The New World of Unified Image Management A Guide to Imaging in the Enterprise A Publication by DICOM Grid
What is Changing in the Healthcare Market Today? Organizations seeking to eliminate old ways of siloed data must embrace a new model that focuses on outcomes and collaboration. The new reform rules promote the limiting of medical procedures and tests unless very necessary, which can certainly cause healthcare organizations to take on more risks. Teamwork between providers and coordination among various points from imaging centers, primary care physicians, and hospital surgical units is absolutely critical. Missing medical images that lead to rescans (an up to 60% occurrence in trauma units alone) is no longer a feasible option. Medical imaging must be available in real-time. The future of an interoperable medical imaging landscape lies in the Cloud. The Cloud allows for rapid and efficient exchange among care providers, enhanced workflows firing away routing rules that successfully automate processes, scalable vendor neutral archiving capabilities, mobile viewing capabilities from anywhere and anytime, and seamless access to data within EMR and RIS systems. Stay tuned for case studies featuring two facilities using DICOM Grid to power enterprise wide storage, exchange, workflows, and viewing. - 2 -
The Arrival of Outside Images What about images arriving from outside the system, like those arriving with a patient from an external trauma unit? The first issue centers on data. Metadata must be connected to the EHR, as key patient information must sync with image storage systems. With each healthcare organization housing its own IT system, differing semantics can lead to a lot of confusion. This makes it difficult to measure performance or gain insights that could ultimately lead to major medical breakthroughs due to inconsistencies across clinical data terminology. In addition to incoming metadata, the medical imaging itself must enter the system. A VPN, which is a common method of connecting facilities in high-volume image sharing scenarios, operates on a hub-and-spoke model. Once a VPN environment has been set up and configured across institutions and firewalls (a hefty task), exams are funneled from the referring location to the recipient hospital. Upon arrival, images must be manually uploaded into the receiving hospital s PACS. Universal Viewing Finally, we reach the universal viewer. From a technology standpoint, older viewers lack the speed and innovation to address today s challenges. In recent years, the industry has made steps forward with the advent of browser-based viewers. A universal viewer that is associated with a VNA can extend the archive s functionality to provide seamless access to images enterprise wide. In addition, a universal viewer that is configured with the EHR can launch directly from the patient s jacket with single sign on. DICOM Grid s image management solution is one of the few that allows for full image-sharing capabilities along with a universal viewer. However, siloed viewers chosen by each -ology remain very much the norm. ebook Download Evaluating Universal Medical Viewers: A Buyer s Guide for the Technology Selection Process - 4 -
Problems with Existing IT Solutions Cost The purchase of a traditional PACS system includes hardware and software licensing (typically a 5+ year long commitment), extensive IT staff to maintain and update the system, electricity costs for power and cooling, purchasing and updating user licenses, and wasted hours of solving IT dilemmas onsite. A recent survey found that the average healthcare institution spent $627,418 per IT downtime incident. Accessibility In a fast-paced medical environment, like that of a trauma unit, CDs have become a matter of life or death. Frequently, patients arriving from a trauma center or as a referral have medical imaging on a CD. If the CD was not lost or damaged in transport, it might be incompatible with the system upon arrival leading to a tedious upload process. This method is not only highly frustrating for medical staff, but also places patients at high risk for redundant radiology exams exposing them to additional radiation. In an increasingly digital world, doctors are beginning to require information at their fingertips when and where they need it. With traditional viewing infrastructures, when a patient comes in as an emergency, doctors are unable to make a preliminary assessment from their homes. The key now is allowing doctors to view images as they are received in real-time, from any location and on any device. Interoperability Exchanging medical images is complex due to the extremely large size of image files and the many systems that must be interconnected to seamlessly access and care for all of a patient s record regardless of the file type. As a result, digital transfer of imaging and reports can be a daunting and slow process. While most PACS have perfected managing DICOMs within their facilities walls, it s often necessary for this information to be shared with sources outside of a network, and also with EMR & RIS. Digital sharing of large medical image files using VPNs can slow down a network and require an extremely large download window. This type of connection is limiting, as direct point-to-point connections must be set-up before image sharing can occur. Further, complicating matters is that using a hub-and-spoke model prevents two spoke hospitals from exchanging data without first passing through the hub hospital. - 5 -
Redefining Medical Image Management in the Cloud DICOM Grid provides a combination of software, services, and support that enables the four pillars of image management to seamlessly work together: workflows, archiving, viewing and exchange which can easily be remembered with the acronym WAVE. We provide the tools you need to ensure the right image is at the right time and the right place all under one roof. Workflow Archive Viewing Exchange PHI Normalization Routing Automation Analytics 3rd Party Integrations Operationalized Lower Cost Disaster Recovery Searchable Scalability Vendor Neutral Zero-Footprint Viewer Mobile Access Remote Access EMR Integration Collaboration Web-based Sharing Gateway Technology No VPN CD Ingestion Real-time Exchange - 6 -
