Subproject Advance File page1

SUBPROJECT ADVANCE FILE

Project: Innova Saúde

Subproject 2: Medical image centre

Thematic Area: Innovation in care

1. Number of proposals received and participating companies:

2. Project scope/functional analysis:

The main objective of this project is for medical imaging to be available, with sufficient quality/resolution

for diagnostic purposes, for all employees of the Galician Health Service who may need to view it,

regardless of where the image has been generated.

Once this goal has been achieved and via the organization and management of the process associated with

the generation of a medical image, the project will provide:

� Informational access by any team of health care professionals which may require it, irrespective

of the health centre in which they are located (reference centres, 2nd opinion, referral

professionals, contingency management in the field of medical images, 3rd party information

SUBPROJECTNUMBER OF PROPOSALS

LIST OF PARTICIPANTSLAST SENDING OF PROPOSALS

ACCENTURE S.L.

ALMA IT SYSTEMS, S.L.

BAHÍA SOFTWARE S.L.

BULL ESPAÑA S.A.

CANDEDO & ABYPERSONALIZE

CITIC: Centro de Investigación en Tecnoloxías

da Información e as Comunicacións da Universidade da Coru

ña

DOMINION INSTALACIONES Y MONTAJES, S.A.-EMEDICA

IKIRIA KNOWLEDGE, S.L.

INTERSYSTEMS IBERIA, S.L.

ITMATI (Instituto Tecnológico de Matemática Industrial)

MUNDO R

PHILLIPS IBÉRICA S.A.

ROCÍO LÓPEZ CONDE

SOFTWARE AG

TELEFONICA SOLUCIONES DE INFORMATICA Y

COMUNICACIONES DE ESPAÑA, S.A.UDIAT Centre Diagnòstic - CSPT

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Subproject Advance File page2

services)

� Access to the information via mobile terminals, when the characteristics of the image allow it

� Coordinated management of all data related to the images, including associated radiation

dosages

All of these factors will result in an improved coordination of image resources, especially with regards to

information, making effectiveness and efficiency a priority. Furthermore it will improve the working

conditions of the medical imagery healthcare professionals and recognition of their efforts.

In the current system several needs have been detected:

At present, each hospital has its own medical image centre (x-ray, non x-ray).The image may be viewed in

the hospital where the image was produced and in other hospitals using a simple light-box, but it does not

allow for the use of diagnostic tools (post-processing reconstructions, etc.) This impedes an effective use

and analysis of the information associated to the images from the same patient which might have been

taken in at a different health centres, allowing the professional to make a comparison of data in reference

to injuries, information concerning medications, importance of further exploration, and frequency of

treatment etc. This situation also hinders centres (in the same area or different areas) when faced with

patient overloads or equipment failures.

This subproject strives to create a model in which images and their associated information may be

processed with diagnostic quality in any health centre regardless of where the image was taken.

This will allow:

- Study of images from radiology, MRI, and radiotherapy.

- Study of images from other areas: pathology, cardiology, digestive, dermatology, ophthalmology,

or surgery

The strategic goals are:

� To ensure access to the image by the healthcare professional providing medical assistance,

with all the relevant information, regardless of where the image was generated

� Improve the overall quality of the medical assistance provided by giving the healthcare

professional better access to the image and related information, there by improving

effectiveness and efficiency.

� Improve security by avoiding the need to retake images because of all the accompanying

Subproject Advance File page3

processes, including radiation dosages

� Optimize the management and use of existing equipment, implementing this new model

in the workplace and bettering working conditions by incorporating new elements

The operative goals of this subproject can be divided into 12 points:

� Access to images taken in any health centre from the health care professionals’ usual

workplace (clinical specialists and image specialists)

� Execution of ecographs by technical staff followed by an analysis by a specialist.

� Post process of the image and storage of data provided if so desired by the healthcare

professional

� Comparison of images taken in different health centres.

� Remote Access to images

� The option to provide assistance to other centres when there are too many patients.

� Management of all the related information including medication for any given image

� More efficient use of images.

� Increase the availability of specialist diagnosis

� Reduction of the amount of images/tests done to any given patient due to the availability

of diagnostic quality images via the new model.

� Availability and management of all information related to a patient’s medical images,

including radiation dosage.

