Advanced Image Viewing, Storage and Collaboration Technologies Offering Solution Brief

Transcription

1 GE Healthcare Advanced Image Viewing, Storage and Technologies Offering Solution Brief Introduction The same clinically rich tools and diagnostic functionality used by large hospitals is now compact, robust and affordable. GE Healthcare brings together Image Visualization, Workflow, and Image Archiving to small and medium-sized providers to help drive better clinical quality, operational efficiency and financial performance. These tools are designed to help deliver better outcomes for healthcare providers: Visualization to help improve diagnosis Workflow to help speed the delivery of results This next generation software is delivered with Open Virtual Archives (OVAs) for use with VMware. Automated scripts install the software to help reduce cost and increase repeatability making the offering robust and stable. The virtual environment also helps optimize the use of data center space. Over 3,000 organizations trust Centricity Imaging Solutions because GE Healthcare delivers high-quality service, reliability, and technology innovation, which allow providers to help reduce the cost of ownership today while preparing for the challenges of the future. to help radiologists confer with clinicians and patients Archiving to help store and manage the growing volumes of clinical images Integrated Centricity Solution GE Healthcare delivers an integrated Centricity solution with Universal Viewer 100 edition, Universal Viewer ZFP, and Enterprise Archive 100 edition * to provide a powerful unified workspace for radiologists and clinicians to help improve access and optimize productivity. Visualization Archiving Workflow Integrated Centricity Solution Centricity Universal Viewer 100 Edition Centricity Universal Viewer Zero Foot Print client (ZFP) Centricity Enterprise Archive 100 edition Clinical Quality Operational Efficiency Financial Performance imagination at work 1 * Naming of Centricity Enterprise Archive 100 edition is still to be finalized.

2 Index Centricity Universal Viewer 100 edition Centricity Enterprise Archive 100 edition ZFP

3 Centricity Universal Viewer 100 edition Visualization Workflow Universal Viewer helps optimize radiologist workflow efficiency through the use of advanced study layouts, multiple presentation states, intelligent hanging protocols with variable-sized, asymmetrical windows and copies of windows, 2D stack-based reading tools, and 3D reconstructions. With a few mouse clicks, a dedicated referrer can readily access the same software and clinical tools as used by radiologists. Based on the user s explicit needs and preferences, the highly customizable viewing tool includes: report and diagnosis, key images, scanned documents, and patient study layouts. Adaptive Streaming The adaptive streaming engine helps generate rapid image display by enabling adjustments for bandwidth and device compute power. To efficiently deliver images to the user s screen, the adaptive streaming engine evaluates the format in which images are stored (uncompressed, compressed in JPEG, JPEG2000, or RLE formats), as well as the network conditions between the data store and the viewer. (Note: Patient and study information are safely transmitted using SSL encryption.) 3

4 Centricity Universal Viewer 100 edition Visualization Workflow Smart Reading Protocols 1 A standard feature of Universal Viewer, Smart Reading Protocols (SRP) represents a new way for radiologists to work with hanging protocols. In contrast to traditional hanging protocol functions available with PACS software, SRP is designed to make hanging protocol creation simple with drag and drop tools. During the normal review process, radiologists can set up images based on their preferences and teach the system using a one-click learning feature. The next time the radiologist opens an exam of a similar type, SRP automatically applies the previous learnings to hang the image to their preference. Enhanced Usability and Access Universal Viewer s web-client provides radiologists, referring physicians, and other clinicians with system access from virtually anywhere 2. The study list is browser accessible and serves as the hub of the workflows. This gives the viewer fast access to vital study and patient information, including order data, notes, and reports. Utilizing the re-architected adaptive streaming engine, the first image is displayed within two (2) seconds. 3 From that point on, the user can freely navigate the study content and view images in the best available quality. As defined within the study list, the Auto-Fetch option improves the images display time by allowing the pre-loading of studies from storage. All referrers have access to the same advanced post-processing capabilities as the radiologist, including the ability to consult large datasets from their practice desk for quicker diagnosis. Universal Viewer additionally offers security and preference settings to define what external users can do, helping to enhance the security of patient data. Universal Viewer s flexible web-based architecture provides tight connectivity with Centricity Enterprise Archive for one-click access to prior images. 4

5 Key Benefits Visualization Workflow Standard Tools Automatic, adaptive display sizing Easy arrangement of images using exclusive SNAP tool Smart Reading Protocols Smart and customizable algorithms that pick the most appropriate window width and window level MIP/MPR launched directly from preferred hanging protocol (HP) and in Smart Reading Protocols (SRP) Native PET/CT with ability to apply SUV units to all viewports True-resolution magnifying glass Anatomical 3D cross-reference Slab scrolling Global stack with a keyboard short cut that provides the ability to go to the next or previous series True-size viewing Annotations and measurements Evaluate prior exam comparison with multiple methods for image synchronization, including image number, relative position and image registration Image registration allows the synchronization of multi-modality images, and comparison studies from Computed Tomography (CT), Magnetic Resonance (MR), and PET to assist with the alignment of anatomical levels during the exam comparison workflow Display minimum, maximum, and standard deviation with Region of Interest (ROI) displays Study comparison Create key images with a single mouse click Ability to enable up MIP/MPR on up to three series in a single viewer session Percent of images viewed in a series displayed Pulls data for the next patient on the study list into the cache The ability to create Canned Exam Notes from within the Universal Viewer and display worklists based on the content of a canned exam notes STAT Workflow within the Universal Viewer, the STAT indicator changes color if there are STAT exams on the worklist clicking the STAT button displays all STAT exams, which are highlighted in the worklist Ability to reject images Ability to store cardiology DICOM objects Display cine studies in multiple viewports Export cardiology cine studies for local conferencing in AVI format 5

