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Picture Archiving and Communication Systems
Utrecht, May 22, 2012
Theoretical principles and practical implications
dr. Rogier van de Wetering
Seminar Medical Informatics
© 2012 Deloitte The Netherlands
Contents
1
A brief history of medical imaging
What is PACS?
Exercise
PACS Maturity concepts
Break! (10 min.)
Results from Dutch hospitals
Trends in medical imaging
A brief history of medical imaging – the Classical time
2
Careful anatomical lessons in 17th century
The Anatomy Lesson of Dr. Nicolaes Tulp (1632) by Rembrandt
Src: retrieved from Wiki 2012
Revolution came with Röntgen's discovery of the X-ray
3
• 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
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
4
Acquire
images
Store into
central
repositories
Distribute
upon
request
Display
images
“Workflow-integrated imaging systems”
“Designed to streamline
operations”
“Many interrelated
system components ”
PACS consists of many interrelated system components and is most
efficient when integrated with the Hospital- and Radiology information
system
5
PACS components
Source: Canadian Association of Radiologist
Hospital IT-architecture
Source: Muller et al., 2004
Related terms and standards in the PACS environment
• Digital Imaging and Communications in
Medicine
• Facilitates interoperability of devices claiming
conformance
• DICOM applies to medical images and
acquisition systems (CT, MRi, X-ray etc.)
• DICOM standard also specifies services that
can be used with respect to these information
objects (e.g. find, move, store, get)
6
• Health Level 7
• HL7 provides standards for interoperability that
improve care delivery and optimize workflow
• Communication of textual information between
different systems (RIS, HIS, PACS, etc.)
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
7
X–Ray Exam with PACS: an efficient process
Patient
Registered Exam Performed
GEYMS
CT
Radiologist Read
Dictate & Approve
Referring Physician
Accesses Report
and Films
8
PACS are thus workflow-integrated imaging systems designed to streamline
operations throughout the entire patient-care delivery process (Huang)
9
To:
Digital Workflow
From:
Film Based Workflow
‘How can hospitals mature their PACS?’
© 2010 Deloitte Touche Tohmatsu
PACS maturity concepts
PACS maturity: an evolutionary plateau of process improvement including a
checklist to evolve on to the next level
12
The PMM describes five levels of PACS maturity and towards higher levels
of maturity, operational efficiencies, IT-integration and effective care expand
13
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).
Does this sound familiar to you?
14
“… we see the computer age
everywhere but in the productivity
statistics.”
Robert Solow, New York Review of Books, 12 juli 1987
Business/IT alignment
A conceptual model was developed combining (1) PACS maturity, (2) PACS
alignment and (3) PACS performance
15
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
© 2010 Deloitte Touche Tohmatsu
PACS Maturity results from Dutch hospitals
Dutch hospitals matured PACS towards the beginning of level four and have
the ambition to mature PACS much further
17
Lowest scores:
a: All departments of the hospital can request and plan
radiology exams using an electronic order-entry
system
b: All diagnostic images from other departments are
stored into one central PACS archive
Highest scores:
a: PACS is compatible with current international
standards and classifications
b: PACS exchanges information with the radiology
information systems (RIS) and hospital information
system (HIS) without any complications
a: (HIGHEST) Primary interpretation by radiologists
using uncompressed (highest resolution) images from
all modalities
b: (LOWEST) Strategic and operational (multiyear)
plans contain impact and opportunities
for chain partners with respect to PACS
Van de Wetering, 2011: A Strategic PACS Maturity Approach
Dutch hospitals matured PACS towards the beginning of level four and have
the ambition to mature PACS much further
18
a: (HIGHEST) Radiologist are aware of the fact that
PACS has the potential to influence the
competitive position of the hospital
b: (LOWEST) Innovative solutions (e.g. integration of
new tools and applications) with PACS are discussed
during clinico-radiological meetings
Lowest scores:
a: PACS generates comprehensive management
information that is always on time
b: The hospital has an accurate overview of the
contribution of PACS to overall cost prices per
radiology exam
Dutch hospitals have the ambition to mature their PACS towards the
Enterprise PACS Chain while simultaneously improving their alignment
19
PACS alignmentAverage scores
Hospitals can formulate strategies and maturity roadmaps to further
improve the performance of the adopted PACS system
20
Technical IS
perspective
Clinical
contributions
Service outcomes
Organizational
efficiency
PACS performance constructs
© 2010 Deloitte Touche Tohmatsu
Trends and developments
In search for metrics that allow standardized measurement of productivity,
for comparative evaluation and ongoing efforts to improve efficiency
23
Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
An illustrative example for automating real-time reporting on Imaging
procedures and productivity monitoring
24
Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
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Picture Archiving and Communication Systems

