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3rd Spanish Interoperability Forum

Towards national Electronic Health Imaging Record

Manuel VegasGE Healthcare IT

May 8th, 2013

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Electronic Health Imaging Record

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Year 2020

A dutch tourist, with a recent hip replacement, is on holidaysenjoying Alicante’s Costa Blanca

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Year 2020

“The replacement has moved”

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Year 2020

“An urgent re-intervention is needed"

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Year 2020

They plan toghetherthe re-intervention

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Nowadays“Imaging Islands"

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PACS:82% spanish hospitals *EHR:94% spanish hospitals *

NowadaysInfrastructure

Broadband connectivity:92% european hospitals *

(*) EUROPEAN COMMISSION: eHealth Benchmarking III. SMART May 2011

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Tecnological

NowadaysObstacles

Architectural/Standars

Economic/Efficiency

Organizative/Semantic

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SolutionIHE

IHE XDS-I profile

IHE XDS profile

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Solution/XDS-I

Registry

Repository

ImageManager

Source

Consumer

Patientidentification

Query documents

Patient identificationfeed

Registerdocuments

Retrievedocuments

Provide and register documents

· Image retrieve· WADO retrieve

Standards:

Web Services

HL7

DICOM

PIX ATNAConsistent

Time

Profile IHE XDS

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Solution“Plug-in” interoperability model

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A strategic opportunity for the MoH

− Consolidation of all clinical documents and medical imaging generated by all the regions in Spain and the private health centers

− Centralized master registry owned and managedby the MoH

− Plug-in model: Any entity can be added to theexchange, given it implements the interoperabilitycontract (XDS based)

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A technical opportunity for the MoH

− IHE XDS/XDS-I based and plug-in model

− DICOM/non-DICOM imaging and clinicaldocuments (structured/unstructured) in a common index

− National registry and affinity domain, defined and managed by the MoH

− Universal multi-device web access

− Cloud and SaaS paradigms

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· National registry and affinity domain

· Unique Patient Identifiyin (CIP-SNS), IHE PIX based

Privileges-based universal access from any point of the Spanish geography. With total audotory and compliance with data protection regulations

XDS

Adaptor

ValenciaRegion

MoH

RepositoryValencia region

MPIMoH

Plataform

a de

Integración

RegistryMoH

RepositoryMoH

SolutionUse case

EHR

StudyRegistrationStudy

Registration

DocumentProvisioning

DocumentRegistration

DocumentQuery

Document Retrieval

17Centricity Clinical Archive overview

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XDS RepositoryVendor Neutral Archive level 4

Infrastructure and Information Sharing

Departmental Archive

DICOM Archive

Enterprise DICOM Archive

Multi-PACS, cardiology

Enterprise Multi-specialty

Archive

Connecting to ‘ologies, enterprise registry

Multi-institutionPatient Information

Management

Multi-PID, patient consent, gateway

to image exchange

Level 2 (DICOM)Imaging consolidation across enterprise

Level 3 (+XDS)Enterprise-wide clinical data consolidation

Level 4 (+XDS)Cross-enterprise patient repository & sharing

Level 1 (DICOM)Independence of PACS application

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Zero-footprint and browser-agnostic

XDS/XDS-I consumerDesired characteristics

Web Technology

Imaging and docs history

Mobile

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History

Images and reports viewer

Advancedfilters

Centricity Patient Information ViewerWeb zero-footprint integrated access

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Imagen Patológica–Zona de interés

ECG Jpeg

Centricity Patient Information ViewerAcceso web zero-footprint integrado

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Centricity Radiology Mobile AccessNative App to access from mobile devices

Native apps iOS + Android

Diagnostic quality (retina)

Streaming (WiFi + 3G)


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Experience across the globe

Neutrality• Connected to Agfa, Carestream,

McKesson, Sectra, Siemens, Phillips, Ramsoft

• Multidimensional (format, storage, access)

South Western OntarioVNA & integrated workflow

Cloud friendly• Cloud based archive and PACS• Pay as you go• Hosted environment

Ile De FranceCloud PACS + results sharing

Scalability• 60 M studies• 3 Bn images• 1 Petabyte

LSP, EnglandVery large archive

Standards• XDS infrastructure• GE active member of

standardization

VGR, SwedenVNA + integrated access


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Objective

• Connect care providers

• Central repository of images and reports for instant

access, and exchange

• Improve care provider productivity

• IT infrastructure cost savings

• Reduce patient transfers and duplicate scans

Solution

• Central repository and information access

• Hardware redundancy and disaster recovery

• High availability with dual data centers

South Western Ontario (Canada)