6 Key Features Visualization Workflow Work Flow Enhancement tools Flexible, individual, user-defined, on-the-fly worklists Multi-study, multi-modality hanging protocols Key Image Viewer Patient timeline and series navigator with user defined preferences to resize the timeline and navigator thumbnails Dictation integration Local CD burning CD import DICOM send DICOM print Assign to worklist Grant temporary access Bookmarks and conference display protocols with multiple comparison studies Display historical images stored in third party archives, utilizing the investment in the organization s current infrastructure Open desktop integration standards based tools provide connectivity to external applications, including the ability to launch other GE Healthcare and third party products from Universal Viewer Universal Viewer s web-client provides radiologists, referring physicians, and other clinicians access to the system from any location 2. The study list serves as the hub of the workflows and is browser accessible, providing fast access to vital study and patient information, including order data, notes, and reports. DICOM router A DICOM router will enable users to easily establish any number of DICOM Routing rules and automatically route studies or images to any number of DICOM destinations. The DICOM Router can route large volumes of studies to multiple workstations, PACS systems or tele-radiology service providers. It includes up to 350GB raw capacity to cache studies if necessary. The DICOM router also has a robust and feature-rich pre-fetch capability. The pre-fetch engine can be easily configure to query and pre-fetch relevant priors from any number of PACS systems and route them to any number of DICOM destinations. 6

7 Key Features Visualization Workflow DICOM Support Single-frame and enhanced CT, MR, US, PT, XA, RF, SC Images CR, DX, MG, IO, SC, XA, VL endoscopic, microscopic, and photographic image storage, slide coordinates microscopic image storage Presentation states (GSPS) Key image notes (KIN) Scheduled workflow Clinical Gateway Centricity Clinical Gateway (CCG) is a software component to provide interoperability among GE products and non-ge products. It acts as a interface between GE Healthcare products and external vendors to form an integrated, collaborative environment by exchanging clinical information, processing orders and providing DICOM modality work list (DMWL) support. CCG supports XML, HL7, and DICOM standards and provides customized services to support radiology scheduled workflow & business analytics. CCG is a point-to-point and multi-cast interface engine for exchanging clinical information. IHE Profiles Patient information/reconciliation Consistent presentation of images Access to radiology information Portable data for imaging Consistent time ATNA IHE Mammo Universal Viewer Authentication Modes Universal Viewer utilizes Windows Authentication to authenticate users. This supports single sign-on when user is logging in from the same Windows domain as other Windows applications. When implemented with Centricity Universal Viewer 100 edition, ZFP supports authentication against the Universal Viewer 100 edition user repository. Universal Viewer also supports Active Directory integration for user authentication. 7

8 Key Features Visualization Workflow Web Client Language Support As per regulatory requirements, Universal Viewer web-client provides either (or both) the operator s manual or the GUI in these languages: Brazilian Portuguese Danish Dutch English Finnish French German Greek Hungarian Italian Korean Norwegian Polish Portuguese Russian Simplified Chinese Spanish Swedish Traditional Chinese Turkish Japanese Smart Reading Protocols The ontologies in the smart reading protocols have been localized for additional languages. They are available in Brazilian Portuguese, English for the U.S. and U.K., Dutch, French, German, Hebrew, Italian, Japanese, Korean, Polish, Russian, Simplified Chinese, Spanish, Swedish, and Turkish. Supported Browsers Microsoft Internet Explorer 8 32-bit (with Windows XP for Clinician Workstation only) Microsoft Internet Explorer 8 64-bit Microsoft Internet Explorer 9 32-bit Microsoft Internet Explorer 9 64-bit Microsoft Internet Explorer 10 in full mode Microsoft Internet Explorer 11 in compatible mode 8

9 Key Features Visualization Workflow CD Burning Solo CD in the workstation Universal Viewer Launch by other Applications Inbound URL launch Launch exam based on access number Launch exam based on Study Instance UID Launch patient folder based on patient ID Launch single image or series Microsoft Windows authentication SAML SSO Token authentication N N N N Inbound Proxy URL Launch Not supported Outbound Frontend API Generic launch based on Accession Number (command line) Generic URL launch based on Exam UID or Accession Number Generic dictation system integration (TCP based) Outbound open API Interface and Connectivity to GE products AW Server AW Suite Breast Imaging without tomo powered by IDI V4.7 MR3 12 Breast Imaging with tomo powered by IDI V4.7 MR3 12 Viewpoint *13 Xeleris* 13 MUSE Cardiology (EKG, Report) 15 Centricity Cardiology Data Management System (DMS) Report Precision Reporting without RIS-IC N 9

10 Key Features Visualization Workflow Interface and Connectivity to 3rd Party products Merge Mammo (Cedara) Traumacad by VoyantHEALTH version N TeraRecon version or any version that supports integration via Open API Vitrea by Toshiba Voxar by TOSHIBA v6.3.2 (for current customers only, no longer available for sale) peervue versions 6.0 & 7.0 (proprietary API) Nuance Powerscribe 360 (via IDR) Nuance Powerscribe 360 (via TCP) N Minimum Client Specifications 4 Operating System Universal Viewer Web-Client Diagnostic Use Microsoft Windows 7 64 bit Compute Power 8 Cores 4 Cores RAM 8 GB 4 GB Universal Viewer Web-Client Clinician Review Microsoft Windows 7 32 or 64 bit Microsoft Windows XP 32 bit Hard Drive 146 GB, RAID GB, RAID 0 Interface 1 GB NIC 1 GB NIC Monitor Single color display of 1024 x 768 resolution or better with colors High-resolution grayscale 2mp or better Single color display of 1024 x 768 resolution or better with colors 10

