August has traditionally been a sleepy month for government regulatory agencies, but this year, Washington’s usual summer torpor was interrupted by a rush of new initiatives, as more than three-quarters of a trillion dollars from the American Recovery and Reinvestment Act (

) surged into a mind- boggling range of projects. One of these efforts, the Health Information Technology for Economic and Clinical Health (HITECH) Act, provides a billion-dollar bolus of funding for electronic health records (EHRs).

Speaking at an August 20 press conference (

), Secretary of Health and Human Services (HHS) Kathleen Sebelius explained, “We’re announcing $1.2 billion in grants directed to two primary areas; the first is helping doctors and hospitals adopt EHRs and get assistance from regional health centers, and the second is to help support health information exchange—help states set up systems where we’ll be able to communicate across the lines of healthcare agencies.” Sebelius added that “this is just the first wave of resources invested in health technology, aimed at really transforming our paper-driven system to an electronic system over the next several years.”

Health IT proponents cheered the new funding, but many have reservations about other aspects of the Act. In particular, HITECH is shining a spotlight on the problem of data security in health IT, an issue that has long been regarded as the field’s biggest challenge.

HHS officials agree. “Security is absolutely essential, it’s foundational, and we are tasked by the law to develop new methods and to examine technologies for assuring security, and we are going to be asking our health IT policy committee to look directly at that subject in the very near future, so we understand that that’s critical,” said David Blumenthal, MD, National Coordinator for Health Information Technology (

Indeed, HITECH already implements some new security requirements. Most notably, the Act expands the coverage of the earlier Health Insurance Portability and Accountability Act (HIPAA). Previously, entities such as hospitals and clinics were covered by HIPAA, but their contractors, software vendors, and other business associates were not, a loophole that incensed many privacy advocates. Under HITECH, all of these business associates will now be subject to HIPAA’s stringent security requirements and legal penalties (

“HITECH is a real game changer with respect to the legal obligations of business associates, and it’s going to have a significant impact on business associate relationships and all vendor relationships,” says Reece Hirsch, a partner in the law firm of Morgan, Lewis & Bockius in San Francisco, CA. Hirsch, who specializes in healthcare regulation, adds that “there are a whole host of new individual rights with respect to [personal health information] for patients, and... they all relate to rights of patients with respect to EHRs.”

Most of the new rules will take effect in February, a deadline that has some vendors sweating. “For large business associate organizations like a major outsourcing company, let’s say, it’s highly likely that they’ve already implemented a comprehensive security compliance program, [but] for smaller business associates, particularly those who aren’t exclusively dedicated to the healthcare industry, they may have a lot of work to do, because between now and February 18, they’ll be required to get that kind of formal, comprehensive security compliance program in place,” says Hirsch, who recently presented a Webinar reviewing the changes (

Although the business associate rules will affect most physicians indirectly, other HITECH measures will have a direct impact. For example, the new funding includes “almost $600 million of support for what are called regional extension centers... whose purpose is to support physicians and hospitals in the adoption and meaningful use of EHRs, and... approximately $600 million in support for state- designated entities to promote health information exchange within their jurisdictions,” according to Blumenthal (

HITECH also provides for a series of incentive payments for Medicare and Medicaid providers to spur them to adopt EHRs between 2011 and 2015, after which the government will begin penalizing those who have not adopted them (see Timeline). For cash-strapped hospitals and overworked physicians, those dates appear imminent, but public health officials argue that deadlines are an essential component of the legislation.

“If you never have a deadline then you really will end up with people being all over the place; they might decide from one day to the next ‘well this isn’t such a priority if it doesn’t have to be done tomorrow, and we’ll use our resources somewhere else,’” says Rachel Block, Deputy Commissioner of Health Information Technology Transformation in the New York State Department of Health.

Block adds that meeting the deadlines will require individual doctors and hospitals, as well as state governments, to tackle data security problems at several levels simultaneously. “Policy is one issue, but we really need to look as well at the implementation, support, and the... institutional or cultural variables that might determine whether security is considered important or not,” she says. In other words, sophisticated encryption systems become useless if a doctor’s password is “password.”

