Dedicated Test System (DTS) Guide

UNITY TM RIS/PACS Dedicated Test System (DTS) Guide Release 8 U.S. Patent Number 5,452,416

1 Getting Started Dedicated Test System (DTS) Guide Release 8 December 2007 TCP-000109-A 2 Technical 3 Features 4 Interfaces Specifications Hardware specifications Features and components available for testing Connections to and from DTS 5 Implementation Preparing for installation 6 Testing Procedures High-level description 7 Reference Frequently used tasks 8 Glossary 9 Notes

Copyright and Notice Copyright 1997-2007 DR Systems, Inc. All rights reserved. All data and information contained in or disclosed by this document are confidential and proprietary information of DR Systems, Inc. All rights therein are expressly reserved. By accepting this material, the recipient agrees that this material and the information contained therein will be held in confidence and in trust by the recipient, and will not be used, copied, or otherwise reproduced in whole or in part, nor its contents revealed in any manner to others, without the express written consent of DR Systems, Inc. While reasonable efforts have been made to ensure the accuracy of this document, DR Systems, Inc., assumes no liability resulting from any inaccuracies or omissions in this document, or from any use of the information obtained from this document. DR Systems, Inc. reserves the right to make changes in content herein, with no obligation to notify any person of revisions or changes. DR Systems, Inc. does not assume any liability arising out of the application or use of any product or software described herein; neither does it convey any license or any other right under its patent rights or other intellectual property or proprietary rights or the proprietary rights of others. DR Systems, Inc. reserves the right to make changes in technical and product specifications at any time, in its sole discretion, without prior notice. Trademarks and Patents The products and equipment described in this document are manufactured under one or more patents, including U.S. Patent #5,452,416. Products and equipment by DR Systems described herein are manufactured under one or more patents, including U.S. Patent Number 5,452,416 and other patents pending. Specifications are subject to change without notice. Ambassador, Catapult, CD Ambassador, Communicator, DICOM Guardian, Disk Array Guardian, Document Scanning, Dominator, DR Mammography Reporting and Tracking, DR Scheduler, DR Systems, Film Tracking, Guardian, Image Shuffling, Instant Reporter, Management Reports, Media Ambassador, Messenger, Multiprocessor Communicator, Network Media Ambassador, Patient Link, Patient Tracking, Pixel Tracking, Report Manager, Sentinel, SmartForms, Smart Shuffling, Unity RIS/PACS, Universal Manager, Web Ambassador, Web Dominator, and Web Transcription are trademarks of DR Systems, Inc., San Diego, CA. Other trademarks used herein are the property of their respective owners. Other trademarks used herein are the property of their respective owners. License Agreement The software described in this document is furnished under a License Agreement. The software may be used or copied only in accordance with the terms of this agreement. It is against the law to copy the software produced by DR Systems, Inc. on disk or any other medium for any purpose other than that specifically allowed in the License Agreement. Warranty DR Systems, Inc. provides a warranty for the system that it configures. The specific warranty terms for each product are included in the documentation provided by DR Systems, Inc. for such product. Warranty services are provided only to the original registered owner of the equipment. Warranty services are coordinated through the DR Systems Technical Services team. Exclusions from warranty include: Unauthorized modification or misuse; operation outside the stated environmental specifications for the product; and improper or unauthorized maintenance by the customer. Patient Confidentiality DR Systems wants to remind its customers that there may be legal, ethical, and moral obligations for medical care providers to protect sensitive patient information.

Dedicated Test System Guide - Release 8 Table of Contents Chapter 1 Getting Started 1-1 About this guide...1-1 Description of the DTS...1-1 Concurrent use with your production system...1-2 Purpose of the DTS...1-2 New sites - Advantages of using the DTS...1-2 Existing sites - Advantages of using the DTS...1-2 What you can test...1-2 Product configurations...1-4 DTS Standard...1-4 DTS Workstation...1-4 DTS restrictions...1-5 Functions and features not included...1-5 Uses not permitted...1-5 Getting Help...1-6 Contacting Customer Support...1-6 Viewing Online Help...1-6 Viewing and downloading documentation...1-6 Chapter 2 Technical Specifications 2-1 DTS Standard...2-1 DTS Workstation...2-3 Chapter 3 Features and Components Available for Testing 3-1 Features you can test...3-1 Interface validation...3-2 Specific interfaces...3-2 System components summary...3-2 Testing DR Systems software components...3-2 Third-party software components included...3-4 Components that are not available in the DTS...3-4 DR Scheduler option...3-4 DR Scheduler Features...3-5 Table of Contents i

Dedicated Test System Guide - Release 8 Instant Reporter option...3-6 Instant Reporter features...3-6 Testing report content and presentation...3-6 SmartForms option...3-6 Features...3-6 Testing SmartForms...3-7 Chapter 4 Interfaces 4-1 Interfaces for DTS Standard...4-1 Interfaces for DR Scheduler...4-1 HL7 Data Flow...4-1 Chapter 5 Implementation Process 5-1 Planning and site preparation...5-1 DTS Standard...5-1 DR Scheduler (option)...5-2 HIS/RIS Interface...5-2 Remote Access...5-3 Installation...5-3 Installation notes for all sites...5-3 Installation notes for new sites...5-3 Setup and data conversion...5-4 DTS Standard with DR Scheduler...5-4 DTS with Instant Reporter...5-4 DTS with SmartForms...5-4 Chapter 6 Testing and Validation 6-1 About this chapter...6-1 Test the standard exam process...6-1 Test the Instant Reporter option...6-1 Test the DR Scheduler option...6-2 Chapter 7 Reference 7-1 Detailed instructions...7-1 Instructions for testing the two-way interface between Meditech and DR Systems RIS/PACS...7-1 Instructions for testing the Communicator...7-2 Glossary Index ii Table of Contents

