Web-Based PACS and EHR System

Web-Based PACS and EHR System Ashesh Parkh, Ph.D a and Nhal Mehta, Ph.D. b a netdicom, 11105 Latmer Drve, Frs, TX USA; b netdicom, 11105 Latmer Drve, Frs, TX USA ABSTRACT We demonstrate how a cloud-based PACS can exchange nformaton wth other medcal systems, ncludng other cloud-based PACS, to provde a mprehensve and ntegrated vew of a patent s health rerd. Such a nsoldated report wll lead to mproved patent care. Keywords: Web-based PACS/EHR, Cloud Computng 1. INTRODUCTION A patent s clncal data s frequently mantaned on a varety of systems scattered across several dfferent healthcare facltes. Ths data s prmarly of two types: textual and graphcal. The textual ntent ntans nformaton mprsng of bllng, schedulng, laboratory test results, etc. The graphcal ntent prmarly mprses the DICOM medcal mage fles. Textual nformaton can be easly stored n relatonal databases, and securely accessed both by nternal systems as well as external thrd party applcatons usng a varety of standard protols. Sharng graphcal nformaton, on the other hand, s a fraught wth dffcultes. Not only s t mpractcal to transfer large numbers of DICOM medcal mage fles over any type of network, the avalablty of low-st and DICOM vewers for dagnostcs s a challenge. Fgure 1 shows the types of nformaton ntaned n varous medcal systems. A key factor, however, for effectve patent treatment s enablng an effectve and rapd physcan-patent mmuncaton that ncludes a patent s medcal hstory, dagnoses, medcatons, treatment plans, mmunzaton dates, allerges, laboratory test results as well as DICOM medcal mages that when mbned together forms a patent s mprehensve Electronc Health Rerd (EHR). 1 Ths vson for the EHR entals support for all medcal mages that resde on a varety of PACS to enable physcans wth pont-of-care access to nsoldated magng data. Moreover, for a mprehensve patent health vew, t s crtcal to present data resdng on multple nsttutons and ntegratng wth mages that resde on PACS 2 n a sngle presentaton surface regardless of the provenance of the medcal data. 2. URGENT NEED FOR COMPREHENSIVE EHR To gan an apprecaton of the exgency for the need for an effcent EHR, nsder a typcal case for a patent. A patent may vst Insttuton 1 for prmary care. The annual blood and urne test along wth the hstory resdes on the HIS at that Insttuton. A pror Breast MRI scan may have been performed at Insttuton 2, where the patent had undergone partal mastectomy followed by chemo treatment for breast cancer. The patent now gets admtted to a Hosptal for chest mplcatons (Insttuton 3). If all three nsttutons systems were nterlnked together so that nformaton uld be shared n a secure manner, then the attendng physcan at Insttuton 3 would be able to vew the earler radology mages to evaluate the dsease progresson and determne the best treatment plan. Further author nformaton: (Send rrespondence to Ashesh Parkh.) Ashesh Parkh: E-mal: ashesh.parkh@netdm.net, Telephone: (972) 905-NET-D (6383) Nhal Mehta: E-mal: nhal.mehta@netdm.net, Telephone: (972) 905-NET-D (6383) Medcal Imagng 2015: PACS and Imagng Informatcs: Next Generaton and Innovatons, edted by Tessa S. Cook, Janguo Zhang, Proc. of SPIE Vol. 9418, 94180A 2015 SPIE CCC de: 1605-7422/15/$18 do: 10.1117/12.2081975 Proc. of SPIE Vol. 9418 94180A-1

HIS RIS - Radology- specfc Patent schedulng, bllng, fnancals, reports, worklsts, labs, and many other tems that rerd the mplete patent path through a healthcare system PACS Repostory of Images Image -based (lght on text) Text -based Fgure 1. Schematc showng types of clncal nformaton n varous systems RIS -1 HIS -1 Blood Report Urne Sample g11/2008 PACS-1 PACS -2 MRI- Breast blateral T w /out Contrast @ 1112008 PACS -3 PET CT Tumor Whole Body @ 8/2008 Fgure 2. Components of Patent s EHR. In the absence of mmedate avalablty of the patent s hstory, the physcan nstead ordered PET CT Tumor Whole Body followed by MRI Blateral T wthout Contrast. These addtonal tests uld have been avoded wth a mprehensve EHR. Fgure 2 llustrates the above scenaro. In ths example, the patent medcal data resdes on several systems, such as Health Informaton Systems (HIS), Radology Informaton Systems (RIS) whle the actual radology mages resdes on the organzaton s PACS. 3 Many of these systems are propretary and are nmpatble n several regards and unable to mmuncate or exchange nformaton wth each other usng standards based mmuncatons. Proc. of SPIE Vol. 9418 94180A-2

