Adding Ologies to your VNA

1. Adding Ologies to your VNA Anders Osterholm Vice President, Sales Operations

2. Adding Ologies to your VNA Overview of the session • Why is this important? • Overview • Sectra Solutions for DICOM and non-DICOM • Hands-on • Questions and Answers

3. HIPAA – is all clinical information secure? • Patient information needs to be secure and auditable • Patients have the right to know ‘who, when, why’ • Many do not have these controls in place – especially for smaller departments

4. Enterprise Image Management Patient privacy …This reporter has personally spoken with doctors who share X-rays and charts with colleagues via Dropbox….. And data breach after a doctor's laptop was stolen from an unsecured area of the hospital. In violation of Beth Israel and HIPAA protocol, the doctor's computer contained an unencrypted Excel spreadsheet with names and diagnoses for more than 4,000 patients. …The oral surgeon read Evas obstetric journal ...included information such as physician’s name, patients’ date of birth, diagnosis descriptions, summaries of treatments provided, medical histories and medical record numbers.... had exposed 32,000 patients’ data across 48 states. “People have the right to expect that their personal health information is protected,” says Ken Croken, Vice President,“And sadly, in this instance, it was not.” ... When the Swedish Minister of foreign Affairs was murdered, her journal was accessed by unauthorized personel at the Hospital- and later convicted for the crime ... 686 breaches of patient privacy have been reported at hospitals statewide and substantiated by investigators at the California Department of Public Health, including four by healthcare workers Six people were fired from a Los Angeles hospital after “inappropriately accessing” patient health records days after reality television star Kim Kardashian gave birth at the facility June 15. Angela Rose, a director of HIM practice excellence at AHIMA, said that whenever a celebrity or VIP is admitted to a facility there’s going to be heightened interest in their health information. To prevent breaches, Rose said it comes down to having a policy, process, and procedure in place for tracking and monitoring the access of all medical records.

5. Enterprise Image Management Accessanywhere vs. patient privacy …This reporter has personally spoken with doctors who share X-rays and charts with colleagues via Dropbox….. And data breach after a doctor's laptop was stolen from an unsecured area of the hospital. In violation of Beth Israel and HIPAA protocol, the doctor's computer contained an unencrypted Excel spreadsheet with names and diagnoses for more than 4,000 patients. …The oral surgeon read Evas obstetric journal ...included information such as physician’s name, patients’ date of birth, diagnosis descriptions, summaries of treatments provided, medical histories and medical record numbers.... had exposed 32,000 patients’ data across 48 states. “People have the right to expect that their personal health information is protected,” says Ken Croken, Vice President,“And sadly, in this instance, it was not.” ... When the Swedish Minister of foreign Affairs was murdered, her journal was accessed by unauthorized personel at the Hospital- and later convicted for the crime ... 686 breaches of patient privacy have been reported at hospitals statewide and substantiated by investigators at the California Department of Public Health, including four by healthcare workers Six people were fired from a Los Angeles hospital after “inappropriately accessing” patient health records days after reality television star Kim Kardashian gave birth at the facility June 15. Angela Rose, a director of HIM practice excellence at AHIMA, said that whenever a celebrity or VIP is admitted to a facility there’s going to be heightened interest in their health information. To prevent breaches, Rose said it comes down to having a policy, process, and procedure in place for tracking and monitoring the access of all medical records.

6. Patient Centric View • SINGLE PATIENT VIEW Pathology Cytology ... Dermatology Opthalmology Endoscopy .... Radiology Cardiology Pathology Cardiology

7. What is Enterprise Image Management? Back end perspective: • Addresses the Vendor Neutral Archive opportunuties. • Typically driven from a C-level decision maker, to separate the archive from PACS. • Priority on integration capabilities and efficient EMR workflow.

8. Healthcare Trends – EIM provides a solution • Prioritize Patient centric over individual departments • Enable sharing of patient image records • EMR, Meaningful Use patient portal • Push to consolidate department silos with unified archive • Manage storage better (redundancy, availability) • Information Life Cycle management – secure the data • Data growth • Access and audits (HIPAA)

9. Key Concepts - Simplified An EIM strategy enables Store & Exchange Capture Consume & Distribute of any image, anywhere, DICOM or non-DICOM

10. Enterprise Image Management Beyond DICOM-land

11. Enterprise Image Management Leverage existing infrastructure Derma-tology Endo-scopy …and many others Radio-logy Mammo-graphy Ortho-pedics Sectra PACS Sectra PACS ? ? ?

