audits may be performed to make sure that the radiology enterprise is correctly billing for procedures, in addition to making sure that there is CMS compliance for any bonus reimbursements available.

This will also help radiology departments prove to entities like CMS that correct reporting is being performed. From an educator’s standpoint, Illuminate’s tagging feature provides hot-keys that allow quick identification of studies for teaching cases without leaving the daily workflow.

With the searching features, additional cases can easily be identified to complete the teaching presentation.  No longer will an educator have to wait to accumulate cases in a folder or three-ring binder.

From a researcher’s point of view, groups of studies exhibiting similar characteristics, like findings or diagnoses, can quickly be identified using advanced search criteria. New studies can be found by using “Saved Searches,” and “Alerts” can be set to track patients as they return for continued care.


image: How long does it typically take for Illuminate to be implemented?

McLenon: Less than a day! Softek Illuminate begins crawling as soon as it is connected to the PACS. In less than an hour, data is available to begin searching. Depending on the volume at the institution, a complete backload of data can take anywhere from a few hours to a few days. It literally works out of the box.


image: Version 2.0 of Illuminate will be introduced at RSNA. What are some of the new features and what drove you to make those changes?

McLenon: First of all, Illuminate is focused on information retrieval, whereas traditional systems have mainly focused on information gathering. So we are thinking about this from the opposite angle of traditional systems design. Secondly, exciting ideas and uses have emerged as customers use Illuminate – they are beginning to think differently.

The introduction of instant search has opened up a whole new realm of possibilities, which means radiologists and clinicians are now discovering new ways to improve the healthcare process. This, in turn, is what has been driving the development process on Illuminate.

Make no mistake, the boundaries have been moved substantially and the innovative uses doctors are inventing are occurring weekly. It is really exhilarating to be working on a product that is this revolutionary.

Here are some of the highlights of our new capabilities included in our next release: Doctors can now be alerted when a patient undergoes additional imaging studies, allowing them to confirm prior diagnosis and insure their recommendations for additional imaging are followed through with and in a timely manner.

The first evolution in the sophistication of our search and indexing algorithms has been completed giving radiologists and clinicians faster access to what they are truly looking for.
We now keep an unlimited history of searches allowing us to over time improve the accuracy of the search engine by analyzing how people search for medical information.

Users have already enjoyed how seamlessly we fit into their workflow, but now have even easier use with the introduction of certain quick keys for common tasks. We have worked with radiologists and eliminated at least one time-consuming task that is done on every patient with prior studies.

This adds up to greater productivity from this point forward. We have also expanded the availability of Illuminate to all Philips iSite customers in North America by supporting all releases of Philips software.


image: Any other comments?

McLenon: Philips Healthcare and their iSite PACS product have been an excellent starting point for us because they have taken an open platform approach, allowing companies to build value-added functionality easily.

At their recent annual user group conference, one of the key speakers and industry visionary, Paul Chang, MD, of the University of Chicago, made an interesting point. He likened PACS to the operating system of a computer and the add-on products like Illuminate to the applications we choose to run on our computer.

The computer operating system (i.e., PACS) becomes the enabler for people to run the applications (e.g., Illuminate) they choose, bringing them the greatest productivity and value. I think this positions both Philips and Softek well for the future.

— Jane Kollmer