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Picture Perfect: Imaging Strategies in Pathology. Cerner Health Conference 2005 Orlando, FL October 9 – 12, 2005. Why Do Imaging in Pathology?. UPMC Perspective Strengthen the reporting of results in anatomic pathology
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Picture Perfect: Imaging Strategies in Pathology Cerner Health Conference 2005 Orlando, FL October 9 – 12, 2005
Why Do Imaging in Pathology? • UPMC Perspective • Strengthen the reporting of results in anatomic pathology • Provide images for tumor boards and build libraries of images for teaching • Correlation between microscopic appearance, the clinical presentation, and gross specimen appearance • Image on reports as “A Marketing Tool”
Why Do Imaging in Pathology? • Cerner Perspective • Promotes a single, central point of data for each specimen • Temporary states such as tissues during gross can be recorded • Requisitions, diagrams, lab results, consult reports, plus other pertinent info are tied directly to AP data • Quicker access to pertinent microscopic information • No need to request retrieval from storage and re-locate area of interest on the slide • Images access from any enabled workstation can eliminate tedious slide or paperwork retrieval activities • Images are directed to permanent storage immediately, minimizing impact due to misfiling or misplacement • Images on reports are cool – our clients want cool reports!
Overview of our Plan • The 2001 Image Solution Project • Upgrade UPMC’s Imaging Solution to accommodate: • Better integration with AP system • Improve correlation of different phases of the specimen via image use • Enhance teaching curriculum via image use by keeping a file of all interesting cases • Enhance tumor board presentations exporting selected images into PowerPoint • Include images on patient reports
Challenges Associated with Imaging • Software-hardware compatibility • Gross and microscopic camera types • Scanner types • Workflow • EASE of use • Image storage • Local Area Network (LAN) support • Deployment and support of image capture workstations over the UPMC Health System • Inability of results interface (HL7) or archival systems to store and/or manage images
Meeting Challenges Head-on • Hardware/Software Compatibility • Assessment of current hardware • Grossing Stations • 5 existing Sony Video cameras at became go-forward hardware • Microscopic workstations • 11 Existing Sony Video cameras would be used • Added 12 Spot Insight digital camera workstations • Scanners • 3 Scanners used at transcription workstations • Worked with vendor to find new compatible cameras • Camera compatibility is on-going issue as technology changes
On-Going Technology Changes • Researching New Hardware and Compatibilities • Research cycle generally follows Bill’s release cycle • Workstation hardware, OS, and acquisition devices all need to work together • Steps undertaken: • Install PICSPlus on designated Test Environment workstation • Acquire new hardware/OS • Obtain loaner acquisition device of interest • Test, Test, and Test again! • Cost justification ever-present challenge • Staff is happy to get new toys!
Meeting Challenges Head On (continued) • Needs and Workflow • Demands from Grossing Bench • Easy… maintain current standards • Demands from the Pathologists • Specific requests for digital cameras in personal offices • New workflows investigated and implemented for scanning • requisitions • reports
Meeting Challenges Head On (continued) • Image Storage • Image capture predictions were way off • In actuality, approximately 2300 images are acquired per month • We check storage stats daily! • Expansion of storage space done • Local Area Network Configuration • 12 acquisition devices were added • Images are captured and viewed from 4 out of 9 different hospitals • Storage is on a single image server • Image Server Maintenance and Backups
Meeting Challenges Head On (continued) • Deployment throughout UPMC Health System • Deployment Plan • Since we had an existing solution, all workstations came on-line at same time • Educating the end-users • initial one-on-one training for Spot Insight and Scanner users • Continuous Education • High turnover in transcription; staff predominately takes on this training • Training is on-going for new residents and fellow • Image Acquisition “Go Live”
Meeting Challenges Head On (continued) • Supporting Imaging Workstations and Users • Support Needs • At the beginning, support requests predominately due to training issues • including my own education • Once things settled down, now I see • As cameras age, these issues increase; most cameras are 5 years old • White balance is most prevalent issue • found California vendor to refurbish cameras, effectively resetting camera’s standard default setting
Meeting Challenges Head On (continued) • Interfaces & Other Systems cannot handle Images • HL7 Result Interfaces are used to transmit results to hospital system • We do not transmit reports with imbedded images to other systems • Printing Reports with Images • Consulted with other sites using images on reports for Printer recommendations • Lexmark C910 Model • Our clients are very happy with image-enabled reports!
