Hospital Wide Image Management

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22 april 09 ConhIt Berlin

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Hospital Wide Image Management

  1. 1. Martijn Schasfoort business manager Medical and Information Technology 22 april 2009 m.schasfoort@mmc.nl
  2. 2.  Máxima Medisch Centrum  Vision  Methods  Solution  Results and wishes
  3. 3. Princess Máxima Royal family Veldhoven Eindhoven 58.000 m2 45.000 m2 Profile: acute / specialized Profile: short stay / planned / elective
  4. 4. ● Medical specialists: 230 ● Medical specialism’s: 28 (common) ● Employees: about 3,500 ● Beds: 836 ● Admissions: about 23,600 ● Outpatients: about 416,000 ● Day care admissions: about 20,000 ● Visits to the emergency department: about 44,500 ● foundation Top-Clinical hospitals Holland (20 of 100 hospitals, no university hospitals) ● Workstations (fat client): 2000 numbers of 2007 ● Workstations (thin client) : 400 (Citrix, Softgrid, Powerfuse) ● Mobile workstations : 120 (COW’s, laptops) ● Servers : 300 ● Printers : 500 (incl. receipt printers) HIS : Chipsoft EZIS v.4.10 ● IP telephones : 800 (Nortel) LIS : Philips Labosys ● Wireless IP telephones : 800 (Nortel) RIS : Agfa Quadrat ● Wireless Access Points : 650 (Cisco) MIS: Centrasys ● Wired network active ports : about 10.000 (Cisco)
  5. 5. Department Medical and Information Technology is an integration of departments IT and Medical Technology clinical and IT technicians clinical and IT engineers 2 x clinical physicist 1 x IT architect 2 x safety and policy continuity implementation idea
  6. 6. HIS  Cardiology Obstetrics OR EHR Ophthalmology Urology Plastic surgery Orthopedics ……. Dermatology Dental X-Ray
  7. 7. EHR •Formal data •Contains no images •(can contain text) Image Text PDMS-DS PACS •Informal data Images available via links Laboratory •No images with EHR or PDMS/DS Radiology Outside the Radiology
  8. 8. Standardized central storage and distribution of all medical images using the network infrastructure of the hospital and standard (central / hospital) IT components - standard hardware (Intel-based / HP) - standard operating system (Windows XP, Server) - standard software (Microsoft Office) - standard applications (PACS, PDMS, HIS) - standard storage (NAS) - hospital network
  9. 9.  One PACS hospital wide  Use of international accepted communication standards (HL7, DICOM)  All medical images in DICOM ◦ ECG, endoscopy, ultrasound, radiology, photography  Patient demographics available at the source  All images available for all physicians (requirements)  Integration in hospital applications  Reporting in HIS
  10. 10.  Interest in hospital wide image management started in 1999  Solution for endoscopy (image/video) not availible on Dutch market  Search for open and transparant software  PACS implementation Radiology department in 2002  Radiology PACS vendor was not interested in endoscopy  First contact in 2002 with Visus TT GmbH
  11. 11.  Started 2003 testing with JiveX in Operation Rooms (orthopedics) ◦ Testing central software and DICOM-izer software ◦ Changes to software  Implementation JiveX hospital started 2004  Used “bottom-up” approach ◦ At first no integration with EHR and HIS, because EHR and HIS functionality was not available ◦ In 2008 integration started in HIS and EHR  Implementation by internal project team
  12. 12. PACS Three Outside hospital PACS Two Outside Radiology PACS One Radiology
  13. 13. 2 MRI (1 and 1,5T Philips – 3T in 2010) 1 mobile MRI (1,5T Philips) 1 CT (Philips) 2 multislice CT (Philips MX8000) 2 digital mammography (Hologic Selenia) 6 Ultrasound (ATL, Aloka, Toshiba) 2 angio (Philips) 7 Bucky (Philips, 4 new Siemens) 1 digital thorax (Hologic) 4 DSI (Philips) 4 mobile DSI (Ziehm) 3 mobile CR (Shimadzu) - Storage in PACS from Agfa - Use of department planning system (RIS) - Total procedures : 200.000 per year - Total capacity (cmpr.) : 2,3 TB per year - EHR integration (reports RIS and PACS-WEB)
