Lecture on the role of information systems within healthcare. Adressing the various types of information systems and their respective benefits. Also, PACS maturity as a concept is introduced.

1. Health IT & Picture Archiving
and Communication Systems
Utrecht, May 16, 2013
dr. Rogier van de Wetering
Seminar Medical Informatics

2. © 2012 Deloitte The Netherlands
Content
1 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Introduction
Key health developments
Types of Health IS
A brief history of medical imaging and PACS
Exercise
Introduction to PACS Maturity concepts
Optional: Trends in medical imaging
Preview on lecture (31-05)

3. Introduction
2 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
 dr. Rogier van de Wetering
 Background in Information Sciences
 Currently Manager at Deloitte Consulting
 Former positions:
 Senior managing consultant (Deloitte
Consulting)
 Lecturer Information Sciences and
Medical Informatics
 Phd-student – A Strategic PACS maturity
approach (2007-2011)
 Management consultant (Deloitte
Consulting)
 Business Analist (Deloitte Consulting)
Short introduction

4. Key health
developments

5. A perspective on key developments in healthcare using an international lens
4 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Individuals
more engaged
in decisions
and purchases
Providers
develop new
services to
clients (product
and quality
information)
Innovations to
improve
efficiency &
transparency
Growing costs
of healthcare
Ageing
population
E-prevention
programs will
reduce future
healthcare
spending
Providers
develop
management
information on
performance

6. International Comparison of Spending on Health, 1980–2007
5 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Source: Davis et al., How the performance of the U.S.
health care system compares internationally. The
common wealth fund (2010). See also OECD.org

7. What is driving health care costs?
 Spending on healthcare in all OECD countries are rising faster than economic growth, especially
within the U.S.
 Advances in medical technologies improve diagnosis and patient treatment. However, they also
increase health spending
 This can be clearly seen from the rapid growth and use of computed tomography (CT) scanners
and magnetic resonance imaging (MRI) units used for diagnostic purposes
 Factors include:
6 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Advances in
medical
technology
Population
expectations
Population
ageing

8. The U.S. and Greece show a big difference in their use per capita as
opposed to the Netherlands
7 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
98,1
91,2
72,3
62,8
53,7
48,5 47,7
38,8 37,8
31,2
27,8
24,2 21,4
12,7
0
20
40
60
80
100
Greece
UnitedStates
Iceland
Luxembourg
Belgium
France
OECD
Netherlands
Denmark
Canada
CzechRepublic
SlovakRepublic
Australia1
Korea
MRI exams per 1 000 population
Data include only exams for out-patients and private in-
patients (excluding exams in public hospitals).
Number of MRI exams per 1 000 population, 2008 (or latest year available)

9. Developments in healthcare from a hospital CXO perspective
8 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Hospital CXO ICD10/DOT
Governance, risk &
compliance
Horizontal /vertical
integration
Reimburse
ments
M&A Alliances
Order
mngt
Lean
operations
Tele-medicine /
eHealth
Patient
influence
Cloud solutions /
SaaS
Mobile
apps
Information
Management
Patient
engagement
/ empower-
ment
Shared
Services
Integrated
supporting
processes
Information
Security
Medical
Imaging
Technology
Minimal
Invasive
surgery
RFID / Track
& Trace
Regulations
Virtualization
Big Data/
Analytics
Mobility
outpatient
clinic
Business
Intelligence
Customized
care
EHR/EPR
Business
IT
Healthcare
Lean
Chain care

10. Hype Cycle for Healthcare Provider Applications and Systems 2012
9 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

11. Types of Health IS

12. Overview of various types of IS/IT
• Electronic health records
(ePR/eMR)
• Computerized provider order entry
(CPOE)
• Decision and diagnostic support
(e.g. CAD/CAR)
• Advanced visualization tools
• Surgical simulation and modeling
• Knowledge discovery/mining and
retrieval systems
• Enterprise-wide image
management systems (i.e. PACS)
• Data exchange networks (e.g.
XDS-i, IHE)
• Prescribing systems
• E-Health / consumer informatics /
educational
• Tele-medicine
• Mobile (apps) computing
• Administration
(Cf. Haux, 2010; Chaundry, 2006;
Huang, 2010; Van de Wetering, 2011)
11 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Source: M. J. Schuemie et al., Mapping the Domain of Medical
Informatics. Methods Inf Med 2009; 48: 76–83
Extracted medical informatics clusters/classifications appearing between 2005 and 2008
Organization, application,
and evaluation of health IS
Medical knowledge representation
Signal and data
analysis

13. There are many possible benefits and costs of implementing health
information technology
Effects of health IS/IT (Cf. Chaundry, 2006):
• Quality
• Efficiency
• Costs
Challenges for the future:
• Interoperability of medical data
• Adoption rates of IS/IT
• Misalignment of incentives for its use
Key question remains: How to apply IT effectively?
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14. A brief history of
medical imaging and
PACS