� Professional advancement, improved training of healthcare professionals, and better use

of image tests.

The main benefits of the project will be:

a) For the public health system:

- Improved management of human and material resources in the field of medical

imagery

- Improved data security

- Improved efficiency of information given to the patient as a result of medical security

- Better use of resources due to imagery, both in simple cases and more complex ones.

The possibility of accessing specialist aid in certain cases.

b) For Patients:

- Improvement in the quality and response time of information.

- Reduction in number of diagnostic tests.

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c) For health care professionals:

- Possibility of obtaining specialist advice

- Professional advancement

- Management of related information

- Better work conditions

- Possibility of providing medical assistance outside of the medical centre

d) For other agents

- Implementation of new technological elements, management and distribution of

images, dosages, and development of remote assistance.

3. Identification of innovative elements for development:

Identification of possible developments in 2 areas: in respect to patients and in respect to healthcare

professionals responsible for medical imagery.

Patients

� Evolution of DICOM process to DICOM 2.0.

The DICOM2.0 will be a system by which remote images can be stored temporarily (via storage in a remote

PAC) with basic DICOM functions which should permit:

- Use of primitive DICOM basics (store, move, find…)

- Streaming of medical imagery depending on bandwidth available (without setting a

default compression ratio and providing the best quality image)

� Availability of a universal viewer for images.

Main characteristics which must be met:

- Secure access via internet from any point (web based, zero footprint)

- Multiplatform (windows, android, IOS, etc.) and multi-navigator.

- Easy interface. Adaptable design for both desktop and remote terminals such as tablets

(iPad, Microsoft Surface, Android, etc.) or smartphones (iPhone, Android, Windows

Phone, etc.).

- Real-time downloads of images, even with limited bandwidth via streaming.

- Diagnostic quality images or clinical quality images depending on patient needs

Subproject Advance File page5

- Viewing of radiological images (ccr, ct,mr,mg,etc.) and non-radiological images (ecg,

dermatology, pathology,etc.)

- Viewing medical information and other patient documents (DICOM, PDF,ETC).

- Automatic configuration depending on image being viewed.

- Direct Access to advanced plugging for vascular analysis, mamographs, etc.

HEALTHCARE PROFESSIONALS

� Access with diagnostic visor to any SERGAS image: local PACS connection or DICOM2.0

� DICOM 2.0 process

� Central platform will include at a minimum:

- Remote information services.

- Logistics of activity distribution of

• Management of professional portfolios subscribed to different types of

studies with time periods, classified by diagnostic abilities (management of

abilities may be automatic based on activity of each professional, for

example: better studies, number of studies by type, etc.)

• Manual or automatic designation via logarithms of activity

• Control of activities carried out by each professional.

- Logistics of image recovery and corresponding DICOM processes.

- Management and maintenance service of a master index of images for the whole

organization.

- Service of image anonymity to be used by other components of the central system

� Remote services: availability of application use in remote terminals which allows for

reception and consultation of assigned activity (anonymous) for each professional and

light anonymous visualization of assigned cases still awaiting medical information. It will

not be used for diagnosis.

� Definition of stages, prerequisites, characteristics of services, management, quality

criterion, labour aspects, and remote terminal information.

� Comparative studies, within the workplace, alternatives in ecograph diagnosis without

the direct involvement of specialists:

- Use of automated systems for the remote management of diagnostic ecographic

studies

- Definition of stages, prerequisites, service characteristics, management, quality

criterion and creation of a technical guide in order for

personnel not from the medical imagery department

� Management system for radiation dosages to improve patient

of prescriptions, and use of tests/therapies which

� Management of dosim

- Incorporate dosage information within the area of

radiotherapy, and hemodynamics/radiological interventions

Dosage information will be done

• DICOM image headers stored in the PACS. They will allow for

incorporation of dosage history

• MPPS data generated during each test

• DICOM SR. Gathered in

• Analysis of dosage information by the protocol required by each study

- Storage of information in a data warehouse, allowing for consultation

the same

- Incorporation of a presentation for different profiles

• Radio physics

• Radiology (integrating

Other Test (IANUS)

All the components should be able to

• Central components

Subpro

criterion and creation of a technical guide in order for execution

not from the medical imagery department (TER, nursing

Management system for radiation dosages to improve patient safety

and use of tests/therapies which use radiation (x-rays, etc.)

dosimeter: the system should:

Incorporate dosage information within the area of radio diagnostics

and hemodynamics/radiological interventions

Dosage information will be done via several channels:

DICOM image headers stored in the PACS. They will allow for

incorporation of dosage history.