To address those problems, New York and other states are now implementing a wide range of security measures to protect exchanges of health data between systems. “Ultimately, we will have audit policies and protocols, and we will be setting up monitoring systems to ensure that those audits are being conducted, and that any findings are followed up on,” says Block.

Those efforts don’t come cheap, though. New York’s state government and hospitals will spend close to a half-billion dollars on health IT implementation over the next four years, and other large states will likely see similar expenditures. Block says that the $1.2 billion in new federal funding from HITECH, while helpful, will still leave states, hospitals, and individual physicians picking up a big tab. One way New York has reduced the overall cost is by storing records in a federated network rather than a centralized database. Each clinic or hospital stores its own patient records, and data are only exchanged across the network in response to specific, authenticated requests. Besides spreading and reducing costs, this approach could also provide better security; a breach of one server will not affect patient data on other nodes of the network.

Potential data breaches are also a hot topic for federal regulators. In September, new HHS rules came into effect requiring data holders to notify patients when their information may have fallen into the wrong hands (

). Any breach affecting more than 500 patient records triggers automatic notification of the media as well. The data breach rules are just the fi rst of what will likely be a large body of new federal regulations on EHR security. At least 45 states already have laws covering various aspects of EHR privacy (

), so a unified federal policy could actually simplify the regulatory situation—that is, if regulators can address some of the thorny questions still surrounding the issue.

Many of those questions came to light at a September 18 meeting of the HHS Health IT Policy Committee in Washington, DC (

), and the ensuing debate hinted at the challenge now facing regulators. For example, Deborah Peel, MD, founder of the bipartisan Coalition for Patient Privacy, asked the committee to implement a straightforward and stringent policy based on patient consent. In Peel’s formulation, each request to access a patient’s information would have to be approved by the patient, who could selectively segment the data for different levels of access.

However, Deven McGraw, Director of the Health Privacy Project at the Center for Democracy and Technology, argued that a purely consent-based system would fail: “It absolutely doesn’t surprise me that people in focus groups and in surveys say ‘give me control of the data,’ but consent doesn’t work as well to protect privacy as we would like it to.” She added that “healthcare doesn’t present us with good opportunities in a lot of cases to provide people with a meaningful right to say no.” Instead, McGraw advocates a robust framework of regulations—analogous to the security rules governing e-commerce Websites&mdash;that would provide blanket prohibitions against certain types of abuse and also establish a strong enforcement mechanism to deal with violations.

Formulating such a framework will be tricky, though. While few patients would object to doctors having general access to their immunization or allergy records, other types of information may need to be compartmentalized, and not just for the patients’ sake.

“Our providers risk their personal safety by coming to work every day and doing their job,” said Eileen Twiggs, National Director of Information Systems and Technology at Planned Parenthood. Twiggs concedes, though, that simply walling off certain types of care will not solve the problem, as that information may become critical in a patient’s future treatment.

As the meeting wrapped up, at least two things were clear about health IT: EHRs are on the way, and the debates surrounding their security will not cool off anytime soon. 

Alan Dove is a freelance healthcare and science writer. 

Articles

August has traditionally been a sleepy month for government regulatory agencies, but this year, Washington's usual summer torpor was interrupted by a rush of new initiatives, as more than three-quarters of a trillion dollars from the American Recovery and Reinvestment Act surged into a mind- boggling range of projects. 

Healthcare IT Still Seeks a Security Blanket 

Financial help for physicians who are willing to implement, test, and help optimize health IT systems.  

If economics is the dismal science, Health economics is its most dismal branch. Hardly anything in medicine is priced rationally, inefficiencies abound, and cost-effective solutions are rare. Consider health IT, the sales pitch for which sounds irresistible: it promises to slash prescription costs, reduce errors, and streamline the entire healthcare system. Even better, recent studies have shown that some of those claims are actually true. How can doctors continue to reject such a compelling business argument? Easily. The costs of health IT systems fall almost entirely on physicians and hospitals, but most of the benefits flow to insurers, patients, and the public. Worse, health IT is still in its infancy, so early adopters must invest considerable time and money just to figure out which systems work best. Doctors simply can’t afford to do the right thing. An economist would diagnose this as a “positive consumption externality,” and prescribe a government subsidy to treat it. 