Ol \ Fgure 3. DICOMs resdng on Cloud 3. CLOUD COMPUTING As stated earler, the prmary challenge to have a mprehensve Electronc Health Rerd (EHR) for a patent s the need to handle a patent s DICOM medcal mages, possbly mantaned by several healthcare organzatons. Ths dffculty arses because DICOM medcal mages are typcally mantaned on LAN based PACS, or on CDs that are carred by the patent themselves when they vst doctors. Whle better mmuncaton of exstng medcal mage fles outsde the nternal network of the medcal faclty s defntely requred, a soluton for storage s needed as well. Preferably, ths soluton should avod the sts of creatng large amounts of dedcated nfrastructure beforehand. A soluton for ease of data access would be to move the medcal mage fles from a LAN-based PACS to a cloud-based soluton. 4 A cloud-based soluton s a flexble pay-as-you-go platform that provdes for scalable growth as and when needed. Fgure 4 llustrates the benefts of movng from a managed on-premse web-based system to a purely cloud-based soluton. In a managed on-premse soluton, the healthcare faclty has to ncur both human captal sts to manage the nfrastructure as well as the st to provson the varous mponents that make up a web-based PACS. On the other hand, n a cloud-based Software as a Servce model, the human captal sts are devolved to the cloud mputng provder. Furthermore, wth the elastc pay-as-you-go model, addtonal mponents can be provsoned as needed. Thus, sts ncrease only wth ncrease n demand for servce. Commercal Cloud servces, such as Mcrosoft s Azure, 5 are wdely avalable today. (The Cloud Servces provded by Mcrosoft Azure has been used as an example here; however, smlar platforms are avalable from several other provders such as Amazon Web Servces, Cloudera, Google Cloud Platform to name a few.) Fgure 5 shows the mnmal mponents requred to deploy a cloud-based PACS servce. 4 At the heart of the nfrastructure s a relatonal SQL database. Here, all the nformaton rangng from Patent to Studes to Images s mantaned once extracted from DICOM medcal mage fles. Assocated wth the rerd of each patent are the actual DICOM medcal mage fles stored on the fle server. Standard features of a Cloud archtecture are also avalable and can be sutably talored to the user needs. The soluton can be deployed across dfferent geographcal regons. Furthermore, t s easy to acmmodate requrements from certan untres that have legal requrements specfyng geographcally where the mages need to resde. Smlarly, data and mages can be backed-up wth ether local, zonal or geographcal redundancy as requred. Even features such as the performance level of the database s customzable. Fnally, analytcs tools for data mnng and machne learnng are avalable for future use. Proc. of SPIE Vol. 9418 94180A-3

a> a) 0 C 2 zo } Applcatons Applcatons a) Applcatons] C Data N Data Data C Runtme Runtme o Runtme 2 >- Mddleware Mddleware Mddleware o} O/S OIS OIS ca 2 Applcatons Data IRuntme Mddleware 0/S Vrtualzaton Vrtualzatorl Vrtualzaton Servers Servers Servers J ó Storage Storage m Storage Networkng Networkng Networkng ä < äm Vrtualzaton Servers Storage Networkng On Premse Infrastructure as a Servce Platform as a Servce Software as a Servce Fgure 4. Levels of Cloud Servces Mcrosoft Azure sz e IN ALL ETEMS all tems l`t WEBSET" NAME TYPE STATUS SUBStJ1 11ON EOCAt10N 4 VIRTUAL MACHINES MOBILE SEAVICE 0 CLOUD SERVICES mtdicom 4 MIAMI A/ Run,,n0 n.idicom SQL Database Default...no, Dn.Ttay wnnamamcam VlwatAUW Dune J O+r. s/ Amr+ J Ama! Pay-As-Yen-Go Shared by all Default Dv Ra - AS-TVA -GO Sauth Central US Urged blue.s SUAVE Central US tj SOL DATABASES STORAGE \ NDENSIGHT v MEDIA SERVICES SERVICE BUS A VISUAL STUDIO ONLINE Fgure 5. Mnmal Components for a Cloud-Based PACS Proc. of SPIE Vol. 9418 94180A-4