MPPS data generated during each test

DICOM SR. Gathered in real-time or by the PACS.

Analysis of dosage information by the protocol required by each study

age of information in a data warehouse, allowing for consultation

Incorporation of a presentation for different profiles:

Radio physics (analysis system with alarm indicators [dashboard

Radiology (integrating the dosiometer information in the RIS

All the components should be able to be integrated within existing IT systems:

Central components platform

Subproject Advance File page6

execution of an ecograph by

nursing, FEA de URG )

safety, increasing quality

rays, etc.).

radio diagnostics, nuclear medicine,

DICOM image headers stored in the PACS. They will allow for the

Analysis of dosage information by the protocol required by each study

age of information in a data warehouse, allowing for consultation, and analysis of

(analysis system with alarm indicators [dashboard])

information in the RIS )

• Management of components of dosages

4. Attached Documentation:

Subpro

Management of components of dosages

Subproject Advance File page7

Subproject GS3-SIS-2 :

Medical Imaging Center

Santiago de Compostela, 22 February 2013

GeneralGeneralDescriptionDescription

Scope of theScope of the ProjectProject

NeedsNeeds DetectedDetected

Scope of theScope of the ProjectProject

StrategicStrategic ObjectivesObjectives

TasksTasks ToTo DevelopDevelopDesignDesign Of the solutionOf the solution

OverviewThe purpose of this project is, and its main objective, is that medical images are

available, with diagnostic quality, for all the professionals of the Galician Health Service

with relative expertise on it, regardless of where this has been generated.

Once this is achieved, and through coordinated organizational development and

management of the processes associated with medical imaging, the project will

provide:� Access to information by professional teams that need it, from the center where they are

( reference centers, second opinion, professional reference, management of

contingencies in the area of the image, services from reported to third ).contingencies in the area of the image, services from reported to third ).

� Access to relocated information, when the characteristics of the study permit it or

pathology, through mobile devices.

� Coordinated Management of all data relating to the images, including the doses

associated.

The final analysis will enable better coordination of the image resources, especially in

regards to aspects of information, making the effectiveness and efficiency gain

importance and become a key aspect, favoring and also improving the working

conditions of professional image and its appreciation.

At present each hospital self-deploys medical images

(radiology and radiological not):

• 14 RIS (SIDI - System of diagnostic information per

image).

• 14 PACS (image files).

There is a specific RIS for screening for breast cancer (it

will also be used for image management in Primary

Care):

• SIDICM

• 1 PACS (UDIAT Center)

Identified needs

AGFA

UDIAT Center

Sectra

General Electric

Various manufacturers:

From the HCE SERGAS (IANUS) a mechanism for consultation has

been implemented, using a lightweight viewer, non-diagnoses, from

studies of other centers.

IANUS currently from a hospital can:

• See the medical image of the hospital itself and the rest of

SERGAS hospitals, but in this case without diagnostic quality,

which in a few occasions leads to the repetition of images for

procedures where there are references ( thoracic surgery,

neurosurgery, pediatric surgery, …)

• Consultation of radiology reports associated with imaging

studies.

In Primary Care may also consult the image from IANUS and

radiology reports generated in any hospital of SERGAS.

Identified needs

Access to the imaging studies in other centers, with diagnostic tools (

Postprocessing: reconstructions of planes, etc. )

imaging tests information from other centers.

Joint management of the information associated with tests performed on the

same patient in different centers: Comparison of studies for monitoring of

injury, data relating to dose, adequacy of the exploration, admissions, etc.injury, data relating to dose, adequacy of the exploration, admissions, etc.The different professionals should access this information at the right time and

with the level of detail appropriate to their role/profile in the organization.