Chapter 1 Getting Started About this guide...1-1 Description of the DTS...1-1 Purpose of the DTS...1-2 Product configurations...1-4 DTS restrictions...1-5 Getting Help...1-6 About this guide This guide describes the Dedicated Test System (DTS). The DTS is a standalone client/server solution for testing that operates concurrently with the production system without impacting it. The DTS includes a test database of patients, referring doctors, and exam codes to test the HL7 Gateway, ResultsOut, ResultsIn, Instant Reporter, Report Manager, Communicator, Web Dominator, Web Transcription, DR Web Launch, DR Scheduler, and DR Scheduler HL7 Interface. This guide is designed for all staff involved in using the Dedicated Test System (DTS). This may include system administrators, radiology administrators, or other staff. Description of the DTS The Dedicated Test System (DTS) is a standalone client/server solution with hardware and software for: Validating new releases of DR Systems software and new RIS/PACS applications before rolling out to the entire enterprise. Testing new features and options. Testing interfaces to third-party products. Testing purchased products before installing a new RIS/PACS/Reporting system. Testing applications such as Instant Reporter and DR Scheduler, using the optional DTS Workstation.

Dedicated Test System Guide Concurrent use with your production system For existing sites, the DTS operates concurrently with your RIS/PACS/Reporting system. The DTS is set up in a separate domain, and does not cause any degradation of performance in the production system. Note: The DTS is designed as a testing environment, and is not for clinical use. Purpose of the DTS New sites - Advantages of using the DTS By completing a testing process using the DTS, new sites can: Improve implementation and roll-out of new RIS/PACS system. Test products and interfaces before installation of the complete DR Systems RIS/PACS. Validate inbound and outbound interfaces. Existing sites - Advantages of using the DTS By completing a testing process using the DTS, existing sites can: Improve implementation and roll-out of new builds. Minimize IT integration issues. Eliminate interruptions to your live operating system. What you can test Note: For a complete list of features you can test using the DTS, see Chapter 4, Features and Components Available for Testing. Using the DTS, you can: Test all interfaces before going live. Test orders received from HIS/RIS. Test interfaces after changes in the HIS/RIS interfaces. Test when DR Systems upgrades to a new build or release. 1-2 Purpose of the DTS Getting Started

Dedicated Test System Guide Test all interfaces before going live Test all inbound and outbound interfaces between HIS/RIS vendors and the DR Systems PACS. Test the inbound and outbound interfaces between DR Scheduler and the DR Systems PACS. Review setup for facilities and procedures in DR Scheduler. Test outbound billing messages. Test orders received from HIS/RIS External HIS/RIS. Test orders received from external HIS/RIS, for customers without DR Scheduler or RIS. DR Scheduler. Test orders generated by DR Scheduler. Test interfaces after changes in the HIS/RIS interfaces External HIS/RIS. Test orders after changes in external HIS/RIS interface. DR Scheduler. Test orders after: Changes in DR Scheduler Updates received from the DR Systems PACS Test data Review data such as exam types, referring doctors, reading physicians, insurance plans, and service codes. Test DR Systems software upgrades Test software upgrades for a new build or for a major release before going live. Test new features and review changes to the user interface. Getting Started Purpose of the DTS 1-3

Dedicated Test System Guide Product configurations The product configurations include: DTS Standard. DTS Workstation (optional). Available options DR Scheduler and Instant Reporter. DTS Standard DTS Standard is a standalone client/server solution for validating interfaces and new RIS/PACS features before rolling out to the entire enterprise. The DTS Standard is a hardware/software solution. In most cases, DTS Standard and monitor are in a server rack. To conduct testing, you can use your office PC via terminal services to the DTS Standard. Available Options Instant Reporter and DR Scheduler are available product options, if your facility has purchased these products. DTS Standard can be purchased in the following configurations: DTS Standard (no options). DTS Standard with DR Scheduler. DTS Standard with Instant Reporter. Note: Your facility must purchase DR Scheduler or Instant Reporter to enable these products to work in DTS. If you add options after you purchase the DTS If your facility adds Instant Reporter or DR Scheduler after you purchase the DTS, you can request an upgrade of the DTS to include these products. Note: Contact Customer Support if you want to upgrade the DTS to include Instant Reporter or DR Scheduler. If you want to add DR Scheduler to an existing DTS, you may need to ship it to DR Systems for an upgrade. DTS Workstation DTS Workstation is an optional component used in conjunction with DTS Standard. The workstation configuration allows you to test directly without having to use remote access into the server room. Use this workstation to: Test dictation and transcription in Instant Reporter. The DTS workstation includes a desktop PC, monitor, dictation microphone and a transcription foot pedal. Test DR Scheduler. Using the DTS Workstation allows you to test DR Scheduler. 1-4 Product configurations Getting Started