In 2004, Congress earmarked money to do just that, through the 

Agency for Healthcare Research and Quality

 (AHRQ). “What they realized was there are a number of activities or research areas that sort of cut across the standard organizational structure of the agency, centers, and offices, and health IT is certainly one of those,” says Bob Mayes, senior advisor to AHRQ’s Center for Primary Care, Prevention and Clinical Partnerships. 

As a research organization, AHRQ focuses on funding studies to test and optimize health IT systems, but it can also help clinics and hospitals make the initial purchase. Indeed, the first round of grants was aimed at getting the technology into small, rural hospitals. “There had been some successful examples of electronic medical records and other uses of health IT to improve safety and quality, but historically they had been really confined to larger institutions, big academic medical centers, or other large integrated delivery systems, such as the VA or Kaiser,” says Mayes. “The question really was ‘Why hasn’t it trickled down into smaller facilities?’” 

Although money is certainly part of the problem, AHRQ’s research has revealed more insidious difficulties as well. For example, newcomers to e-prescribing often view it as a simple series of data transactions; the reality is far more complex. A physician must write the correct prescription, and a pharmacy with an entirely different system must fill it, raising numerous compatibility and implementation problems. After those hurdles, the e-prescription faces an even tougher challenge. “The most important piece of the whole thing is did the patient actually take the medication?” says Mayes, adding that “We’ll continue to look at e-prescribing, but we also are looking more at how we move into the whole area of adherence.” 

To address such multifaceted problems, AHRQ funds a wide range of health IT grants, from $100,000 to $1.2 million, enabling everything from small-scale, proof-of-concept studies to large, demonstration projects. With a total annual budget around $45 million, the agency must turn down many applicants, but Mayes says they take pains to make the process straightforward. 

“One of the things we’re trying to do is get involvement with a broader cross-section of the health sector,” says Mayes. “Ultimately, if we put out findings, we need to have people go on the website and look at the kinds of things that research has been done on and say ‘oh, yeah, that’s me, that’s my practice.’” 

Those efforts seem to be paying off. “The AHRQ folks were very easy to work with,” says Rick Breuer, MD, an attending physician at Community Memorial Hospital in Cloquet, MN, and the lead investigator on a recent AHRQ health IT project. “Going after a Federal grant was kind of scary for us because we weren’t sure how much of a jumble of paperwork and regulations we might have to meander through, but it was really a very good process.” 

The Minnesota team used its AHRQ grant to see whether small, rural hospitals would benefit from using a networked e-prescribing system. The project connected small facilities across the state with a 24-hour pharmacy at St. Luke’s hospital in Duluth. “That’s really what the purpose of this whole project was: to give everybody access to that 24-hour pharmacy coverage,” says Breuer. 

Once the system was set up, physicians at any of the hospitals in the network could send their prescriptions to the pharmacy in Duluth for immediate review. Having a dedicated pharmacist on call was a boon for physicians accustomed to more limited coverage, and the hospitals kept the system running after the grant expired. “Every facility has stuck with it. It is an expense that we have now that we didn’t have before, but I think we see it being worth it in the satisfaction of our staff and our own pharmacists when they come back on a Monday morning and how everyone feels about what this means for patient care,” says Breuer. 

E-prescribing can also provide more quantifiable benefits, as another AHRQ project recently demonstrated. Researchers 

 from physicians using the PocketScript system and discovered a substantial payoff : a single feature of the program saved $845,000 per 100,000 patients per year. “The device or the program actually looked up the patient and got that patient’s formulary from their own insurance company and then informed the physician of the tiers of the co-payments, so the physician knew at the point of prescribing what the tier was,” says Joel Weissman, PhD, senior health policy advisor, Massachusetts Executive Office of Health and Human Services, and study co-author. 

The feature was unobtrusive, simply listing medications in different font colors based on their formulary tiers, but it influenced prescribing practices. “Doctors want to do the right thing. If there’s a choice of drugs and if they can help out the patient to pay a lower co-payment by prescribing an equivalent drug in a lower tier, they’re going to do that,” says Weissman. 