12. Enterprise Image Management Capture anything Multimedia sources CardiologyPACS EPR Streaming video • JPEG, TIFF, GIF, PNG, • BMP, MPEG-2, PDF Image Central Frame • grabber Metadata DICOM DICOM DICOM DICOM Sectra PACS

13. Enterprise Image Management Capture from multiple MRN domains CardiologyPACS IDS7 Logical MRN domainsto keep patients separate even if they have same MRN. Links established by eMPI. John Taylor 123 Amy Hall 123 DICOM DICOM Sectra PACS

14. Enterprise Image Management Capture from DICOM modalities Multimedia sources EPR Metadata (DICOM MWL) Metadata (HL7 ORM) DICOM Sectra PACS

15. Enterprise Image Management Capture streaming video Multimedia sources EPR Streaming video Frame • grabber Metadata (HL7 ORM) Metadata (DICOM MWL) DICOM Sectra PACS

16. Enterprise Image Management Capture non-DICOM files Multimedia sources EPR • JPEG, TIFF, GIF, PNG, • BMP, MPEG-2, PDF Image Central Metadata (URL & manual input) DICOM Sectra PACS

17. Enterprise Image Management Capture non-DICOM files 1 2 3 Select the patient in the EPR. Launch the Sectra import application straight from the EPR. 4 • Select images & videos to import. Note that clinical context is added automatically but can be complemented manually if required. Thumbnails appear in the EPR, and clicking on them starts IDS7 or LiteView Images immediately available to anyone with access to view them

18. Image Central Photograph 2 1

19. Image Central Import 3 4 5 Patient Directory

20. Image Central Import... 6 7

21. Hands-on • Importing Images • Viewing images from other ologies

22. Enterprise Image Management Access anywhere CardiologyPACS EPR URL launch • IDS7 & LiteView DICOM QR (supports multiple MRN domains) Direct Archive Access HL7 Content Notification Sectra PACS

23. Enterprise Image Management Access multiple MRN domains CardiologyPACS IDS7 The Sectra PACS knows what MRN that applies in other PACS, and uses tag morphing to fit the destination. John Taylor 123 Amy Hall 123 • DICOM QR Direct Archive Access Sectra PACS

24. Enterprise Image Management Access from EPR EPR URL launch • IDS7 or LiteView Direct Archive Access HL7 Content Notification Sectra PACS

25. Enterprise Image Management Access from mobile device Zero footprint Zero learning curve • Sectra LiteView Direct Archive Access Sectra PACS

26. Enterprise Image Management Access anywhere vs. patient privacy CardiologyPACS Advanced access control, audit, patient lock and block management in both IDS7 and Sectra LiteView EPR URL launch Not yet widespread use of standards (e.g. IHE XUA, BPPC, sup-99 QR). Intermediate solution in Sectra PACS with filering on Institution name for DICOM QR. • IDS7 & LiteView Direct Archive Access Sectra PACS

27. Enterprise Image Management Clinical results Better access Complete patient overview Improved collaboration

28. Case study

29. Enterprise Image Management Case scenario 1 2 3 • Young male assult victim arrives at ER The CT images of the head are stored in Sectra PACS, together with retinal images of an orbital trauma The hospital photographer documents the abuse, and restricts access to these images

30. Enterprise Image Management • Case scenario 4 5 6 • A CD is created as evidence material for the police. MDT – a team of doctors can discuss the case while viewing a complete overview all images. • Follow up visit at the GP that can access all history directly from the EPR system.

31. Enterprise Image Management Sörmland County Council • 2004 Radiology & Nuclear Medicine • 2009 ER, Ortho, Surgery, Medicine • 2010 Full scale Enterprise Image Management

32. Enterprise Image Management Sörmland County Council • Today, Sectra PACS is used in more than 30 departments, e.g. radiology, nuclear medicine, ER, orthopedics, surgery, pediatrics, gynecology, dermatology, primary care, physiotherapy etc.... With Sectra Image Central we have increased transparency between different departments and avoid the problem of having images stored in several different systems or in the physicians’ computers. Cecilia Halvardson, Manager Healthcare IT SörmlandCounty Council, Sweden

33. Enterprise Image Management Sörmland County Council Multimedia sources Picsara (endoscopy) Advanced access control, audit, patient lock and block management in both IDS7 and Sectra LiteView EPR URL launch Streaming video • JPEG, TIFF, GIF, PNG, • BMP, MPEG-2, PDF Image Central Frame • grabber Metadata • IDS7 Direct Archive Access DICOM DICOM DICOM DICOM Sectra PACS

34. A glance into the crystal ball

35. Enterprise Image Management Project fact sheet • Scope: Histopathology • Time: 2012-2014 • Partners: CMIV, Sectra and nine Swedish County Councils (health care for ~3,8 million people) • Size: 2,3 million € • Funding: Swedish Innovation Agency, co-funded by partners

36. Enterprise Image Management Savings with digital pathology • Less non-diagnostic work • Faster diagnostic review • Less work related injuries • Cost-efficient education • Effective resource management

37. Enterprise Image Management Care benefits with digital pathology • Less risk for error • Benefits for referring physician • Improved education • Easy consultation and collaboration • Image analysis  new diagnostics

38. Enterprise Image Management Summary • Image enabling the EMR is key • Create a patient centric view of the medical record • All departments need the ability to store all images in the medical record • Is your hospital securing all medical images?

39. Questions?