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VA/DoD and VA to VA Image Sharing

VA/DoD and VA to VA Image Sharing. Class 755 Julian Werfel and Roger Coney. Cumulative Images Captured 2003-2010. Image Sharing. Provides more patient information to use in diagnosis and treatment Reduces number of procedures for patient by making remote data available

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VA/DoD and VA to VA Image Sharing

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  1. VA/DoD and VA to VA Image Sharing Class 755 Julian Werfel and Roger Coney

  2. Cumulative Images Captured 2003-2010

  3. Image Sharing • Provides more patient information to use in diagnosis and treatment • Reduces number of procedures for patient by making remote data available • Saves money by reducing procedures • Saves patient and staff time “A picture is worth a thousand words”

  4. VA Remote Image Views • Clinical Display communicates across the VA WAN to retrieve images from the VistA Imaging systems at remote VA facilities

  5. VA/DoD Image Sharing • NDAA (National Defense Authorization Act) El Paso pilot to share radiology images and reports with DoD • Full access to patient record • DoD provides images to VA, viewed in Clinical Display

  6. VA/DoD Image Sharing • Provide VA images to DoD users • Particularly important for Polytrauma patients • Transfer images in DICOM with JPEG 2000 compression • Thumbnail, Lossy, and Lossless quality • Realized as the VIX service – Imaging Patch 83

  7. VIX for VA/DoD Image Sharing • VistA Imaging Exchange (VIX) Service • VIX implemented as part of VISA (VistA Imaging Service Architecture) • Encapsulates VistA Imaging behind well defined interfaces - SOA • Standards based: JPEG2000, DICOM, XCA • Clinical Display requests DoD images from site VIX • DoD images available to clinicians since Patch 72 Display client

  8. VA/DoD Sharing Field Testing • All sites with Imaging Patch 83 can see DoD images

  9. View DoD Radiology Images • View DICOM Radiology images for shared patients from the 7 original DoD NDAA sites • BHIE Image Adapter (BIA) requests DoD images from site PACSi (analogous to VIX) • Compression and caching to boost performance

  10. View VA Radiology Images in DoD • Provide DICOM radiology images for shared patients • Access images from all VA sites with a VIX Server • Available to DoD facilities with a PACSi server • Images viewable from the web based Advanced Medical Image Viewer (AMIV)

  11. Imaging Patch 72 • DoD images integrated with VA images

  12. Enhanced Remote Image Views • Access remote VA images through VIX • Remote VA and DoD images now available to VistARad in Imaging Patch 90

  13. Enhanced RIV Benefits • Take advantage of VIX Caching and Compression • Image is compressed at source before transfer over WAN • Image cached at local and remote VIX • VIX handles remote connection rather than client • Fewer connections over WAN • Enhanced RIV seamless to user

  14. Enhanced RIV Image Quality

  15. Imaging Patch 93 • Updated user interface

  16. Viewing Remote Images • DoD accessible same as VA data

  17. Viewing DoD Images • Accessing images from DoD same as VA

  18. Viewing DoD Images

  19. Viewing DoD Images • No special tools for DoD, same as VA

  20. Comparing VA and DoD images BHIEPATIENT DoD Image WBAMC 03/2007 VA Image El Paso 10/2001 Area of Clinical Interest

  21. VistARad and the VIX • View images and reports from DoD • View images, reports and requisition reports from remote VA sites • Monitor exam lists from remote sites without requiring user to login • Exams from remote sites integrated with exams from local site

  22. VistARad Manager • VistARad Manager shows exams from multiple sites including the DoD

  23. VistARad Displaying DoD Images

  24. Monitor Remote Sites • Monitor remote sites without logging in

  25. Support New DoD Architecture • HAIMS, the Healthcare Artifact and Image Management Solution, will replace the NDAA El Paso solution in the DoD enterprise • NDAA El Paso pilot will be sustained through the transition • No changes will be required to the VA architecture

