Emergency Neuro Image Transfer System (ENITS) January 2014

Emergency Neuro Image Transfer System (ENITS) January 2014

ENITS Training Agenda During this presentation, you will learn about the following: ENITS program update ENITS Account Creation ENITS Account Authentication Role of OTN Help desk Role of CritiCall Ontario The ENITS on-line process Help desk contact details On-line resources

ENITS Program Update ENITS is currently used by Ontario s neurosurgeons, neurosurgery residents, spinal specialists, pediatric intensivists and Telestroke neurologists. ENITS can be accessed at : https://www.enits.ca As of December 2012- ENITS account holders have access to the ENITS application 7 days a week - 24 hours a day. As of January 2014, ENITS provides access to push all CT head and spine exams as well as on-demand MR images from 80 + referring sites across Ontario. Over 350 modalities are now connected to ENITS MR imaging will be primarily requested on-demand to further improve the decisions made to transfer neurosurgical patients, especially those with possible spinal cord injury.

ENITS Program Update An inventory of MRI sites connected to ENITS can be found at the following link: http://criticall.org/webconcepteur/web/criticall/en/nav/applications.html As of March 2013, all active Telestroke neurologists have on-boarded to ENITS. The efilm application has been officially decommissioned as of April 10, 2013. ENITS continues to provide secure web based access to CT and MR images from any PC or Mac and allows the ENITS consulting physician to support a consultation request from CritiCall Ontario. The ENITS Help Desk will continue to service the consulting physicians. The ENITS Help Desk can be reached at 1-877-465-7167 The OTN Help Desk will provide technical support to Telestroke neurologists The OTN Help Desk can be reached at 1-866-454-6861

ENITS Account Creation An account management process has been developed that allows physicians to create a request to access ENITS. A Registration Authority at each ENITS consulting hospital or organization has been identified to review a fully completed account management form. Once approved by the Registration Authority, account credentials will be sent directly to the approved end user by the ENITS help desk. The account management process and related documentation can be found on the CritiCall Ontario web site: http://criticall.org/webconcepteur/web/criticall/en/nav/applications.html

ENITS Account Authentication ENITS physicians must complete the following steps to authenticate to ENITS: 1. Logon with an updated user name and temporary password provided by the ENITS Help Desk using the following link: : https://www.enits.ca 2. Update their temporary password to a permanent password based on the approved criteria. 3. Generate responses to five (5) challenge and response questions For ENITS physicians who have successfully authenticated to the new ENITS application, they will be required to use their: Assigned user name Updated password Respond to one pre-answered challenge and response question.

Role of OTN Help Desk OTN remains responsible for the Telestroke program(video, work station and network connectivity) and will provide: Basic troubleshooting for ENITS- password resets and verification of application availability. In the event an issue cannot be resolved by the OTN Help Desk, it will be escalated to Tier 2 (ENITS Help desk) for resolution. New physician additions to the Telestroke program, the primary registration authority is by Dr. Frank Silver (Frank.Silver@uhn.ca). New accounts can also be approved by Jennifer Mills-Beaton (jmillsbeaton@otn.ca). ENITS accounts will be created by the ENITS Help Desk. There are no changes to CritiCall Ontario s role in the Telestroke consultative process as a neurologists move to the ENITS platform.

Role of CritiCall Ontario in ENITS Advising ENITS consulting physicians that CT and MR studies are available for review, consultation for treatment, and/or patient transfer. Facilitate the consultation process between the referring ED physician and ENITS consulting physician. In the event that technical difficulties are encountered, CritiCall Ontario will direct the consulting physician to connect with the appropriate Help Desk.