The apparent simplicity of such changes—pharmacy coverage and colored fonts are hardly technological breakthroughs&mdash;highlights what many see as the real challenge of health IT. “It wasn’t technically overly challenging to put networked pharmacies together&mdash;it was more getting all of these people together and changing our process,” says Breuer. 

Although e-prescribing is certainly hot, AHRQ funded researchers are looking at many other aspects of health IT as well. Indeed, individual sites often host multiple projects in distinct fields, such as the three-pronged effort now underway at the University of Texas Medical School in Houston, TX. There, assistant professor of medicine Eric Thomas, MD, is testing new technologies in settings ranging from intensive care units to outpatient clinics. 

In the ICU, Thomas and his colleagues are studying the impact of remote presence systems. “There’s a severe shortage of intensivists in the United States, and so the idea is that by putting a few intensivists in an off -site location and then connecting them via telemedicine technology to numerous ICUs, you could kind of help provide more coverage and more care by intensivists to more patients,” says Thomas. The study is using the 

, but its results, which Thomas expects to have soon, should be relevant to competing products as well. 

Another study focuses on developing algorithms to detect diagnostic errors by analyzing electronic health records. “What we’re doing is looking at things like visit patterns to try and detect a diagnostic error. For example, if a patient sees their primary care physician today, and then three days from now they go to the emergency room or get admitted to the hospital, it may be an indicator that the primary care physician missed something, and then a few days later it got worse and they ended up in the hospital,” says Thomas. Of course, there could be other explanations for such a pattern, so the algorithm also incorporates additional clinical information. Ultimately, the system might function like audit flags in tax-processing software, automatically highlighting areas for a human to check more closely. 

Even so, any error-checking system could be a tough sell if it’s not implemented carefully. “There might be some resistance when it gets rolled out as a day-to-day quality tool,” says Thomas, adding that a key issue will be “whether or not it’s in a punitive environment or an environment that’s focused on learning and improvement; it depends just on the culture of the place.” 

Thomas’s colleagues are also working on a less controversial application of the technology, analyzing health records to keep cancer patients from getting lost in the healthcare system. “Let’s say a 60-year-old man presents with a new iron deficiency anemia. If a man has a new anemia, then he needs to get a colonoscopy. We can detect the anemia, we can then screen to see if the colonoscopy occurred, if it did what was the pathology, if it was cancer, has that person seen a surgeon or an oncologist, if they have, have they also begun a therapeutic regimen?” says Thomas. 

When government-funded researchers produce new algorithms and software, they often release those products under open-source licenses so other researchers can copy and modify them. In health IT, things are more complicated. “There are really two pieces when you look at an application; there is the computer programming expertise and knowledge, and then there’s the domain expertise of what does it do and is it actually doing what it is supposed to?” says Mayes. He adds that it’s no accident that the open-source movement’s biggest successes have been operating systems such as Linux and general-purpose desktop applications. “If you look at Linux for instance, the very people that created the code were also the experts in operating systems,” says Mayes. 

Making an open-source health IT application work requires a more rare form of dual expertise: medicine and computer programming. The scarcity of physician-programmers means that any health IT application requires a diverse team, and commercial software development may be the most practical way to achieve that. 

The price difference—open source software is free, whereas commercial applications cost money&mdash;may not matter in health IT. “We’ve actually run focus groups with physicians and you often hear ‘what would you pay for an e-prescribing system?’ and a lot of them say ‘Well, free is not good enough,’” says Weissman. He adds that “It really does cost them time and hassle.” 

That makes the economic prognosis sound dismal, but help is on the way: true to its mission, AHRQ is now gearing up to fund a new round of studies on health IT implementation.

Can AHRQ really make a difference in HIT implementation?

Financial help for physicians who are willing to implement, test,
and help optimize health IT systems.

We're From the Government and We're Here to Help

Are you neo-Amish? It’s the hot new buzzword in Silicon Valley, describing technophiles who’ve eagerly adopted almost every new gadget, but then, incongruously, decided to reject one. The neo- Amish include the computer scientist who spends his days writing innovative software but can’t be reached by e-mail, the serial entrepreneur who refuses to own a cell phone, and the Web guru who doesn’t have a blog.

