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Transcript of Seis hce imagen_final_english
3rd Spanish Interoperability Forum
Towards national Electronic Health Imaging Record
Manuel VegasGE Healthcare IT
May 8th, 2013
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Electronic Health Imaging Record
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Year 2020
A dutch tourist, with a recent hip replacement, is on holidaysenjoying Alicante’s Costa Blanca
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Year 2020
“The replacement has moved”
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Year 2020
“An urgent re-intervention is needed"
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Year 2020
They plan toghetherthe re-intervention
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Nowadays“Imaging Islands"
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PACS:82% spanish hospitals *EHR:94% spanish hospitals *
NowadaysInfrastructure
Broadband connectivity:92% european hospitals *
(*) EUROPEAN COMMISSION: eHealth Benchmarking III. SMART May 2011
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Tecnological
NowadaysObstacles
Architectural/Standars
Economic/Efficiency
Organizative/Semantic
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SolutionIHE
IHE XDS-I profile
IHE XDS profile
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Solution/XDS-I
Registry
Repository
ImageManager
Source
Consumer
Patientidentification
Query documents
Patient identificationfeed
Registerdocuments
Retrievedocuments
Provide and register documents
· Image retrieve· WADO retrieve
Standards:
Web Services
HL7
DICOM
PIX ATNAConsistent
Time
Profile IHE XDS
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Solution“Plug-in” interoperability model
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A strategic opportunity for the MoH
− Consolidation of all clinical documents and medical imaging generated by all the regions in Spain and the private health centers
− Centralized master registry owned and managedby the MoH
− Plug-in model: Any entity can be added to theexchange, given it implements the interoperabilitycontract (XDS based)
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A technical opportunity for the MoH
− IHE XDS/XDS-I based and plug-in model
− DICOM/non-DICOM imaging and clinicaldocuments (structured/unstructured) in a common index
− National registry and affinity domain, defined and managed by the MoH
− Universal multi-device web access
− Cloud and SaaS paradigms
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· National registry and affinity domain
· Unique Patient Identifiyin (CIP-SNS), IHE PIX based
Privileges-based universal access from any point of the Spanish geography. With total audotory and compliance with data protection regulations
XDS
Adaptor
ValenciaRegion
MoH
RepositoryValencia region
MPIMoH
Plataform
a de
Integración
RegistryMoH
RepositoryMoH
SolutionUse case
EHR
StudyRegistrationStudy
Registration
DocumentProvisioning
DocumentRegistration
DocumentQuery
Document Retrieval
17Centricity Clinical Archive overview
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XDS RepositoryVendor Neutral Archive level 4
Infrastructure and Information Sharing
Departmental Archive
DICOM Archive
Enterprise DICOM Archive
Multi-PACS, cardiology
Enterprise Multi-specialty
Archive
Connecting to ‘ologies, enterprise registry
Multi-institutionPatient Information
Management
Multi-PID, patient consent, gateway
to image exchange
Level 2 (DICOM)Imaging consolidation across enterprise
Level 3 (+XDS)Enterprise-wide clinical data consolidation
Level 4 (+XDS)Cross-enterprise patient repository & sharing
Level 1 (DICOM)Independence of PACS application
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Zero-footprint and browser-agnostic
XDS/XDS-I consumerDesired characteristics
Web Technology
Imaging and docs history
Mobile
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History
Images and reports viewer
Advancedfilters
Centricity Patient Information ViewerWeb zero-footprint integrated access
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Imagen Patológica–Zona de interés
ECG Jpeg
Centricity Patient Information ViewerAcceso web zero-footprint integrado
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Centricity Radiology Mobile AccessNative App to access from mobile devices
Native apps iOS + Android
Diagnostic quality (retina)
Streaming (WiFi + 3G)
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Experience across the globe
Neutrality• Connected to Agfa, Carestream,
McKesson, Sectra, Siemens, Phillips, Ramsoft
• Multidimensional (format, storage, access)
South Western OntarioVNA & integrated workflow
Cloud friendly• Cloud based archive and PACS• Pay as you go• Hosted environment
Ile De FranceCloud PACS + results sharing
Scalability• 60 M studies• 3 Bn images• 1 Petabyte
LSP, EnglandVery large archive
Standards• XDS infrastructure• GE active member of
standardization
VGR, SwedenVNA + integrated access
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Objective
• Connect care providers
• Central repository of images and reports for instant
access, and exchange
• Improve care provider productivity
• IT infrastructure cost savings
