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in the management and integration of virtual slides in Pathology   Marcial García Rojo(1), Carlos Peces(2), Jose Sacristan...
Presentation objective <ul><li>We describe our experience in the use of emerging  IT standards in Pathology , including th...
Infrastructures development SANITEL:  Communication network BACKBONE inter-province communication network 155 Mbps circuit...
Population-based patient database  search engine Images Central database YKONOS.  Hospital 1 Hospital 2 Primary care centr...
Standards in Pathology <ul><li>Integration in Pathology Information Systems has not yet been achieved. </li></ul><ul><li>S...
IHE Definition <ul><li>IHE is an initiative  by healthcare professionals and industry  to improve the way computer systems...
Sitios web relacionados <ul><li>Integrating the Healthcare Enterprise –  Europe:  http://www.ihe-europe.org/ </li></ul><ul...
The IHE Process (annually) <ul><li>Identify Interoperability Problems </li></ul><ul><li>Specify Integration Profiles </li>...
2. Specify Integration Profiles <ul><li>Experienced healthcare IT professionals  identify relevant standards  and define  ...
IHE Pathology. An example of problems to deal with <ul><li>Pathology images are in a digital format but often without any ...
IHE promotes standards: Advantages of DICOM <ul><li>Organization: Central repository of medical images for all medical spe...
Actors in Pathology Information Framework <ul><li>Actors:  information systems or components of information systems that p...
Transactions in the Pathology Technical Framework <ul><li>Transactions: Interactions between actors that transfer the requ...
HL7: A common languaje <ul><li>Messages between applications: </li></ul><ul><li>MSH|^~&|APA||||20050714150127||ORM^O01|-11...
File format problems <ul><li>PACS systems manage images which are DICOM-compliant.  </li></ul><ul><li>DICOM files are limi...
Our project: Serendipia <ul><li>Serendipity: The faculty of making fortunate discoveries by accident . </li></ul><ul><li>K...
Telepathology HOSPITAL A HOSPITAL B Sender Second opinion
SERENDIPIA Project  specific objectives <ul><li>Pathology Information System (LIS) </li></ul><ul><li>Image management (inc...
Pathology workflow
Standards: IHE. Actors & Transactions
SESCAM integration design Gross station Autopsy room Micro photo App  server  J2EE DICOM viewer Virtual slide scanner Virt...
Storage needs <ul><li>Hospital clinical workload : </li></ul><ul><ul><li>Number of specimens per year: 5,000 to 40,000. </...
Storage needs per hospital <ul><li>On line storage for 4 years (1 st  phase): </li></ul><ul><ul><li>Albacete Hosp.  (800 b...
Architecture: Components <ul><li>Pathology Information System ( Novopath ) </li></ul><ul><li>PACS 5.6 ( Udiat ): JPGEG2000...
Architecture Reference Hospital J2EE/Aurora SIAP BACKUP PACS/APERIO Tapes library Storage server Application server/Web Li...
Virtual slides <ul><li>Virtual microscopy:  Aperio ScanScope </li></ul><ul><li>XT: 120-slides / CS: 5 slides </li></ul><ul...
Object identification <ul><li>Documents </li></ul><ul><li>Containers </li></ul><ul><li>Cassettes </li></ul><ul><li>Slides ...
RFID: Identifying with  radiofrequency <ul><li>Low/high frequency. Passive/active </li></ul><ul><li>label (“tag”) </li></u...
Specific workstations <ul><li>Reading (high res.) wkst and  teleconsultation </li></ul><ul><li>Autopsy and gross room: Was...
<ul><li>Small hospital </li></ul><ul><li>Code bar reading  containers / slides </li></ul><ul><li>Gross station </li></ul><...
Support centre <ul><li>Centralizing malfunctions or breakdowns notifications and technical consultations. </li></ul><ul><l...
CONCLUSIONS <ul><li>Eight  public hospitals have been included in the initial phase, including integration with enterprise...
9th European Congress on Telepathology http ://www.seapcongresos.com/telepathology2008/
IHE & DICOM. Collaborate with standardization bodies! <ul><li>Christel Le Bozec </li></ul><ul><li>[email_address] </li></u...