Ride the WAVE: How to Create a Seamless Content Management System Across the Enterprise Exchange & Workflows Cloud-based sharing solutions like DICOM Grid support image transfers and uploads from a variety of inputs. Web upload and transfers are leveraged in cases of ad-hoc referrals, pre-visit patient uploads, and electronic second opinion portals. Gateway software can be set-up to facilitate point-to-point connections through the Cloud to transfer from DICOM modalities and PACS, as well as RIS via HL7. Additionally, routing rules can be configured within DICOM Grid s system to push studies from outside facilities directly into the PACS in the trauma room or surgical suite. The combination of direct image transfer through online sharing and image gateways, as well as through click-once local CD intake application, greatly improves the flow of outside data becoming integrated into the image infrastructure at the receiving hospital. These solutions lower the time wasted by clinicians fumbling around to access the image off the CD. Another key benefit of digitizing the image share process is that it provides enterprise-wide viewing of a study simultaneously. In other words, multiple specialists can access and view an exam at the same time and from different places. Workflow automation is a powerful tool and an integral part of an image management strate- - 7 -
gy. You can leverage routing rules to automate your workflow and share studies across organizations, locations, groups, or users. You can also send studies to specified PACS, modalities, or viewing stations, based on user-defined parameters. Regardless of where the study comes from, DICOM Grid can perform both automated and semi-automated processes to match incoming studies to local orders for imaging based on basic patient information, like Name and Procedure Code via Modality Worklist (MWL) query, or our unique Auto Film Library capability (with no human intervention necessary). DICOM Grid can match or write the hospital-specific information to incoming studies, replacing outside tags for local storage and data management. Archive DICOM Grid s archiving capabilities allow for the consolidation of disparate imaging systems onto one repository allowing the organization to improve interoperability across your facility and provide a single point of access to image data. Configurable retention rules can be established to purge data. In addition, the ability to retrieve a back-up copy of imaging data that might be otherwise lost due to a hardware/software malfunction is a federally mandated requirement. DICOM Grid s disaster recovery solution acts as a backup method to provide instant access to secondary versions of medical images and priors if primary data becomes unavailable. Viewing DICOM Grid s zero-footprint, HTML5 viewer can be accessed through the web or integrated into any PACS. Simple-to-use viewing tools are available for annotating and collaboration. Hanging protocols and viewer customization can allow an organization to cater the viewing experience to specialty physicians and surgeons. In addition, mobile viewing capabilities put medical images at your fingertips from anywhere and at any time. - 8 -
Case Studies Memorial Hermann Healthcare System, a multi-site facility, has used DICOM Grid to: Connect over 100 external sending sites to its main campus, for receiving trauma and general referrals from external PACS systems in real-time Image-enable a system-wide EHR and separate outpatient EHR Image-enable its private HIE Distribute all imaging performed onsite to referring physicians Backup years of imaging data in a Cloud VNA New England Baptist Health, a center of orthopedic excellence, has used DICOM Grid to: Establish a universal viewer for all departments and install the DICOM Grid Viewer in 16 ORS. Archive all imaging in DICOM Grid s Cloud VNA Power exchange capabilities including web uploads from patients and referring physicians, CD ingestion for onsite uploads, direct gateway connections, and outbound electronic distribution of imaging and reports to patients and referring physicians Implement an Auto PHI process that requires no human intervention - 9 -
Conclusion We ve covered a lot of ground in this ebook! We ve walked through the current state of enterprise image management, key pain points, and Cloud solutions to address your facilities needs. Additional Resources Download our ebooks below to learn more about the world of image management. Medical Images in the World of Trauma Transfers Learn More How to Image-Enable the EMR Learn More The Ultimate Guide to Implementing a Medical Image Sharing Portal Learn More - 10 -
Request a Demo We invite you to chat with one of our knowledgeable imaging experts to receive a customized demo. Cloud solutions can help your facility streamline PHI Normalization Standardize the patient identifiers across imaging data being received by outside facilities Image Routing Gateway technology can be used to auto-route imaging to groups of users or DICOM destinations Automation Create workflows to automate activities around PHI normalization, image sharing, etc. Analytics and Audits Get a snapshot of your practices imaging flow and see which users are viewing, sharing, downloading information and more 3rd Party Integrations Integrate imaging with other technologies such as your EMR and RIS Disaster Recovery Implement long-term image storage as part of your business continuity plan Vendor Neutral Archive Create a centrally accessibly and searchable vendor agnostic storage system Mobile Viewing Pull up exams using a viewing application that is specifically optimized for small screens Remote Access Log into your worklist from any device with Internet connectivity Real-Time Collaboration Take advantage of instant image sharing, annotation and reporting tools in a HIPAA safe environment Web-Based Sharing Facilitate real-time image sharing securely across the web CD Ingestion Improve your process around uploading and normalizing incoming exams burned onto physical media - 11 -