William Osler Health Centre Chooses mTuitive’s xPert for Pathology to Meet CCO Standard

Press Release

FOR IMMEDIATE RELEASE

Contact: 
Mike Valentine, VP North American Sales
mike.valentine@mtuitive.com
508.771.5800 

-October 31, 2009-

William Osler Health Centre becomes the thirteenth Ontario hospital to implement xPert for Pathology

Boston, MA – William Osler Health Centre in Brampton, Ontario, has selected mTuitive’s xPert for Pathology synoptic reporting solution to meet Cancer Care Ontario’s 2008-2009 CAP/CS aligned data standard for pathology reporting.

Standardized pathology reporting increases the availability and consistency of cancer pathology information that is essential for treatment decisions, evaluation, and research.

mTuitive complies with the 2008-2009 CAP/CS aligned data standard developed by Cancer Care Ontario in conjunction with the College of American Pathologists (CAP) Cancer Committee, the Centers for Disease Control and Prevention and the American Joint Committee on Cancer. The CAP checklists¹ for breast, lung, colorectal, prostate, and endometrium were amended to include the mandatory pathologic collaborative staging elements.

xPert for Pathology interfaces with all available Pathology and Laboratory Information Systems on the market which lends itself to wide use throughout the province.  Other Ontario hospitals utilizing mTuitive’s xPert for Pathology synoptic reporting solution to meet the CCO data standard include Thunder Bay Regional Health Sciences Centre, The Scarborough Hospital, North York General Hospital, Lakeridge Health, Sunnybrook Health Sciences Centre, Rouge Valley Health System, Bluewater Health, Peterborough Regional Health Centre, Cambridge Memorial Hospital, Stratford General Hospital and Sudbury Regional Hospital.

About mTuitive: mTuitive, Inc. develops data capture and synoptic reporting software to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines. Our unique method of capturing structured information provides valuable data for pathology, oncology, and cancer staging applications. Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com.

1. This material includes the Cancer Checklists and Cancer Protocols which are copyrighted works of the College of American Pathologists. Encoded within the Checklists are portions of the copyrighted work of the International Health Terminology Standards Development Organization, SNOMED CT. © 1998-2007 IHTSDO. The Cancer Checklists and Cancer Protocols are used with permission of the College of American Pathologists – which has also authorized use of SNOMED CT as encoded in the Checklists.

mTuitive and Sudbury Regional Hospital Achieve 100% Compliance with CCO Data Standard

Press Release

FOR IMMEDIATE RELEASE

Contact: 
Mike Valentine, VP North American Sales
mike.valentine@mtuitive.com
508.771.5800 

-October 13, 2009-

mTuitive and Sudbury Regional Hospital Achieve 100% Compliance with CCO Data Standard

Boston, MA – In August, as part of the Cancer Care Ontario Synoptic Reporting project, Sudbury Regional Hospital went live with mTuitive’s xPert for Pathology synoptic reporting system.  Today, Cancer Care Ontario announced that Sudbury has reached 100% compliance with the 2008-2009 College of American Pathologist/Collaborative Stage-aligned data standard adopted by Cancer Care Ontario.  The current standard, Phase I, includes five disease sites:  Breast, lung, prostate, endometrium and colorectal.

“Sudbury Regional Hospital pathologists work in a busy environment, reviewing a large number of tests daily that are critical to the health and treatment of its patients. A user-friendly and reliable solution was required that would provide simple, efficient and accurate reporting, while also satisfying provincial certification standards. We are pleased to have achieved 100% compliance with these standards,” stated Dr.Anna Bojarski, Chief of Pathology at Sudbury Regional Hospital.

Sudbury licensed the MEDITECH Pathology Transcription Suite which mTuitive leveraged to send results back to MEDITECH using HL7. xPert for Pathology is launched directly from within MEDITECH, the template is completed by the pathologist, and the data is then sent across the ‘Results In’ portion of the interface into the desired data sections within MEDITECH.

