Cardiology PACS Integration The Heart Hospital, Baylor Plano

Herman Oosterwijk, OTech, Inc.

Christopher J. Oropeza

Richard Sanders

Lori Crissup

© 2009 OTech Inc.

Provided by ITN and OTech Inc.

Sponsored by GE Medical Systems

© 2009 OTech Inc. Page 2

Introduction

• Herman Oosterwijk: President OTech, Inc.

• Christopher Oropeza: Enterprise Imaging Administrator

• Richard Sanders, RN: Cath Lab Manager

• Lori Crissup, RN: Cardiology RN/IT Manager

© 2009 OTech Inc. Page 3

Heart Hospital Background (Richard)

• $100 million, 68 beds

• Opened Jan 22, 2007

• Free standing cardio vascular hospital, Collin County, TX

• Mission: maximizing delivery of safe, quality and compassionate healthcare

© 2009 OTech Inc. Page 4

Project Background (Chris)

• 7 month implementation timeline

• 100+ Baylor Info Systems resources

• 70 IT projects

• 70 interfaces

• 8 new systems to the organization

• 3 systems implemented within 90 days

• Staged off-site prior to installation to test

• Exam dictionaries are essential

© 2009 OTech Inc. Page 5

System Description (Chris/See Diagram)

• GE PACS 3.2: EMC SAN CX300 SATA with HP 1.9TB and long term Centera (11 TB)

• 3 DAS gateways

• IDX imagecast

• Powerscribe and DMS structured reporting

• CVIS 2.0 for review

• Cloverleaf interface engine

• ConnectR IDX Interface engine

• 2 worklists: CVIS and radiology; ONE ADT

• GE centricity enterprise

© 2009 OTech Inc. Page 6

THE HEART HOSPITAL Baylor Plano

Current RISIC/ Enterprise Imaging

Interface and Image Transfer

EP Labs x4 CVIS/DMS Reporting

Workstations

x3

Cath Labs x4 CVIS/DMS Reporting

Workstations

x4

OR Suitesx4

Sequoia’s x4 Cath/EP Lab

x1

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ConnectR Hl7 Engine

RISIC

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PACS

Baylor Clover

Leaf HL7 Engine

Ord

ers In O

RR

^002

Siemens Sensation 64

Siemens E-Cam

Kodak CR825

Siemens Sequoia x3

DICOM Image Send

DICOM Modality Work List

QDX Hl7 Engine

CVIS/DMS DICOM Image Send

DICOM Image Send

DICOM Image Send Radiology Modalities

Diagnostic WS

RA1000 Power Scribe

Integration Diagnostic WS x2

CVIS/DMS

Reporting Workstations

Stress lab x1 Card RR x1

TeraRecon & Power

Scribe For Cardiologist

PACS Tech

Workstation x7

DIC

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Modality

Work

list

GE Centricity

Enterprise

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Created by: Christopher J. Oropeza

Rev. A: 01/31/2009

DICOM Modality Work list

DIC

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Modality

Work

list

AD

T In

Charges OB

GE AMX DR

Portable

© 2009 OTech Inc. Page 7

Hemodynamics (Richard/Lori)

• GE Mac-lab for hemodynamics and Cardiolab for EP

• ADT info used to feed

• Orders goes to scheduler

• Patient is selected, case started and

• Hemodynamics and ECG goes to DMS server

• Reporting added and results

• Mapping from Mac-lab to imaging system

• Images can be pulled in report

• Reports can go to offices

• Referring physicians get fax

© 2009 OTech Inc. Page 8

OR Solution (Chris/Richard)

• PACSweb integrated on boom and 50” wall monitors

• Nurse accesses information

• Cath lab and surgical team both work in OR

• MAClab monitors available

© 2009 OTech Inc. Page 9

Issues

• Exam dictionaries not consistent

• Different systems have different record lengths

• Cardiology results posting in RIS

• More stringent workflow testing and cardiology staff education: schedule, arrive, begin, completion

• Downstream systems might be out of sync (complete status)

• Mismatches require clean-up and prevent physicians completing reports

• Hemodynamics input linked to charging: issues with lacking ADT

© 2009 OTech Inc. Page 10

Lessons Learned

• Transition by physicians from dictation to computer entry difficult

• High quality reports: use Structured reports with images included

• Finish results and fast completion

• Run discrepancy reports

• Crystal reporting used to access database

• Monthly reports about #cases

© 2009 OTech Inc. Page 11

Lessons Learned (cont.)

• Administrator database access

• One password for centricity (DMS)

• Same username for main hospital domain

• Challenge to have one password (single sign-on)

© 2009 OTech Inc. Page 12

Architecture

• Single repository

• Single folder for cardiology and radiology

• Patient room provides access to images for review using PACSweb

© 2009 OTech Inc. Page 13

Final Recommendations

• Passwords issues

• Stringent RIS workflow testing

• Tough to get physicians on board: more training

• Future web based report confirmations

• Workflow support is critical