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Healthcare information standards (IHE, DICOM, HL7)

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  • Digital Imaging and Communications in Medicine (DICOM) DICOM refers to a file header standard. This standard header for image files allows that all DICOM compliant devices can work with images coming from very different sources, and from many different original formats [7]. DICOM headers can “wrap” many commonly used image file types, including JPEG and TIFF. These are common format files in many medical specialties. A new work group in DICOM (WG26) is committed to the proposal of modifications to the DICOM standards that would allow an efficient use of digital slides.
  • These efforts are worthwhile, and the main advantages of DICOM in Pathology are: For the organization: Central repository of medical images can be used for all medical specialties using PACSs ( Picture Archiving and Communicating Systems) Integration with e-Health Record One viewer for all medical images Independence of devices manufacturers’ proprietary file formats. Image Consistent Presentation: independence of the display device. Thus, the same result is obtained using different acquisition, display or print devices. Pathologist’s transformations made to images are saved and available to other doctors. Correct image storage is confirmed
  • Actors in Pathology Technical Framework Actors are information systems or components of information systems that produce, manage, or act on information associated with operational activities in the enterprise. The following are the actors defined by IHE and referenced throughout the rest of this document (in alphabetic order) [2]. Some examples of actors are: Acquisition Modality – A system that acquires and creates medical images while a patient is present, e.g. a Computed Tomography scanner or Nuclear Medicine camera. A modality may also create other evidence objects such as Grayscale Softcopy Presentation States for the consistent viewing of images or Evidence Documents containing measurements. Order Filler – A pathology department-based information system that provides functions related to the management of orders received from external systems or through the department system’s user interface. Order Placer – A hospital or enterprise-wide system that generates orders for various departments and distributes those orders to the correct department, and appropriately manages all state changes of those orders. In some cases the Order Placer is responsible for collecting and identifying the specimens. Image Archive – A system that provides long term storage of evidence objects such as images, presentation states, Key Image Notes and Evidence Documents. Image Display – A system that offers browsing of patients’ studies. In addition, it may support the retrieval and display of selected evidence objects including sets of images, presentation states, Key Image Notes, and/or Evidence Documents.
  • Transactions in the Pathology Technical Framework Transactions are interactions between actors that transfer the required information through standards-based messages. The following examples of transactions will be probably defined by IHE: Filler Order Management – This transaction contains all the messages required between the Order Filler and the Order Placer for the notification of a new filler order, as well as the creation of the placer order that reflects it. Its main goal is to ensure that each filler order will be represented by a placer order, and will have both a filler order number and a placer order number. It can also be used for order modification or cancellation. Modality Worklist Provided – Based on a query entered at the Acquisition Modality, a modality worklist is generated listing all the items that satisfy the query. This list of Scheduled Procedure Steps with selected demographic information and information about specimen is returned to the Acquisition Modality.
  • There are some issues to solve before normalization is obtained in the digital slides archiving into PACS systems. Some of these issues are related to image format. Since PACS systems manage images which are DICOM-compliant, manufacturers should generate DICOM-compliant files, however, the existing standard, as mentioned, need to be improved. In fact, DICOM files are limited in size to 2GB. Although this limiting size can be enough for some compressed files, many large slides could not be saved, because they are over 2 GB even after using efficient compression systems likes JPEG2000. Even when some manufacturers are using standards formats, like TIFF files, the internal structure of these TIFF files may not be recognized by PACS, because most DICOM systems cannot manage TIFF files with a tiled organization, and/or TIFF files with JPEG or JPEG2000 compression. For these reasons it is generally not possible to import virtual slides generated by the existing systems directly into PACS.