11 Key Features Visualization Workflow Server Specifications Web Server Controller and Node 4 Following well-established security practices, the server accessed by external users without a VPN must be separate from the database server. External users are clients outside the firewall, typically referring physicians accessing the Universal Viewer Web over the Internet. Controller Universal Viewer 100 edition Core Solution Universal Viewer 100 edition Add-on Components VMWare Vsphere for Servers ESXi 5.x or later ESXi 5.x or later Microsoft 2008 R2 SP1 Microsoft 2008 R2 SP1 Server Operating System Microsoft SQL 2008 R2 SP2 Microsoft SQL 2012 SP1 Microsoft SQL 2008 SP2 R2 Microsoft SQL 2012 SP1 Standard, Enterprise, DataCenter for Windows No of Core 12 (24) 10 Standard, Enterprise, DataCenter for Windows CPU 2 x E5-2697v3 1 x E5-2670v3 vcpu 24 (48) 20 CHz Memory 12 x 8GB (96GB) 4 x 8GB (32GB) 340GB (OS) 240GB (OS) Storage 1290GB (DB) 225GB (logs) 100GB (cache) 250GB (DB) 225GB (logs) 500GB (cache) Concurrent users per server * TB (image storage) *See detailed Server requirements in the Universal Viewer 100 edition release notes: DOC

12 Centricity Enterprise Archive 100 edition Archive On site archive and disaster recovery tools Centricity Enterprise Archive 100 edition is a clinical content repository that supports DICOM, HL7 and XDS standards, to enable a robust way of storing and managing patient data and seamlessly connecting DICOM devices. Enterprise Archive 100 edition allows modalities to send and store data and images and make it available for clinical review as required. Its vendor-neutral architecture enables you to connect disparate systems from multiple vendors across multiple specialty departments and multiple facilities, along with managing a large variety of storage systems: It uses CIFS (Common Internet File System), iscsi (Internet Small Computer System Interface) protocols to connect to network attached storage: NAS (Network Attached Storage), SAN (Storage Area Network), and CAS (Content Addressable Storage). Deployment models for all sizes Enterprise Archive 100 edition can scale to support sites from small clinics with low volume to large regional health organizations or entire countries with millions of exams stored. As your needs grow, it can be expanded to a full enterprise or community-wide image and document repository. The proven, scalable architecture allows you to connect multiple systems from different vendors across your enterprise or region *. Flexible Prefetching and Auto-routing of images With Enterprise Archive 100 edition, your clinicians can request retrieval of prior patient studies stored in PACS and simultaneously allow for these images to be routed to designated modality workstations. Prefetching allows relevant images and diagnostic reports to be available in advance thus complementing the diagnosis process. Select prefetch parameters such as exam type, disease category, age of studies etc. are stored and managed in the Enterprise Archive database which allows selective prefetching based on requested parameters. 12 * Southwest Ontario Diagnostic Imaging Network currently has 60+ hospitals, 7 vendor PACS and 5 Vendor RIS with 3.2 million exams / year and users connected to a single, provincial wide DICOM archive. Centricity Clinical Archive Customer Case Study- Southwestern Ontario Canada, October 2013.

13 Centricity Enterprise Archive 100 edition Archive Query Spanning Enterprise Archive 100 edition supports query-spanning to help retrieve patient images that are distributed over several image archives. When the query-spanning feature is enabled, a query performed in Enterprise Archive will span across one or more remote image archives. Both the results from Enterprise Archive and the remote image archives will be merged and returned to Universal Viewer. This allows users to see one large archive consisting of both Enterprise Archive images and the remote archive images. This is particularly helpful should patients have multiple image types from different mobilities stored in different archives such as X-ray, CT or Ultrasound as these studies can be retrieved by Enterprise Archive to create one single patient jacket of prior images for the clinician. HL7 updates HL7 is a standard used to exchange clinical and administrative data between information systems. Enterprise Archive 100 edition can receive HL7 messages from a hospital, radiology or cardiology system over a TCP/IP connection so you can keep patient information up to date. It can also send HL7 messages. Enterprise Archive also accepts and works with the HL7 messages Patient Update and Patient Merge. The Patient Update message allows you modify patient data in Enterprise Archive by means of a HIS/RIS so you can keep patient demographics up to date. Patient demographics consist of patient names etc. The Patient Merge message allows you to combine different patient data (e.g.,demographics and images) of a single patient under one patient name. This means that patient demographics and images registered under both Adam Smith and John Doe could be brought under a single entry; e.g., Adam Smith. Enterprise Archive 100 edition also works with Order message (ORM). This is a propriety message that keeps PACS systems and Enterprise Archive databases in sync with each other so that hospitals connected to long term storage centers can retrieve the most accurate information available. 13