Dedicated Test System Guide Set up report templates. This allows you to: Create your own templates or modify the DR Systems supplied templates. Customize the report header Insert your site logo. Set up SmartForms. This allows you to: Create your own SmartForm templates or modify the DR Systems supplied SmartForm templates. Customize the SmartForm templates headers. Insert your site logo. DTS restrictions Functions and features not included The following functions and features are not currently included in the DTS: Archiving. Document Scanning. Faxing. Management Reports. Medical Necessity Library (IMO). This library is a standard component of DR Scheduler in a production system. It is not included in the DTS. Modem access. Printing. SSL support (option). Note: Web serving of images and reports is available. Uses not permitted The product is not intended for the following uses: Backup or failover system. The DTS is not intended for use as a backup system. Clinical review. The DTS is designed as a testing environment, and is not for clinical use. Multiple DTS units in a facility. Only one DTS is permitted per facility. Product evaluation. The DTS can only be used to test products already purchased. Scheduling as a standalone product. DR Scheduler is only integrated in the DR Systems PACS. Clustered configuration. The DTS does not work in a clustered configuration. Getting Started DTS restrictions 1-5

Dedicated Test System Guide Getting Help Contacting Customer Support Phone, fax, and e-mail contacts To contact DR Systems Customer Support: Phone: 1-800-794-5955 Fax: 1-858-625-3337 Email: drsupport@dominator.com Online contacts To contact Customer Support online: Customer Support Self-Service: http://www.dominator.com Note: For access, call Customer Support for your user ID and password. Viewing Online Help To display online Help: Press F1, or Click Help Topics from the Help menu. Viewing and downloading documentation To view and download the most current documentation, visit the Resource Center on the DR Systems Web site. Register online for your user ID and password http://www.dominator.com 1-6 Getting Help Getting Started

Chapter 2 Technical Specifications DTS Standard...2-1 DTS Workstation...2-3 DTS Standard Features Processor and speed Chipset RAM Cache memory Operating system Fault tolerance Redundancy Optical storage Removable storage Server-class machine: monitor, keyboard and mouse NIC Expansion Slots Mounting UPS Intel Xeon 3.0 GHz Dual Core Processor Intel 5000P Chipset 4.0 GB. 4MB level 2 ECC cache (full speed) Microsoft Windows 2003 Server R2 RAID1 fault tolerance. Smart Array P400i Controller Hot plug hard drives, 2.5 SAS 10K SFF Capacity: 146 GB 700W hot plug redundant power supply Hot pluggable fans 24X Max CD-R/W DVD-ROM Combo Drive USB ports located on front and rear. Standalone. The unit can ship standalone with a standard keyboard, mouse, and 17 LCD monitor For rack: When part of a rack, 1 U form factor 17 TFT flat-panel with keyboard and mouse (optional) Two Gigabit NICs (embedded) 10/100/1000 WOL (Wake on LAN). 2 available PCIe slots, including: 1 slot, full size X8 hot-plug PCIe 1 slot, low profile X8 hot-plug PCIe Rack mounted Options: 1500 VA Note: A rack is not included in the DTS Standard.

Dedicated Test System Guide Unit details DTS Standard Rated voltage range Rated line frequency Operating temperature 100-120 VAC or 200-240 VAC 50 or 60 Hz 50 to 95 degrees F (10 to 35 C) Operating humidity 10% to 90% Rated input current Redundant power supplies Power input Power output Heat dissipation Rack dimensions Weight 7.1A @ 115 V or 3.5A @220 V 852 W (100 to 240 VAC) 700 W 2910 BTU/hr 1.70 x 16.78 x 27.75 in (4.32 x 42.62 x 70.49 cm) 1 U form factor 37 lb (16.78 kg) 2-2 DTS Standard Technical Specifications

Dedicated Test System Guide DTS Workstation Unit details (typical) DTS Workstation Processor and speed RAM Operating system Hard drive Optical storage Removable storage Keyboard and mouse Audio NIC Chassis Dimensions Weight Operating voltage range Rated voltage range Rated line frequency Rated input current Maximum rated power Heat dissipation Operating temperature Operating relative humidity Intel Core 2 Duo 2.13 GHz (1066 MHz Front Side Bus) Standard L2 Cache, 2 MB Integrated ECC 1GB DDR2 PC2-5300 Microsoft Windows XP SP2 Professional 80 GB 7200 rpm SATA 48X SATA combo drive USB flash ready STD. keyboard / USB Optical Mouse Integrated audio, High Definition Stereo Integrated Broadcom NetXtreme Gigabit, Ethernet data rate: 10/100/1000 Mb/s ATX carbon & silver chassis configurable as a tower or desktop computer 3.95 x 13.3 x 14.9 in. (10.3 x 33.78 x 37.85 cm) 17.2 lb (7.8 Kg) 90 to 132 VAC or 180 to 264 VAC 100-127 VAC or 200-240 VAC 50 to 60 Hz 3.5A at 115 VAC 240 W Max. (240W):1260 BTU/hr. Typical (99W input): 337 BTU/hr. 50 to 95 F (10 to 35 C) 10% to 90% relative humidity Unit Details DTS Workstation Monitor Description Dimensions Weight 20 or 24 LCD flat-panel 20 : 19.6 H x 17.4 W x 8.7 D inches 24 : 15.3 H x 22 W x 7.7 D inches 20 : 19 lbs (8.62 Kg) 24 : 18.3 lbs (8.3 Kg) Technical Specifications DTS Workstation 2-3

Dedicated Test System Guide Unit details for Reporting Option Hardware Component Philips SpeechMike Transcription Foot pedal Component Details USB USB 2-4 DTS Workstation Technical Specifications