Medicine, though, is the original homeland of the neo-Amish. Hospitals rush to get the latest multi-Tesla MRI machines, physicians eagerly prescribe the latest biotechnology-derived medicines, and medical laboratories happily deploy cutting-edge genomic tests on a daily basis. Meanwhile, many clinicians still keep patient charts with paper and pen, communicate with hopelessly outdated pagers, and often transfer information by entering it manually from one computer system to another.

Regulatory and financial barriers may keep some of these antiquated approaches active for a while longer, but gadget-loving doctors can take comfort in a new crop of technologies that will transform other aspects of medicine. That’s especially true in oncology, where vibrant collaborations between clinicians, researchers, and engineers are producing intriguing new tools. Ranging from electronic resources that are already available to future diagnostic and treatment systems, a sampling of these technologies shows how they could change your practice dramatically.

At the University of Colorado medical center in Denver, CO, the oncology pharmacy of the future is already up and running. Sealed inside a containment chamber, a robot makes a series of precise movements, measuring and mixing chemotherapeutic agents and loading them into syringes or IV bags for delivery to patients. The robot, called CytoCare, was designed to overcome a slew of problems that have plagued chemotherapy administration for years.

“The first element was sort of the patient priority, and making sure that we are delivering...the right dose to the right patient,” says Jack Risenhoover, Senior Partner for North American operations at Health Robotics, the system’s manufacturer. Besides using both bar codes and computer vision technology to ensure that the medications are correct, CytoCare also weighs each dose and the fi nal mixture to be sure they’ve been measured accurately.

That alone provides a significant improvement over human pharmacists who measure doses with plastic syringes. “The variation just of the syringe marks can be plus or minus 5%, so CytoCare is usually at least 50% more accurate...than what you could do manually if the only thing that you looked at was the variation in the black lines on the syringe,” says Risenhoover. In addition, the robot is immune to the errors that can creep into human judgment, such as technicians’ natural tendency to underdose toxic medicines.

Pharmacists need not fear that robots will take away desirable jobs, however. Indeed, recent research has highlighted the many hazards that chemotherapy poses for pharmacy technicians— from exposure to the cytotoxic drugs themselves to repetitive strain injuries from drawing each dose into and out of a syringe.

The contamination doesn’t stop at the pharmacy doors, either. “Aerosols happen, aspirations happen, errors happen, leaks happen, and it doesn’t take very many of them for you to have contaminants in a variety of places, from the laminar fl ow hood where the technician performs that initial survey...to the fl oors where the syringes and bags are administered,” says Risenhoover. With the robotic system, pharmacists simply insert the sealed, bar-coded bottles of medicine through an air lock, and collect the sealed, fi nished bags or syringes for each patient’s dose from the same portal a few minutes later.

A complete system costs about $1 million, but the company estimates that it will save money in the long run by limiting errors and freeing pharmacists for other tasks. Because the robot documents each measurement and movement meticulously, it could also provide important new data on drugs. “It gives you a much more fertile, accurate field of information for future research to be able to evaluate which drugs had what kind of consequences downstream when you have an electronic medical record of all of the compounding activities that took place,” says Risenhoover.

Technophile oncologists don’t need to wait for a new robot if they want to be at the cutting edge of patient management, however. Through the National Cancer Institute’s (NCI) new Cancer Biomedical Informatics Grid (caBIG), anyone with an Internet connection can now tap into a trove of useful data about cancer.

Scientific and medical databases are certainly not a new idea, but most of these tools have amassed so much raw data, in so many diff erent formats, that they are virtually unusable by anyone but hardcore bioinformaticians. Over the past few years, caBIG has been connecting these disparate databases, standardizing their content, and equipping the whole interlinked system with user interfaces that working physicians can understand.

For example, caBIG recently released the fi rst version of a clinical trial software suite. “This is different from typical clinical trial software that’s really designed for the sponsor, for drug companies, and so on to operate,” says John Speakman, Associate Director of Clinical Trials Products at the NCI in Bethesda, MD.

