Kevin O’Donnell, Toshiba Medical Research Inst.Co-chair, IHE Radiology Planning Cmte.
Presenter perceives no conflict of interest with this presentation but discloses being an employee of:
Toshiba Medical Research Institute USA,
a division of Toshiba Medical Systems
“The future is already here, it’s just not evenly distributed yet” – Paul Saffo
JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data
& ServicesEHR Data & Services Data
Warehouse
OutbreakMgmt
PHSReporting
SharedHealth
Record
DrugInformation
DiagnosticImaging
LaboratoryHealth
Information
ClientRegistr
y
ProviderRegistry
LocationRegistry
TerminologyRegistry
POINT OF SERVICE
Hospital, LTC,CCC, EPR
Physician
Office EMR
EHR Viewer
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security Mgmt
Privacy DataConfig
Services
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health
Provider
Longitudinal Record Services
HIAL Communication BusCommon Services
and…
or…
Easier, perhaps.
You may be part of the problem.
IHE Portable Data for Images (PDI) Profile Standardize media
IHE Import Reconciliation Workflow (IRWF) Profile Fix demographics, IDs and codes
IHE Basic Image Review (BIR) Profile Baseline behavior for viewer software
Compatibility requirements Standard CD format and file system Consistent disc organization Use most generic DICOM media profile Images MUST be present in DICOM
o May have copies as “web content” (i.e. JPEGs)
Avoid most common mistakes (highlighted)
Connectathon testing Peer-to-Peer vendor testing Results checked by RSNA project managers 50+ companies tested PDI in the last few
years
Endorsed by AMA/ACR/AANS/ACC/… Stopped just short of declaring it “standard of
care”
Buying equipment that burns DICOM media? Ask that it support PDI as a Media Creator
Receiving media frequently? Ask the provider for PDI compliant media
Additional Media:
Compression Optionally allowed; but leave policy to PACS On-board “Sender Software” recommended.
Encryption Optionally allowed; password based Please consider support needs before
creating
DVD
1) Insert CD; Run SendSoft
2) “Enter Password:”
5) DICOM Association Negotiation
7) Send Images (C-STORE)
4) “Enter Destination:”3) SendSoft Decrypts CD Images
6) SendSoft decompresses & converts CD Images (as needed)
Improvements to consider:
Staff pre-load media onto yourdrive / Import media into PACS
Install YOUR preferred viewer /Use your reading workstation
Reconcile patient demographics & IDsto integrate with local records
“The Images are in the PACS but are messed up” The patient ID is wrong, it doesn’t come up in a
query I can’t hang the new images with the old The unknown procedure codes mess up my hanging
protocols The images aren’t linking to the EMR.
Patient’s chart won’t come up Impact:
Lost time Incomplete data Drags on effectiveness
During image import, details are fixed to match (or not conflict with) local values Patient IDs, Name Procedure Codes, Accession Numbers, etc.
Two ways of getting demographics DICOM Worklist HL7 Demographics Feed
Work In Progress BASIC Image Review Defines a Baseline
Feature set Look and feel Performance Minimum Platform
“Advanced” Button = Show me what else you can do
Facilities distribute images; Physicians review them Rising frustration; too often the viewer:
requires installation on a locked down machine does not successfully run starts up too slowly does not successfully load the images warns the images are non-diagnostic is missing some basic critical function has Yet Another GUI where basic operations are non-obvious
Impact: delayed care, inaccessible information, repeat examination
and irradiation, and poor use of valuable clinician time.
Trial Implementation Spec. in June
Potential applications of BIR Spec. Media Viewer (PDI Option)
o Requires a BIR Compliant viewer be placed on media Third party viewer Web Portal
Radiologists may be unaware of the pain suffered by the clinicians (i.e. their customers)
Ask for PDI compliance in media & equipmentConsider IRWF if you import regularlyWatch for BIR in the near future
Pursue the future; And have backup plans.
Any sites here that didn’t use their fax last month?