Chapter 3 Features and Components Available for Testing Features you can test...3-1 Interface validation...3-2 System components summary...3-2 DR Scheduler option...3-4 Instant Reporter option...3-6 SmartForms option...3-6 Features you can test You can test the following features: Feature Acquiring images (use test pattern as image). Option required? No Dictating a report on Web Dominator. Yes - Instant Reporter Dictating a report on Dominator. Yes - Instant Reporter Moving the exam to online (generate an HL7 message and send an order status). No Publishing, viewing, and storing a report. Yes - Instant Reporter Reading an exam on Dominator Reading an exam on Web Dominator Receiving orders. Receiving patient data. Scheduling - generating appointments Scheduling orders No No No No Yes DR Scheduler Yes DR Scheduler Sending reports to a third-party system Yes - Instant Reporter Transcribing a report on Web Transcription Yes - Instant Reporter Transcribing a report on a Transcription workstation. Yes - Instant Reporter Verifying that messages were received by PACS. No

Dedicated Test System Guide Feature Verifying that messages were sent to and received by other vendors. Option required? No Interface validation Using the DTS, you can validate and test from your workstation via remote access services, or from the DTS workstation: Verify that messages were received by PACS Verify that messages were sent to and received by other vendors Specific interfaces Inbound and outbound admission, discharge transmissions, orders in, order status, ResultsIn, and ResultsOut. HIS/RIS interface changes. HIS/RIS product version updates. DR Scheduler integration (optional). Integration of DR Systems Web Launch, which allows users to view images on an external HIS. You can test systems such as Meditech or the McKesson Horizon WP Physician Portal. System components summary Testing DR Systems software components See the following table for details on DR Systems software components that are available for testing. Software Component Active Directory Automation Communicator Database Database Server (Sybase) DBArch DR Scheduler Purpose for test User accounts. Report Status Notification and Billing Status Notification. Viewing reports and launching images. Patient data, exam codes, referring doctors, reading physicians, service codes, ICD-9, production report templates. Database (5 concurrent licenses). Backup of test database. DR Scheduler (requires DR Scheduler option). 3-2 Interface validation Features and Components Available for Testing

Dedicated Test System Guide Software Component DR Scheduler Database Dr Scheduler Interface Service DR Web Launch Dragon HL7 Gateway Image Server Instant Reporter Internet Explorer NetSupport Manager Philips SpeechMike Report Manager ResultsIn ResultsOut Transcription Universal Manager Web Dominator Purpose for test Microsoft SQL Server for the DR Scheduler database with a single license. (Not a processor license. Requires DR Scheduler option. Interface between DR Scheduler or an external application (HIS) and Hl7 Gateway application (Web Service). (Requires optional Dr Scheduler.) Image viewing from third-party programs. Voice recognition (requires optional Instant Reporter). ADT-in and ADT-out, orders-in, order status-out. Exam images for viewing. Report content and presentation. Test dictation, voice recognition, transcription, approval. (Requires optional Instant Reporter). Browser-based support for Internet-based scheduling, and viewing images and reports. Communication between site and DR Systems. Additional license to provide access to service the system. Standard microphone provided with Instant Reporter for dictation. (Requires optional Instant Reporter.) Report storage, report viewing. Reports imported from external systems. Reports, 2 voice files, file path, financial transactions out to external systems. Transcribing reports. (Requires optional Instant Reporter.) User interface to software components. Diagnostic reading software for a home PC. Web Server Report or image viewing from the Web (IIS 6.0). Web Transcription Transcribing reports at remote sites, such as home offices. Features and Components Available for Testing System components summary 3-3

Dedicated Test System Guide Third-party software components included The following third-party software is included in the DTS. Software Component Microsoft Word Stedman s Medical Spellchecker Dragon Amyuni NetSupport Manager Internet Explorer Purpose for test Word processor used in Instant Reporter to create reports. Medical Spellchecker used in Instant Reporter for dictation and transcription. Voice Recognition software. Used with Instant Reporter. Converts Microsoft Word to Adobe PDF, for Web distribution of reports to referring physicians. Used with Instant Reporter. Provides communication between the site and DR Systems. Provides Web browser-based support for Internet based scheduling; web image viewing, and report viewing. Components that are not available in the DTS For details, see DTS restrictions in Chapter 1, Getting Started. DR Scheduler option Dr Scheduler enables automated enterprise-wide, resource-based scheduling of patients, resources, and facilities. As a fully integrated module of the DR Systems PACS/RIS option, the DR Scheduler provides health-care facilities with significant savings in time, resources, and money by reducing operating expenses, increasing efficiencies, and improving insurance payment cash flow. DR Scheduler can be configured for both the front-desk users connected via the LAN and remote users connected via the Web: For front desk users Front-desk staff can generate appointments or view schedules, and view prior exams. For Web users The Internet-based DR Scheduler allows referring doctors to schedule their patients for exams and get immediate feedback about available times and locations. 3-4 DR Scheduler option Features and Components Available for Testing

Dedicated Test System Guide Figure 1 DR PACS/RIS Registration Modules DR Scheduler Features Provides enterprise resource-based scheduling. DR Scheduler can check availability across multiple sites, facilities, and resources to offer the next available appointments. Provides rules-based scheduling. Provides Internet based scheduling for referring physicians and their offices. Records and tracks Authorization and Precertification. Collects patient registration data including demographics and insurance data (Patient and Exam properties dialogs). Provides exam preparation information. Provides preregistration worklists. Tracks payments against the exam (Exam Tab). Tracks payments against the patient (Patient Tab). Stores data required for a 3 rd party billing company to effectively bill (Exam and Patient dialog boxes). Collects insurance data such as the primary, secondary, tertiary insurance plans. Tracks whether ABN forms are required. Records and tracks appointments that have been phone confirmed. Provides business management schedules and reports. Note: Medical necessity and biannual subscription service are not available in the DTS. Medical necessity is available in the main installed DR Scheduler, but is not available for testing in the DTS. Features and Components Available for Testing DR Scheduler option 3-5

