759 VI – New Imaging Applications and Technologies.

759 VI – New Imaging Applications and Technologies

759 VI – New Imaging Applications and Technologies

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IntroductionsIntroductions

Scott Madsen, Chief of Clinical ServicesLarry Carlson, Project Manager for

VistA ImagingMaryann Shovestul, Project Manager

for VistA ImagingDr Ruth Dayhoff, MD, VHA, VistA

Imaging

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Development TeamDevelopment Team

VA and Harris Development Managers

Document and Ancillary Imaging Maryann Shovestul, VA Project ManagerMehul Kaji, Harris Task Manager

Filmless Radiology Maryann Shovestul, VA Project ManagerMehul Kaji, Harris Task Manager

VA/DoD Image Sharing Maryann Shovestul, VA Project ManagerRoger Coney, Harris Technical Project Manager

Core Infrastructure Larry Carlson, VA Project ManagerLarry Jenkins, Harris Task Manager

Storage Architecture Larry Carlson, VA Project ManagerChuck Sylvester, Harris Project Manager

Telemedicine Larry Carlson, VA Project ManagerSharon Littles Harris Task Manager

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Other Key Imaging StaffOther Key Imaging Staff

VA Imaging Staff

Kathryn McGuyer, Test Site Coordinator

Peter Kuzmak, Developer for the DICOM Gateway

Richard Price, Developer for the Background Processor

Lackan Singh – Implementation Manager for Telemedicine

Avi Sadan – Analyst

Don Smith – Technical Writer

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Year in ReviewYear in Review

• During FY10 the following patches were released or are soon to be released– MAG*3*54 DICOM Maintenance IV– MAG*3*101 VistARad Maintenance V– MAG*3*93 Clinical Display Maintenance II– MAG*3*111 Broker Security Enhancements– MAG*3*83 VistA Imaging Exchange Service– MAG*3*53 DICOM Import– RA*5*90 Radiology Order and Exam API– MAG*3*90 VistARad Maintenance– MAG*3*94 Clinical Capture Maintenance– MAG*3*108 Import API– MAG*3*49 HL7 ADT Interface– RA*5*47 Standardize VistA RIS Messaging Interface– MAG*3*39 Background Processor Enhancements– MAG*3*114 Telereader Configurator– MAG*3*66 DICOM Query Retrieve– MAG*3*98 Site Storage Utilities

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Document & Ancillary Imaging

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Document and Ancillary Imaging


Patch What the Patch addresses

MAG*3.0*108VistA Imaging Import API

•The enhancements being made to the VistA Import API in this patch will support new functionality needed by the VIC (Veterans Identification Card) system.•Scheduled to complete Field Testing in June 2010

MAG*3.0*117Clinical Display and Capture Maintenance Patch

•The clinical display, capture and telereader applications will be separated out into separate installations•Updates to the QA Reporting features introduced in Patch 93•Improve the QA Report to run as a task•Ability to print multiple images•Add a new security key to the application – MAG QA REVIEW•Scheduled to begin Field Testing in August 2010

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Future Workload for FY11Clinical Capture and Display Maintenance (Patch 117)

•Modify existing Capture and Display to resolve outstanding defects identified on remedy tickets• Update the QA Report statistics to include groups being marked as QA reviewed• Allow users to mark individual images in a group as reviewed• Allow the QA Review windows to search for more than a 7 day date range• Allow the users to print more than one image at a time • Add a new security key to the application – MAG QA REVIEW• Improve the QA Report to run as a task•Enhance Clinical Display to allow DoD NCAT data to be viewed•Scheduled for release: June 2011

Watermarking of Rescinded Images (NSR 20060401)•A watermark will be used to indicate that images are no longer in effect while allowing users to verify the previous document content.•Asynchronous loading of images•Scheduled to begin Field Testing: FY11

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Filmless Radiology

VistARad

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Filmless RadiologyFilmless Radiology


MAG*3.0*115VistARad Maintenance II

This is a maintenance patch for the VistA Imaging Filmless Radiology software. •A process for automatically updating the VistARad client software•Provide management functions including remove or disable a user from the settings file (e.g. residents who leave); provide a default profile to copy settings/hanging protocols to new users•Correct defects identified in Remedy Tickets•Scheduled to begin Field Testing in August 2010

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Filmless RadiologyFilmless Radiology

Future Workload for FY11

VistARad Maintenance II (Patch 115)• Complete release of this patch of work from previous increment• Modify existing VistARad application to resolve outstanding defects identified on remedy tickets• Auto update of the VistARad client• Modifications to the user preference settings management functions; this includes remove or disable of a user from the settings file (e.g., users who leave)

Estimated Release Date: February 2011VistARad Maintenance III

•Issues identified in Remedy tickets will be addressed in this patch.Estimated Start of Field Test Date: July 2011

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VA/DoD Image Sharing

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VA/DoD Image SharingVA/DoD Image Sharing