Instead of simply collecting data for the drug company, the new programs track and unify the information that oncologists and hospitals actually need, such as which patients are participating in multiple trials, when their chemotherapy appointments are scheduled, and which adverse events they’ve experienced. “Typically, what you do with adverse events is you just send a report off to the sponsor or the FDA or whoever and you don’t keep local track of it,” says Speakman.

The caBIG suite helps prepare those reports, but also tracks non-serious side effects, makes sure the patients’ electronic medical records mention the problem, and modifi es the treatment schedule automatically. “If the patient experiences an adverse event, chances are that their schedule of treatment will have to be modifi ed, and so you don’t actually have to keep track of these things yourself,” says Speakman.

Other software from caBIG, all of which is free and open source, includes an application that can transfer data from non-standard clinical laboratory systems into a hospital’s central database, eliminating manual data entry, and a program that tackles the onerous but essential regulatory paperwork associated with clinical trials. Another system, called caMATCH, provides a portal for oncologists and patients to fi nd clinical trials that might benefi t them.

Most of the current users of caBIG are physician-researchers at large medical centers, but that could change as the system develops. Indeed, one of the NCI’s goals with the program is to make it easier to manage clinical research so that any oncologist can do it. “What we want to do is lower the barriers ... toward regular physician practices, community medical centers, and so on participating in clinical trials,” says Speakman.

Unsurprisingly, the NCI is also working on several other cancer-fi ghting technologies. Th e fi rst tools practicing oncologists are likely to see from these tightly linked eff orts are new biomarkers. In recent years, numerous projects have promised to fi nd new cancer biomarkers, but in this case, they might actually materialize.

The difference is that the NCI is focusing on the core problem in the cancer biomarker fi eld, which can be summarized in three words: validation, validation, validation. Researchers seem to report a new marker for diagnosing or staging cancer every day, but further studies often reveal these tests to be unreliable or impractical. Now, the NCI has stepped in and built a complete pipeline for biomarker discovery and validation, and some physicians are already taking advantage of it.

One of the effort’s most popular programs right now is the rapidly expanding Cancer Genome Atlas, which aims to collect the signifi cant DNA mutations that appear in all major types of cancer. So far, the project has amassed a large data set on glioblastoma, and data on ovarian cancer and lung cancer are now pouring in as well. “We do have clinicians who are starting to look at the Atlas already in terms of how they’re classifying their patients. You might use these data to try to stratify patients into treatment groups,” says Anna Barker, PhD,, Deputy Director of the NCI.

The institute also wants doctors to start giving something back to the program, in the form of more carefully collected clinical specimens. “This is an area that we’ve had to work on a great deal, because there were no standards for collecting these tissues, [and] we want to be sure that we’re measuring in these tissues the changes in genes related to disease, not related to something like anesthesia,” says Barker. Indeed, the Atlas’s initial focus on glioblastoma was driven partly by a shortage of wellcharacterized tissues for other tumor types, so getting oncologists to collect better samples is critical for the project’s future.

To make the Atlas more accessible, NCI is collaborating with the FDA and other agencies to ensure that new biomarkers and sample collection procedures will be both approvable and billable. “It’s going to be expensive... to do these kinds of things well, you’re going to have to have very highly characterized, clinically annotated samples, which is not something that people have been accustomed to doing,” says Barker.

“Expensive” will probably also describe another breakthrough technology now on its way into the clinic: the combined PET/ MRI machine. While PET/CT systems have become standard equipment in recent years, combining the functional imaging of PET with the fi ne-grained structural imaging of MRI has remained more a dream than a reality.

“Often, in order to interpret the signal you get from the PET, you really need to understand exactly where that signal’s emanating from anatomically. That’s particularly true in cancer, because you know if you’re looking at metastasis, exactly where those metastases are has a big impact on how you treat the patient and the patient’s outcome as well,” says Simon Cherry, PhD, Chair of Biomedical Engineering at the University of California in Davis, CA. The higher resolution of MRI compared to CT could be especially useful when tumors are buried in soft tissue, such as in the pelvis or the brain.

