Tips From A Road Warrior (5): Know Basic Language And Demand Access

Tips From A Road Warrior (5): Know Basic Language And Demand AccessIn most foreign countries I typically can get around using English along with a basic knowledge of the French and German languages I learned in high school. English is prevalent, especially in major foreign cities. For example in Tokyo, the names of the metro stations are in English in addition to Japanese. However, if you venture outside the main cities, it can be a challenge getting around. Case in point: when I was in Japan and wanted to take the train from Kyoto to Nara, there were only Japanese signs on the platforms. I asked a friendly teenager for the train to Nara, he pointed us to platform five, and when the train arrived, we jumped in. After about one hour, which was the time we expected to arrive in Nara, we looked outside and saw to our surprise that we were back at the same station as we started.

We had taken the “loop train” instead of the train to Nara.

A similar situation occurred when I was in Tokyo looking for the location of the conference for which I was scheduled to speak. I knew it was only three blocks from the hotel, but I could not find it, as I can’t read Japanese. I had to go back to the hotel twice to ask directions from the friendly doorman. By the way, taxi drivers are no help either, as a matter of fact, because of the archaic street numbering system in Tokyo, they also rely heavily on asking around to get you to the right place.

When I talk with some healthcare imaging and IT administrators, I get the feeling that they often feel the same way. An image might get lost and they don’t always know what or where to look. A cryptic error message might pop up on the user screen such as “ Association could not be established,” or worse, something like “error C008 occurred when trying to transmit an image”

There are generally two reasons healthcare imaging and IT professionals might feel lost. The first reason is a lack of training and familiarity with the terminology. This is relatively easy to solve. Just as I take a couple of basic Spanish lessons, knowing that I travel at least once a year to Latin America, anyone who speaks “IT” needs to add some basic vocabulary from the DICOM, and IHE “dialects” by reading textbooks, or taking a class in these subjects. There are free on-line classes and resources available, as well as relatively inexpensive e-books that teach the basics.

I feel strongly that professionals should know, for example, basic SQL queries to get into a database, and UNIX commands to investigate the status of their servers. Similarly, they should be able to interpret a DICOM image header to determine that, yes indeed, the patient name was filled in wrong, or that the series description of a CT procedure was incorrectly entered by a technologist. The same applies for finding a patient ID or accession number in a HL7 transaction.

Keeping up-to-date is a continuous journey, as I recently noticed when looking at the new HL7 version 3.0 CDA transactions, which are exchanged between primary care physicians and hospitals with clinical information. Being able to interpret these XML data strings is critical, especially as these types of transactions will increase exponentially with the advent of Electronic Health Records.

The second reason healthcare imaging and IT professionals can feel lost is that, in addition to being able to interpret the information, it is also critical to have easy access to all of the source data. Here is where many systems fall short. I remember that right after the HIPAA security and privacy requirements came into effect, every vendor claimed to be storing the required audit trails. Well, storing is one thing, presenting them in a uniform, easy interpretable manner is another. Several users actually have to implement their own data mining, presentation formats and reports, as the ones provided by vendors cannot easily be customized for end users’ needs.

My last complaint against many vendors is that the information is often available in detailed log files, however, as with the access to the back-end database, the information is locked up through access controls and security mechanisms. When I explain this to any IT person outside the imaging field, they never understand, as access to database schema and the capability to run sophisticated reports based on SQL query scripts executed by in-house personnel is the rule, not an exception. One exception in imaging IT, the hospital system administrator for the AGFA site in Dallas has the complete database scheme hanging on the wall in his office. His system is also known for having virtually no down time, which in my opinion, also occurs because he has full access to the information and can resolve tricky issues himself.

The lesson learned from my experiences: first of all, learn enough basic terminology to get around. For example, I have learned the “open” and “close” Japanese symbols to get me in and out elevators, and “men” and “women” so I can find the right bathroom. Second, do whatever you can to coerce vendors to provide access, passwords and system admin privileges. The reason they often cite to deny this information is that access control is necessary to maintain the integrity of their system. In my experience, this is unjustified. I have seen more damage done by vendors to the database integrity than by in-house personnel. Getting access is merely a matter of negotiation. Some institutions require full access to the information and stipulate that as part of the purchasing agreement. Other institutions fail to negotiate access, and find their systems locked down.

In short, learn the “language,” and negotiate access in your purchasing agreements. You’ll feel less like a “blind person,” and be able to get around, and support your systems to maintain the integrity of patient images and related information.

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