• 62 hospital locations across the region

• 19 hubs with separate RIS/PACS systems

• 12 different RIS/PACS vendors

• 3.2 million exams/year

• 1600+ system users


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Objective

• Consolidate information from different

departments (radiology, cardiology, nuclear

medicine and other sources such as Olympus

Endobase)

• Access to DICOM and non-DICOM data

• Give consolidated access to patient information

• Lower cost of IT management

Solution

• A multi-ology information repository

• IHE Standards based solution

• Consolidated view of patient information

• Virtualized environment

Antwerp University Hospital(Belgium)

• 600 bed hospitals

• 500k exams per year

• Heterogeneous departmental IT systems (GE PACS, Agfa cardiology, Olympus Endobase)

• 50 modalities directly connected


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Objective

• Central repository of images and reports

• Immediate access to prior images and reports

from the whole region

• Primary viewing platform outside imaging

• Improved imaging workflow

Solution

• Common repository across 17 hospitals

• IHE standards

• Web access to images and reports

• ASP model since 2006

Västra Götaland region(VGR, Sweden)

• Sweden’s second largest region

• 1.5 million residents

• 17 hospitals

• Heterogeneous RIS/PACS systems


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Objective

• Improve oncology and cardiology treatment

• Share radiology data across legacy RIS/PACS

• Replace patient CD workflow

• Avoid redundant exams

• Improve coverage of rural areas

Solution

• A patient centric document repository

• IHE-XDS & DICOM to connect multi-vendor systems

• Web portal for multi-disciplinary teams

• Hosted deployment model

NHS Wales (UK)

• 4.5 million patients

• 13 multi-vendor systems

• Connected to Welsh Master Patient index

• Starting with oncology network


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Objective (regions sans film)

• Leapfrog Paris region to HIT

• Sharing imaging results

• Improve care quality through collaboration

• No more film or CD by 2012

Solution

• Standards based information repository

• Data center

• 24 x 7 high availability service

• SAAS model – pay per use

Ile de France (France)

• 12 million patients, 500+ radiologists

• 30 hospitals growing to 90

• Multi-vendor RIS-PACS systems (PACS: carestream, Telemis, GE; RIS: EDL, Waid, home grown)

• Standards Compliance (DICOM, IHE, HL7)


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Objective

• Connect the radiology departments across

communities

• Central long term archiving of all imaging

data with HA and DR

• Enable access of images to physicians and

specialist

Solution

• Cloud deployment of imaging repository

• Dual data centers, virtualization

• Business continuity & DR solutions

• Central archive for 74 different PACS

instances

Southern and NWWM Clusters (UK)

• Central archive ~60 million exams

• 40% of England covered: 20M patients, 72 NHS trusts

• Delivered average uptime of 99.98%**

** As reported by NHS Connecting for Health for the period August 2009 to July 2011

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University Hospital Antwerp(UZA - Belgium)

Objective• Enterprise-wide repository for medical imaging

(radiology, cardiology, etc.) and scanned documents

• Migration of proprietary scanned documents archive to XDS standard

• Image viewer for all clinicians context-integrated to EMR

• Consent management

Benefits• Helps to facilitate the replacement of

departmental workflow solutions• Longitudinal patient record that facilitates

access to relevant clinical information across departmental boundaries

• 600 beds hospitals

• 500 k exams per year

• Heterogeneous departmental IT systems ( GE PACS, Agfa cardiology, Olympus Endobase…)

• 50 modalities directly connected

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EA

Document and Image Access

UZA Solution OverviewDICOM

HL7

proprietary

Publish objects to XDS

XDS

RIS (GE)

PACS (GE)

New DICOM exams

PDF documents with meta data (e.g. HL7 MDM)

HIS/EMR

Caradigm XDS Document Registry (central index)

New DICOM exams

Patient demographics (HL7 ADT)

Other ology DICOM archive

XDS adapter

CVIS (Agfa)

Cardio PACS (Agfa)

Gastro + other ologies

Document scanning

Radiologylong-term archive

Cardio long-term archive

Publish image references to XDS

XDS/XDS-I Document Repository

DICOM data

Non-DICOM data with meta data (e.g. video)

Register objects in XDS repository: HL7-CDA, PDF, DICOM image references, JPEG, video, etc.


Cweb PIVXDS viewer

Centricity Web DICOM viewer

Query registry


EPD C2M (EMR) client

User and patient context integration (client-side)

Patient demographics (HL7 ADT) and orders (HL7 ORM)

Publish final reports to XDS

Patient demographics (HL7 ADT) Patient demographics (HL7 ADT) Patient demographics (HL7 ADT) Patient demographics

Patient demographics (HL7 ADT) and orders (HL7 ORM)

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Building bridges …

¡Thank you very much!

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