15. A brief history of medical imaging – the Classical time
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Careful anatomical lessons in 17th century
The Anatomy Lesson of Dr. Nicolaes Tulp (1632) by Rembrandt
Src: retrieved from Wiki 2012

16. Revolution came with Röntgen's discovery of the X-ray
15 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
• Wilhelm Conrad Röntgen (1845 - 1923)
• German physicist
• Discovered penetrating “X-ray” (invisible beam) on November 8, 1895
• A brief article was published on January 5, 1896
• He earned the first Noble Prize in 1901 in Physics
Src: retrieved from Auntminnie.com

17. PACS – background and definition
• Due to the changing health care environment, hospitals are obliged to utilize the full potential of
Information Systems and Information Technology and (IS/IT)
• Hospitals have taken on this challenge by moving towards filmless operations and investing in Picture
Archiving and Communication System (PACS)
• The concept of PACS was introduced as early as 1982
16 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
Acquire
images
Store into
central
repositories
Distribute
upon
request
Display
images
“Workflow-integrated imaging systems”
“Designed to streamline
operations”
“Many interrelated
system components ”

18. PACS consists of many interrelated system components and is most
efficient when integrated with the Hospital- and Radiology information
system
17 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
PACS components
Source: Canadian Association of Radiologist
Hospital IT-architecture
Source: Muller et al., 2004

19. X–Ray Exam without PACS: an inefficient process
Un–Hang Films
& Attach Report
Patient
Registered Exam Performed
Patient Data
Re–Entered
at Acq Device
Previous Exams
hung in Reading
Room
GEYMS
CT
Return Films
to File Room
Re–assemble
Film Jacket
Send Films &
Report to Referring
Physician
Retrieve Films &
Report to Referring
Physician
Radiologist Read
Dictate & Approve
Develop
Film
Quality
Assurance
Hang
Films
18 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

20. Exercise

21. 1. Develop a X–Ray Exam with PACS: an efficient process
2. Identify possible uses for mobile apps
Un–Hang Films
& Attach Report
Patient
Registered Exam Performed
Patient Data
Re–Entered
at Acq Device
Previous Exams
hung in Reading
Room
GEYMS
CT
Return Films
to File Room
Re–assemble
Film Jacket
Send Films &
Report to Referring
Physician
Retrieve Films &
Report to Referring
Physician
Radiologist Read
Dictate & Approve
Develop
Film
Quality
Assurance
Hang
Films
20 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

22. X–Ray Exam with PACS: an efficient process
Patient
Registered Exam Performed
GEYMS
CT
Radiologist Read
Dictate & Approve
Referring Physician
Accesses Report
and Films
21 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

23. PACS Maturity

24. PACS are thus workflow-integrated imaging systems designed to streamline
operations throughout the entire patient-care delivery process (Huang)
To:
Digital Workflow
From:
Film Based Workflow
‘How can hospitals mature their PACS?’
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25. The PMM describes five levels of PACS maturity and towards higher levels
of maturity, operational efficiencies, IT-integration and effective care expand
24 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
References:
Van de Wetering, R. and R. Batenburg (2009). "A PACS maturity model: a systematic meta-analytic review on maturation and evolvability of PACS in the hospital
enterprise." Int J Med Inform 78(2): 127-40. &
Van de Wetering, R., R. Batenburg and R. Lederman (2010). "Evolutionistic or revolutionary paths? A PACS maturity model
for strategic situational planning." Int J CARS (in press).

26. Does this sound familiar to you?
25 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
“… we see the computer age
everywhere but in the productivity
statistics.”
Robert Solow, New York Review of Books, 12 juli 1987
Business/IT alignment

27. A conceptual model was developed combining (1) PACS maturity, (2) PACS
alignment and (3) PACS performance
26
Reference:
Van de Wetering, R., Batenburg, R., Oudkerk, M., Van Ooijen, P.M.A., Brinkkemper, S., and Scheper, W., A situational alignment framework for PACS. Published online 5 March
2011 in the Journal of Digital Imaging
a: PACS is compatible with current international
standards and classifications
b: PACS exchanges information with the RIS and
HIS without any complications
a: End-users affect the decision making process in
selecting a specific PACS vendor
b: End-users affect digital PACS-workflow and
functionality improvements
a: Impact and opportunities for chain partners with
respect to PACS
b: External environment is consciously inquired for
new developments to optimize PACS functionality
dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

28. Trends and
developments

29. 28 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

30. In search for metrics that allow standardized measurement of productivity,
for comparative evaluation and ongoing efforts to improve efficiency
Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
29 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

31. An illustrative example for automating real-time reporting on Imaging
procedures and productivity monitoring
Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
30 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

32. Questions

33. Contact me
32 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
dr. Rogier van de Wetering
Email: rvandewetering@deloitte.nl
Tel: +31620789870

34. Preview lecture by Erik van der Zijden BSc MBA
33 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems
• Erik is CEO & Co-founder of Synappz
• Lecture on Medical Apps (31 May)
• Development process
• What would you like to know?