Getting PET and MRI into a single system, however, has been hard. The MRI machine’s massive magnetic fi elds and powerful radio frequency pulses will obliterate a standard PET scanner, which, in turn, generates more than enough electromagnetic noise to befuddle the MRI. By carefully redesigning both systems, however, Cherry and his colleagues recently managed to install a PET scanner inside an MRI machine, creating a system that performs both scans simultaneously.

That design contrasts markedly with the layout of a typical PET/CT scanner, which runs the two scans in tandem rather than simultaneously. For Cherry, research needs drove that decision: “If I wanted to study both the permeability of the brain to [a] drug and then also see what happens, where the drug actually goes inside the brain, I could measure permeability with MRI, and I could measure the drug itself, radiolabeled, with PET and look at both of those things at exactly the same time.” He adds, “if I had to take the scans, 10, 20 minutes apart, I wouldn’t be able to do that.”

For hospitals, the simultaneous scanning should improve patient throughput, and might also enable new types of data analysis. Physicians won’t have to wait long to fi nd out if the system lives up to its promise. Siemens (Munich, Germany) has already delivered a prototype of a clinical PET/MRI system to Massachusetts General Hospital in Boston, MA.

Whatever modern imaging technique physicians use, the final product is inevitably a kind of digital photograph. In order to shoot those pictures faster and for less money, oncologists may soon be using a somewhat counterintuitive technology: the one-pixel camera. “This doesn’t sound so exciting at first. Everyone wants megapixels; this has one pixel, but in terms of medical imaging, pixels are really expensive,” says Kevin Kelly, PhD, Assistant Professor of Electrical Engineering at Rice University in Houston, TX.

The problem is that medical imaging relies on electromagnetic signals well outside the visible light range, where the cheap silicon detector chips used in consumer cameras become useless. Instead, medical imaging systems must use more exotic detectors, giving clinicians Hobson’s choice between sub-optimal resolution and an unaff ordable price.

Rather than try to come up with a cheaper high-resolution detector, a goal that has so far eluded researchers, Kelly and his colleagues pull more information out of each pixel. “Our single-pixel camera technology is something that will allow you to take maybe 10,000 measurements and build up a 1-megapixel image, and it does this with some really cool mathematics,” says Kelly.

In a typical experiment, the researchers take an incoming electromagnetic image, then apply a known modulation signal to it and feed it through the single-pixel camera. “The reason you don’t normally want to do that is, if there’s light hitting your eye or light hitting your camera sensor, if you threw all the light together you wouldn’t understand the picture, but it turns out through special mathematics and controlling the modulation, we can easily understand the picture and pull back out a visual image,” says Kelly.

The process is superfi cially similar to image compression techniques such as JPEG, which shrinks large digital pictures into fewer bits and then expands them again later. However, the mathematical algorithm Kelly uses can actually reconstruct the original image perfectly, with no loss of fi delity.

When the one-pixel system enters clinical use, which Kelly predicts will be within fi ve years, doctors could face a much happier choice in imaging systems. A relatively cheap one-pixel setup could enable smaller clinics and practices to aff ord sophisticated imaging technologies, while higherpriced units might incorporate larger detectors to accelerate the pace of care at big hospitals. “You could think about it as higher throughput of patients through there, or you could think about it as cheaper,” says Kelly. For CT and other radioimaging techniques, faster scans could also reduce patients’ exposure to radiation. The one-pixel camera—and all of the other new medical technologies now in development&mdash;still have to prove themselves both clinically and economically before becoming standard tools. Th ere’s little doubt, though, that at least a few of them will change your practice, if they haven’t already. Now, if only we could do something about those darn pagers.

Alan Dove, PhD, is a freelance healthcare and science writer.

Hospitals rush to get the latest multi-Tesla MRI machines, physicians eagerly prescribe the latest biotechnology-derived medicines, and medical laboratories happily deploy cutting-edge genomic tests on a daily basis. 

Alan Dove, PhD

Articles

Healthcare IT Still Seeks a Security Blanket

We're From the Government and We're Here to Help

5 Technologies That Could Change Your Practice