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  • Transcript of "Healthcare information standards (IHE, DICOM, HL7)"

    1. 1. in the management and integration of virtual slides in Pathology Marcial García Rojo(1), Carlos Peces(2), Jose Sacristan(2), Gloria Bueno(3) 1) Hospital General de Ciudad Real. Spain 2) Castilla-La Mancha Health Care Services (SESCAM) 3) University of Castilla-La Mancha
    2. 2. Presentation objective <ul><li>We describe our experience in the use of emerging IT standards in Pathology , including the integration of Virtual Slides in Pathology general workflow. </li></ul><ul><li>A regional project on digital pathology is presented </li></ul><ul><li>This digitalization effort has been of special benefit for second opinion (teleconsultation), continuing medical education, and quality assurance in Pathology. </li></ul>
    3. 3. Infrastructures development SANITEL: Communication network BACKBONE inter-province communication network 155 Mbps circuits ATM between TO & AB-CR-CU-GU Gigabit Ethernet ring in province capitals STM-1 STM-1 STM-1 STM-1 E3 _ _ TOLEDO _ _ CIUDAD REAL _ _ ALBACETE CUENCA GUADALAJARA Talavera
    4. 4. Population-based patient database search engine Images Central database YKONOS. Hospital 1 Hospital 2 Primary care centre 1 Primary care centre 2
    5. 5. Standards in Pathology <ul><li>Integration in Pathology Information Systems has not yet been achieved. </li></ul><ul><li>Standardization efforts are progressing to provide integration in healthcare information technology (IT) systems, such as: </li></ul><ul><li>CEN TC 251 (pr EN13606): electronic health record </li></ul><ul><li>HL7: messages </li></ul><ul><li>DICOM: images </li></ul><ul><li>IHE initiative ( http://www.ihe.net/ ): How to use standards </li></ul><ul><li>Fist goal is to elaborate a document, the Pathology Technical Framework that identifies the workflow, the IHE actors (i.e. functional components, application roles), and shows the transactions between them. </li></ul>
    6. 6. IHE Definition <ul><li>IHE is an initiative by healthcare professionals and industry to improve the way computer systems share healthcare information. </li></ul><ul><li>IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. </li></ul><ul><li>Systems developed in accordance with IHE communicate with one another better , are easier to implement, and enable care providers to use information more effectively . </li></ul>
    7. 7. Sitios web relacionados <ul><li>Integrating the Healthcare Enterprise – Europe: http://www.ihe-europe.org/ </li></ul><ul><li>IHE.net: http://www.ihe.net/ (American College of Cardiology, Healthcare Information and Management Systems Society and the Radiological Society of North America) </li></ul><ul><li>IHE Technical Frameworks: http://www.ihe.net/Technical_Framework/index.cfm </li></ul><ul><li>IHE-UK: http://www.ihe-uk.org/ </li></ul><ul><li>IHE-France: http://www.gmsih.fr/tiki-index.php?page=IHE </li></ul>
    8. 8. The IHE Process (annually) <ul><li>Identify Interoperability Problems </li></ul><ul><li>Specify Integration Profiles </li></ul><ul><li>Test Systems at the Connectathon </li></ul><ul><li>Publish Integration Statements for use in Request For Proposals (RFPs) </li></ul>
    9. 9. 2. Specify Integration Profiles <ul><li>Experienced healthcare IT professionals identify relevant standards and define how to apply them to address the problems, documenting them in the form of IHE integration profiles . </li></ul><ul><li>Examples: Use of HL7 (ADT) to send a request of pathology study from the HIS to PIS, and how to retrieve pathology images using DICOM </li></ul>
    10. 10. IHE Pathology. An example of problems to deal with <ul><li>Pathology images are in a digital format but often without any organization. Model for integration: IHE </li></ul><ul><li>A model in digital radiology (Scanner and magnetic resonance)  DICOM </li></ul><ul><li>DICOM: Digital Imaging and Communications in Medicine , refers to a file header standard. </li></ul><ul><li>DICOM headers can “wrap” many commonly used image file types, including JPEG and TIFF </li></ul><ul><li>Can we apply DICOM standard in pathology? How this is done with virtual slides? WG26 </li></ul>