The ENITS On-line Process

Emergency Neuro Image Transfer System Consult Workflow with MRI Process NON-NEUROSURGICAL CENTRE 3c Request for additional imaging with MRI 6c Tele-consultation 5 Follow Up Consultation 3b Tele-consultation 2a Consultation request 1a Acquire Images ENITS Shared PACS CRITICALL 3a 2b Page to On-call Consulting Physician * 1b Image Transfer 3b/6b Telephone Confirmation CT Modality CONSULTING PHYSICIAN * MRI Workflow 4 January 2014 v9 Updated on-demand Image Transfer to ENITS Shared PACS MR Modality 6a Specialist reviews additional MRI Imaging * Includes NEUROSURGEON, ORTHOPEDIC SPINAL SPECIALIST, PEDIATRIC INTENSIVIST, TELESTROKE NEUROLOGIST

The Updated ENITS process Temporary logon credentials will be provided to new ENITS account holders by the ENITS Help Desk. This will allow physicians to create a new account as well as access the new ENITS/ eunity interface.

The updated ENITS process After updating your password, you will be prompted to provide responses to the ENITS Q&A. Your updated ENITS credentials will be required to complete the ENITS Q &A. You are required to complete this once as part of the account creation process.

The updated ENITS process Your password will require updating every 180 days.

The updated ENITS process You are required to answer five questions. This will be the only time you are required to complete this portion of the account creation process. These responses will be used to authenticate your access to the ENITS application. At logon, you will be asked to respond to one of the five questions.

The updated ENITS process In the event you provide an incorrect response to your authentication question, your account will be locked after three attempts. A new question will not be presented. Please contact the ENITS (consulting physicians) or OTN (neurologists) Help desk for assistance.

The Updated ENITS process After successfully logging on to ENITS with your username, password and authentication question the consulting physician will be directed to the eunity search screen and study repository.

Other Work screen features Passwords expire after 180 days (previously 90 days) The ENITS Help Desk is available 24 x7 for account management support

Search Options Work Screen features Additional search options are available:

Search Options-Work list access Search criteria are available based on information from CritiCall Ontario: 1. Patient name 2. Patient ID 3. Accession Nos. ENITS end users after a successful logon are directed immediately to the eunity search screen.

Main work screen Studies Study of Interest posted at the top of the application Launches selected study for review

eunity Navigation- Posting all Studies Once the study has been launched, the consulting physician will be required to Show available Series Once launched, the consulting physician is presented with the complete study.

Individual exams in eunity must be dragged and dropped into the main viewing area. The study of interest is flagged and the border is highlighted. To remove all of the available studies from view- select eunity Navigation- Posting all Studies

eunity Navigation- Standard Features Navigation Window Leveling and Preset Inverting Brightness Toggle Demographics

eunity Navigation- Other features Expanding this heading presents additional image reference tools Angle measurement Freeform ROI Eraser Revert to original Export Image to JPEG/ PNG The Revert to Original Tool allows user to reset a series of images to its original state. (Note: Navigation is not reset)

eunity Navigation- Triangulation Triangulation-Using your mouse over the study of interest, allows you to position within a reference location in the same study.

eunity Navigation- Toggle Reference Lines Toggle reference lines allows the specialist to observe the reference cut line in a related Sagittal, Coronal or Axial study(s).

eunity Navigation- Linking Images Reference Image Lead Image Links features (navigation, window leveling, zoom and pan) between exams in the same study. January 2014 v9

eunity Navigation- Cine Cine - Preset cine rates, start and stop available. During Linked mode, users can toggle cine between reference exams.

eunity Navigation- Image comparison Allows image comparison in the same series Allows image comparison in a different series Maximum comparison is 2 x 2

eunity Navigation- Log Out

On-line help for eunity Helpdesk for ENITS Contact the 24 hour ENITS Helpdesk Toll free at 1-877-465-7167 Email: enits@lhsc.on.ca Helpdesk for OTN Toll free at 1-866-454-6861 Email: servicedesk@otn.ca

ENITS On-line Resources On-line resources can be found on the CritiCall Ontario web-site: http://criticall.org/webconcepteur/web/criticall/en/nav/applications.html Within this link, you will find details on the following: A copy of this presentation + ENITS video Final MRI deployment summary ENITS Account Management Process and Form ENITS FAQ Thank your continued participation in the ENITS program Anytime,Anywhere