Spintech wins $1.5m to expand automated ultrasound reporting

Melbourne company Spintech Oceania has won a Commercialisation Australia grant worth $1.5 million to further develop its MIDAS software, which automates written diagnostic ultrasound reports and is customisable for individual medical specialists.

The patented software provides automated interpretive written report generation from the measurements and observations taken by sonographers during an ultrasound study and can be integrated into any brand of ultrasound system that uses DICOM structured reporting.

Spintech Oceania's founder and managing director, Phil Spinks, said part of the grant money would be used to further develop the MIDAS software, which currently runs on Windows, to be able to work on any device or platform, and to work across an unlimited number of sites with an unlimited number of users.

Mr Spinks, who has worked in the medical imaging industry for over 30 years, said there was no other software available in the world that can automate ultrasound reporting while not interfering with specialist doctors' workflows.

Mr Spinks said the conventional process of doing an ultrasound scan and then having that scan reported by a doctor had not changed much in the last 40 or 50 years. The only change in that time had been the introduction of voice recognition software, which is prone to error.

What Spintech has achieved is the creation of software using a programmable rules engine invented by Christine Mingins, a former professor of IT at Monash University. The rules are able to be programmed with whatever specialist knowledge is required for whatever domain is being worked in, he said.

“The normal process for reporting ultrasound scans is basically this: the patient goes in to a scan room in a hospital or a radiology practice or a specialist's office.,” Mr Spinks said. “Someone performs that ultrasound scan; it could be a sonographer or in some cases the doctor themselves will do the scan.

“During the scan, they will save images on the machine and on those images will be some measurements and some calculations. What then normally happens is that the sonographer or doctor has a piece of paper beside them on which they scribble their observations and comments about the scan.

“They then take that piece of paper when the scan is finished, they go and sit at a computer, they will scan that piece of paper into the computer, and they will then sit there and type up a summary of the scan, and they will either take the pictures on film or the pictures will be sent electronically from the ultrasound machine through to the reporting doctor's office.”

The reporting doctor will then get a copy of the scanned worksheet, a copy of the referral, and the pictures from the scan, he said. They will then dictate their conclusions into a tape recorder, which turns into a voice file and is sent to the doctor's secretary or transcription service, where it is typed up and sent back to the doctor.

The doctor then corrects the draft report verbally, it is often sent back to the transcriber to type up, sent back to the doctor to verify, and then printed out on letterhead and posted or faxed to the referring doctor and sometimes the patient.

“That workflow essentially has been the same for the last 40 or 50 years,” Mr Spinks said. “In that 40 or 50 years, there is only one thing that has changed in that workflow process, and that is voice recognition, and the problem with voice recognition is that it actually makes a lot of errors.

“The only way that hospitals and radiology practices have been able to make an economic decision on purchasing voice recognition software, is that they get rid of all of their typists. But then what happens is that one in every three reports will have errors. Many reporting specialists won't use voice recognition because they can't be bothered sitting there correcting spelling mistakes and punctuation.”

Few real solutions have been devised to improve this workflow except for some software from the major equipment manufacturers like GE, which markets a reporting package that uses preset word templates into which the measurements are inserted.

However, Mr Spinks said this type of software was inflexible and forced doctors to alter their workflow to suit the program, whereas MIDAS can be customised to suit the individual.

The spark that set off the development of a truly customisable automated reporting system was a fortuitous meeting with Professor Mingins, Mr Spinks said.

“Christine had invented a piece of software called a programmable rules engine. You can program the rules with whatever specialist knowledge you want to for whatever domain you work in, and then you tell it whatever you want it to produce.

“I said my background is predominantly ultrasound, so if we took measurements from an ultrasound scan and we took observations from the sonographer, could the rules engine then generate a written report the same way as if a doctor had dictated it? She said yes.”

