from the January 2009 issue

Patient photos aid doctors in reading CT scans

Government officials and HP Israel CEO Yehoshua Bakula signed an agreement to bring the cards to Israel. After nearly ten years of wrangling, tenders, lawsuits, and mud-slinging, the saga of the tender for smart ID cards has reached its end. In an impressive ceremony worthy of a project which became so complicated, representatives of the Ministries of the Interior and Finance signed a contract with HP Israel CEO Yehoshua Bakula to bring the smart ID cards to Israel.

The project is worth about NIS 270 million. It will take three years, and will include 5 million ID cards. As part of the project, HP will set up a plant in Caesarea that will employ 30 workers.

The smart ID cards has been a long-standing vision in Israel. It is a plastic card with an embedded electronic chip, and on the chip. Thye chip will hold the details of the holder. The details will allow identification through various public computer systems. The card will also be ready for biometric identification.

Using the card, Israeli citizens will be able to access government services, to identify themselves to authorities through verification and identification (electronic signatures), to pay taxes, to renew drivers licenses, and other actions.

The estimated price of each card is NIS 46, 1 shekel higher than the Ministry of Interior estimate, while HP's base estimate was NIS 64.

An Israeli study found that adding photos of patients' faces to their medical files made radiologists more meticulous when looking at their X-rays. They reported more details and said they felt more empathy for patients who were otherwise strangers.

Adding patients' photos is a simple, low-tech way to reap rewards for both doctors and their patients, the researchers concluded.

Several experts not involved in the study agreed, although James Thrall, chairman of the American College of Radiology's board of chancellors, said making it common practice in the U.S. could be problematic because of privacy laws. Also, the benefits of including photos might disappear when the novelty of the practice wore off, said Dr. Thrall, a Massachusetts General Hospital radiologist. Still, he said it merits more research.

The study involved 15 radiologists at Shaare Zedek Medical Center in Jerusalem and 318 patients who agreed to be photographed before undergoing CT scans. The color photos appeared automatically when the doctors opened the patients' computer files.

The study's focus wasn't on the ailment the scans were meant to evaluate, but rather on incidental findings that often show up on CT images, such as kidney cysts in patients scanned for suspected appendicitis. Doctors reported these extra findings in 81 scans when the photos were included.

Three months later, the doctors unknowingly viewed the same 81 scans, but without patients' photos. This time, the doctors failed to report 80% of the incidental findings.

"We look but we don't always report" these incidental findings, particularly if they are considered unlikely to affect the patients' outcome, said study co-author Irith Hadas-Halpern, a radiologist at the Jerusalem hospital.

Still, they often are things patients would want to know about or that could affect them down the road, she said. The patients' photographs made doctors look more carefully and report more detailed information on these findings.

Also, all 15 radiologists reported that the photographs made them feel much more empathy toward the patients.

"Once you see that this is a human being .. the attitude changes," Dr. Hadas-Halpern said. "You see this is a young woman, an old suffering man. It adds something."

Dr. Hadas-Halpern said it would be particularly beneficial to radiologists involved in outsourced telemedicine. These doctors often interpret computerized scans sent from time zones away, literally far removed from the patients.

The study was being released Tuesday at the Radiological Society of North America meeting in Chicago. Yonatan Turner, a radiology resident, hatched the study idea as a way to make the job less impersonal.

Joan Anzia, a Northwestern Memorial Hospital psychiatrist, said adding photos is "simple and ingenious."

"Feeling more connected with the patient and actually working a little harder totally makes sense from what we understand about the way the brain works in terms of facial recognition and attachment," Dr. Anzia said.

From early infancy, she explained, the brain is programmed to respond to faces, and that response is the beginning of an emotional attachment. Eric Stern, a University of Washington radiologist, said the study was important "because technology has absolutely dehumanized the patient."

Dr. Stern said he saw a rare example of patients' photos accompanying radiology files when he reviewed chest X-rays of Southeast Asian immigrants as part of a tuberculosis control program. Photos were included for identifying purposes because many patients had similar last names, Stern said.

"I found it to be an unexpected pleasure to be able to put a face to the X-ray," he said.

Dr. Stern said there could be drawbacks to using patients' photos if something about their appearance -- race or an angry demeanor, for example -- triggered radiologists' biases. But he said the benefits of potentially increasing empathy would far outweigh potential biases.

Israel has emerged as a world leader in high technology and is considered the next "Silicon Valley" or the "Silicon Wadi".

Israel boasts the highest per capita ratio of scientists and engineers in the world with approximately 13.5 engineers per 1,000 residents. More than 25 percent of the Israeli work force is employed in technical professions and Israel ranks first in the world in its amount of scientific publications per capita.

Israel is home to thousands of high-tech companies and technological incubators sponsored by the Office of the Chief Scientist, which are located in or around more than twenty Israeli cities and towns. Technology giants such as Microsoft, IBM, Motorola, Intel, Cisco, 3Com, HP, Sun and many others have substantial development facilities in Israel. Israel is second only to the United States (in absolute terms) in the number of start-up technology companies and third after Canada in the number of publicly traded companies on NASDAQ.

Today, Israel is known to be the largest non-US beneficiary of US-based venture capital and private equity investments. Israel is also considered a "cellular hub" with some of the most advanced technology oriented cellular operators in the world and a cellular penetration rate of over 85%. Multinational cellular infrastructure and handset manufacturers utilize this unique market as a testing center for advanced cellular and telecom technologies.

Reprinted from the Israel High-Tech & Investment Report January 2009

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