“Our hospital looks for products and services that support a project through implementation with solid technical knowledge, a willingness to work with existing systems and strong end user education. These factors led to a smooth implementation of electronic Pathology synoptic reporting”, stated Mark Hartman, Interim Vice President for the Regional Cancer Program.

mTuitive is preparing its customers for Phase II of the project which will include the entire set of more than seventy College of American Pathologists Cancer Checklists.  mTuitive already provides the full set of CAP checklists to its customers, and will be updating them and including them as part of the 2010 CCO standard when it becomes available.  Because most current customers report all cancers synoptically via xPert for Pathology, they are very well prepared for Phase II. 

Current mTuitive customers in Ontario include: Lakeridge Health Corporation, Thunder Bay Regional Health Sciences Centre, North York General Hospital, Sunnybrook Health Sciences Centre, The Toronto East General Hospital, Kingston General Hospital, The Scarborough Hospital, Rouge Valley Health System, Peterborough Regional Health Centre, Bluewater Health, Cambridge Memorial Hospital, Markham Stouffville Hospital, Stratford General Hospital and William Osler Health Centre. mTuitive has already helped eleven of these hospitals go live with synoptic reporting and meet the Cancer Care Ontario certification standards.

About mTuitive: mTuitive, Inc. develops data capture and synoptic reporting software to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines. Our unique method of capturing structured information provides valuable data for pathology, oncology, and cancer staging applications. Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com.

1. This material includes the Cancer Checklists and Cancer Protocols which are copyrighted works of the College of American Pathologists. Encoded within the Checklists are portions of the copyrighted work of the International Health Terminology Standards Development Organization, SNOMED CT. © 1998-2007 IHTSDO. The Cancer Checklists and Cancer Protocols are used with permission of the College of American Pathologists – which has also authorized use of SNOMED CT as encoded in the Checklists.

Virtual Autopsy Table

Take a look at this virtual autopsy using a Microsoft Surface table.  Structured data capture solutions created with mTuitive’s Agile Author would be nice supplement to this emerging technology.

The Virtual Autopsy Table from NorrköpingsVisualiseringscenter on Vimeo.

Stratford General Hospital Chooses mTuitive’s xPert for Pathology to Meet CCO Standard

Press Release

FOR IMMEDIATE RELEASE

Contact: 
Mike Valentine, VP North American Sales
mike.valentine@mtuitive.com
508.771.5800 

-September 15, 2009-

Stratford General Hospital becomes the twelfth Ontario hospital to implement xPert for Pathology

Boston, MA – Stratford General Hospital in Stratford, Ontario, a member of the Huron Perth Health Alliance, has selected mTuitive’s xPert for Pathology synoptic reporting solution to meet Cancer Care Ontario’s 2008-2009 CAP/CS aligned data standard for pathology reporting.

Standardized pathology reporting increases the availability and consistency of cancer pathology information that is essential for treatment decisions, evaluation, and research.

mTuitive complies with the 2008-2009 CAP/CS aligned data standard developed by Cancer Care Ontario in conjunction with the College of American Pathologists (CAP) Cancer Committee, the Centers for Disease Control and Prevention and the American Joint Committee on Cancer. The CAP checklists1 for breast, lung, colorectal, prostate, and endometrium were amended to include the mandatory pathologic collaborative staging elements.

xPert for Pathology interfaces with all available Pathology and Laboratory Information Systems on the market which lends itself to wide use throughout the province. Other Ontario hospitals utilizing mTuitive’s xPert for Pathology synoptic reporting solution to meet the CCO data standard include Thunder Bay Regional Health Sciences Centre, The Scarborough Hospital, North York General Hospital, Lakeridge Health, Sunnybrook Health Sciences Centre, Rouge Valley Health System, Bluewater Health, Peterborough Regional Health Centre, Cambridge Memorial Hospital and Sudbury Regional Hospital.