  26. Providing VA Images to DoD with HAIMS • No changes will be required to the VA architecture

  27. VA/DoD Artifact Sharing • Share Artifacts • Non radiology images • NCAT (Neurocognitive Assessment Test) reports from DoD • Bidirectional • Implemented with IHE profile Cross Community Access (XCA) • Development in progress

  28. Expanding the VIX – the CVIX • Centralized VistA Imaging Exchange (CVIX) Service • Enterprise gateway for image sharing • Currently deployed in AITC (Austin Information Technology Center) • Highly Available, Load Balanced, Clustered Deployment • Based on the VIX design

  29. CVIX Provides • Artifacts available to VA Users • Artifacts from HAIMS • NCAT (Neurocognitive Assessment Test) reports • Artifacts from VA to DoD • Radiology sharing through CVIX • Support Future Interfaces • NHIN (National Health Information Network) • VLER (Virtual Lifetime Electronic Record)

  30. View DoD Artifacts and Radiology Images • CVIX retrieves HAIMS artifact and radiology lists from the BHIE Framework for viewing by VistA Imaging client applications • CVIX retrieves HAIMS artifact lists from the BHIE Framework for viewing by VA applications • CVIX retrieves HAIMS and NCAT artifacts for viewing by VistA Imaging client applications – Imaging Patch 104 (June 2010 – Pending Approval)

  31. Providing VA Artifacts and Radiology Images to DoD with CVIX • CVIX provides VA study and artifacts lists to the BHIE Framework for consumption by HAIMS • CVIX provides radiology images to the BHIE framework for consumption by HAIMS • CVIX provides artifacts directly to the HAIMS gateway

  32. Image Enabling VistaWeb • VistA Imaging providing Advanced Web Image Viewer (AWIV) to VistaWeb for image viewing • View images associated with Progress Notes and Radiology Reports • VistaWeb users can view VA images within VistaWeb • Similar to CPRS/Clinical Display interface • VistaWeb version 12

  33. AWIV • Uses components from Clinical Display • Easy access from VistaWeb • Does not show all images stored in VistA Imaging • Will view DoD Radiology and artifacts in future • AWIV uses Centralized VistA Imaging Exchange (CVIX) server • Currently in field testing (June 2010) – Imaging Patch 105

  34. VistaWeb Viewing VA Images • AWIV retrieves all images from CVIX • CVIX communicates with VA sites with and without a VIX

  35. VistaWeb Progress Notes • New icon indicates images are associated with note

  36. AWIV Viewing VA Note

  37. AWIV Viewing VA Note

  38. VistaWeb Radiology Reports • New icon indicates images are associated with report

  39. AWIV Viewing VA Radiology Image

  40. VistaWeb Viewing DoD Artifacts • Prototype of Artifact Sharing • Future Development

  41. AWIV Viewing NCAT Report

  42. AWIV Viewing DoD Artifacts

  43. VA/DoD Radiology Sharing Today • DoD radiology images available in Clinical Display and VistARad

  44. AWIV Viewing VA Images • AWIV can view VA images through VistaWeb – Field Testing June 2010

  45. VA Viewing DoD Artifacts • DoD Artifacts available in Clinical Display • HAIMS providing artifacts and radiology • Field Testing December 2010

  46. Server Deployment Changes - 2011 • CVIX clustered and moved to Philadelphia • NDAA fully replaced by HAIMS

  47. AWIV Viewing DoD Artifacts - 2011 • Artifacts available in VistaWeb and AWIV

  48. Image Sharing Big Picture • Sharing of images improves patient care • VA users can now view Radiology Images from VA and DoD in Clinical Display and VistARad • DoD can view VA images • VistaWeb users can view VA images with AWIV • Artifact sharing with DoD coming soon

  49. VIX Makes Image Sharing Work • VIX provides access to images for VA and DoD • Improves performance within VA • VIX is reliable • Optimized for delivery of images as quickly and safely as possible • VIX encapsulates functionality with standards using VISA

  50. Questions? Julian Werfel Julian.werfel@va.gov (240) 638-2634 Roger Coney Roger.coney@va.gov (240) 638-2604

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