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Surviving sneakernet while you wait for the web

Kevin O’Donnell, Toshiba Medical Research Inst. Co-chair, IHE Radiology Planning Cmte. Surviving sneakernet while you wait for the web. Presenter perceives no conflict of interest with this presentation but discloses being an employee of: Toshiba Medical Research Institute USA,

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Surviving sneakernet while you wait for the web

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  1. Kevin O’Donnell, Toshiba Medical Research Inst.Co-chair, IHE Radiology Planning Cmte. Surviving sneakernetwhile you wait for the web

  2. Presenter perceives no conflict of interest with this presentation but discloses being an employee of: Toshiba Medical Research Institute USA, a division of Toshiba Medical Systems disclosure

  3. Longitudinal Record Services Common Services Communication Bus JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services EHR Data & Services DataWarehouse Registries Data& Services OutbreakMgmt PHSReporting SharedHealth Record DrugInformation DiagnosticImaging Laboratory HealthInformation ClientRegistry ProviderRegistry BusinessRules EHRIndex MessageStructures NormalizationRules LocationRegistry TerminologyRegistry Security Mgmt Privacy Data Config Services HIAL Public HealthServices PharmacySystem RadiologyCenterPACS/RIS Lab System(LIS) Hospital, LTC,CCC, EPR PhysicianOffice EMR EHR Viewer Pharmacist Radiologist Lab Clinician Physician/Provider Physician/Provider Physician/Provider Public Health Provider POINT OF SERVICE “The future is already here, it’s just not evenly distributed yet” – Paul Saffo Coming soon…

  4. and… CDs To The Rescue or…

  5. CDs To The Rescue?

  6. Easier, perhaps. Better To Give Than To Receive? You may be part of the problem.

  7. IHE Portable Data for Images (PDI) Profile • Standardize media • IHE Import Reconciliation Workflow (IRWF) Profile • Fix demographics, IDs and codes • IHE Basic Image Review (BIR) Profile • Baseline behavior for viewer software IHE’s 3-Step Program

  8. IHE Portable Data For Imaging (PDI)

  9. Compatibility requirements • Standard CD format and file system • Consistent disc organization • Use most genericDICOM media profile • Images MUST be present in DICOM • May have copies as “web content” (i.e. JPEGs) • Avoid most common mistakes (highlighted) IHE Portable Data For Imaging (PDI)

  10. Connectathon testing • Peer-to-Peer vendor testing • Results checked by RSNA project managers • 50+ companies tested PDI in the last few years IHE Portable Data For Imaging (PDI)

  11. Endorsed by AMA/ACR/AANS/ACC/… • Stopped just short of declaring it “standard of care” • Buying equipment that burns DICOM media? • Ask that it support PDI as a Media Creator • Receiving media frequently? • Ask the provider for PDI compliant media IHE PDI: Ask For It By Name

  12. But Wait, There’s More

  13. Additional Media: • Compression • Optionally allowed; but leave policy to PACS • On-board “Sender Software” recommended. • Encryption • Optionally allowed; password based • Please consider support needs before creating IHE PDI Extensions (Work In Progress) DVD

  14. “Sending Software” 1) Insert CD; Run SendSoft 2) “Enter Password:” 3) SendSoft Decrypts CD Images 4) “Enter Destination:” 6) SendSoft decompresses & converts CD Images (as needed) 5) DICOM Association Negotiation 7) Send Images (C-STORE)

  15. Improvements to consider: Staff pre-load media onto yourdrive / Import media into PACS Install YOUR preferred viewer /Use your reading workstation Reconcile patient demographics & IDsto integrate with local records Media Workflow: Watching Paint Dry?

  16. IHE Import Reconciliation Workflow (IRWF)

  17. Why Reconcile? • “The Images are in the PACS but are messed up” • The patient ID is wrong, it doesn’t come up in a query • I can’t hang the new images with the old • The unknown procedure codes mess up my hanging protocols • The images aren’t linking to the EMR. Patient’s chart won’t come up • Impact: • Lost time • Incomplete data • Drags on effectiveness

  18. During image import, details are fixed to match (or not conflict with) local values • Patient IDs, Name • Procedure Codes, Accession Numbers, etc. • Two ways of getting demographics • DICOM Worklist • HL7 Demographics Feed IHE Import Reconciliation Workflow (IRWF)

  19. Work In Progress • BASIC Image Review • Defines a Baseline • Feature set • Look and feel • Performance • Minimum Platform • “Advanced” Button = Show me what else you can do IHE Basic Image Review (BIR)

  20. Facilities distribute images; Physicians review them • Rising frustration; too often the viewer: • requires installation on a locked down machine • does not successfully run • starts up too slowly • does not successfully load the images • warns the images are non-diagnostic • is missing some basic critical function • has Yet Another GUI where basic operations are non-obvious • Impact: • delayed care, inaccessible information, repeat examination and irradiation, and poor use of valuable clinician time. Motivation for BIR

  21. Trial Implementation Spec. in June • Potential applications of BIR Spec. • Media Viewer (PDI Option) • Requires a BIR Compliant viewer be placed on media • Third party viewer • Web Portal IHE Basic Image Review (BIR)

  22. Radiologists may be unaware of the pain suffered by the clinicians (i.e. their customers) • Ask for PDI compliance in media & equipment • Consider IRWF if you import regularly • Watch for BIR in the near future • Pursue the future; And have backup plans. Takeaway Any sites here that didn’t use their fax last month?

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