    11. 11. IHE promotes standards: Advantages of DICOM <ul><li>Organization: Central repository of medical images for all medical specialties: PACS </li></ul><ul><li>Integration with e-Health Record </li></ul><ul><li>One viewer for all medical images </li></ul><ul><li>Independence of </li></ul><ul><ul><li>devices manufacturers </li></ul></ul><ul><ul><li>proprietary file formats </li></ul></ul>
    12. 12. Actors in Pathology Information Framework <ul><li>Actors: information systems or components of information systems that produce, manage, or act on information associated with operational activities in the enterprise. </li></ul><ul><li>Acquisition Modality – Acquires and creates medical images , e.g. a Computed Tomography scanner or Nuclear Medicine camera. A modality may also create other evidence objects such as Grayscale Softcopy Presentation States for the consistent viewing of images or Evidence Documents containing measurements . </li></ul><ul><li>Order Filler – A pathology department-based information system that provides functions related to the management of orders received from external systems or through the department system’s user interface. </li></ul><ul><li>Order Placer – A hospital or enterprise-wide system that generates orders for various departments and distributes those orders to the correct department, and manages state changes of those orders. </li></ul><ul><li>Image Archive – Provides long term storage of evidence objects such as images, presentation states, Key Image Notes and Evidence Documents. </li></ul><ul><li>Image Display – Offers browsing of patients’ studies . In addition, it may support the retrieval and display of selected evidence objects including sets of images, presentation states, Key Image Notes, and/or Evidence Documents. </li></ul>
    13. 13. Transactions in the Pathology Technical Framework <ul><li>Transactions: Interactions between actors that transfer the required information through standards-based messages. </li></ul><ul><li>Filler Order Management – </li></ul><ul><ul><li>Contains all the messages required between the Order Filler (PIS) and the Order Placer (HIS) for the notification of a new filler order , as well as the creation of the placer order that reflects it. </li></ul></ul><ul><ul><li>Ensure that each filler order will be represented by a placer order, and will have both a filler order number and a placer order number. </li></ul></ul><ul><ul><li>It can also be used for order modification or cancellation. </li></ul></ul><ul><li>Modality Worklist Provided – </li></ul><ul><ul><li>Based on a query entered at the Acquisition Modality, </li></ul></ul><ul><ul><li>Listing all the items that satisfy the query. </li></ul></ul><ul><ul><li>List of Scheduled Procedure Steps with selected demographic information and information about specimen is returned to the Acquisition Modality. </li></ul></ul>
    14. 14. HL7: A common languaje <ul><li>Messages between applications: </li></ul><ul><li>MSH|^~&|APA||||20050714150127||ORM^O01|-11407200515012714|R|2.3|PID||1|1||MOD_NOMB^MOD_APE1^MOD_APE2||19410907000000|F|||^^^^||||||||||||||||||||PV1|||^|||^|||||||||||||0|||||||||||||||||||||||||||ORC|XO|-1|05B0000003||CM|||||||||||| </li></ul><ul><li>MSH|^~&|APA||||20050714150134||ORU^R01|-11407200515013414|R|2.3|PID||1|1||MOD_NOMB^MOD_APE1^MOD_APE2||19410907000000|F|||^^^^||||||||||||||||||||PV1|||^|||^|||||||||||||0|||||||||||||||||||||||||||ORC|XO|-1|05C0000001||CM|||||0^DESCONOCIDO||10009^GOMEZ , ALICIA|||||OBR|1|-1|05C0000001|^^^^|||20050714145607||0|^^^|F|||20050714000000|^^^^^|10009^GOMEZ , ALICIA^^|||GI^GINECOLOGIA|||20050714145607|||F||0^^^^^^^^^|||||10002^GARCIA^F.^H.^^||||20050714145607|0||^^^^|OBX|1||73^MUESTRA^L^A^|0|CERVIX CT1|^^^^|||0||||||^^^^|^^^|^^^^|OBX|2||^MATERIAL REMITIDO^L^^|1|CITOLOGIAS/ RASPAT CV/ A) CERVIX CT1|^^^^|||0||||||^^^^|^^^|^^^^|OBX|3||^DATOS CLINICOS^L^^|2||^^^^|||0||||||^^^^|^^^|^^^^|OBX|4||^MACRO^L^^|2||^^^^|||0||||||^^^^|^^^|^^^^|OBX|5||^MICRO^L^^|2|A ) celulas vaginales normales|^^^^|||0||||||^^^^|^^^|^^^^|OBX|6||^MICRO^L^^|3| |^^^^|||0||||||^^^^|^^^|^^^^|OBX|7||^DIAGNOSTICO^L^^|4|A ) CITOLOGIA NORMAL|^^^^|||0||||||^^^^|^^^|^^^^|OBX|8||^DIAGNOSTICO^L^^|5| |^^^^|||0||||||^^^^|^^^|^^^^|OBX|9||T83000^SNOMED^L^^|6|CERVIX|^^^^|||0||||||^^^^|^^^|^^^^|OBX|10||M00120^SNOMED^L^^|7|CITOLOGIA NORMAL|^^^^|||0||||||^^^^|^^^|^^^^| </li></ul>
