A multi-site Radiology Information Systems (RIS) and Picture Archiving and Communications System (PACS) was implemented in Doha by Hamad Medical Corporation (HMC). This system allows physicians to access their patients’ x-ray image records instead of using traditional X-ray films on their screens at the touch of a button. A better understanding of the patient’s imaging records becomes more accessible with the RIS/PACS solution.

“The new system will facilitate improved diagnosis and patient care capabilities. Imaging is becoming increasingly integral to preventive and treatment management practices. The system allows for easy access of comprehensive diagnostic information by physicians and other care providers, which enables faster patient management decision making. We placed great emphasis on not only implementing the technology but ensuring relevant training for all clinicians” said Dr. Ahmed J Omar, Acting Chairman of Radiology at HMC.

Mr. Abdullah Al Emadi, Executive Director of Health Information System (HIS) at HMC commented “Key members from the Clinicians Group, Radiology and Health Information Systems departments worked closely together to ensure the successful completion of this very large and complex project. I am delighted that we were able to roll this system out throughout seven hospitals in less than a year and a half – this is a record achievement in the global healthcare sector and reflects the achievement of a key milestone in HMC‘s strategic IT plan”.

No matter where the x-rays images and scans have been captured, the new system will record them electronically and will be viewed on any PC across HMC and this process is specified for healthcare environments. Utilizing this system creates flexibility and interoperability between different imaging devices in addition to a stable infrastructure enhancing efficiency and improving the quality of patient services within HMC.

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ICT for Health along with its US partners OTech Imaging is organizing its 4th PACS seminar in the Middle East with a special emphasis on EHR implementation & strategies, particularly the open source Electronic Health Record WorldVista, developed by VA. Course is delivered by industry leaders from US who carry over 25 years of experience in PACS related training and consulting.

Participants will get a thorough understanding of all the aspects of an Electronic Health Record, PACS system, the typical PACS System Administrator’s job and the DICOM standard. Our seminars are limited with regard to the attendance and is very interactive with a great deal of hands-on, especially during the last day.

Detailed Learning Objectives:

Participants will understand the basic components of Electronic Health Record, Picture Archiving and Communication System (PACS), the associated clinical workflow, and the technical aspects to exchange the image and information management between digital modalities, PACS and Radiology Information Systems (RIS) using DICOM. This will allow the participants to assist in:

• Planning, preparing and supporting the implementation of a comprehensive Electronic Health Record (EHR)
• Preserving the image and information integrity, including image quality.
• Managing the installation and/or enhancements of a PACS system.
• Continuously improving the system efficiency and integrity.
• Assisting PACS and EHR users such as physicians and technologists through training and support.
• Troubleshooting of connectivity, image quality and data integrity issues.

For additional information:

Please contact us at info@ictforhealth.com
OR
call +2010-8523040

About ICT for Health ICT for Health is pioneer in healthcare technology training and consulting in the Middle East. ICTFH provides a variety of solutions and services to the healthcare facilities in the Middle East and US. Some of our solutions and services include EHR Strategy & Planning, Radiology Transcription, teleradiology and Dictation Management System.

Contact Information:

Zaheer Abbas Malik
ICT FOR HEALTH 53, Ahmed Qasim Goda Nasr City, Cairo, Egypt
www.ictforhealth.com
zaheer@ictforhealth.com

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Imaging Center Chain Upgrades to Web-Based RIS/PACS to Improve Productivity, Service

Speaking Out with Steve Canino, President, Island Radiology Management Inc., New York

Some healthcare facilities favor a best-of-breed approach where they assemble equipment from different manufacturers to suit their clinical needs rather than going with a single vendor offering a complete package. You chose to install a new PACS that interfaces via HL7 with your existing radiology information system (RIS). What do you see as the advantages and disadvantages of either strategy? Download Full PDF File

CANINO: We actually favor going with a single-vendor solution for RIS/PACS because of the need for a tight interface between the two platforms. We did install a new KODAK CARESTREAM PACS and interfaced it to our existing RIS via HL7, but we did this as an interim step to implementing a new RIS from Carestream Health in 2008 that is designed for outpatient imaging centers.We could continue using our existing RIS but the new RIS offers us added features and functionality that will improve the productivity of our radiologists and enhance the overall efficiency of our operation. Download Full PDF File

Island Radiology owns and operates three imaging centers in the greater New York City area, and we see 250 patients a day. Download Full PDF File

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Developing a Radiology Information System and Picture Archiving and Communications System (RIS/PACS) for a Kenyan Hospital

RIS/PACS systems can greatly improve patient care and physician education. However, these features come at a high cost not attainable in most developing countries. Our goal was to explore low-cost options for basic RIS/PACS. We were able to design and implement a low cost RIS/PACS solution that was used for thousands of studies. Future work will expand on the functionality and reliability of this low-cost solution.

