electronic access to lab results – an MRI reading, information overload!

I have access to my lab results (web interface to EPIC).

When is information too much information? I cannot possibly understand these results and if I search terminology on the Web I am likely to cause myself much anxiety, whereas a Physician might just say “all is ok”

Report: Minor straightening of the typical lumbar
lordosis.  Stature preserved.  Reactive marrow changes along the
superior endplate of L4.  Focal fatty marrow or hemangiomata in
the left paracentral L3 and L4 vertebral bodies.  Reactive
change and/or  focal fatty marrow in the left superior endplate
of T12.  Schmorl’s node defects bridging the T12-L1 and L2-L2
levels, and the superior endplates of L3 and L4.  Conus extends
down to the mid upper body of L1.  The descending cauda equina
normal.  Mildly complex fluid intensity mass affiliated with the
left kidney which shows relative thinning in the cortex and
appears to be a fluid filled distended proximal ureter.  Normal
appearing right kidney.  No bulky prevertebral soft tissue
or adenopathy.  1.5 to 2 cm diameter fluid collection
adjacent to the right psoas margin on the lowest axial image
which may be fluid within bowel though another cystic/fluid
filled mass in the retroperitoneum is not excluded.

T12-L1: Mild disk desiccation and intervertebral space
narrowing.  Minor left paracentral annular bulge.  No
mass effect on the central canal.  Minor asymmetric attenuation
of caudal margin of the exiting left neural foramen but with
preservation of perineural fat.

L1-L2: Minor annular bulge flattening the ventral margin of the
thecal sac.  No significant mass effect on the central canal.
Lateral recesses and neural foramina unencumbered.

L2-L3: Mild annular bulge flattens the ventral margin of the
thecal sac. Mild facet arthropathy.  Minor extension in the
caudal margins of both exiting neural foramina with proximal
attenuation of the perineural fat.

L3-L4: Minor annular bulge is present flattening the ventral
margin of the thecal sac.  Mild to moderate facet arthropathy
overall yielding a mild to moderate central canal stenosis
contributed in  part by borderline congenitally foreshortened
pedicles.  Attenuation of the caudal margins of both exiting
neural foraminal with proximal attenuation of perineural fat.

L4-L5: Mild disk desiccation.  Broad-based disk bulge flattens
the ventral margin of the thecal sac.  Mild to moderate facet
arthropathy.  Pedicles are also borderline foreshortened. There
is extension on he caudal margins of both exiting neural
with moderate bilateral neural foraminal stenosis.

L5-S1: Central annular bulge without  significant mass effect.
Mild facet arthropathy.  Minor extension of the caudal aspects
both exiting neural foramina but with preservation of perineural

1. Mild broad-based bulges and spondylosis at L3-L4 and L4-L5 in
conjunction with borderline congenitally foreshortened pedicles
and mild to moderate facet arthropathy yielding mild to moderate
central canal, lateral recess and bilateral neural foraminal
2. Mild broad-based bulge in association with mild facet
arthropathy at L2-L3 yielding mild central canal and mild
bilateral neural foraminal attenuation.
3. Mild annular bulges at T12-L1 and L1-L2 but without
significant mass effect.
4. Central annular bulge at L5-S1 in association with facet
arthropathy but without significant mass effect on the central
canal but yielding mild bilateral neural foraminal attenuation.
5. Probable hydronephrosis and proximal hydroureter with
attenuation of native renal cortex, left kidney; ? longstanding
congenital ureteral pelvic junction obstruction.  Clinical and
urologic correlation recommended.  If this is de novo depiction
of this entity, then evaluation can begin with ultrasound or CT
to confirm.


a final post (for 2009)

See you in a few weeks…

PHRs: tethered and untethered at HIMSS in chilly San Francisco

If  Mark Twain quipped “The coldest winter I ever spent was a summer in San Francisco”, then he was definitely not around this December week.