  14. 14. 9 Cardiac and vascular ultrasound (Philips, ATL) 15 Obstetrics and gynecology ultrasound (Kretz, ATL, Aloka, Toshiba) 1 Cardiac digital angio (Philips) 1 Cardiac MRI (Philips i.c.w. Radiology) 1 Digital ECG’s (Mortara) (this year increase to 4) 10 endoscopic solutions (gastro, lung, urology) 16 endoscopic solutions (OR) 7 digital photography (derma, ophthalmology, plastic surgery, dialysis) 1 dental digital x-ray (Oldelft)
  15. 15. PACS URL / HL7 Two HL7 non Radiology HIS / EHR Radiology HL7 RIS URL / HL7 PACS One
  16. 16. PACS One - Keep solution for Radiology PACS Two - Storage in PACS from Visus - Use of HL7-query and worklist-generator Use of HIS planning system planned 2009 - Total procedures : 25.000 per year - Total capacity : 2 TB per year - EHR integration (URL-link images) - All image flavors in DICOM - Video’s in DICOM
  17. 17. Workflow DICOM modalities PACS Two • Query or worklist available on modality • Acquisition of images on the modality • Selection of relevant images on the modality • Images are sent to the Server • Accession number is generated by the Server • Configured images flavors are generated • Notification to the HIS • Review images with high, medium or low end viewer, reporting in the HIS/EHR
  18. 18. Mortara ELI 350 ECG recorder (rest ECG) Mortara M-gate (DICOM gateway) possibility of integration in JiveX Review Client DICOM ECG in JiveX Review Client (#1680)
  19. 19. Canon CF 60 UV OIS Winstation 1400 Dell workstation ophthalmology
  20. 20. Workflow non-DICOM modalities PACS Two • Query or worklist available on the DICOM-izer application • Acquisition of images on the DICOM-izer application • Selection of relevant images on the DICOM-izer application • Images are sent to the Server • Images are deleted from the DICOM-izer application • Accession number is generated by the Server • Configured images flavors are generated • Notification to the HIS • Review images with high, medium or low end viewer, reporting in the HIS/EHR
  21. 21. Gastroenterology Olympus CV160 VISUS JiveX AMG/AV 1165 Sumicom (industrial PC) IDS Falcon PCI framegrabber
  22. 22. Lungdisease Olympus CV240 VISUS JiveX AMG/AV 1165 Sumicom (industrial PC) IDS Falcon PCI framegrabber
  23. 23. Gastroenterology Pentax EPK-i (gastro, colon) NDS Radiance SC-SX19-A1511 VISUS JiveX AMG/AV 1189 Sumicom (industrial PC) IDS Falcon PCI framegrabber  HD: IDS Eagle framegrabber
  24. 24. Cardiology Philips / ATL HDI 5000 VISUS JiveX AMG/AV 1165 HP DC 7100 SFF IDS Falcon PCI framegrabber
  25. 25. Gynaecology WISAP endoscopic tower VISUS JiveX AMG/AV 1165 Onyx 175 Medical Panel PC IDS Falcon PCI framegrabber
  26. 26. Orthopedics Smith&Nephew 350 3-ccd VISUS JiveX AMG/AV 1165 Onyx 175 Medical Panel PC IDS Falcon PCI framegrabber
  27. 27. Neonatal Intensive Care Plastic Surgery Dermatology Dialysis Canon 350D / 400D digital camera Canon EFS 60mm macro-lens Sigma EM-140DG macro-flash VISUS JiveX AMG/AV 1189 Installed on standard hospital workstation
  28. 28. Workflow MR/CR • Patient planned in radiology workflow • Procedure finished • Transfer from “PACS One” to “PACS Two” • Workflow cardiology (one viewer) • Workflow pediatric physicians (one viewer) • Review images with high, medium or low end viewer, reporting in the HIS/EHR
  29. 29.  It works…  All images in DICOM  Total 40.000 procedures till now  All images available for physicians  Integration in EHR (link to images)  Reporting in HIS/EHR for “PACS Two” BUT,  Two PACS vendors  PACS One is Agfa  PACS Two is Visus
  30. 30.  Functionality versus politics and emotion  Acceptance of physicians of provided solution  Introduction too much technology driven  No expectation management  Vendor rigidness by integration issues  No cooperation althought functionality available
  31. 31.  Hemodynamic waveforms in DICOM ◦ Lungfunction results, cardiac stress test  Full integration in HIS and EHR  One PACS (it is possible)  Dutch citizens service number  Comply to IHE compliance  ……
  32. 32.  Hemodynamic waveforms in DICOM  Recording full OR-procedures  Full integration in HIS/EHR  Regional PACS And….  One PACS

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