The Problem

In developed countries the advantages of RIS/PACS systems have been clearly established. However for developing countries, millions of patients go without the benefits of comparison examinations. Education in all aspects of diagnostic radiology is enhanced by exposure to a large, comprehensive case load. Due to the high cost of film, radiology training programs in developing countries often lack the necessary robust teaching file. Inexpensive digital archiving has the opportunity to provide improved patient care and dramatically enhance radiology education in developing countries.

The Solution

A database to track patient and report information was created using MS Access® and a digital camera. Installed in a teaching hospital in a developing country, the system remained in use until hardware failure 6 months after installation. By that time over 3000 studies had been stored in the database. We utilized the institution’s existing internet connection to provide e-mail correspondence with radiologists at Indiana University. Cases shared through e-mail have been used for teaching at IU.

One of the major difficulties facing any system is user acceptance. The users of our system at home and abroad have embraced it from the beginning. One year later, we continue to receive e-mail from Kenya requesting continuation of the project. We consider this unequivocal proof-of-concept.

We are developing an open-source solution built with a robust data model, existing libraries, high-level development tools, and standards-based network communication. This second generation system will support customized web-based or stand-alone clients.

Download Full Case Study

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Quantitative Evaluation of The Quality and Efficiency of A Filmless Radiology Department in A Fully Digital Regional Hospital

Reggio Emilia’s Arcispedale Santa Maria Nuova regional hospital installed a Carestream Picture Archiving and Communication System (PACS) in 2003 to meet its strategic goal of sharing information, reports and data online. At the same time, the hospital commenced a study on the economic impact of PACS compared with a non-digital system over a period of at least four years. Evidence shows that the new PACS has delivered very significant benefits in financial terms, in simplified workflow and in the management and use of human resources.

Productivity has increased, and the instant availability of reports has enhanced clinical activity by reducing average hospitalisation times. by Dr Andrea Nitrosi

Reggio Emilia’s Arcispedale Santa Maria Nuova is a 900-bed regional acute hospital in Italy. The hospital invests more than 2% of its global budget in IT annually (twice the Italian average). A total of 180 000 imaging examinations are performed every year by the radiology department, with a large outpatient population representing 40% of the workload. The emergency department represents 31%, while in-patient and day patients account for the remaining 29%.

Transition to full digital imaging

A joint multi-functional management project team for PACS was formed during the initial project phase and continues to provide guidance in ongoing PACS operations. The team set clear criteria to monitor the implementation and measure the clinical and business outcomes, providing solutions for specific clinical departmental requirements such as digital orthopaedic preoperative planning for the operating room [Figure 2]. Specifications for the system included full PACS/RIS/HIS (Radiology Information System/Hospital Information System) and modality integration, load balancing mutual takeover PACS server configuration, Everything on Line (EOL) architecture in the form of Carestream PACS 5.2, automatic speech recognition systems (ASRS), and web-based full-depth 12-bit image ward distribution via an intranet PACS web-access on any of the hospital’s 1400 personal computers.

Extensive user training on the PACS web module involved more than 400 medical and nursing professionals. To facilitate and accelerate the use of the IT process, a portion of the clinical staff’s incentive plan was tied to deployment of the Electronic Patient Record (EPR) component.

Download Full Case Study Now

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Rochester General’s All-Digital Workflow Marries Increased Physician, Patient Satisfaction With 11 Percent Revenue Gain

For more than 160 years, Rochester General Hospital (RGH), a 528-bed tertiary care facility, has been a key provider of healthcare services for the Rochester community. As the recipient of more than a dozen quality and recognition awards in the last seven years alone, including six designations at a Top 100 Cardiac Hospital by Solucient, Rochester General is known for its commitment to performance improvement. In addition to recognizing RGH for its high quality patient care, Solucient has also cited the hospital for operational efficiencies that have enhanced its financial standing and contributed to its success.