But attendees were very warmly welcomed by Microsoft with quite a delicious repast served up before the Northern California Chapter of HIMSS met to discuss Personal Health Records. Robert Half International, Axolotl and a few other vendors were on hand to greet us as we started the meeting. A short recap:

1. The Microsoft presentation showcased NewYork Presbyterian hospital (NYP) as an example  deployment of the Microsoft Amalga HIS. Amalga integrates various components of a hospital system and of course HealthVault.   The presentation described several steps which I will summarize as follows:

  • Continous Care Records (CCRs) are exported from the NewYork Presbyterian system, on Amalga, to HealthVault. How can the patient be sure the data was not modified/compromised en-route? Firstly the CCRs are digitally signed and secondly there is an uneditable audit trail in HealthVault.  The final point is central to me, because my basic issue with patient entered data in PHRs is “what is stop a patient modifying data or deliberately or unintentionally altering their health record?”
  • Does the patient own their health data? In the above example, the patient grants NYP consent to send the CCR to their HealthVault record. The HealthVault patient ID is linked to the NYP Enterprise Master Patient Index (EMPI)
  • HealthVault acts as a transport layer of loosely coupled applications.  Kryptiq polls Amalga and imports new CCRs  into the patient’s HealthVault account.

Bottom line: integration in healthcare environments is difficult, Amalga, HealthVault and Kryptiq attempt to simplify the process.

2. We also were privileged to hear from epatientdave (his blog) .  After a moving story of his successful fight against kidney cancer, Dave described participatory medicine. In essence the patient and physician co-operate in the healthcare of the patient. Patients are empowered s they areeducated on their conditions and treatments by reading websites and interacting in peer support groups online. The patient thus makes an informed visit to their physician discussing the various treatment options. Key to this process is, patient access to their data: your healthrecord, your PHR. Without access to their own patient, the patient cannot engage the broader community to discuss diagnoses and treatments.  It is a difficult question, who owns the data the patient, the physician/medical institution or even perhaps the insurance company? Dave referred us to the Journal of Participatory Medicine and the Society of Participatory Medicine (a project of e-patients.net) and a book  “The Innovator’s Prescription.”  Oh, for a fascinating view of the human body in colour and detailed video, view this.

3. Dr Albert Chan presented the PHR of the Palo Alto Medical Foundation (PAMF) As I am patient at PAMF I was able to gloss over this presentation, suffice to say the patient portal provides an excellent way for patients to view their Electronic Medical Record maintained by the PAMF. Patients can also make appointments online, pay bills, view test results and email their physician.

I got in the final question, humorously tagged “inflammatory” by one of the panelists,  at the end of the  discussion: “If a patient is allowed to enter data into their PHR, what is to stop a patient from modifying or entering incorrect data (for example a patient could remove diabetes from the their healthrecord)? ” This is a hot topic because medical institutions can use this scenario to provide patients with read-only/view-only access to their PHR. This question is partly answered above “provide an uneditable audit trail of who entered/modified data in a patient’s record”, but is an ongoing discussion.  I also took home the last raffle prize, a 2006 Kathryn Hall Cabernet Sauvignon, which a few attendees tried unsuccessfully to persuade me that it is plonk and “leave it behind”. Sorry fellow HIMSS members, it is in my rack at home awaiting a festive occasion.

Courtesy of Vince Kuraitis I offer this view of a PHR

A simple data model for an Electronic Medical Record

I present a simple data model for an EMR created using ARGO UML

Key components of this model:

  1. Patient – the person treated by the physician
  2. Physician – doctor
  3. Medication – drug prescribed for a diagnosis
  4. Encounter – a patient visit
  5. Diagnostics – what the physician deduces is wrong with the patient.


  • 1:1 (one to one) – where one component can only be related to one instance of another component.
  • 1:m (one to many) – where one component is related to several instances of another component
  • m:m (many to many) – where several components are related to several instances of another component

Below is the model with comments alongside each object and each relationship

EMR model

Health Internet vs NHIN: in pictures

I read with great interest, David Kibbe’s posting on the HealthCare blog, NHIN vs The Health Internet; that same week I also read Robert Rowley’s take on the NHIN vs The Health Internet.  So I thought I would sum up the two perspectives with two pictures. (Forgive the delay, I took a break over Thanksgiving)

  • NHIN – National Health Information Network – “is a collection of standards, protocols, legal agreements, specifications, and services that enables the secure exchange of health information over the internet.” Basically a Federal push for standards, specs and protocols to allow electronic data to be exchanged.
  • HealthInternet – an open-market standards-based approach to enable the exchange and sharing of electronic health data, using existing Internet standard protocols and web technologies.

So here then a graphical view of the two approaches


Health Internet