Vendor Vendor 2 Vendor 3 Vendor 4 \ l Inst -1 Blood Report Urne Sample @11/2008 Inst -2 MRI- Breast blateral T w /out Contrast @ 11/2008 Inst-3 PET CT Tumor Whole Body @ 8/2008 Fgure 6. Uploadng Patent Data from Multple Insttutons to Multple Vendor Systems 4. EHR ON CLOUD Fgure 6 llustrates how a Patent s EHR s dstrbuted across multple healthcare facltes. Each faclty would transfer the patent data to some cloud-based system, whch would most lkely be dfferent for dfferent healthcare provders. Once on the cloud, though, nformaton across dfferent cloud-based systems can be exchanged usng standards based protols. See Fgure 7. Fnally, a patent s data obtaned from multple healthcare facltes can be shown n a sngle nsoldated vew. See Fgure 8. 5. SUMMARY & CONCLUSIONS Among the nformaton that nsttute a patents mprehensve EHR, such as medcal hstory, dagnoses, medcatons, treatment plans, mmunzaton dates, allerges, radology mages, and laboratory test results, the DICOM medcal mages are a domnant mponent. Enablng quck access to medcal mages that resde on any PACS would enable physcans wth tmely and accurate dagnoss. The key barrer to acmplsh ths s to mbne data resdng on multple nsttutons and mbnng wth the mages that resde on PACS. However, a cloud-based PACS that exchanges nformaton wth other systesm n a secure manner usng open standards, the ablty to present a nsoldated vew of a patent s nformaton n ts entrety s acheved. Proc. of SPIE Vol. 9418 94180A-5

LVendor 1 H L7 Vendor 2 HL7 Vendor 3 HL7 Vendor 4 \ l HL7 Protol allows webstes of dfferent vendors to talk to each other <nso:adt A04 22 GLO DEF xmhts: ns0="http://netdicom. net/hl7/2x"> <EVN_EventType> <EVN.1 EvenlTypeCode>A0841EVN.1 EventTypeCode> <EVN.2 DaleTmeOlEvenb201401080823</EVN.2 DateTlmeClEvent> <EVN.3 DateTlmePlannedEvent>201401080823UEVN.3 DateTmePlannedEvent> <EVN.4 EVBnlRéasonCodB>01UEVN.4_EventReasonCode> UEVN_EventType> <PID Patlentldent8catlon> <PID.1 SelldPatrentld>3175875vPID.1_SetltlPatlentld> <PID.2 PaUeNldExtemalld> cpid.s PatlentName> Fgure 7. Exchangng Patent Data Usng Standard Protols MRI Blateral wth T wout Contrast Study Date. tm 2005 Study Intormaton I. Image Seres PET CT Tumor Whole Body Study Date: 8/1/2 Study Informaton Image Seres PET CT TUMOR, WHOLE BO Study Date: 8/1/2oo8 Study Inform -'.on Image Seres MRI Breast Blateral T wthout ntrast Study Dale: 6/24/2oo8 St :dv Infnrrnabnn Image Seres <nst 2 Patent Name: Mrs. Jane Doe DOB: 10/17/1949 Gender: Female Notes: Pt s a 66 y/o female s/p hosptalzaton at Medcal Cty due to AMS and deblty. PMHx ncludes: HTN, hyperlpdema, breast CA, s/p R breast mastectomy 2007, chemoradaton, s/p R frontal cranotomy for tumor, stage IV small cell lung ca wth multple bran mets and R hlar mass, s/p whole bran radaton and 2-3 rounds of systemc chemo. D/C Plan: Pt to return home wth husband wth ncreased strength to resume her PLOF Severe chest pans. Pneumona symptoms. Non smoker. 8/1/2008 PET, CT Tumor, whole body Lungs, Chest 11 /1 MRI Breast Fgure 8. Integrated Vew of Patent Data Obtaned from Multple Healthcare Facltes Proc. of SPIE Vol. 9418 94180A-6

REFERENCES [1] [Electronc Health Rerds]. http://www.hmss.org/lbrary/ehr/. [2] Bolan, C., [Cloud PACS and moble apps renvent radology workflow]. http://www.appledradology.m/. [3] Panykh, O. S., [Dgtal Imagng and Communcatons n Medcne (DICOM)]. Sprnger. [4] Parkh, A. and Mehta, N., PACS - next generaton, SPIE Conference Proceedngs (2015). [5] [Azure: Mcrosoft s Cloud Platform]. http://azure.mcrosoft.m/en-us/. Proc. of SPIE Vol. 9418 94180A-7