Have alternatives to meet load increases Working In the centers ( In the same

health area or other areas ) before demand overloads or contingencies (

malfunctions of equipment, lack of timely resources, etc. )

Scope of the Project

� Imaging studies of the areas of diagnostic radiology, nuclear medicine and

radiation therapy.

Medical

imaging

� Imaging studies of other areas: pathology, cardiology, digestive dermatology,

ophthalmology and surgery block.

imaging

Center

Strategic Objectives

� Ensure the Access To the medical imaging of the patient by the professionalthat needs it for healthcare process, with an integrated vision, regardless ofwhere it is generated.

� Increase therefore the Quality of care of process on the basis of makingavailable to the professional that require it, the best available informationassociated with the medical image, thus improving Efficiency andeffectiveness

� Increase at the same time Patient safety, by not repeating studies, and also, tohave access to all the image data of the patient, including the doses needed.

� Optimize Management And utilization of human resources and materials, alsoincreasing the Capacity And the Results Of the existing equipment,implementing the system in its Normal working environment And alsoimproving their Working conditions, By incorporating elements of Mobility.

Operational Objectives

� Access to imaging studies in any centre from the usual working environment

of each professional that need it ( users and clinical specialists)

� Progress in the Notarization of Ultrasound Tests To improve the efficiency in

the processes of acquisition and information gathering.

� Post Processing of the image studies remotely, with storage for the new

series generated in the original study in the event that the professional so

considers.

� Comparison of studies generated in different centres.

� Information of imaging tests of any type in remote mode.

� Support from other centres in case of overload of reported activity.

� Management of information from all studies associated with the same

patient, including the dosimetric where appropriate.

Operational Objectives

� Improvement in the average lead times and quality of the information.

� Increase availability of specialists . Possibility of having professionals of

reference to specific areas.

� Reduction in the number of studies carried out on the patient (as a result of

access to the entire patient history in respect to medical imaging diagnostic

quality) for the same diagnosis without thre need o another study. Decrease inquality) for the same diagnosis without thre need o another study. Decrease in

the recurrence of unnecessary tests.

� Availability and data management relevant to medical images from the same

patient, including the dosimetry.

� Professional Development - Improvement of aspects of training for the

performance of diagnostic tests by health care professionals and other

trained specialists.

� Evolution of the DICOM Process DICOM � Process 2.0 .The process DICOM 2.0 will be a temporary store of local studies of remote image (stored in a remote

PACS) with DICOM basic functionality that should allow inter alia:

• Use of primitive basic DICOM ( STORE, MOVE, FIND, …)

• Streaming image Studies to display in function of the bandwidth of the data channel available

(without deciding a compression ratio by default and the study delivered to the customer at level of

100% [review quality clinic] ).

� Availability of a viewer universal curriculum.

PROCPROCPROCPROC

DICOM 2.0DICOM 2.0DICOM 2.0DICOM 2.0

HOSP2HOSP2HOSP2HOSP2

Tasks to develop/perform

� Availability of a viewer universal curriculum.Main features:

• Secure access via the Internet from any location (web Based, Zero Footprint, Web Client Access).

• Multiplatform (Windows, Android, IOS, …) and Multinavegador.

• Common user interface, ergonomic, pleasant and easy-to-use design adaptable to both desktop

devices such as mobile devices Multi-touch Type tablets (Ipad, Microsoft Surface, Android, etc. )

or Smartphones (Iphone, Android, Windows Phone, ... ).

• Downloading images in real time, even in environments such as low-bandwidth connection to the

Internet, by means of Streaming.

• Diagnostic image quality (DICOM) or clinic (JPG) according to the profile of the user.

• Radiology image display Multimodality (CR, CT, MR, MG, etc. ) and not radiation (ECG, dermatology,

pathology, Retinography, etc. ).

• Viewing reports and other documents of the patient (DICOM format, PDF, etc. ).

• Configurable display automatically depending on the type of images.

• Direct access to Plug-ins Advanced analysis for Vascular, orthopaedic, mammogram, etc.

Scope clinical

users

Tasks to develop/perform

� Access with heavy viewer (diagnostic) to any SERGAS study : Connected to the PACS or local Process

DICOM 2.0 .

� Process DICOM 2.0 . * Already described above.

� Central Platform. Shall consist of a minimum of the following modules:

� Remote Reporting Services.