Dedicated Test System Guide Instant Reporter option Instant Reporter features Instant Reporter has the following features: Digital dictation. Automated user-defined report templates. Voice recognition (not available for Web Dominator). Report status tracking. Transcription. Transcriptionists can access all the case-related information directly on the Transcription Workstation. Report approving and auditing. Electronic report approval. Report revision. Report distribution. An audio report summary that is available to medical providers even before the final written report is completed and approved. Testing report content and presentation Using DTS, you can test report content and presentation: Corporate logos Report headers Report templates SmartForms option Features SmartForm templates provide extensive features for creating, managing, and printing forms required in your practice. SmartForm Templates are Microsoft Word template files for standard editing. When a patient arrives at the front desk, the appropriate forms for the patient s procedure are automatically available for printing. Staff select the forms to print from a list based on the patient's exam type, insurance plan, and acquiring site. Users with the required rights can create, edit, or print the SmartForms needed by reading physicians, staff, patients, and referring physicians. The Synchronize utility upgrades existing RIS Forms to SmartForms. 3-6 Instant Reporter option Features and Components Available for Testing

Dedicated Test System Guide Testing SmartForms Using DTS, you can test SmartForms content and presentation: Create SmartForm templates or modify the DR Systems supplied SmartForm templates. Customize headers. Insert your site logo. Features and Components Available for Testing SmartForms option 3-7

Dedicated Test System Guide 3-8 SmartForms option Features and Components Available for Testing

Chapter 4 Interfaces Interfaces for DTS Standard...4-1 Interfaces for DR Scheduler...4-1 Interfaces for DTS Standard For details on interfaces, ask your Project Manager for the appropriate specifications: Document Number Title Descriiption 21-04-07-0040 RIS/PACS Interface Specification: Interface between hospital or imaging system, DR Systems & RIS 21-04-07-0329 RIS/PACS HL7 Outgoing Results Interface Specification: HL7 outgoing results interface between DR Systems & RIS 22-04-07-1363 HL7 Interface Specification: DR Scheduler interface RIS/PACS interface, including: Orders In Orders Out ADT HL7 Gateway Outgoing results, including: Billing interface Dr Scheduler interfaces - incoming and outgoing DEV-000095 HL7 Incoming Results Interface Specification: HL7 incoming results interface between DR Systems and third-party transcription application Incoming results from third-party transcription program Interfaces for DR Scheduler HL7 Data Flow HL7 configuration will be site dependent, depending on whether a Hospital Information System (HIS) is in use at the site. HIS Configuration An existing Hospital Information System plays the role of master patient demographics source. 1. The HIS sends patient demographics updates to DR Scheduler (via HL7). 2. DR Scheduler forwards the updates to the DR Systems PACS for synchronization purpose.

Dedicated Test System Guide 3. The DR Systems PACS forwards billing information, generated when an order is complete (for example at the time the report is approved) to the HIS for processing. 4. DR Scheduler sends updates for scheduled exams and referring physicians to the DR Systems PACS via HL7. Figure 1 Sample HL7 Data Flow HIS to Scheduler Message Type Action Description ADT/A08 Patient Updates ADT/A28 New Patient Billing Message Type Action Description DFT/P03 Or Full billing Send billing information Flat file billing Reports Message Type Action Description ORU/R01 MDM/T02 Send report Medical Document Management interface original (preliminary) 4-2 Interfaces for DR Scheduler Interfaces

Dedicated Test System Guide MDM/T04 MDM/T10 Medical Document Management interface update (final) Medical Document Management interface replacement (addendum) RIS Configuration In this configuration, DR Scheduler plays the role of Radiology Information System (RIS) and is responsible for maintaining Patient Demographics. 1. DR Scheduler sends scheduled exams and referring physician updates to DR Systems PACS. 2. The PACS sends billing information to a third-party billing system. 3. The PACS sends reports to third-party reporting systems using ResultsOut. Billing Figure 2 DR Scheduler as RIS configuration Message Type Action Description DFT/P03 Full billing Send billing information via HL7 Flat file billing Interfaces Interfaces for DR Scheduler 4-3

Dedicated Test System Guide 4-4 Interfaces for DR Scheduler Interfaces

Chapter 5 Implementation Process Planning and site preparation...5-1 Installation...5-3 Setup and data conversion...5-4 Planning and site preparation DTS Standard For new sites only Record data Record data such as exam types, referring doctors, reading physicians, service codes. The project manager provides HL7 Interface forms for the System Administrator to record data such as exam types, referring doctors, reading physicians, service codes, and other required data. Provide data to mirror your HIS or RIS. For sites currently using DR Systems RIS/PACS Export data Export data such as exam types, referring doctors, reading physicians, service codes. The interface team will assist in exporting current data and importing to DTS. For all sites The System Administrator needs to provide the following information: Connection information Remote access Select available options Placement information All connection information, including: port numbers IP addresses for incoming and outgoing external interfaces IP address and port for DTS Remote access (VPN or dial-up) to your site is required for configuration and testing. Determine if these options are required for your facility: Instant Reporter DR Scheduler Initial placement. For a new site, the typical initial placement is on a desktop. Final placement. After installing the complete RIS/PACS system, the typical placement is in the rack with the core PACS servers and components.