As part of its continued commitment to quality improvement, the hospital recently focused on improving the delivery of radiology services. This has been beneficial to the hospital, physicians and—most importantly—its patients. RGH converted from film- and paper-based image systems to an integrated KODAK RIS/PACS (radiology information system/picture archiving and communications system) that expedites and enhances all stages of the exam process from patient registration and exam scheduling to the viewing, storage and distribution of imaging studies and reports. The implementation of RIS/PACS has boosted internal productivity and increased the satisfaction levels of both patients and physicians.

Dramatic Improvements in Less Than One Year

Less than a year after implementing integrated RIS/PACS, part of KODAK CARESTREAM Radiology Solutions, the results are impressive:

• Revenue is up by 11 percent, due in part to greater efficiency and room scheduling by the RIS/PACS, which has fueled growth in modalities such as CT and ultrasound
• Feedback from referring physicians indicates satisfaction is much higher, since radiology reports are furnished in as little as one hour
• Inpatients benefit from a more efficient process with reduced wait times, and outpatients are now routinely scheduled for imaging exams the same day

The all-digital workflow begins with centralized scheduling that expedites booking of exams, including interventional and other specialized procedures that require physician availability. This efficient process also benefits patients, since wait times during examinations are reduced and multiple schedulers are available to arrange appointments within 24 hours of the request if necessary.

All general radiology exams at Rochester General are now conducted digitally using KODAK DIRECTVIEW CR 850 and CR 950 computed radiography (CR) systems in the operating suite, ICU and throughout the department, as well as a KODAK DIRECTVIEW DR 9000 digital radiography (DR) system that serves the emergency department.

Images from these systems and all other imaging modalities are transmitted to the PACS in seconds, ready for viewing and reading. Rapid access to soft copy images is the foundation of PACS and its benefits are most clearly evident in the ICU and ED, where images can be immediately viewed in response to emergency situations, allowing quicker diagnoses that can dramatically affect patient care.

Integration Creates Efficiencies throughout the System

Tight integration within the RIS/PACS suite enhances productivity and affords greater convenience to Rochester General’s team of radiologists and other clinicians. After an initial sign-on, physicians can instantly access the fully integrated RIS/PACS without enduring multiple system log ons and a series of windows dedicated to each application.

For RGH, there are benefits beyond achieving efficiencies within the department, notably the cohesive communication that expedites auxiliary functions as well. The RIS/PACS is integrated with the hospital information system, medical records system and laboratory and billing systems. Real-time access to the status of unbilled and billed procedures has improved the timeliness of billing. In the past, it was sometimes difficult to bill for procedures because paper bills could be lost or misplaced, or because the bills were not submitted within insurance carriers’ accepted time limits.

An electronic workflow led to a more efficient allocation of coders on weekends and to the re-design of the billing process. Procedure codes are added by the schedulers and confirmed or sometimes changed by the technologists. All billing information is verified by the radiology department’s billing staff as they match procedure codes with the dictated report. This is supplemented by the medical records team that reviews specialized coding for invasive procedures. Information is then transferred seamlessly between the RIS and the billing system, so that accurate bills can be quickly generated for all procedures.

Accurate Information Allows Better Management

Comprehensive reporting achieved through a menu of standard reports and the ability to generate ad hoc reports enables Rochester General to better utilize its personnel and equipment. Imaging study volumes are viewed by room and modality to see which rooms is under and over-utilized. Staff assignments are tailored to match each day’s schedule, which simultaneously promotes productivity and patient satisfaction.

RIS/PACS also provides information about outpatient imaging that allows the staff to determine the number of patients sent by each referring physician and the types of imaging studies requested. Detailed information about patient volumes for each modality now drives capital investments and has enabled an improved decision-making process regarding expansion of capacity. Scheduling adjustments and re-allocation of exam rooms made as the result of RIS/PACS reporting has helped foster a 20 percent volume increase in modalities such as ultrasound and CT.

Outpatient imaging is an especially competitive area, and one that is expected to see continued revenue gains. The hospital’s streamlined scheduling process allows same-day scheduling for most patients and is much more efficient for managing interventional procedures that require specific physicians and equipment.