  • 1. Picture Archiving and Communication Systems Utrecht, May 22, 2012 Theoretical principles and practical implications dr. Rogier van de Wetering Seminar Medical Informatics
  • 2. © 2012 Deloitte The Netherlands Contents 1 A brief history of medical imaging What is PACS? Exercise PACS Maturity concepts Break! (10 min.) Results from Dutch hospitals Trends in medical imaging
  • 3. A brief history of medical imaging – the Classical time 2 Careful anatomical lessons in 17th century The Anatomy Lesson of Dr. Nicolaes Tulp (1632) by Rembrandt Src: retrieved from Wiki 2012
  • 4. Revolution came with Röntgen's discovery of the X-ray 3 • 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
  • 5. 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 4 Acquire images Store into central repositories Distribute upon request Display images “Workflow-integrated imaging systems” “Designed to streamline operations” “Many interrelated system components ”
  • 6. PACS consists of many interrelated system components and is most efficient when integrated with the Hospital- and Radiology information system 5 PACS components Source: Canadian Association of Radiologist Hospital IT-architecture Source: Muller et al., 2004
  • 7. Related terms and standards in the PACS environment • Digital Imaging and Communications in Medicine • Facilitates interoperability of devices claiming conformance • DICOM applies to medical images and acquisition systems (CT, MRi, X-ray etc.) • DICOM standard also specifies services that can be used with respect to these information objects (e.g. find, move, store, get) 6 • Health Level 7 • HL7 provides standards for interoperability that improve care delivery and optimize workflow • Communication of textual information between different systems (RIS, HIS, PACS, etc.)
  • 8. 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 7
  • 9. X–Ray Exam with PACS: an efficient process Patient Registered Exam Performed GEYMS CT Radiologist Read Dictate & Approve Referring Physician Accesses Report and Films 8
  • 10. PACS are thus workflow-integrated imaging systems designed to streamline operations throughout the entire patient-care delivery process (Huang) 9 To: Digital Workflow From: Film Based Workflow ‘How can hospitals mature their PACS?’
  • 11. © 2010 Deloitte Touche Tohmatsu PACS maturity concepts
  • 12.
  • 13. PACS maturity: an evolutionary plateau of process improvement including a checklist to evolve on to the next level 12
  • 14. The PMM describes five levels of PACS maturity and towards higher levels of maturity, operational efficiencies, IT-integration and effective care expand 13 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).
  • 15. Does this sound familiar to you? 14 “… we see the computer age everywhere but in the productivity statistics.” Robert Solow, New York Review of Books, 12 juli 1987 Business/IT alignment
  • 16. A conceptual model was developed combining (1) PACS maturity, (2) PACS alignment and (3) PACS performance 15 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
  • 17. © 2010 Deloitte Touche Tohmatsu PACS Maturity results from Dutch hospitals
  • 18. Dutch hospitals matured PACS towards the beginning of level four and have the ambition to mature PACS much further 17 Lowest scores: a: All departments of the hospital can request and plan radiology exams using an electronic order-entry system b: All diagnostic images from other departments are stored into one central PACS archive Highest scores: a: PACS is compatible with current international standards and classifications b: PACS exchanges information with the radiology information systems (RIS) and hospital information system (HIS) without any complications a: (HIGHEST) Primary interpretation by radiologists using uncompressed (highest resolution) images from all modalities b: (LOWEST) Strategic and operational (multiyear) plans contain impact and opportunities for chain partners with respect to PACS Van de Wetering, 2011: A Strategic PACS Maturity Approach
  • 19. Dutch hospitals matured PACS towards the beginning of level four and have the ambition to mature PACS much further 18 a: (HIGHEST) Radiologist are aware of the fact that PACS has the potential to influence the competitive position of the hospital b: (LOWEST) Innovative solutions (e.g. integration of new tools and applications) with PACS are discussed during clinico-radiological meetings Lowest scores: a: PACS generates comprehensive management information that is always on time b: The hospital has an accurate overview of the contribution of PACS to overall cost prices per radiology exam
  • 20. Dutch hospitals have the ambition to mature their PACS towards the Enterprise PACS Chain while simultaneously improving their alignment 19 PACS alignmentAverage scores
  • 21. Hospitals can formulate strategies and maturity roadmaps to further improve the performance of the adopted PACS system 20 Technical IS perspective Clinical contributions Service outcomes Organizational efficiency PACS performance constructs
  • 22. © 2010 Deloitte Touche Tohmatsu Trends and developments
  • 23.
  • 24. In search for metrics that allow standardized measurement of productivity, for comparative evaluation and ongoing efforts to improve efficiency 23 Source: Hu et al. (2011) Informatics in Radiology. Efficiency Metrics for Imaging Device Productivity
  • 25. An illustrative example for automating real-time reporting on Imaging procedures and productivity monitoring 24 Source: Hu et al. (2011) Informatics in Radiology. Efficiency Metrics for Imaging Device Productivity
  • 26. Q&A