Dedicated Test System Guide DR Scheduler (option) Determine if data needs to be converted Synchronize data in the PACS and DR Scheduler are in synch Determine if data needs to be converted, if legacy information exists. Verify that the PACS and DR Scheduler are in synch with each other before moving the DR Scheduler to the production server. This includes data for: Patients Exam types Referring physicians HIS/RIS Interface Import data Import the following data: Exam types Referring doctors Reading physicians Service codes (optional required for billing) Insurance plan names and numbers (optional) HL7 Gateway Setup Mirror current site configuration or determine necessary configuration for testing. Determine what will be tested, such as orders, ADT, MFN, or DFT. Obtain IP and port address for interfaces. Provide interface validation for incoming and outgoing data. ResultsOut (option) Setup Mirror current site configuration or determine necessary configuration for testing. Obtain IP and port address for interfaces. Provide interface validation for incoming and outgoing data. Billing (option) Determine billing methods Obtain IP and port address Validate interface Determine methods for: HL7 messages Flat file billing Message format Obtain IP and port address of receiving application. Provide interface validation for outgoing data. Report Manager (option) IP and port address Validate interface Obtain IP and port address for interfaces. Provide interface validation for incoming data. 5-2 Planning and site preparation Implementation Process

Dedicated Test System Guide Remote Access Components for access Determine the components your facility plans to use for remote access: Internet Explorer - for simple browser-based viewing. Web Ambassador - web access for referring physicians. Web Dominator - web access for reading physicians. Web Transcription - web access for transcriptionists. Installation Installation notes for all sites Domain name. Dedicated Test System will ship with a distinct domain name: DTS<site#>.DRS Rack not included. DR Systems ships the test system without a rack. DTS workstation. A separate DTS workstation may be required to install, if you are testing Instant Reporter or DR Scheduler. DR Scheduler upgrade requirements. If you purchase DR Scheduler at a later time, the DTS must be shipped back to DR Systems for upgrade. Installation notes for new sites Initial location on a desktop Initially, the system requires desktop space, which the customer must provide. Note: While on a desktop, the test system is not protected with a UPS. Moving the DTS to a rack After installing the PACS, the System Administrator or DR Systems Field Service moves the DTS to the HP rack. Reserve a 1U space in the rack for the DTS. Note: After the system is moved to the main server rack, it is protected by a UPS. Implementation Process Installation 5-3

Dedicated Test System Guide Setup and data conversion DTS Standard with DR Scheduler The following steps are involved in setting up a site with scheduling: 1. Complete the DR Scheduler Implementation Survey for each facility. This survey includes the following sections: Facilities (required) Modalities (required) Suites (required) Procedures (required) Precedence Staff Equipment Cancellation/Reschedule Codes 2. Complete the data conversion templates for referring doctors, exam types, insurance plans, plan types, authorizations, pre-certifications, and all other required data. Note: Database tables and scheduling configurations will be preloaded as much as possible. DTS with Instant Reporter Several tasks are required before you start using Instant Reporter. 1. Create users, assign rights, and define roles. Completed by System Administrator. 2. Set up base template. Completed by System Administrator with assistance from Customer Support. DTS with SmartForms Some tasks are required before you start using SmartForms. 1. Assign rights and define roles. Completed by System Administrator. 2. Create a SmartForm or edit a DR Systems supplied SmartForm. Completed by System Administrator. 5-4 Setup and data conversion Implementation Process

Chapter 6 Testing and Validation About this chapter...6-1 Test the standard exam process...6-1 Test the Instant Reporter option...6-1 Test the DR Scheduler option...6-2 About this chapter This chapter provides a high-level guide to testing on the DTS. For details on these steps, see the User Guide or Online Help. Test the standard exam process The following is a typical workflow for the standard exam process: 1. Add a patient. 2. Add insurance data for the patient. 3. Add patient demographics. 4. Schedule an exam for a patient. 5. Acquire a sample image. 6. Go online 7. Read the exam. 8. Click the Actions button to review any possible failures. Test the Instant Reporter option The following is a typical workflow for using Instant Reporter: : 1. Dictate the body and conclusion for the report 2. Transcribe the report. 3. Approve the report.

Dedicated Test System Guide Test the DR Scheduler option The following is a typical workflow for using DR Scheduler: : 1. Book the appointment. 2. Confirm and manage the appointment. 3. Receive the patient on the scheduled tab within the PACS 4. Collect signatures and scan required documents. (no signatures) 5. Add notes on the Scheduled tab. 6-2 Test the DR Scheduler option Testing and Validation

Chapter 7 Reference Detailed instructions...7-1 Instructions for testing the two-way interface between Meditech and DR Systems RIS/PACS...7-1 Instructions for testing the Communicator...7-2 Detailed instructions For detailed step-by-step instructions and overview information for using the system, see: Online Help (includes procedures for all products) Printed guides all available on the Resource Center User Guide System Administration Guide Instant Reporter Guide DR Scheduler Guide Web Dominator Guide Instructions for testing the two-way interface between Meditech and DR Systems RIS/PACS The following are instructions for testing the two-way interface between Meditech and DR Systems RIS/PACS. Note: The testing needs to be done on the RISGateway PC, station 59. 1. Generate an order on Meditech test. DR Risgate Test receives the order 2. On Universal Manager on station 59, select the Risgate Test datasource. 3. Click the Scheduled tab. 4. Look for the exam just sent from Meditech and select it. 5. Click the Acquire button on the toobar. 6. When the next screen displays, click the Grab Image button on the toolbar. 7. The Insert Series dialog box opens. You can type in a name for the series if you wish, but you can also just click OK without naming the series. A test pattern displays as the image. 8. Click the Grab Image button multiple times, and the system grabs the test image each time.