The benefits of the hospital’s digital imaging solution were realized just months after installation and are expected to continue producing improvements in productivity, revenue and service. It’s important to realize that the impact of an efficient digital workflow goes far beyond the radiology department. It shapes a hospital’s reputation within the local community by dramatically improving service to referring physicians and their patients. At Rochester General Hospital, this improvement in quality of service is something the staff strives for each and every day.

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Third bi-annual PACS | DICOM | HL7 Seminar, organized by leading healthcare organization in the Middle East, ICT for Health, ends on Thursday Nov, 5, 2009.  The seminar was a blend of radiology professionals, CEOs, Decision Makers, including delegates from Aspetar Hospital Qatar, King Fahad Hospital Saudi Arabia, ICC Group Saudi Arabia, Senior officials from Ministry of Health (MOH) Saudi Arabia & CEOs of different reputed healthcare organizations.

In a small ceremony held in Safir Hotel, Mr. Abbas, the CEO of ICT for Health distributed certificates of participation and appreciation to the participating delegates.  He also added in his closing remarks the importance of healthcare technology training in the Middle East.  Most of the healthcare organizations are spending millions of dollars annually on upgrading hospitals systems, RIS/HIS/PACS, modalities and other equipment but they are overlooking the importance of staff training to handle this digital revolution in healthcare industry.  The participants appreciated very much the efforts put by Mr. Herman Oosterwijk, President OTech, who is considered authority on PACS subject and who delivered the course material.  ICT for Health announced tentatively its upcoming seminar in Kuwait including “Policies & procedures” for PACS system.

For additional information:  Please contact us at info@ictforhealth.com or call +2010-8523040

About ICT for Health

ICT for Health is pioneer in Diagnostic Imaging Training and Consulting in the Middle East.  ICT for Health provides a variety of solutions and services to the healthcare facilities in the Middle East and US.  Some of the solutions include PACS / RIS/ HIS/ medical transcription, teleradiology and Dictation Management System etc.

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Digital Imaging and Communications in Medicine (DICOM) is a clinical messaging syntax used to exchange medical images between medical equipment and information systems. The DICOM standard was created by the National Electrical Manufacturers Association (NEMA) to aid in the distribution, storage, and viewing of medical images, such as computed tomography and magnetic resonance imaging scans and ultrasound.  DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system (PACS).

A practical example is the transmission of x-ray images to an electronic health record (EHR). The ability of the sender and the receiver to mutually use the DICOM standard allows this transmission to succeed.

The different devices come with DICOM conformance statements that clearly state the DICOM classes they support. DICOM models the image acquisition process and information objects related to imaging, and it specifies how the image data, the metadata, and related objects are represented in a binary format.

DICOM has been the global standard for medical image information since the 1980s. It is pervasive throughout the medical imaging community, and nearly every medical imaging device supports some aspect of the standard. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists’ and doctors’ offices.
DICOM is an independent, international standards development organization administered by NEMA’s Medical Imaging and Technology Alliance. More information on DICOM can be found on the NEMA Web site.

Despite its pervasiveness, size, and complexity, DICOM lacks a reference information model of the imaging domain. A reference information model is a formal description of a domain that enables users to share consistent meaning and establish semantic interoperability beyond a local context.

Researchers Zhau and Lee developed a methodology to transform programmatically structured reporting (SR) templates defined by the DICOM standard into an XML schema representation to promote common formats for specific reporting applications or domains.

Some current research based on DICOM has focused on designing structured reporting modules corresponding to the specifications from the Content Mapping Resource section of the DICOM standard, which defines the structure of the DICOM medical reports and their composing elements: coded concepts, context groups, and templates.

An information model of imaging based on DICOM is needed to enable the community to create intelligent, imaging-based applications that are interoperable. The Stanford Center for Biomedical Informatics Research is developing the DICOM Ontology (DO), an ontology that will be a single common reference information model for the imaging domain. The DO will be analogous to the Gene Ontology (GO) and serve a role in radiology similar to that which GO serves in biology. The DO will unify and make explicit all the key entities and relations in DICOM in a user friendly and machine-processable format.

The DO will ultimately become a reference ontology–one that comprehensively represents knowledge about the medical imaging domain independent from specific objectives or applications, guided by a theory of the imaging domain and by robust ontology design principles that encourage reuse.

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