    15. 15. File format problems <ul><li>PACS systems manage images which are DICOM-compliant. </li></ul><ul><li>DICOM files are limited in size to 2GB. </li></ul><ul><li>Most DICOM systems cannot manage TIFF files with a tiled organization, and/or TIFF files with JPEG or JPEG2000 compression . </li></ul><ul><li>For these reasons it is generally not possible to import Aperio SVS files directly into PACS. </li></ul>
    16. 16. Our project: Serendipia <ul><li>Serendipity: The faculty of making fortunate discoveries by accident . </li></ul><ul><li>Knowledge transference opportunities are common, but the key driver in order that transference to take place (encouraging serendipity) are: </li></ul><ul><ul><li>The need of the receptor organisation </li></ul></ul><ul><ul><li>Perspective by donor and receptor </li></ul></ul><ul><ul><li>Adequate resources in order transference to happen </li></ul></ul><ul><li>However, concordance between donor and receptor is not easy and often, serendipity is a key factor in success. </li></ul><ul><li>Organizations must improve Serendipia probabilities , offering adequate resources and structures. </li></ul><ul><li>(British National Space Centre. 2004) </li></ul>
    17. 17. Telepathology HOSPITAL A HOSPITAL B Sender Second opinion
    18. 18. SERENDIPIA Project specific objectives <ul><li>Pathology Information System (LIS) </li></ul><ul><li>Image management (including virtual slides) </li></ul><ul><li>Increasing automation in Pathology laboratory </li></ul><ul><li>Object identification: Code bar, RFID </li></ul><ul><li>Specific workstation for pathologists (high resolution: reports, washable: gross/autopsies) </li></ul><ul><li>Data entering (user interface) </li></ul><ul><li>Viewing images and text data </li></ul><ul><li>Communication interactive tools </li></ul><ul><li>Information searches </li></ul><ul><li>Knowledge management </li></ul>
    19. 19. Pathology workflow
    20. 20. Standards: IHE. Actors & Transactions
    21. 21. SESCAM integration design Gross station Autopsy room Micro photo App server J2EE DICOM viewer Virtual slide scanner Virtual slide server Virtual slide viewer Virtual slide repository Path report managing (LIS)
    22. 22. Storage needs <ul><li>Hospital clinical workload : </li></ul><ul><ul><li>Number of specimens per year: 5,000 to 40,000. </li></ul></ul><ul><ul><li># slides per case: 5 </li></ul></ul><ul><ul><li>Not every case is digitized. Initially, only those requiring collaborative work or when they are of high scientific or teaching interest. </li></ul></ul><ul><ul><li>Range of size per slide: 0.5 – 4 GB </li></ul></ul><ul><ul><li>Medium size (40x), using JPEG2000 compression: 1 Gigabyte -> 100 times an X-ray film . </li></ul></ul>
    23. 23. Storage needs per hospital <ul><li>On line storage for 4 years (1 st phase): </li></ul><ul><ul><li>Albacete Hosp. (800 beds) : 40 Terabytes. </li></ul></ul><ul><ul><ul><li>Almansa (100 beds) : 8 Terabytes. </li></ul></ul></ul><ul><ul><ul><li>Villarrobledo (100 beds) : 8 Terabytes. </li></ul></ul></ul><ul><ul><li>Alcázar de San Juan (400 beds) : 32 Terabytes. </li></ul></ul><ul><ul><ul><li>Tomelloso (100 beds) : 8 Terabytes. </li></ul></ul></ul>
    24. 24. Architecture: Components <ul><li>Pathology Information System ( Novopath ) </li></ul><ul><li>PACS 5.6 ( Udiat ): JPGEG2000 links </li></ul><ul><li>Web application J2EE ( Satec ) </li></ul><ul><li>Image Server software and viewer ( Aurora ) </li></ul><ul><li>Virtual slide ( Aperio ) </li></ul><ul><li>User management: LDAP, Kerberos </li></ul><ul><li>Balancing web access by hardware, clustering </li></ul><ul><li>Integrations by HL7 messaging, no intermediary file </li></ul>