• Reduce patient transfers and duplicate scans
Solution
• Central repository and information access
• Hardware redundancy and disaster recovery
• High availability with dual data centers
South Western Ontario (Canada)
• 62 hospital locations across the region
• 19 hubs with separate RIS/PACS systems
• 12 different RIS/PACS vendors
• 3.2 million exams/year
• 1600+ system users
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Objective
• Consolidate information from different
departments (radiology, cardiology, nuclear
medicine and other sources such as Olympus
Endobase)
• Access to DICOM and non-DICOM data
• Give consolidated access to patient information
• Lower cost of IT management
Solution
• A multi-ology information repository
• IHE Standards based solution
• Consolidated view of patient information
• Virtualized environment
Antwerp University Hospital(Belgium)
• 600 bed hospitals
• 500k exams per year
• Heterogeneous departmental IT systems (GE PACS, Agfa cardiology, Olympus Endobase)
• 50 modalities directly connected
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Objective
• Central repository of images and reports
• Immediate access to prior images and reports
from the whole region
• Primary viewing platform outside imaging
• Improved imaging workflow
Solution
• Common repository across 17 hospitals
• IHE standards
• Web access to images and reports
• ASP model since 2006
Västra Götaland region(VGR, Sweden)
• Sweden’s second largest region
• 1.5 million residents
• 17 hospitals
• Heterogeneous RIS/PACS systems
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Objective
• Improve oncology and cardiology treatment
• Share radiology data across legacy RIS/PACS
• Replace patient CD workflow
• Avoid redundant exams
• Improve coverage of rural areas
Solution
• A patient centric document repository
• IHE-XDS & DICOM to connect multi-vendor systems
• Web portal for multi-disciplinary teams
• Hosted deployment model
NHS Wales (UK)
• 4.5 million patients
• 13 multi-vendor systems
• Connected to Welsh Master Patient index
• Starting with oncology network
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Objective (regions sans film)
• Leapfrog Paris region to HIT
• Sharing imaging results
• Improve care quality through collaboration
• No more film or CD by 2012
Solution
• Standards based information repository
• Data center
• 24 x 7 high availability service
• SAAS model – pay per use
Ile de France (France)
• 12 million patients, 500+ radiologists
• 30 hospitals growing to 90
• Multi-vendor RIS-PACS systems (PACS: carestream, Telemis, GE; RIS: EDL, Waid, home grown)
• Standards Compliance (DICOM, IHE, HL7)
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Objective
• Connect the radiology departments across
communities
• Central long term archiving of all imaging
data with HA and DR
• Enable access of images to physicians and
specialist
Solution
• Cloud deployment of imaging repository
• Dual data centers, virtualization
• Business continuity & DR solutions
• Central archive for 74 different PACS
instances
Southern and NWWM Clusters (UK)
• Central archive ~60 million exams
• 40% of England covered: 20M patients, 72 NHS trusts
• Delivered average uptime of 99.98%**
** As reported by NHS Connecting for Health for the period August 2009 to July 2011
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University Hospital Antwerp(UZA - Belgium)
Objective• Enterprise-wide repository for medical imaging
(radiology, cardiology, etc.) and scanned documents
• Migration of proprietary scanned documents archive to XDS standard
• Image viewer for all clinicians context-integrated to EMR
• Consent management
Benefits• Helps to facilitate the replacement of
departmental workflow solutions• Longitudinal patient record that facilitates
access to relevant clinical information across departmental boundaries
• 600 beds hospitals
• 500 k exams per year
• Heterogeneous departmental IT systems ( GE PACS, Agfa cardiology, Olympus Endobase…)
• 50 modalities directly connected
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EA
Document and Image Access
UZA Solution OverviewDICOM
HL7
proprietary
Publish objects to XDS
XDS
RIS (GE)
PACS (GE)
New DICOM exams
PDF documents with meta data (e.g. HL7 MDM)
HIS/EMR
Caradigm XDS Document Registry (central index)
New DICOM exams
Patient demographics (HL7 ADT)
Other ology DICOM archive
XDS adapter
CVIS (Agfa)
Cardio PACS (Agfa)
Gastro + other ologies
Document scanning
Radiologylong-term archive
Cardio long-term archive
Publish image references to XDS
XDS/XDS-I Document Repository
DICOM data
Non-DICOM data with meta data (e.g. video)
Register objects in XDS repository: HL7-CDA, PDF, DICOM image references, JPEG, video, etc.
Publish image references to XDS
Cweb PIVXDS viewer
Centricity Web DICOM viewer
Query registry
Publish image references to XDS
EPD C2M (EMR) client
User and patient context integration (client-side)
Patient demographics (HL7 ADT) and orders (HL7 ORM)
Publish final reports to XDS
Patient demographics (HL7 ADT) Patient demographics (HL7 ADT) Patient demographics (HL7 ADT) Patient demographics
Patient demographics (HL7 ADT) and orders (HL7 ORM)
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Building bridges …
¡Thank you very much!