14 Centricity Enterprise Archive 100 edition Archive Virtual Archives ou can configure Enterprise Archive 100 edition so that it contains multiple regular archives. Each of these archives acts as a completely separate entity on the DICOM network and has its own Application Entity (AE) Title e.g, multiple modality types, each is a AE. As images from the network arrive, Enterprise Archive stores them in the appropriate regular archive according to the AE Title specified as the destination address in the DICOM message. Multiple regular archives mean that different departments can have their own archive without any need for additional hardware or software. ou can keep different types of data completely separate so that users can access some archives but not others. More specifically, a provider can use two virtual archives, one for radiology and one for cardiology, each with its own configuration. Furthermore, these separate archives can write to the same long-term storage media. ou might also use multiple archives when Enterprise Archive operates as a backup archive for an external DICOM system; e.g., an Image Vault. This allows an external system to easily retrieve data from Enterprise Archive 100 edition. Standards-based architecture Enterprise Archive 100 edition delivers a single repository for DICOM clinical data across the enterprise and enables standards-based archiving for image and other clinical content across radiology, cardiology, pathology, dermatology, surgery and other departments. Enterprise Archive also manages other DICOM objects such as Structured Reports, Presentation States, and Key Image Notes. Management Console Enterprise Archive 100 edition includes a rich administrator console designed with Microsoft Silverlight that can be used to configure the system. Administrator privileges can be managed at a variety of system levels, from enterprise to a virtual partition. Usage and performance reports are available on the console. The console can be run from any device that supports Microsoft Internet Explorer version 8, 9, 10, and bit versions where Silverlight is supported. 14

15 Centricity Enterprise Archive 100 edition Archive Enterprise Archive 4.0 and Enterprise Archive 100 edition Enterprise Archive 100 edition is scalable, allowing you to grow as your patient populations grow without the need to change software. Below are additional software modules that are available should you require additional functionality to connect to the broader community. Please ask your GE Healthcare sales representative about the most suitable option for your organization. Capability/definition Enterprise Archive 100 edition Enterprise Archive 4.0 Store Images in DICOM es es Prefetching of studies from Modality Auto-routing to standalone workstations es es es es HL7 updates workflow es es Query Spanning query studies from DICOM device es Virtual Archives es (single) es (multiple) es Tag morphing No es Information Lifecycle Management No es Media Manager No es XDS capabilities and registry No es Audit Trail Repository No es Support for multiple patient MRN s No es High Availability No es Scalable Architecture for load balancing No es Database Shadowing No es 15

16 Technical Specifications for Centricity Enterprise Archive Archive A brief description of the technical specifications and requirements for select solution components is provided below. our GE Healthcare product sales specialist will provide a detailed configuration to meet the needs of your specific implementation. IHE Profile Support Centricity Enterprise Archive supports the following IHE profiles: Audit Trail and Node Authentication (ATNA) Cardiology Evidence Documents (ED-CARD) Consistent Presentation of Images (CPI) Access to Radiology Information (ARI) Key Image Note (KIN) Simple Image and Numeric Report (SINR) Evidence Documents (ED) NM Image (NM) Enterprise User Authentication (EUA) Consistent Time (CT) For additional information on IHE and DICOM support, please visit these sites

17 Technical Specifications for Centricity Enterprise Archive Archive Minimum Server Specifications * Application Server The application server houses the Long Term Storage Management middleware. Application Server VMWare Vsphere for Servers VMware ESXi 5.1 or 5.5 Server Operating System Compute Power RAM Microsoft Windows 2008 R2 Standard Edition or Microsoft Windows 2012 R2 Standard Edition Microsoft SQL Server 2008 R2 Standard or Enterprise Edition, Microsoft SQL Server 2012 Standard or Enterprise Edition 4, or Microsoft SQL Server 2014 Standard or Enterprise Edition 1 x Intel 2.66GHz Quad-core or better 6 GB RAM 8 x 146 GB in a RAID5 configuration Storage Centricity Enterprise Archive server supports fiber channel and network attached storage solutions. Centricity Enterprise Archive uses CIFS (Common Internet File System), iscsi (Internet Small Computer System Interface) protocols to connect to network attached storage. Multiple storage systems can simultaneously be connected to one Enterprise Archive server. The application server can be deployed with external image cache for customers who plan to keep additional images online for fast access. * Minimum specifications are provided for reference purposes. Actual configurations may differ depending on the specific implementation. 17

18 Cloud based archive and disaster recovery tools Archive Centricity Image Archive from GE Healthcare is a vendor-neutral, cloudbased data-storage service that helps you reduce the total cost of storage. It provides peace of mind by offloading the burden of managing onsite storage and helps prevent loss of critical patient data in the event of disasters. Simultaneously, it gives clinicians easy access to prior images to help with the process of diagnosis and treatment planning. Centricity Image Archive offers two levels of services to meet your storage needs. Disaster Recovery: Safeguard your critical patient data by automated backup of onsite primary archive. Long-Term Archive with Disaster Recovery: Reduce costly overheads by offloading your long-term archive into our remote data centers. Clinicians get near real-time access to patients prior images and you gain an affordable, secure and reliable way to manage your growing storage needs. Secure Infrastructure to safeguard your data In order to help enable security of stored patient data, GE Healthcare works with leading and trusted data center partners. Our Tier 3 level data centers provide: Robust infrastructure & support, to help ensure reliable and scalable archiving and management of your valuable patient data. Data centers are run using Industry standard operating systems. Our 24/7 proactive system monitoring & ITIL (Infrastructure Technology Infrastructure Library) processes for change control, and incident management help mitigate risks and enable speedy problem resolution. Certified expertise with managing professionals that are trained in industry standards and best practices for hardware infrastructure management, network connectivity, and support services. Well-equipped hosting facilities with redundant power supply with UPS, redundant onsite generators, redundant HVAC, redundant OC-192 internet connections for sustainable connectivity; along with the ability for full monitoring and alerts for electrical and mechanical systems components. Privacy and security with security officers on duty 24/7 and monitored video surveillance and photo IDs along with security measures such as Biometric scanners. Dedicated firewall and data protection with encrypted backup. We follow established policies and procedures that meet industry standards in support of customer security requirements. Geographical redundancy provided at all times. We maintain two geographically separated data centers that house two copies of data. This helps provide data protection and loss prevention. 18