About mTuitive: mTuitive, Inc. develops data capture and synoptic reporting software to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines. Our unique method of capturing structured information provides valuable data for pathology, oncology, and cancer staging applications. Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com.

1. This material includes the Cancer Checklists and Cancer Protocols which are copyrighted works of the College of American Pathologists. Encoded within the Checklists are portions of the copyrighted work of the International Health Terminology Standards Development Organization, SNOMED CT. © 1998-2007 IHTSDO. The Cancer Checklists and Cancer Protocols are used with permission of the College of American Pathologists – which has also authorized use of SNOMED CT as encoded in the Checklists.

An “iPhone-like” Platform for Heathcare Information Technology

I stumbled across a recent paper by doctors at Children’s Hospital in Boston that calls for a marketplace that would enable vendors to sell modules of software that meet very specific needs in an interchangeable and integratable way.  There is a website championing the cause:

http://chip.org/platform

 There are links there to the original paper in NEJM.

 I believe this is a response to the Obama funding that many believe will just entrench established vendors and poor software more deeply.

mTuitive and Sudbury Launch Seamless Integration of xPert and MEDITECH C/S

Press Release

FOR IMMEDIATE RELEASE

Contact: 
Mike Valentine, VP North American Sales
mike.valentine@mtuitive.com
508.771.5800 

-August 7, 2009-

Boston, MA—Sudbury Regional Hospital in Sudbury, Ontario and mTuitive, Inc. of Boston, Massachusetts are pleased to announce the successful integration of mTuitive’s xPert for Pathology synoptic reporting solution with MEDITECH Client Server. 

Sudbury purchased the MEDITECH Pathology Transcription Suite which mTuitive leveraged to send results back to MEDITECH using HL7.  xPert for Pathology is launched directly from within MEDITECH, the template is completed by the pathologist,  and the data is then sent across the ‘Results In’ portion of the interface into the desired data sections within MEDITECH.

“This has been the easiest MEDITECH interface implementation that I have done to date, and I have done many,” said Peter Cox who is the Clinical Applications Analyst at Sudbury.  “Working with Peter O’Toole at mTuitive made the implementation a snap.  I received data in the MEDITECH INBOX with the first message that was sent.  After a few minor tweaks, we were receiving results in the pathology data section within 10-15 seconds after the synoptic report was submitted from the mTuitive software.”

“Sudbury Regional’s talented MEDITECH users were able to seamlessly launch mTuitive from within MEDITECH C/S, creating a very smooth workflow for the pathologists,” said Peter O’Toole of mTuitive.  “Then our HL7 messaging infrastructure combined with the MEDITECH transcription interface provided a reliable, rock solid, and very fast way to put results back into the pathology report, almost instantaneously.”

Current mTuitive customers in Ontario include:  Lakeridge Health Corporation, Thunder Bay Regional Health Sciences Centre, North York General Hospital, Sunnybrook Health Sciences Centre, The Toronto East General Hospital, Kingston General Hospital, The Scarborough Hospital, Rouge Valley Health System, Peterborough Regional Health Centre, Bluewater Health, Sudbury Regional Hospital, Cambridge Memorial Hospital and Markham Stouffville Hospital.  

mTuitive has already helped nine of these hospitals go live with synoptic reporting and meet the Cancer Care Ontario certification standards.  mTuitive is actively seeking to replicate this integration with a MEDITECH Magic customer.

mTuitive has integrated xPert for Pathology with the majority of pathology systems on the market in Canada, the United States and United Kingdom.

About mTuitive
mTuitive, Inc. develops structured data capture and synoptic reporting software with embedded clinical decision support to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines.mTuitive software improves care to the patient through quality assurance and error reduction while standardizing and automating manual reporting processes, reducing both time and labor costs. Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com.

Amazing New User Interface Makes Journey from Lab to Phone – Could the Hospital Be Next?

It’s always interesting to see the fun stuff researchers are doing and think about how research will flow into industry applications.   A good example was the multi-touch interface research by Jeff Han at NYU that quickly made its way from the lab onto the iPhone and now a part of Windows 7.

