PACS Consolidation and Imaging Record Quality Policies MEDICAL IMAGING INFORMATICS AND TELERADIOLOGY CONFERENCE
Genady Knizhnik Industry Consultant 20 years in Healthcare IT industry across the globe Contact: dondennison.com genady@dondennison.com @Genady_Knizhnik Potential Conflict of Interests Used to work for Imaging and Healthcare IT vendors Provide consulting services to Imaging IT vendors
Organizations are seeking to consolidate existing systems into larger, shared systems To enable multi-facility diagnostic reading workflow To set and enforce common standards of practice To improve physician collaboration To reduce cost and complexity of managing multiple disparate systems To benefit from economies-ofscale
PACS Consolidation: What Does it Mean? Multiple PACS, Multiple Archives Facility A Facility B Facility C Facility D Single PACS, Single Archive Facility A Facility B Facility C Facility D PACS A PACS B PACS C PACS D A B C D Each PACS with its own Image Archive Consolidated PACS A, B, C, D Shared PACS* and Image Archive Users have different tools, fragmented data Shared Tools and Imaging Data *PACS server deployment may be centralized or federated, depending on its design
Approaches for a Consolidated PACS Buy a new PACS to replace existing ones Build up an existing PACS and consolidate others into it
Product Vendor Decision: New vs Existing PACS Positive and Reliable Relationships Adequate Support Adequate SMA costs Radiologists and PACS Admin s satisfaction Performance Scalability Responsiveness to new technical and clinical trends Multi-facility acquisition workflow Multi-facility reading workflow Multiple Patient ID domains environment Multiple Terminology domains environment Multi-facility system administration Multi-facility security model Multi-facility desktop integration Interoperability Existing PACS should be evaluated against these categories One or more negative answers would suggest buying new system
Things to Consider Don t underestimate Required change-management Difficulty to satisfy all clinical stakeholders with one system Complexity and comprehensives of local clinical workflows Variability of facilities operational and IT processes and capabilities Migration readiness (or not) of different PACS systems Inconsistency in data quality Develop Onboarding plan for each facility Schedule of PACS to be consolidated Plan to have the legacy PACS in operation in parallel during the switchover and beyond Staffing required to manage the system Staffing responsibilities for data quality control Imaging record quality policy
Imaging Record Policy To deal with Comingled data from different facilities and systems Different practices, standards, systems, identifiers, codes, etc. Older data that is migrated, may be incomplete Some departments may not provide complete records
Imaging Record Policy A policy, typically endorsed by an executive, like the CMIO, that specifically defines a complete and consistent medical record for imaging Records that do not meet the criteria are noncompliant and are subject to correction or even rejection (if unsafe for access) Systems and departmental staff that produce non-compliant imaging records are subject to corrections defined in the policy, including system changes, additional training, workflow corrections, or even removal Administrative and technical safeguards are used to ensure data quality
Imaging Record Policy Phase 1 Phase 2 Phase 3 DEFINITION Define and approve the imaging record quality policy DETECTION Configure or develop tools to detect and report on quality policy compliance Provide feedback to data owners on quality of their data, impact of noncompliance ENFORCEMENT Develop tools to correct, segregate or reject detected quality policy noncompliance Provide support services to correct noncompliant data and/or source systems
Imaging Record Policy Be pragmatic. It is best to start with a core set of the most important attributes with clear requirements. You can always add more attributes to the policy once you have applied the initial one. Be consistent. When migrating or importing imaging records acquired externally, it is best to assess the adherence of the data against the policy to determine if any corrections are required Seek endorsement of senior leadership. It is recommended to educate executives, such as the CIO and CMIO, on the importance of having such a imaging record quality policy and ask them to endorse it.
PACS Consolidation Process ADDITIONAL SLIDES
PACS Consolidation Process Planning & Analysis System Selection System Development Configuration, Integration, Testing Data Migration Per Legacy PACS Training & Change Management Pre Go Live Prep & Testing Go Live Decommission of Legacy System
Planning & Analysis Inventory Historic (Archive) Data Annual (New) Data Modalities Other Imaging Systems Information Systems, Interfaces Desktop Integrations Existing Workstations, Monitors Facilities, Reading Areas Users (with Roles), authentication methods Evaluate (per System) DICOM interfaces, data consistency HL7 interfaces Evidence document interoperability (GSPS, KOS, SR) Evaluate (per Facility) Staff capability, capacity Network Reading workstations [Disk image mgmt tools] Test (per System) DICOM migration speed [New PACS Client speed] [Report migration] Test (per Facility) [New PACS Client speed] Decide (per System) DICOM Migration Tools, Method Amount of DICOM to be migrated (e.g. 10 years) [conditional activity]
System Selection Assess Existing system performance, capability Decide Build up Existing PACS, or buy a New PACS Existing PACS: Evaluate System ability to provide capabilities and scale New PACS: Develop RFP representing needs for all facilities Evaluate PACS RFP proposals from Vendors PACS ability to provide multi-facility acquisition, QC and reading workflows Assess System Design (physical deployment) required to serve all facilities needs Overall system resiliency Costs for developing PACS to handle all facilities Staff deployment required Finalize Contract with PACS Vendor, with SLA [conditional activity]
System Development Define Detailed specifications for all required hardware and infrastructure changes Infrastructure development schedule/plan [Back-up and recovery methods] [Failover and failback procedures] [Patching procedures] Deploy [Servers, storage] [System monitoring] Network integration Test Failover and failback, plus cross-system data integrity checks [conditional activity]
Application Configuration, Integration, Testing Configure HL7 listeners DICOM device interfaces (PACS and Modalities) Develop DICOM workflows, behaviors, attribute value coercion rules HL7 interfaces, including Patient Merges/Splits [User authentication integration] [Desktop integrations] Configure User roles, preferences Patient Identity mapping Body part mappings Procedure Code tables Display Protocols Relevant prior exam retrieval rules Archiving rules [Routing rules] [DICOM Modality worklists] [Reading worklists] Test User authentication, permissions Acquisition workflows QC workflows Reading workflows, including Display Protocols Evidence document display Archiving Relevant prior rules Prior exam retrieval [conditional activity]
Data Migration Migrate [DICOM study metadata] DICOM study data [Report data] Validate DICOM data consistency from source to destination Correct Data quality issues Capture Post-migration report [conditional activity]
Training Identify Stakeholders Change Agents Evaluate Training material Develop Training plan, schedule Communication plan [Custom training materials] [Quick reference guides] Provide Access for Clinical users to test system for self-learning Access for Admin users to test system for configuration, QC task selflearning Updates on project progress to stakeholders, users [conditional activity]
Pre Go Live Prep & Testing Re-Validate Data quality Interfaces Procedure code, body part mappings Workflows (Acquisition, QC, Reading) Display Protocols Client deployment, performance Develop Command center for help desk and issue triaging Back out plan in case of severe system issue [conditional activity]
Go Live Switchover [Modalities to new DICOM Modality Worklist] Modalities to store to new PACS Enable New HL7 interfaces Disable Old HL7 interfaces Monitor System health, job queues Data flows User activities Address Reported issues Communicate Progress Transition To normal operations [conditional activity]
Decommission of Legacy System Back-up Database [Application configuration files] [Application server disk image] Cleanse Servers and Storage disks by data wiping them Remove [Servers, if not repurposed] Shred [Storage disks, if not repurposed] [conditional activity]