Enterprise Imaging. Moving Beyond Traditional PACS

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1 Enterprise Imaging Moving Beyond Traditional PACS DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Louis M. Lannum Elena Butler Have no real or apparent conflicts of interest to report HIMSS

3 Session Learning Objectives Apply proven methodologies and tools to implement image management across the enterprise Identify the issues and potential solutions associated with implementing image-based departmental workflow Evaluate alternative approaches to creating the Enterprise Image Archive and Distribution System model Define clinical workflow requirements for the Enterprise Image Archive and Distribution System

4 Introduction Cleveland Clinic Healthcare System 12 hospitals (including 1 in Weston, Florida) 16 Family Health and Ambulatory Surgical Centers Las Vegas Neurological Center Toronto Executive Health Abu Dhabi / 2012 Radiology Roadmap Replacement of Legacy PACS

5 Enterprise Imaging Strategic Oversight Imaging Council Group A senior executive group was established that would provide oversight and direction for a new strategic model of enterprisewide image management and image access. Developed a shared vision across all the institutes and departments Position clinical imaging as a shared strategic resources

6 Creating a Vision No Image Left Behind

7 No Image Left Behind Develop a program to identify, capture and access clinical images in all the imaging intensive institutes and departments.

8 The Strategy Enterprise Strategic Model Longitudinal Imaging Record Cloud-based Storage Model

9 Enterprise Strategic Model Infrastructure Enterprise Storage Model Workflow models EMR integration model Enterprise viewer

10 Replication Parker / (Brecksville) Local Cache Radiology PACS E 89 th Street /(Primary) Local Cache Radiology PACS Local Imaging Manager Cache Imaging Repository Replication Cache Imaging Repository Other X-ology Imaging NAS Archive NAS Archive Enterprise Viewer Enterprise Viewer Enterprise Access / Storage Model Clinical Practices Image Intensive Users

11 Enterprise Access / Storage Model Central Storage of Medical Imaging Single Enterprise Directory for all Clinical Images Provide Access to all Clinically Relevant Imaging Centralized Management of Imaging Infrastructure Image Lifecycle Management Disaster Recovery / Business Continuity

12 Workflow Model Acquisition Layer Image capture Department Radiology Cardiology Image File Types Single / Multi- frame DICOM, 3D & 4D image sets DICOM Data, Video Files (Mpeg, AVI) GI Surgery Oncology Ophthalmology Dermatology Video Files (Mpeg, AVI) Video Files (Mpeg, AVI) - Photographs (Jpeg) - DICOM Treatment Plans (PDF, TAR, Jpeg) DICOM Images and Reports Photographs (PDF, Jpeg), TIFF

13 Workflow Model Image / Data Management Layer Provides a worklist to automate imaging workflow Correctly associate image with patient and order Validate images against the EMR patient data Manage patient and imaging workflow(s) Local image storage for the Tier 1 (Diagnostic Level) users Manage diagnostic workstations and image viewing applications

14 Workflow Model Reporting The capture of an image does not automatically produce a reportable event. However, in many cases diagnostic reports, progress notes or a simple reference to an image is generated by the healthcare provider viewing the study.

15 Workflow Model Storage imaging repository Access single point of image access Centralized image management Image retention rules Patient centric view of clinical imaging data

16 EMR Integration Model Define/Create a Standard Integration Workflow Demographics EMPI Orders-based Workflow Unique Accession Number for Each Study Studies must be uniquely identified in the Archive All studies must be retrievable back to the source system Study Availability Notification (SAN)

17 DICOM Orders / Results HL7 X-ology Imaging Systems Syngo.Workflow Provation GE ViewPoint OIS Muse (XYZ System) ADT Orders Results <ORU> Order Status Update <OSU> New Orders <ORM> Imaging Gateway EMR Validation DICOM SR ADT Enterprise Viewer Advanced Visualization DICOM Image Repository DICOM

18 Enterprise Imaging Model Anesthesia Anatomical Pathology Digestive Disease Cole Eye Institute Women s Health Institute Imaging Institute PACS Cardiology Imaging Database OR / ICU Clinical Practices EMR Integration

19 Institute/Department System Digestive Disease Institute Provation Endoscopic Procedures / Reports Women s Health Institute GE ViewPoint Ultrasound Cole Eye Institute Anatomical Pathology Dermatology / Plastics Zeiss Forum CoPath Canfield Mirror Dentistry Anesthesia OR Ultrasound Point-of-Care Ultrasound Weston GE Muse System Provation ProSolve Orthopedic Imaging - OR Stryker Studio 3 OR Imaging EP Laboratory Emergency Department Urology- Urodynamics Stryker Black Diamond CARTO XP System Velocity Courier System Orthopediacs ENT General Surgery Bariatric Surgery Pediatric Cardiology GYN Urology Point-of-Care Ultrasound Photographs (wounds, rashes, clinical evidence)

20 Cloud Storage Model Reduce the storage footprint in the current data centers Legacy imaging (images acquired more than 3 years ago are accessed less than 5% of the time Retention policies dictate that the images must be kept for a minimum of 7 years The amount of imaging data is about to explode

21 Replication Parker / (Brecksville) Local Cache Radiology PACS E 89 th Street /(Primary) Local Cache Radiology PACS Local Imaging Manager Cache Imaging Repository Replication Cache Imaging Repository Other X-ology Imaging NAS Archive NAS Archive Enterprise Viewer Enterprise Viewer Exchange Exchange Clinical Practices Offsite Private Cloud Archive

22 The Visualization of Imaging is Changing

23 Questions? Louis Lannum Director, Enterprise Imaging Elena Butler IT Manager, Clinical Integration and Interfaces

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