Technology Review reports on 5 extremely innovative user interfaces on display at SIGGRAPH 2009 this week (found via Slashdot). My favorite: giving a real-life Lego mini-figure a virtual bazooka.  How will these user interfaces apply to consumers? To healthcare? Time will tell.

mTuitive Press Release

Press Release

FOR IMMEDIATE RELEASE

Contact: Sarah Sloane
sarah.sloane@mtuitive.com
(508) 771-5800
Boston, MA

–August 3, 2009–

mTuitive, Inc., a Massachusetts based developer of clinical decision support applications, announced that Dr. Selig Leyser has joined the company as Product Strategist for mTuitive’s xPert for Pathology software.  Dr. Leyser worked as a surgical and clinical pathologist for 25 years. After graduating from the University of Cape Town, South Africa in 1973 with an MBChB degree with honors, he left South Africa for the USA, where he completed his residencies in Surgical Pathology, at the University of Chicago, and in Clinical Pathology, at the University of Washington at Seattle.  Dr. Leyser spent his entire career with Eastside Pathology Inc. in the Seattle area, where he served as Medical Director of Laboratories at Overlake Hospital Medical Center and Evergreen Hospital Medical Center.  Dr. Leyser was voted one of Seattle’s best doctors by two local magazines. 

Dr. Leyser is also the developer of two surgical pathology software applications, EasyPath and The Pathology Assistant.  John Murphy, mTuitive CEO, stated that “Dr. Leyser’s mix of clinical experience and software expertise make him uniquely qualified in the growing field of pathology informatics.  We are extremely fortunate to have him work with us.”

Dr. Leyser’s first project will be to manage all clinical and usability aspects of development for version 3 of mTuitive’s xPert for Pathology, which will be released this fall.  Version 3 will be the first complete system for structured pathology reporting.  Structured reporting, the next-generation extension of synoptic reporting, is a critical element of the transition to electronic health records.  Dictated or handwritten reports are not readily compatible with structured database systems that store clinical data for easy retrieval and analysis.  mTuitive structured reports capture clinical data that are directly transferred to medical record databases.  The process accelerates report delivery time and eliminates the need for (and costs of) transcription and data abstraction.

About mTuitive
mTuitive, Inc. develops structured data capture and synoptic reporting software with embedded clinical decision support to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines.  Its unique method of capturing structured information provides valuable data for a variety of clinical applications. The products allow the clinical decision-maker to conveniently receive alerts and reference materials directly at the point of care.  mTuitive software improves care to the patient through quality assurance and error reduction while standardizing and automating manual reporting processes, reducing both time and labor costs.  Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com

Dictation vs. Electronic Templates – by Rob Dean (Knowledge Engineer)

Here’s a link to an American Medical Infromatics Association (AMIA) article about a 2005 study comparing dictated operating reports with operating reports that were created using electronic templates.  Entitled “Efficiency, Comprehensiveness and Cost-effectiveness when comparing Dictation and Electronic Templates for Operative Reports,” the purpose of the study was to see which reporting method was more time efficient and captured better data.

In order to determine the strengths of each method, the study evaluated 369 surgical reports for OB/GYN procedures  – 198 individual reports generated by the “dictation group” and 171 for the “template group.”  At the conclusion of the study, the doctors found that while the operative reports created using electronic templates weren’t perfect, they did pose a significant improvement in many areas when compared with the reports generated by dictation.

Speed of Initial Entry

It did take longer to enter the dictated report than to complete the electronic template generated report – BUT, the average time difference between the two is both minimal and a bit misleading.

The average time it took a subject to enter the dictated report was 5.96 minutes (roughly 5 minutes and 57 seconds) while the average time it took a subject to complete the electronic report was 6.77 minutes (or roughly 6 minutes and 46 seconds).  So the difference in how long it takes to initially enter the information is an average of 49 seconds – that’s less than a minute!