MAG*3*105Advanced Web Image Viewer (AWIV)

•Allows VistA Web users to view scanned documents and mages associated with TIU notes from other VA facilities.•A follow on patch will be planned to allow the viewing of images from the DoD facilities. In order to work within the VistA Web Team, BHIE and DoD schedules, this patch had to be divided into 2 patches.•Complete Field Testing October, 2010

MAG*3*53DICOM Import

•Automate the process of importing DoD studies into VistA Imaging. •Allows fee basis images to be imported into VistA Imaging.•Release Date: July 2010

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VA/DoD Image SharingVA/DoD Image Sharing

Future Workload for FY11DoD CVIX (Patch 104)

• Re-scope the patch to allow for NCAT data and other DoD artifacts to be viewed through the Clinical Display •Scheduled to Release: June 2011

AWIV / VIX Development (Patch 105)• completion of the work started in FY10•Scheduled to Release: November 2011

Importer Phase 2 (Patch 118)• Redevelop the Importer from Phase I using the VistA Imaging Service-oriented Architecture (VISA)• Determine optimal transfer interface between PACS and VistA Imaging• Implement a graphical interface in place of remotely logging onto a particular DICOM gateway•Scheduled to begin Field Testing: FY11

CVIX Cluster Configuration•The CVIX will be deployed as Load Balanced cluster to allow multiple VIX servers to process requests at the same time:•A load balancer appliance will be used to direct requests between a pool of VIX servers.•The Fail Over cluster will be retained as a shared cache of documents and images.•Scheduled to begin Field Testing: FY11

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Core Infrastructure

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Core InfrastructureCore Infrastructure


MAG*3*66DICOM Query Retrieve

Provides machine interoperability for commercial medical imaging devices which implement the DICOM Query Retrieve User Service with the VistA Imaging image archive.

Release Date: Aug 2010

RA*5*47Update Radiology HL7 Interface

Provides v2.4 HL7 interface necessary VA framework for VISN-centric radiology Picture Archiving and Communication Systems (PACS)

Release Date: Sept 2010

MAG*3*49HL7 ADT messages to cPACS

With RA*5*47, implements the IHE Technical Framework for Scheduled Radiology Workflow.

Release Date: Sept 2010

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Patch What the Patch Addresses

MAG*3*99Store DICOM Objects Phase III

Provides native DICOM file format storage support for all currently supported DICOM modality Information Object Definitions (IODs).

Release Date: FY11 Release

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Future Workload

Storage of All DICOM SOP Class Images (Patch 34)• Complete release of patch from previous increment• Create additional data structures and code as needed to store currently unsupported SOP class images• Modify existing storage system to satisfy the Storage SCP requirements of a Level 2 DICOM Archive • Identify and correct new images with duplicate study, series, and/or SOP instance UIDs prior to storage in the VistA Imaging database

Query Retrieval Provider Phase II (Patch 116)• Include additional audit logging to meet security requirements• Enhance Query Retrieval Provider to query and retrieve studies for newly supported SOP class images stored in new data structures in VistA Imaging database (as implemented in Patch 34)

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Future Workload Multiple Modality Worklist (Patch 110 - NSR20071112)

• Expand the worklists for Services that have one worklist for the entire service (Cardiology, Dentistry, Eye Care, Gastroenterology and Surgery) to include multiple worklists by subspecialties.• Provide separate worklists for different kinds of ordered requests (consults and different procedures)• Modify the display presented to the user to include specialty and procedure.• Allow shared devices (X-ray angiography used by radiology and cardiology) access to combined worklists• Improve the Modality Work List for specific instruments or Remedy tickets• Hl7 messaging for Clinical Specialties for cardiology, eye care, and others.

DICOM Gateway Maintenance (Patch 87)• Modify existing Gateway to resolve outstanding defects identified on remedy tickets• Add ability to identify IHS images by health record number (HRN) instead of social security number (SSN)• Incorporate Field Unit Test (FUT) 70 into Gateway patch

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Future Workload DICOM Storage Commit Provider Service (Patch 79)

External Study Tracker / Instance Availability Notification (IAN) (Patch 55)• Develop ability to implement Instance Availability Notification (IAN) Service Class to allow cPACS, to notify VistA Imaging) of the presence and availability of SOP Instances to be exported to VistA Image for storage. • Add ability to pull external DICOM objects within a study from a cPACS that have not yet been forwarded to VistA Imaging• Enhance interface with cPACS, through which patient data, order data and DICOM objects are processed and stored• Provide a mechanism which monitors the Radiology package for completed radiological exams

DICOM Structured Report IOD Storage Analysis (enhancement)

Analysis of Radiation Dosage (NSR 20100402)

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Storage Architecture

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Storage ArchitectureStorage Architecture