Dedicated Test System Guide 9. Click Done when you are finished. 10. Click Complete. The Final Review of Exam Properties opens. If no changes in the exam are required, click Complete without Revisions. If changes are required, make them and click Complete with revisions. 11. Select the Online tab. The acquired exam should be in the list. 12. Select the exam and click the Props button on the toolbar. The Exam Properties dialog box opens. 13. Click the Mark Status button in the toolbar. 14. Enter the Edit password if prompted. If you do not know the password, contact Customer Support. 15. Click the Read button on the toolbar, and click OK. 16. Click the Close button. Soon after this, the exam should displays as Read on the Meditech system. Instructions for testing the Communicator The following steps are for testing only and do not have to be done when the order status interface is LIVE. They make the test exams/images available for display to Meditech through the Communicator:. 1. Copy the exam from the risgate test datasource to the network datasource. 2. Select all exams that were marked read, and click the Copy button. 3. Make sure the site's main database is selected. Click OK. A dialog box opens showing the status of the copy. 4. Select the site's main database as the datasource. 5. On the File menu, click Update Online Exams Database. This takes a few minutes because it checks all.files to be sure there is a matching entry in the online table. When finished a dialog box opens. If it says that no new exams were found: Check if one of the exams is in the table to be sure. 7-2 Instructions for testing the Communicator Reference

Dedicated Test System - Release 8 Glossary Glossary terms... 1 Standard DICOM Modality Codes... 24 Glossary terms A ABN (Advance Beneficiary Notice) A written notice that a physician or supplier gives to a Medicare beneficiary. The purpose of the ABN is to inform a beneficiary before receiving specified items or services that Medicare may not pay for them. The ABN allows the beneficiary to make an informed consumer decision whether or not to receive the items or services. The Health Insurance Portability and Accountability Act (HIPAA) mandated the use of the ABN form. ADT (Admission, Discharge, and Transfer) An interface used in exchanging information to and from external systems and PACS data to synchronize new or updated registration, admission, discharge, transfer, and visit information. adverse reaction A patient pathological condition as a result of ingesting or of being exposed to a chemical substance that was properly administered or taken. Ambassador [DR Systems product] A display workstation from DR Systems. Also see Media Ambassador and Web Ambassador. anonymization A process that removes all personal identification from exams, to allow distributing a patient's exam to others without divulging the identity or compromising the privacy of the patient or others involved in the exam. appointment resources A resource that must be available to successfully complete an appointment, for example: Facility, Modality, Procedure, Suite, Staff Type, and Staff Member, and Equipment. Glossary 1

Dedicated Test System - Release 8 Automatic Faxing [DR Systems product] A distribution component option to Instant Reporter for automatically faxing information to referring doctors. Automation [DR Systems product] A software module that runs on the same server as the HL7 Gateway. If a site does not have HL7 Gateway, it runs on the Messenger server. Automation completes the following tasks: Purges exams and reports. Periodically purges Online and Scheduled exams and reports that exceed their purge dates, if the remaining disk space on the Central Server drops below the configured minimum percentage. Sends reports. Performs sending and automatic resending of reports to Report Manager. Sends requests. Sends requests to ResultsOut, Fax Server, and printer managers. Monitors the notification queue. This queue contains status information from ResultsOut, Fax Server, and printer managers. B bicubic interpolation An image resizing method in which the "new pixels" in a magnified image are computed using a two-dimensional cubic interpolation algorithm. With this algorithm, a 4x4 array of neighboring pixel values is used to calculate the interpolated value. This method offers excellent results but is computationally complex, resulting in considerably slower image rendering times. bilinear interpolation Smoothes the block appearance of the image for better viewing. When small images are magnified they can appear blocky or pixilated. This is an image resizing method in which the "new pixels" in a magnified image are computed using a two-dimensional linear interpolation algorithm. With this algorithm, a 2x2 array of neighboring pixel values is used to calculate the interpolated value. This method offers very good results while being only slightly slower than pixel replication. Billing out [DR Systems product] Sends all related billing information to a third-party billing company, including: Charge information, insurance type, insurance plan, employer information, and payments. billing system A computer-based billing communications system that stores and retrieves patient billing specific data for financial billing purposes. 2 Glossary