But the real flip side is that while it’s technically (and nominally) faster to enter a report via dictation, that initial entry is only a small part of the entire timeline of an operative report.

Turnaround Time

Dictated reports may be “entered” faster, but they are not “completed” any faster.  After a report is entered through dictation, it is merely the beginning of a complicated process.  As the authors point out:

After operative reports were dictated, transcribed and accepted by the system, they were considered “complete” only when housestaff verified the electronic copies, corrected mistakes and signed them electronically. With unverified reports, housestaff frequently needs to be contacted, but returning pages are not always certain. When documents are not “completed” or cannot be located, there are delays in coding and, eventually, reimbursement.

Meanwhile, the electronic templates allowed for the surgeon to approve the finalized report and enter it into the patient’s record upon sign-out.   In addition to taking up less time and energy in the future for the surgeon, this also vastly improves the response to the patient.  In fact the study “found that the use of templates resulted in the presence of a verified operative report in the patient’s medical record (on average) within less than half of an hour compared to over 14 days for the standard dictation process (an 800-fold difference).”

In addition to the automatic filing, the electronic templates also code the procedure for recordkeeping/research purposes and also to speed up the billing process to ensure timely reimbursement to the hospital and the surgeon.

Data Capture/Comprehensiveness of Report

The team set up fifteen required sections that they believe the report had to include.  To see the listing and comparisons between comprehensiveness of the two reporting systems, please view the table here.  Out of the fifteen required sections, the electronic reports had an inclusion rate of 97% versus the 85% of dictated reports that included those same sections.

The study also brought up an interesting fact I hadn’t previously considered: by being more comprehensive and capturing more data, electronic reports can improve the billing process.  As the authors write:

There are also likely indirect financial benefits, since payment for procedures may be deferred or denied altogether when certain components of the report are not fully documented. One published study determined that 76% of dictated operative notes were deficient from a billing standpoint.

Not only does the increased data capture and required section help improve quality assurance and possible future research, but it can speed up billing and ensure proper reimbursement.

***

This is just one study.  I’m constantly searching the internet trying to find more examples of people comparing the electronic reporting with dictated operative reports.  By seeing the difference between the two – where one is lacking while the other succeeds – we can better understand how to improve a future model of reporting for medical professionals.

Has anyone seen other studies like this?  What do you all think about these results?  Please comment below.

What’s Happened to Clinical Data Capture Over the Last Five Years? – by John Murphy (CEO)

Five years ago HealthTech, the non-profit research and education organization, published a technology forecast report titled “The Future of Clinical Data Entry.”  mTuitive used this report as a guide for our product development direction.  After five years we elected to take a look and see how we did. 

The critical findings of the report are listed below in bold.  Our assessments are listed below in blue, italics.  How does your organization stack up?   Remember, this was five years ago.

1.  Clinical data entry technologies will decrease documentation time, facilitate outcomes measurement and management, and improve the accuracy and standardization of data.

• The market has been slower to develop than projected.  Some innovative organizations bought into the concept in anticipation of the value, but for the most part it is difficult to change clinician behavior unless there are immediate paybacks.  Early adopters are beginning to buy in but the adoption is still in early stage.

2.  Patients will experience second-order effects of clinical data entry technologies from faster turnover of information and reduced clerical errors.

• We think most patients are still waiting for the demonstrable benefits. In our own experience, surgeons and patients generally still wait days to receive a pathology report.

3.  Job roles will begin to change in the next two to five years as medical editors replace transcriptionists, coders become patient data specialists, and clinicians do the majority of their own entry.

• This trend is only beginning to evolve but is definitely accelerating.  Hospitals are aggressively seeking to reduce costs through the elimination of redundant processes such as transcription and data abstraction.  Coders can only code what the clinician puts in the report so the emphasis is shifting improved documentation.  Coding has become even more important as payers improve their review systems, but at its core, coding is another redundant process that will be made transparent through direct clinical data capture.  The best coders cannot code missing data.  Innovative organizations are transitioning to direct clinical data entry.  The real challenge is to make the process at least as efficient for the clinician as the current alternatives.