    25. 25. Architecture Reference Hospital J2EE/Aurora SIAP BACKUP PACS/APERIO Tapes library Storage server Application server/Web Linux RH 4.0/iAS Servidor de BBDD Linux RH 4.0 Oracle Cluster 2Gb 2Gb BD SERVICES Server LDAP Solaris 9 Server Backup Linux RH PACS server W2003 SQL Server 2005 iAS/WEB Environment Environment Environment SIAP Environment
    26. 26. Virtual slides <ul><li>Virtual microscopy: Aperio ScanScope </li></ul><ul><li>XT: 120-slides / CS: 5 slides </li></ul><ul><li>Speed: (15 X 15 mm): <2 min/slide, 20x (frozen s) </li></ul><ul><li>Resolution: 40x: 0.25 μm/pixel </li></ul><ul><li>Spectrum™ Plus: Multiuser & muti-site </li></ul><ul><li>Image analysis (Quantification IHQ) </li></ul><ul><li>Files:JPEG2000 </li></ul><ul><li>(original files are single file (TIFF/SVS), or a directory with multiple files (CWS-Composite WebSlide) </li></ul>
    27. 27. Object identification <ul><li>Documents </li></ul><ul><li>Containers </li></ul><ul><li>Cassettes </li></ul><ul><li>Slides </li></ul><ul><li>Bar code </li></ul><ul><ul><li>Direct print: Leica/Sakura (2D: datamatrix) </li></ul></ul><ul><ul><li>Label (resistant) with bar code: </li></ul></ul><ul><li>Radiofrequency </li></ul><ul><li>(RFID): </li></ul><ul><li>tissue blocks </li></ul><ul><li>and slides </li></ul>
    28. 28. RFID: Identifying with radiofrequency <ul><li>Low/high frequency. Passive/active </li></ul><ul><li>label (“tag”) </li></ul><ul><li>Reader </li></ul><ul><ul><li>Only RFID </li></ul></ul><ul><ul><li>Both </li></ul></ul><ul><ul><li>(RFID & bar code) </li></ul></ul><ul><ul><li>Mobile devices </li></ul></ul><ul><ul><li>Single protocol / multi-protocol </li></ul></ul><ul><li>Pending: Better standardization </li></ul><ul><li>Example: identification of slides by scanner </li></ul>
    29. 29. Specific workstations <ul><li>Reading (high res.) wkst and teleconsultation </li></ul><ul><li>Autopsy and gross room: Washable keyboards, mouse and screen. </li></ul>4 Mpixels 30” (75.62 cm) Pitch: 0.250 mm Size: 2560 x 1600 Brightness: 200(Dicom)/ 370 (max) cd/m2 3 Mpixels 20.8” (52.8 cm) Pitch: 0.207 mm Size: 2048 x 1536 Brightness: 500(Dicom)/ 800 (max) cd/m2
    30. 30. <ul><li>Small hospital </li></ul><ul><li>Code bar reading containers / slides </li></ul><ul><li>Gross station </li></ul><ul><li>Wash. Keyb. mouse </li></ul><ul><li>Label printer </li></ul><ul><li>Photomicroscopy </li></ul><ul><li>Scanner(<5 slides) </li></ul><ul><li>Storage (8 TB) </li></ul>Serendipia Project in summary <ul><li>Reference Hospital </li></ul><ul><li>Code bar reading container /cassettes/slides </li></ul><ul><li>Autopsy room </li></ul><ul><li>Reading wkst </li></ul><ul><li>Videoconferencing </li></ul><ul><li>Voice recognition </li></ul><ul><li>Scanner >50 slides </li></ul><ul><li>Storage (40 TB) </li></ul>Telepathology portal
    31. 31. Support centre <ul><li>Centralizing malfunctions or breakdowns notifications and technical consultations. </li></ul><ul><li>Permanent, 7x24, 365 days a year availability. </li></ul><ul><li>On line information about incidences and notifications. </li></ul><ul><li>Two software engineers for support team. </li></ul><ul><li>Corrective, evolutionary & Preventive maintenance. </li></ul><ul><li>Staff training plan </li></ul>
    32. 32. CONCLUSIONS <ul><li>Eight public hospitals have been included in the initial phase, including integration with enterprise health record. Cost: 3,5 million euros. </li></ul><ul><li>Improving and automating critical processes </li></ul><ul><li>Faster and more reliable diagnoses (frozen sect.) </li></ul><ul><li>Foster intra- and interdepartamental consultation </li></ul><ul><li>Remote consultation and distant collaborative work will attenuate the shortage of pathologists . </li></ul><ul><li>Better follow-up of the diagnostic process </li></ul><ul><li>Introducing image processing and analysing tools </li></ul>
    33. 33. 9th European Congress on Telepathology http ://www.seapcongresos.com/telepathology2008/
    34. 34. IHE & DICOM. Collaborate with standardization bodies! <ul><li>Christel Le Bozec </li></ul><ul><li>[email_address] </li></ul><ul><li>Marcial García Rojo </li></ul><ul><li>[email_address] </li></ul>
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