Dedicated Test System - Release 8 BI-RADS (Breast Imaging Reporting and Data System) A method used by radiologists to interpret and report in a standardized manner the results of mammography, ultrasound, and MRI used in breast cancer screening and diagnosis. This system is a quality assurance tool designed to standardize mammographic reporting, reduce confusion in breast imaging interpretations and facilitate outcome monitoring. The American College of Radiology (ACR) is the copyright owner, with cooperation from the National Cancer Institute, the Centers for Disease Control and Prevention, the Food and Drug Administration, the American Medical Association, the American College of Surgeons and the College of American Pathologists. blank disc In the Guardian program, a blank DVD-RAM disc has no files. In some cases, a blank disc may have a file system, and may have been processed with a full certification format. body In Instant Reporter, the audio recording for the portion of the report in which the findings are described, but not the conclusion or impression. The body of the report is typically available only to radiologists, other reading physicians, and transcriptionists, and is not distributed to referring doctors and staff. burned-in annotation An optional DICOM attribute that indicates if the image contains sufficient burned-in annotation to identify the patient and date the image was acquired. The DICOM tag for Burned In Annotation is (0028,0301). C cache A directory on the computer's hard drive where the system stores exams that have been accessed over the Internet or a network. By storing exams on a local drive, the system can quickly display images, rather than trying to access them over a slow network connection. CAD (Computer Aided Detection) The process of running computational algorithms to detect and analyze abnormalities such as lesions and calcifications in a medical image, without human intervention. The input to CAD processing is a set of study images, and the output is typically a Structured Report containing detections and analyses. Catapult Technologist QC Workstation [DR Systems product] A technologist quality control workstation that provides advanced image processing; image importing with advanced image processing, 3D modeling reconstruction in color, volume rendering, and volume measurement. Glossary 3

Dedicated Test System - Release 8 CC (cranio caudal) A view position that is "from above." CCOW (Clinical Context Object Workgroup) A set of integration standards for the clinical desktop. The CCOW standard establishes the basis for ensuring secure and consistent access to patient information from heterogeneous sources through synchronizing and coordinating applications (such as those used for patient registration, order entry, and results reporting) so that they instinctively follow a specific context, including the identity of a user, a patient or a specific clinical observation. CD Ambassador Workstation See Media Ambassador Workstation. Centera An EMC data storage product that provides high reliability, high data integrity, much greater expandability, and significantly lower management costs compared to NAS and SAN. Centera Guardian Workstation [DR Systems product] Stores long-term exam and report archives on a Centera storage device. For additional data security, the Centera may be configured to replicate its data to another geographically remote Centera. Centera Guardian with Disk Array [DR Systems product] Archives exams and reports to a single remote Centera and maintains a copy of local repository archives on a local SAN or NAS device. Central Server A central image and data server from DR Systems. color LUT (Lookup Table) A method used to create a color map, to artificially map a grayscale image to arbitrary color values. Communicator An Internet server from DR Systems that allows Intranet or Internet access, enabling adherence to HIPAA guidelines to protect patient confidentiality. compression A method to reduce data volume by encoding it in a more efficient manner. Compression may be lossless or lossy. 4 Glossary

Dedicated Test System - Release 8 compression ratio The ratio of the number of bits in an original image compared to that in a compressed version of the image. For example, a compression ratio of 2:1 would correspond to a compressed image with one-half the number of bits of the original. conclusion In Instant Reporter, the audio recording that includes the conclusion or impression of a report. Typically, this recording is available to radiologists, other referring doctors, transcriptionists, and is often distributed via the Internet to referring doctors. co-pay (co-payment) A provision in an insurance policy that requires that the policyholder pay a specified amount to a health care provider for each visit or medical service received. CPT codes (Current Procedural Terminology) A set of exam codes used by medical facilities. Each code represents a specific medical procedure. The American Medical Association (AMA) publishes current procedure and service codes annually. CR (Computerized Radiography) A system for acquiring images of patients using a phosphor plate, typically read by a CR-reader for image conversion. CSLA (Customer-Supplied LAN Ambassador) [DR Systems product] Software-only product available for facilities with existing PCs used for clinical applications. Provides the same features as an Ambassador workstation supplied by DR Systems. CSLT (Customer-Supplied LAN Transcription) [DR Systems product] Software-only product available for facilities with existing PCs used for clinical applications. Provides the same features as a Transcription workstation supplied by DR Systems. CSU/DSU (Channel Service Unit/Data Service Unit) The CSU is a device that performs protective and diagnostic functions for a telecommunications line. The DSU is a device that connects a terminal to a digital line. Typically, the two devices are packaged as a single unit. It is similar to a high-powered modem. Such a device is required for both ends of a T-1 or T- 3 connection, and the units at both ends must be set to the same communications standard. CT (Computerized Tomography) A system for acquiring axial images of patients by rotating an X-ray and detector. Glossary 5

Dedicated Test System - Release 8 CTA (Computed Tomographic Angiography) A modality that combines the use of x-rays with computerized analysis of the images. It passes beams of x-rays through the body from several different angles to create cross-sectional images, which are assembled by computer into a threedimensional picture. D database source Allows you to select another server or access exams and images from a removable media, such as USB disk, DVD or CD-ROM, or USB flash drive. DB Archive [DR Systems product] A module that backs up the PACS database on the server and backs up reports to a DVD. Dedicated Database Server [DR Systems product] Improves performance of large databases for sites that need to store 300,000 or more online exams by providing a server dedicated to database functions only. default An option that is selected automatically unless an alternative is specified DFT (Detailed Financial Transaction) An HL7 message sent through ResultsOut that describes a financial transaction to the billing system. DICOM (Digital Imaging and Communications in Medicine) The industry standard for transfer of radiologic images and other medical information between computers. DICOM enables digital communication between diagnostic and therapeutic equipment and systems from various manufacturers. DICOM Gateway [DR Systems product] A system provided by DR Systems as the primary DICOM SCP (Service Class Provider) subsystem, which supports multiple service classes. DICOM Guardian [DR Systems product] Supports the secure storing of exams to a DICOM storage device, using standard DICOM interfaces. To support exam retrieval, the database stores a list of exam components in the archive. 6 Glossary