MAG*3*39BP Maintenance II

Resolved open Remedy tickets for identified defects

Release Date: September 2010

MAG*3*98Additional Site Storage Utilities

• More productive management of storage• Necessary tools to prepare image archive to migrate off DiskXtender to the Archive Appliance

Release Date: August 2010

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Storage ArchitectureStorage Architecture

Future Workload for FY11Storage Architecture

• Continued effort with EIE on storage architecture update, testing and selectionLaboratory Services Reengineering Project (LSRP) (Patch 113)

• Complete release of this patch of work from previous increment• Develop a prototype to demonstrate integration between the Cerner lab services application and VistA Imaging • Provide ability to report on the Cerner application of anatomic pathology images located in VistA Imaging

DICOM File Archiver (Patch 112)• Complete field test and release of this patch of work from previous increment • Implement an archive policy manager that determines archiving location(s) and retention (at a minimum) based on a set of configurable archive rules• Manage archiving of newly supported SOP classes implemented by Patch 34

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Telemedicine

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TelemedicineTelemedicine


MAG*3*114This is an enhancement patch for the VistA Imaging TeleReader

Provides a Graphical User Interface (GUI) to more easily configure the current TeleReader application.

Release Date: September 2010

MAG*3*106This is an enhancement patch for the OCC Teledermatology Program.

•Store and forward telemedicine enhancements for dermatology including DICOM capture client• Workflow reporting enhancements for store and forward telemedicine

Release Date: FY11 Release

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TelemedicineTelemedicine

Future Work for FY11

Teledermatology (Patch 106)• Complete release of this patch of work from previous increment• Enhancements to enable the capture of patient images, the assignment of DICOM elements to each image, and their subsequent transmission to remotely located dermatologists for interpretation

Telemedicine Annotation and Reports• Provide annotation for telemedicine images.•Provide telemedicine utilization and status tracking reporting to meet Dr. Darkin’s needs

Telepathology Analysis•Business requirements and storage requirements analysis to support Telepathology

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New Features for Telemedicine

Dr. Ruth Dayhoff, MD

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The Basic Elements of Telemedicine for Many Different SpecialtiesThe Basic Elements of Telemedicine for Many Different Specialties

Tele Reader

CPRS

VistA Imaging

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New Features for TelemedicineNew Features for Telemedicine

• New Specialties– TeleDermatology– TelePathology– TeleWound Care

• Ability to Create DICOM Standard Images in VistA Imaging

• Improved TeleReader Capabilities– Annotations– New Graphical Interface for TeleReader

Configuration• New Terminologies

– Body Parts– Laterality– Study Description

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Primary Care Clinic VisitPrimary Care Clinic Visit

• No dermatologist is available

• A consult is ordered• Photographs are taken

and attached to local consult at the clinic

• Regional dermatologist can take the case

• Similar procedure if a dermatologist requests a Second Opinion

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Provider Orders a Teledermatology ConsultProvider Orders a Teledermatology Consult

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Dermatology Images are Transferred to VistA Imaging Import DirectoryDermatology Images are Transferred to VistA Imaging Import Directory

Drag and DropPatient’s Images

to Import Directory

List

Camera

Camera Chip

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Select and Capture Images Individually or in Batch ModeSelect and Capture Images Individually or in Batch Mode

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DICOM Images Created Automatically When Capture Button ClickedDICOM Images Created Automatically When Capture Button Clicked

• Only two pieces of information must be provided by the user:

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Imported Images Stored in DICOM FormatImported Images Stored in DICOM Format

• Information placed in DICOM Image Header – Patient and study

information

• Allows information to be a permanent part of the image

• Still necessary to put ruler in the camera shot to gauge size

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TeleReader Configuration Tools EnhancedTeleReader Configuration Tools Enhanced

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Reading Studies with TeleReaderReading Studies with TeleReader

• Lock the study

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Imaging, CPRS & Telereader Automatically Open to PatientImaging, CPRS & Telereader Automatically Open to Patient

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Image AnnotationImage Annotation

ArrowLineRectangleLettersFree handOblongRulerSquareCircleTools

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Templates Can Be Used in Resulting the ConsultTemplates Can Be Used in Resulting the Consult

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Specialist Documents Observations in Interfacility ConsultSpecialist Documents Observations in Interfacility Consult

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Consult Completed in CPRSConsult Completed in CPRS

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Completed Study Appears on TeleReader READ ListCompleted Study Appears on TeleReader READ List

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Many Emerging Bio Technologies May Benefit from Telemedicine CapabilitiesMany Emerging Bio Technologies May Benefit from Telemedicine Capabilities

• New non-invasive melanoma screening using skin heat signatures (JHU)

• New glaucoma testing techniques that identify chemical changes in the cells at an early stage that indicate glaucoma is present (VACPTVL)

• Use of fluorescent and magnetic tags to identify tumor cells and reduce those remaining after treatment (UCSD)

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759 VI – New Imaging Applications and Technologies.

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