19 Tools Universal Viewer ZFP Universal Viewer ZFP puts clinical insights within reach to efficiently deliver patient results. It provides clinicians, radiologists and specialists enterprise-wide and community-wide access to images and reports from anywhere 2 on the user s device of choice 5. Universal Viewer ZFP is cleared for diagnostic use 6 and helps physicians view the clinical content that is available across the longitudinal patient care continuum. Both DICOM data and XDS (Cross Enterprise Document Sharing) content can be viewed with Universal Viewer ZFP. The XDS viewing component can be purchased separately. Universal Viewer ZFP provides clinicians access to imaging and clinical content when the data is stored in Centricity Enterprise Archive solution. Universal Viewer ZFP provides radiologists and clinicians with: Access to patient imaging history and other clinical content on the users device of choice with broad web browser support Basic viewing of reports and key images with 3D reformat tools 7 Ability to view other clinical content in multiple formats, including but not limited to audio, video and visible light A common user experience for clinician and radiologists between Universal Viewer ZFP and Universal Viewer Web client IT staff and leadership benefits: Zero installation means no software download or administrative access rights are required Reduced dependency on IT staff No patient data left behind on devices Secure access to images with Electronic Medical Record (EMR), HIS and RIS, as well as stand alone capabilities Greater efficiency with one viewing solution on Centricity Enterprise Archive from single department DICOM to multiple departments with multi-ology systems with DICOM or XDS content 19

20 Tools Universal Viewer ZFP DICOM viewing capabilities Universal Viewer ZFP offers radiologists and clinicians across your community access to DICOM images and reports for review and interpretation 6. They can choose from one of the pre-defined layouts, use advanced 3D reformatting tools such as MIP/MPR and volume rendering 7, as well as display and simultaneously play up to 4-cine loops with zoom and pan capabilities. 2x2 MPR and volume rendered image Image cross-reference capability Access to images is available through direct patient search or through the launch of ZFP from external applications such as Electronic Medical Record or physician portal, as well as from any API complaint system that will launch ZFP. When using the direct patient search, users can search for any exam by patient name, medical record number or accession number. Searches can be filtered by modality type and exam date. Universal Viewer ZFP can access images in Universal Viewer 100 edition and images created by other systems when stored in Centricity Enterprise Archive. Additionally, ZFP can access data from any DICOM compliant archive using Centricity Enterprise Archive for query retrieve and data moves. In addition, multiple users can remotely access the images from any location. 20

21 Tools Universal Viewer ZFP Key Benefits Helps to mobilize radiologists and clinicians with access to images and reports from virtually anywhere 2 Authorized for use on multiple devices including Windows -based PCs, Apple Mac, Apple ipad and Samsung Galaxy tablet devices 5 Ability to use advanced reformatting tools while viewing images Study search Enhanced user satisfaction by allowing clinicians to use the device of their choice 6 Display and review radiology, cardiology and other medical images on the same device Ability to provide enterprise-wide image access to clinicians and referring physicians directly or through other systems, such as RIS, HIS or EMR No installation of software on the user s device No administration rights are required to install and use the application No data stored on local devices helps support data security and privacy Native gestures on ipad Same streamlined, ergonomic user interface deployed with the Universal Viewer web client Provides clinicians with a consolidated view of the patient s image data across multiple multi-department DICOM archives irrespective of the patient identifier 6 Supports low bandwidth environments by displaying lossy compressed images and automatically disabling the lossless progression of images based on network bandwidth Fast navigation of large data sets allowing users to skim, skip, and scroll through a stack of images Configurable session time-out based on user group 21

22 Tools Universal Viewer ZFP Key Benefits 2D viewing with ability to zoom, window/level, perform measurements and annotate Supports 3D viewing with MPR/MIP and Volumetric Rendering Display and apply different presentation states during the viewing session Multiple image viewport layouts User domain selection through PIX Displays Key Image Notes View reports Specific labeling when lossy images are viewed Automatic cine on up to 4 multi-frame objects with ability to change speed, window/level and pan during cine Show or hide DICOM overlays Image viewing with progressive and adaptive streaming with no user intervention needed Toolbar and right click option for easy access to viewer functions Incorporates series navigator with drag and drop functionality Study search function allows for search of any exam by patient name, medical record number, NHS number or accession number; filter by modality or date range Worklist viewing restrictions provide a method to restrict user access to studies when implemented in a stand-alone mode (not opened by another system) Display historical images from 3rd party archives whether or not they support direct streaming User authentication through Active Directory enables added security and decreased user maintenance Identify hot zones in a viewport to enable zoom, window level or scrolling Modality LUT and Color palette ROI statistics in average Hounsfield units along with a standard deviation (CT studies) Cardio Thoracic Ratio (CTR) measurements 22 Display Pathology Region of Interest (ROI) part, block and stain information Shutter (DICOM and manual) Global stack i.e., ability to scroll through all Cross referencing Synchronization Ability to review Mammo & Tomo images as lossy compressed images Side-by-side comparison allows access to comparison exams Outbound URL launch of 3rd party systems with the ability to launch by accession number or medical record number/patient ID enables connectivity with products such as Orthoview Orthopaedic Digital Imaging, Centricity Cardiology DMS, MUSE Cardiology Information System and Voyant Health Traumacad Native gestures on ipad and Samsung tablet devices Ability to copy and print reports, save and print images

