Embedded Knowledge: Scanner Opportunity

It seems several patients who have received CT brain perfusion scans at some US hospitals have been exposed to an apparent overdose of radiation. The New York Times followed up on the story, which revealed a couple of interesting points. While the scanners have built-in features that allow lower doses of radiation, in some circumstances the scanners actually increase the dose. Oddly, the machines in question do not warn clinicians when the amount of radiation exceeds a safe threshold. Here, technology is used as a valued clinical tool, but it remains isolated from some important facts we know about its use. This lack of “self-awareness” on the part of the technology reinforces the role of people, culture and process in the data life cycle. For example:

  • With information technology, scanners (and other pieces of equipment) could record or make available to the electronic health record, the machine identity and the dose administered, so that the event can be linked to the patient for later analysis. This is as much a patient safety issue as it is one of quality reporting. It should be a simple matter to generate a list of all patients that have been treated using a particular piece of equipment. Part of the problem here is in the creation of medical device identifiers and standardized protocols for communicating among them. This work is underway, but still not completely implemented;
  • Scanners could be made to have an awareness of current guidelines for radiation dosages, and they should not operate at those levels unless deliberately overridden by the clinician. We already use information technology to check for drug interactions, and this is the same thing;
  • Guidelines should be standardized in structure and application, to ensure that there is no variance from vendor to vendor;
  • Physicians must actively participate in developing the data life cycle (from data to knowledge). If they are responsible for entering data, they have every right to expect that it is contributing to the development of better knowledge systems, which should continue to improve with each vendor update;

Technology performs as it is programmed to do. We cannot blame it for shortcomings that are the result of muddy processes. Figuring out how to do this properly involves cooperation among vendors, clinicians, the government, and many others. This is an example of knowing better (we know what constitutes a radiation overdose) but not yet having the processes in place to embed that knowledge into our clinical tools and the information systems that we will increasingly use to connect them. We must create processes that allow us to more fully trust the technology now, so that we can come to rely upon it, and build upon its role in the future.

The full NYT story is here.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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