4.  New entry systems will facilitate the evolution of comprehensive Electronic Medical Records.

• To our chagrin, we embraced the Tablet PC as the “killer application” for clinical data entry.  Unfortunately, users did not share our enthusiasm.  For the most part, our clinician customers who do their own data entry use a keyboard and mouse.  We have integrated speech recognition into our gross pathology product to accommodate the environmental and human factors issues associated with grossing.  Our approach accommodates the capture of structured data which we believe provides advantages in both accuracy and value of data.  We will extend speech capability into other applications over the coming months.  We believe the greatest enhancement will come in the form of touch screen (kiosk like) data entry where the clinician can tap answers and review results immediately.  Preliminary feedback from our customers has been extremely positive in both surgical and pathology reporting.

5.  IT support for training and system maintenance will be critical to successful technology implementation.

• We could not agree more.  Our most effective and satisfied customers are the ones who invest heavily in training and are supported by capable IT organizations.

6.  Speech recognition technology is likely to carry the biggest impacts for healthcare as accuracy is expected to reach 98% in the next ten years. Diffusion of this technology will depend on advancements in post-processing of natural language (e.g., transcribing “BP 120/80 instead of “b p one twenty over eighty”).

• Speech recognition accuracy has improved and the success of companies like Nuance in the healthcare arena supports the validity of this prediction.  Philosophically, our company appreciates the efficiencies of speech recognition but also recognizes the weaknesses of unstructured dictation.  As a company, we take a modified approach that uses speech to capture structured responses as discrete data.  We have also used post-processing of free-spoken, restricted domain, utterances to capture discrete measurement data for our speech recognition enabled products.

7.  Over the next five years, pen and paper systems will gradually decline in use. The digital pen will become more flexible and act to complement the mouse and keyboard. Virtual keyboards on PDAs will facilitate entry for low volume information such as form filling and prescription entry, and bar coding will reduce data entry time and increase the accuracy of drug and materials administration.

• We have not seen much of the digital pen and do not anticipate great acceptance.   Currently our products are used for high-volume data-entry and are not intended for PDA deployment; however, the “iPhone” phenomena may provide a solution, so we are paying close attention.  Overall the reliance on paper is only slightly less than five years ago but the decline in use of paper-based systems appears to be accelerating.

8.  Nearly all data entry technologies will evolve to exploit eXtensible Markup Language (XML) in the next five years, making data web-compatible and enhancing interoperability of standards and modes of entry.

• Although the trend is underway, it cannot happen fast enough.  HL7 now accommodates XML but the elusive “holy grail” of interoperability, one, single, structured and standard format will not happen.  Healthcare has not learned from the experience of other industries.  While the academics and bureaucrats devote time and other resources meeting, debating and formulating the new standard, the market will make the determination.  It may be too late for many vendors whose desire to maintain a competitive edge has created the opportunity for some unforeseen, but extremely intimidating competitors.  What standards are Microsoft and Google following?  At inception, mTuitive recognized that our applications required interoperability and embraced XML.

9.  In the next five years and beyond, the use of multimodal entry systems will bring average dictation time to diagnosis time.

• In pathology, we refer to this as the single step sign out, where the report is issued at examination with no need for transcription or editing.  In pathology, this is still relatively uncommon.  Speech recognition brings this objective closer to reality and has had the greatest impact, but from the mTuitive perspective, the value of structured data is lost. It is our belief that a flexible, tailored user interface will achieve this objective.  The combination of touch screen and speech will be the optimal solution in most cases. 

Curiously, the report missed perhaps the biggest development, browser (web) based data entry.  The ability to enter data from virtually any computer opens a realm of possibilities for solutions and business models. As a Microsoft development partner, mTuitive had a relatively easy transition to a browser based interface.  The core applications deploy easily under MS Silverlight framework.  This expands options for user preference and also opens alternative business models.