23 Tools Universal Viewer ZFP Desktop versus ipad Applications Capability Desktop Manual Cine es es 3D (MIP/MPR/Volume Rendering) Layouts es 1up, 2up, View_H, View_V, View_1+2, View_2+1, 2x2 Cross-reference es es Synchronize es No Global Stack es Image Export es No Annotations Distance, Angle Measurement, Elliptical Region, Ellipse, Freehand, Rectangle, Text, & Arrow Cardio Thoracic Ratio (CTR) es es Elliptical Region es No Annotation Delete Toolbar, Right Click Menu Delete All Right Click Menu No Gesture Help N/A es Mouse Hot Keys es N/A Ambient Light Test N/A es XDS based Patient Timeline es No ipad and Samsung tablet devices No Full, View_H, View_V Available using Navigate to next series gesture Distance & Freehand Toolbar icon DICOM support CT, MR, Enhanced CT, Enhanced MR, US, PT, XA, RF, SC, CR, DX, MG, Breast Tomosynthesis, IO, SC, VL, NM, Endoscopic, Microscopic and Photographic Image Presentation States Key Image Notes Basic Text SR, DOSE SR Complete support information can be found in the product DICOM conformance statement. 23

24 Tools Universal Viewer ZFP IHE Profiles Consistent Presentation of Images (partial support) Key Image Notes as Image Display Actor Access to Radiology Information as Image Display Actor Consistent Time Profile as Time Client Actor ATNA Audit Trail and Node Authentication as Secure Application Actor Complete support information can be found in the product DICOM conformance statement. Universal Viewer ZFP Interface and connectivity options Universal Viewer ZFP can be launched by other applications such as a RIS, HIS, EMR or patient portal using the Open Desktop integration tools. Universal Viewer ZFP can also launch other GE Healthcare products and 3rd party applications with these tools. The Open Desktop Integration is built using JavaScript enabling the interface to provide tighter integration with other applications. See Technical Information (page 18) for more details. Using the Outbound Open API, the following GE Healthcare and 3rd party applications can be launched: GE Healthcare Products Advanced Visualization powered by AW Server 3 embedded applications Advanced Visualization powered by AW Server 2 non-embedded applications AW Suite Breast Imaging with or without tomo powered by IDI MUSE Cardiology (EKG, Report) DMS Report N N N N 24

25 Tools Universal Viewer ZFP - Technical Information Implementation Options Universal Viewer ZFP can be implemented with Universal Viewer 100 edition and Centricity Enterprise Archive. It can be implemented with other DICOM compliant archives when using Centricity Enterprise Archive. Below is a summary of the options available. Please contact your GE Healthcare representative to discuss the implementation options best suited for your enterprise. Capability Universal Viewer 100 edition Windows Authentication es es IMS user authentication es No LDAP support es, utilizing UV100 LDAP support Referring Service worklist es No Referring Physician worklist es (uses referring physician in UV100 IMS) Limiting worklist to AE Title No es RPPS support FCE support es Requires all FCE to be converted to GSPS and sent to EA GSPS support es es Significant Images es No Key Images es es Exam Notes es No Reports Reading directly from CPACS STS Reading directly from EA Centera and NAS Accessed directly from UV100 database es es Centricity Enterprise Archive (EA) No es (uses Referring Physician in DICOM header) Requires all RPPS to be converted to GSPS and sent to EA Requires all FCE to be converted to GSPS and sent to EA Requires HL7 connection to EA, reports converted to DICOM-SR for display on ZFP No es Support for multiple EA es es Support for multiple patient identifiers es utilizing UV100 PIX es (requires one patient ID domain per archive) 25

26 Tools Universal Viewer ZFP - Technical Information Authentication Modes Universal Viewer ZFP utilizes Windows Authentication to authenticate users and support single sign-on when the user is logging in from the same Windows domain as Zero Footprint Client. ZFP supports authentication against Universal Viewer 100 edition user repository. When implemented with Centricity Enterprise Archive, Universal Viewer ZFP supports Windows Authentication to connect to the archive database. Universal Viewer ZFP also utilizes a dynamic token for secure launch. This provides more secure connectivity when ZFP is opened from an EMR, RIS or HIS. When utilized, the ZFP URL payload is encrypted and has a time to live, after which it will expire, helping to prevent anyone from accessing images. Universal Viewer ZFP XDS-enabled viewing supports Active Directory integration for user authentication. (Note: XDS viewing can be purchased separately.) Supported Devices Universal Viewer ZFP has been validated for use on PCs and Apple Mac products as well as the following tablet devices using the browsers and operating systems listed below. Samsung Galaxy Note 10.1 (10 inch model) Samsung Galaxy Tab 4 (7, 8 and 10 inch models) ipad and ipad Mini with Retina display ipad Mini Browsers Supported The performance of Universal Viewer is optimized when it is run in these recommended browsers: Microsoft Internet Explorer 10, Internet Explorer 11, Mozilla Firefox or Google Chrome. Customers who use Microsoft Internet Explorer 8 and 9 will need to implement Legacy Browser Component (LBC), a GE Active X control. In our internal benchmark testing, scrolling performance on Internet Explorer 9 without the use of LBC has not been found to be reasonable (ranges 6-9 images per second). For more details, request a copy of the Universal Viewer ZFP Performance Benchmarks white paper. 26