� Business logic of distribution activity:

� Management of portfolios of professionals who subscribe to the various types of explorations with the

periods of subscription, classified by their diagnosis skills (management skills may be automatically based

on the activity carried out by each professional, for example: types of studies , number of studies , by type, on the activity carried out by each professional, for example: types of studies , number of studies , by type,

etc. .

� Manual or automatic allocation (using algorithms) of the activity.

� Control of activity carried out by each professional.

� logic Recovery studies and movement to the corresponding process DICOM 2.0 (demand).

� Services relating to the management and maintenance of a master index of studies for the entire organization.

� Services from anonymisation of studies will be used by other components of the central.

� Mobility Services Availability application for mobile devices that allow:

� Reception and consultation of activity assigned (anonymous) to each professional.

� Display of light and anonymised cases assigned pending report.

NOT BE USED OR RELIED UPON FOR INFORMATION NOR DIAGNOSTIC

Scope of users of image

Tasks to develop/perform

Scope of users of image

� Definition of the scenarios, requirements, service features, management, quality

criteria, labor issues, among other remote report.

� Comparative Study, in real work environment, alternatives in the testing of

diagnostic ultrasound:

� Study of use of automatic systems (robotic) for remote management of

ultrasound diagnostics studies.

� Definition of the scenarios, requirements, service features, management,Scope of users of image � Definition of the scenarios, requirements, service features, management,

quality criteria and preparation of technical guide to Expand the capacity of

realization Of Ultrasound studies By Different professional profiles (TER,

Nursing, …)

� Information management system of dose for improving patient safety, increasing

prescribing quality and testing/therapies that generate radiation to the patient (

radiologists, TER, radiophysics, prescribers ).

� Management System of dosimetry. You must:

� Incorporate the rate information generated in the areas of diagnostic radiology, nuclear medicine, radiation therapy, and

hemodynamic/interventional radiology.

Dosimetric Data Collection of several input sources:

� Image Headers stored in the DICOM PACS. Allow for the incorporation of historical information of dose.

� MPPS data generated by the modalities in the conduct of each study.

� DICOM SR. picked up from the modalities in real time or from PACS.

� Work and analysis of the dosimetric information by protocol of each study in each modality (configured in each

modality).

Tasks to develop/perform

� Consolidate information in a repository of Data storage types, Allowing it to perform tasks of consultation and analysis of

the same.

� Incorporate a presentation layer with different profiles:

� Radiophysics (system of analysis with warning indicators [Dashboard] ).

� Radiologists (integration of the information in the RIS dosimetry [SIDI] ).

� Rest of clinicians (display of information in the HCE dosimetry [IANUS] ).

HCE = Electronic Medical Record

RIS = Radiology Information System

Components. Central Platform.

All the components described must be integrated with the corporate information systems through interoperability

standards

Components. Management System of dose.

All the components described must be integrated with the corporate information systems through interoperability

standards

HCE RIS.

Results

PUBLIC HEALTH SYSTEM:

� Improving the effectiveness and efficiency in the management of human and material resources in the field

of diagnostic imaging.

� Improvement of the security.

� Improvement in the times and quality of the reported studies of diagnostic imaging.

� Greater availability of resources for the informed of tests, both with low complexity and high specialization

possibility of having professionals of reference to specific areas.

USERS OF THE SERGAS:

� Improvement in the aspects of informed ( time, quality ).

� Reduction in the number of studies to the patient (you can see a recent study with diagnostic quality from� Reduction in the number of studies to the patient (you can see a recent study with diagnostic quality from

any point on the network) and improvements of the dose associated with these

PROFESSIONALS OF SERGAS:

� Have reference specialists for different areas and pathologies.

� Professional Development - Improvement of aspects of training.

� Availability of information associated with the image tests for management and improvement

� Improvement of working conditions

� Possibility of development of charitable activity outside the workplace, delocalised.

OTHER ACTORS:

� Development and implementation of technological elements: management platform and image distribution,

modules of dose, devices for development of charitable activity delocalized.

Subproject GS3-SIS-2 :

Medical Imaging Center

Santiago de Compostela, 22 February 2013

"The image is not of the person who performs it but also the

the Patient Benefit from it , by better Usage"