Advances in Imaging: Internet Ready Devices • Nikon COOLSCOPE: • Microscope with built-in digital camera: used for capturing and consultation over the network
Internet Ready Devices (continued) • Nikon DS-U1 PC based camera: • Observation, photography and networking are all possible with this single unit
Our Imaging Solution In Pathology • The PICSPlus Advantage: • Provides a solution for management of macroscopic and microscopic images and related case information • Images can be acquired using a wide variety of equipment: digital and video cameras and TWAIN compatible devices • Ability to import send-out report files, annotated diagrams and imported copies of requisitions
PICSPlus (v2.4) Use at UPMC • Server Scalability/Multiple servers available • 1 server, high acquisition rate that might change • PICSPlus Maintenance Module • Image Server and Acquisition Workstation Activity • Used quarterly to monitor usage • “Lost” Image detection tools • Nice to have, hoping I never have to use! • Selectable image quality for reports • Default quality setting works well for us • Updated Acquisition Module Implemented • Need for this dictated by hardware problem
Image Acquisition • Updated Acquisition Features Gained • Report linkages indicated in Gallery • Streamlined Matrox acquisition • Template definition per workstation
Image Acquisition • Acquisition of images through the image gallery manager window • Provides a simple key stroke to acquire images into the gallery • Ability to switch options, import from TWAIN, import from file or import from Matrox
Image Gallery Manager • PICSPlus Gallery Manager contains the following components: • File Menu – close manager and return to CoPathPlus • Edit Menu – delete selected image file(s) • Attachment Menu – import from file,export from file, import from Matrox, import from TWAIN • Option Menu – select default templates (PICSPlus Template Dictionary, gross image, microscopic image, etc.) and import action (import from File, TWAIN or Matrox) per workstation • Parameters – assigned to selected image file • Linked to Reports – indicates whether an image is included on any patient reports and the report status
Image View Manager • PICSPLus View Manager contains the following components: • Zoom controls – allows you to increase of decrease the size of the image in the viewer • Annotation feature – objects placed on images to focus on a specific area of interest • Copy to Clipboard – ability to copy the image with annotations to the Clipboard • Burn Annotations – allows you to PERMANENTLY apply the annotation to the image
PICSPlus Report Gallery No specific guidelines for acquisition volumes and report assignments
Reporting Considerations • Report Manager Functionality • Report image gallery displays all the image(s) selected to be on the patient’s report • To transfer image(s) from the image gallery to the report gallery, click and drag! • Benefits and Cautions • Image(s) on reports is a very effective marketing and educational tool • Clinicians are warned that image(s) on reports are for reference purposes, not clinical diagnosis
Thank You Any Questions or Comments? We have Cerner experts in the audience to handle solution-specific questions
PICSPlus v2.5 Features • Preview of Coming • Attractions
PICSPlus General Features • 2 new activities streamline workflow and reduce window painting requirements: • PICSPlus Image Entry/Edit • PICSPlus Report Image Select
Gallery Review Feature • Gallery Review functions cycle through slides in sequence as found in respective gallery • Image Gallery Review shows PICSPlus Gallery images • Report Gallery Review shows Report Gallery images • Use timed review or press spacebar to move • Display Setup configures: • Timer • Magnifier height, width, and shape • Times Magnification
PICSPlus View Manager Features • Redesigned Image Review and Annotation features: • Four tabs of data and tools in View Manager: Marks, Process, Color, and Info • Updated annotation tools • Orientation options to Flip and Mirror with degrees designated • Moving magnifier in maximized view & Gallery Review • Picture in Picture Mark, can use to add lab logo • Undo operations
Images on Signed Out Cases Image on Report Image not on Report • Image Annotations • NOT allowed if image on S/O report • Allowed if image NOT on S/O report
Tools and Utilities • New install is more “gentle” and straight-forward • when activating a PICSPlus Add-on in Wkstn Setup, the system tells you when to run Workstation Add-on Install • Nothing is assumed, add each desired component • JPEG-2000 compression schema recovers disk • Scheduled Background conversion • “Just in Time” conversion • Support of 26 major file formats for import • Previously just jpeg, tiff, and bmp were supported • Multi-page tiff images supported