27 Tools Universal Viewer ZFP - Technical Information Browsers Supported Browser DICOM Viewing XDS Viewing Microsoft Internet Explorer 8 and 9 32-bit (*requires GE Legacy Browser Component) Microsoft Internet Explorer and 64-bit (Microsoft Windows ) Microsoft Internet Explorer and 64-bit Mozilla Firefox v32 (Microsoft Windows) Google Chrome v32 (Windows and Mac OS) * Safari v7 (Mac OS) Google Chrome V32 ios V7 and V8 N on the ipad Safari (ios v7 and v8 on ipad ) N Google Chrome v 32 (Android KitKat v4.4.2 on Samsung ) N Important Considerations Certain SSL certificates do not work with ZFP on ios 8. These certificates are blocked by the ios 8 trust store, which then block access to ZFP. Please refer to ios documentation for specific information. Using Internet Explorer 8 and 9 with LBC, Universal Viewer ZFP does not support the launch of TraumaCAD. This limitation previously existed when Google Chrome Frame was required to implement these versions. OrthoView and MUSE applications can be launched. 27

28 Tools Minimum Client Specifications 4 For optimal performance, a bandwidth of 30 Mbps with a latency of 30ms or lower between the ZFP server and the ZFP client is recommended. Additional memory is required with Internet Explorer. Operating System Minimum Memory Compute Power ZFP on PC or MAC within browser Windows (refer OS versions that support browser) Mac OS X or later 1024 MB for Internet Explorer 8, MB for other browsers Minimum 2 cores (2 GHz) Validated mobile devices N/A N/A N/A ZFP XDS-enabled on PC or Mac within browser Windows OS (refer supported browser versions) Mac OS X or later Minimum 2 GB RAM 6 GB RAM recommended Minimum 2 cores (2 GHz) Recommended 2.7 GHz Quad Core Graphics Card N/A N/A Graphics Card 16 MB Interface Display 30 Mbps <30 ms latency (recommended) 1.5 Mbps <100 ms latency (minimum) Minimum Resolution of 1024 horizontal x 768 vertical pixels for resolution. The monitor should support 1024 grayscales (10/12) and contrast ratio of 850:1. The monitor should have color depth of 32 bit color. Min 70 Hz refresh rates N/A Minimum 1024 x 768 pixels 100 Mbps Minimum 1024 x 768 pixels Recommended 1920 X 1080 pixels The monitor should support 1024 grayscales (10/12) and contrast ratio of 850:1 The monitor should have color depth of 32 bit color Min 70 Hz refresh rates 28

29 Tools Minimum Server Specifications No administrative rights or additional download requirements. As a true HTML5 application, users can access Universal Viewer without the use of these technologies. Additional server is required if DICOM and XDS viewing are installed. our GE Healthcare sales team will provide exact specifications. Deployment Considerations Customers who deploy Universal Viewer ZFP with desktop virtualization technologies such as Citrix must validate Universal Viewer ZFP in their own environment to ensure that image quality meets clinical needs. ZFP Server (see note) (includes XDS Viewing) Physical Hardware VM Environment VMWare Vsphere for Servers Server Operating System Microsoft SQL Server N/A W2008 R2 Sp1 and W2012 R2 64-bit Standard, Enterprise, Data Center for Windows 2008 Server, Data Center for Windows 2012 Server Access to a remote SQL Server 2008, 2012 or 2014 required for XDS Based Patient Timeline Only ESXi5 Compute power 8 cores 8vCPU RAM Storage Interfaces 8 GB RAM (32 GB recommended) 60 GB OS partition 300 GB Data partition RAID OS partition RAID 5 Data partition10k minimum Two 1GB NICs DVD-RWRemote Access (Lights-out) capability Concurrent users per server 8 W2008 R2 Sp1 and W2012 R2 64-bit Standard, Enterprise, Data Center for Windows 2008 Server, Data Center for Windows 2012 Server Access to a remote SQL Server 2008, 2012 or 2014 required for XDS Based Patient Timeline Only 8 GB RAM (32 GB recommended) 60 GB OS partition 300 GB Data partition RAID OS partition RAID 5 Data partition10k minimum N/A 29

30 Tools Interface and connectivity options Using the Open Desktop integration tools, Universal Viewer ZFP can be launched by other applications such as an RIS, HIS, EMR or patient portal. Universal Viewer ZFP can also launch other GE Healthcare products and 3rd party applications. As organizations consolidate clinical content within an archive, the ability to launch a particular document and study from the EMR while being able to access other clinical content on the patient time line is needed. Universal Viewer ZFP supports two different URL arguments to launch a particular document or study with access to patient timeline. Universal Viewer ZFP supports the ability to leverage two (2) factor authentication from certain 3rd party vendors in DICOM viewing only. ZFP launch by other applications URL Launch Launch exam based on accession number Launch exam based on Study Instance UID Launch clinical content based on Document UID Launch patient folder based on patient ID Launch single image or series Windows authentication SAML SSO Token authentication ZFP (DICOM viewing) N N N Java Script Interface launch 10 Launch exam based on accession number Launch exam based on Study Instance UID Launch patient folder based on patient ID Launch single image or series Windows authentication Token authentication ZFP (DICOM viewing) N 30