Four years of development later, and Spintech has developed two parts of the software, he said. “The first part is what we call the rules, so we have been working with a variety of very high-profile specialists in Australia to develop the rules around the way that they do their reporting, for obstetrics, for vascular, for echocardiography, for phlebology and for a range of other things. The second part that we have been working on is the GUI that goes around the rules engine to make it simple to use.”

The development of the DICOM structured reporting standard has been hugely important, as it is now universally used by the equipment manufacturers, whether that be GE, Siemens, Philips, Toshiba or any other. The output from DICOM structured reporting from the ultrasound machine provides the measurements from the study, the images from the study and the patient demographics from the study.

“They all come into our software automatically at the end of the study, so they no longer have to have a piece of paper that they write this stuff down on or colour in pictures,” Mr Spinks said.

“Then the sonographer looks at the measurement screen in MIDAS and they make their observations with a few drop-downs that are on there. Then they click a tick, and that tick button runs all of those measurements and observations through the rules engine that has been written for that specific exam, and up pops a written report.”

MIDAS software is able to interpret each individual measurement that comes from the study and put an associated statement against that measurement that the reporting specialist would use themselves. However, individual specialists use different terminology, and there can be hundreds of measurements from the scan that the doctor would look at in conjunction.

“In say a vascular study, you could have 300 measurements and you could have 300 associated statements, but that's not the way it works. The specialist would look at three things in conjunction with each other and make one statement about three things. Our rules do the same thing.”

The rules themselves can also draw conclusions because they are outputting information based on certain criteria that is individual to that particular doctor, and the rules can be programmed to do that as well, he said.

“Then you take it one step further. If you have a group of doctors who own a group of radiology practices, and you have 20 doctors and 10 of them say '50 per cent stenosis is mild' but the other 10 say '50 per cent stenosis is moderate', we can make one little change in one single rule and based on the doctor's log-in, it will always use the correct wording for that individual doctor for that particular study.

“It is all in the rules, but the customers never see those rules – it is all part of the engine of this system. All they see is the GUI and the report that is generated.”

Mr Spinks said MIDAS Professional software is currently being used in practice and there are numerous orders pending in the next few months from hospitals and large healthcare networks. Universities are also ordering it for their labs as the software also provides a method for quality assurance of the work of sonographers and reporting doctors.

With the Commercialisation Australia grant, however, the company will begin to develop a universal product called MIDAS Enterprise.

“MIDAS Professional is a Windows-based software product with some limitations when you start putting it across a large number of practices with a large number of users,” he said. “What MIDAS Enterprise will do is work on any device – an iPhone, an iPad, an Android phone, laptop, whatever – and it's going to have a whole lot of inbuilt features and security mechanisms that allow us to work across an unlimited number of sites with an unlimited number of users.

“The other component that is important is that while MIDAS is a stand-alone product and is extremely powerful and is unique, where we also have another strength is that we can integrate MIDAS into any existing workflow.”

Hospitals and radiology practices have already invested huge sums in radiology information systems (RIS) and picture archiving and communications systems (PACS), so they are not keen on replacing existing software. What MIDAS can do is integrate into any RIS/PACS system as it uses HL7.

“The practice still keeps using the RIS/PACS in the way that they did, but the reports just pop up in the RIS for the doctor to verify and no one has to type it. That's the other part of this process in the healthcare world: making sure that what we have created is something that can integrate into another platform or another software product that they run their whole business on.

“RISs, because they are a text-based package or are data-based, we can output an HL7 file in our report from MIDAS and the RIS can pick it up.”

Mr Spinks said the awarding of the grant “is very exciting and it's also very humbling”, and he is pleased that what he believes is a wonderful concept – and what many of the large equipment manufacturers he has spoken to along with specialists and sonographers agree is a wonderful concept – has also been recognised by the government for investment.

Interested parties can view videos of how the process works for phlebology, vascular and obstetrics here.

Posted in Allied Health


0 # John Stewart 2013-03-07 19:53
Brilliant. Does more than the article portrays.

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