31 Tools Comparison of URL and Java Script Interface Launch URL Launch Usage scenario External secure URL launch of ZFP Inbound Java Script Interface Tight integration with third party application Tight context synchronization Configuration URL JavaScript object Authentication Initial launch First image display Browser Reuse Static/Dynamic token authentication Static token authentication Active Directory user authentication ~6-8 seconds Faster display because the application is launched in the background 2-3 seconds upon reuse of browser instance es (controlled by calling application) Limited - depends on web browser configuration 2-3 seconds upon reuse of browser instance es Languages Supported 9 Universal Viewer ZFP supports the following languages: Brazilian Portuguese Danish Dutch English Finnish French German Italian Japanese Norwegian Polish Portuguese Russian Simplified Chinese Spanish Swedish Traditional Chinese Turkish Korean 31

32 About GE Healthcare GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NSE: GE) works on things that matter great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. Corporate Headquarters GE Healthcare 540 W Northwest Highway Barrington, IL USA Tel: or or Fax: Asia Headquarters GE Healthcare 1 BLD-3F No.1 Hua Tuo Road, Zhang Jiang Hi-Tech Park Shanghai China Tel: Fax: European Headquarters GE Healthcare 283 rue de la Minière BUC France Asian Sales Office 1 Maritime Square #13-01 (Lift Lobby B) HarbourFront Centre Singapore Tel: Fax: US Patent No. 8,923,580. Shai Dekel, Alexander Sherman, Sohan Rashmi Ranjan, Viswanath Avasarala, Xiaofeng Liu, Alexandre Nikolov Iankoulski, Tianyi Wang, Smart pacs workflow systems and methods driven by explicit learning from users, US patent publication. Publication number US A1. Publication date May 23, Where internet access is available. 3 Performance data reflect results of the tests conducted in a controlled environment; actual performance of the system depends on the operational and networking environment, as well as system load. 4 Minimum specifications are provided for servers and workstations. Requirements for your organization may differ. 5 Refer to the list of supported devices and supported browsers in the technical information section of this solution sheet. 6 Universal Viewer ZFP client has been validated and cleared for diagnostic use by the US FDA on Microsoft Windows and Apple Mac products. ZFP has also received CE Mark for diagnostic use. As regulatory clearance requirements differ by country and region, GE Healthcare must obtain clearance in countries where local specific regulatory approvals are required. our sales representative can provide information on the status of availability in your area. ZFP can also be used on the Apple ipad, Samsung Galaxy Note 10.1 and Galaxy Tab 4 in a review only mode and is not meant for primary diagnosis on these devices. Please refer to the product datasheet for a list of operating systems and browsers supported on these devices. 7 Available with desktop version only. 8 Performance benchmarks show support for up to 600 studies per hour per web node. Recognizing there are high and low usage times, this indicates that one study is viewed approximately every 6 seconds. Performance may degrade with higher volumes. 9 Excludes support for ideographic and phonetic names. 10 For information on the standards-based API and additional products supported, please contact your sales representative. 11 Via client-side or full integration. Embedded applications are disabled when client-side or full integration is implemented. 12 Requires Breast Imaging powered by IDI, IDI V4.7 MR2. 13 Connectivity to Xeleris*, Viewpoint*, MUSE and other products is supported using the Universal Viewer Open API. For Xeleris*, Viewpoint* or MUSE, any version that supports desktop integration can be implemented. For example Xeleris* , Viewpoint* or MUSE Supported versions for other products are provided. Third party software can be installed on the same PC as Universal Viewer provided the PC meets the minimum requirements for all applications. Contact your GE Healthcare representative to learn more General Electric Company All rights reserved. General Electric Company reserves the right to make changes in specifications and features shown herein, or discontinue the product described at any time without notice or obligation. This does not constitute a representation or warranty or documentation regarding the product or service featured. Timing and availability remain at GE s discretion and are subject to change and applicable regulatory approvals. Contact your GE representative for the most current information. GE, the GE Monogram, Centricity, MUSE, ViewPoint, Xeleris, OncoQuant, Autobone and imagination at work are trademarks of General Electric Company. Internet Explorer, Windows Server, Microsoft, Windows, Microsoft Internet Explorer, Microsoft SQL Server, Microsoft Silverlight and Windows 2008 Server are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. Mac, ipad and Safari are trademarks of Apple, Inc., registered in the U.S. and other countries. IOS is a trademark or registered trademark of Cisco in the U.S. and other countries and is used under license. Google Chrome is a trademark of Google, registered in the U.S. and other countries. SAMSUNG and Samsung are trademarks of SAMSUNG in the United States or other countries. Galaxy Note and Galaxy Tab are trademarks of Samsung Electronics Co., Ltd. Merge Healthcare is a registered trademark of Merge Healthcare Incorporated. Mozilla Firefox is a trademark of Mozilla Foundation in the U.S. and other countries. Nuance Powerscribe 360 is a trademark or registered trademark of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. JavaScript is a trademark of the Oracle Corporation in the US and other countries. RSA is the security division of EMC. RSA and the RSA logo are trademarks or registered trademarks of RSA Security in the U.S. and/or other countries. EMC is a registered trademark of EMC Corporation. DICOM is a registered trademark of National Electrical Manufacturers Association (NEMA). Traumacad by VoyantHEALTH VMware reserves all rights to its trademarks, service marks and logos, which together with the trademarks, service marks and logos of subsidiaries of VMware will be collectively referred to as VMware Marks. Voxar by TOSHIBA, Vitrea by Toshiba, and TOSHIBA are the trademark of Toshiba Corporation of Japan. All other product names and logos are trademarks or registered trademarks of their respective companies. All other product names and logos are trademarks or registered trademarks of their respective companies. All third party trademarks are the property of their respective owners. GE Healthcare, a division of General Electric Company. imagination at work JB30954USA