From Departmental Silos to Streamlined Patient-Centric Workflow

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

A recent Auntminnie article spotlights the challenges of storing documents in PACS or RIS and encourages healthcare facilities to instead turn to vendor-neutral archiving (VNA).

As the world’s second largest supplier of vendor-neutral archiving (InMedica Report, April 2012), Carestream manages more than 2 petabytes of managed data and 80 million studies managed at 10 data centers.  We’ve seen interest in VNAs grow as they offer the ability to collect images and data from a variety of departmental systems to create a cohesive patient portfolio that contains imaging exams, lab and pathology data, video files, and JPEG images. A VNA can provide the patient’s clinical record via the Web or existing EHR/HIS virtually anytime, anywhere – no matter where images, documents and data originate or are stored.

radiology information lifecycleHowever, it’s important to note that healthcare providers will understandably favor data storage platforms that deliver information access without the need to migrate existing archives. Integrating or replacing legacy RIS/PACS or Archive systems can be costly. One option is to select a platform that synchronizes multi-vendor and multi-site RIS+PACS  to create a streamlined multi-site workflow to leverage your existing investment. Solutions like Vue Connect allow you to:

  • Synchronize patient data from multiple sites in real time, including metadata, with or without image data
  • Handle DICOM and non-DICOM images, regardless of vendor platform, age, location or network speed
  • Manage multiple patient IDs via MPI systems; accommodates IHE profile compliance such as XDS repository
  • Permit retention of autonomous, single-site reporting while allowing the  referring community to view all patient data, regardless of originating site
  • Automatically retrieve studies from their most accessible locations
  • Expand the system organically as new sites are added to your enterprise

Eliminating departmental silos of information is an urgent goal for healthcare providers worldwide. Meaningful use requirements and the desire to offer access to patient data through an EHR are both spurring the implementation of both vendor-neutral archives AND alternative platforms that can help deliver a cohesive, patient-centric view of medical data within your budget.

Schedule an appointment at RSNA 2012 to speak with our healthcare IT solutions architects about vendor-neutral archives and synchronizing multi-vendor and multi-site RIS+PACS.

National Institutes of Health Lesion Management Presentations at RSNA 12

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Precise lesion measurement is critical for reliable evaluation of metastatic disease and faster assessment of patient response to cancer treatment. This topic is heavily featured at RSNA next month, where National Institutes of Health (NIH) researchers are giving three RSNA presentations that involve use of Carestream’s new lesion management application:

  • “Comparison of Tumor Size Measurements in Simulated Metastatic Lesions on Serial CT in a Phantom”   (Tuesday, Nov. 27, 11:20-11:30 AM, Room S104A)
  • “Semi-Automatic Target Lesion Localization, Segmentation and RECIST Measurements on Serial CT Studies” (Tuesday, Nov. 27, 11:30-11:40 AM, Room S402AB)
  • “Optimizing Efficiency and Consistency of Metastatic Disease Treatment Evaluation Using CT Semi-Automated Lesion Analysis” (Tuesday, Nov. 27, 11:40-11:50 AM, Room S104A)

For radiologists and oncologists, simple quantitative comparisons of historical exams – especially those imported from disparate PACS or modalities – have been a challenge in a traditional PACS, causing many to turn to dedicated workstations.

Our new lesion management application, used by NIH in their research studies, is an embedded application in Vue PACS that enhances assessment of oncology patients by:

  • Providing lesion management as a native PACS clinical tool
  • Accepting prior exam results as baseline images from 3rd-party PACS and from numerous modalities
  • Helping boost  radiologist productivity by simplifying segmentation and analysis
  • Delivering volumetric data with PowerViewer to simplify the comparison process between different data sets
  • Supporting oncology follow up with bookmarking and tracking of general anatomy over time
  • Helping reduce the cost associated with dedicated Workstations

If you are at RSNA the NIH presentations shouldn’t be missed.

Unable to attend NIH’s lesion management presentations at RSNA?  You can see a quick video demonstration below that illustrates how the tool is designed to help to provide faster localization, measurements, and follow-up that could help minimize subjective variation and enhance consistency.

How would consistent, standardized oncology image reporting impact communication and collaboration between physicians at your facility? 

Reading Digital Breast Tomosynthesis Exams From a Single Desktop

Anne Richards, Carestream

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

A recent article in the Wall Street Journal on 3-D mammography discussed the potential for digital breast tomosynthesis (DBT) to enhance the detection of cancers. I was reminded of how important it is to not only capture the best breast images possible, but also to have an efficient and effective system that helps radiologists make an accurate diagnosis.

As I revisited the accomplishments our team has achieved in designing a new module that displays DBT exams on our mammography workstation—while also displaying digital mammograms, breast ultrasound, breast MRI and general radiology exams from a single desktop—I was struck by how easy it is (or could have been) to add yet another dedicated workstation to the radiology reading environment and then falsely believe we have actually improved the diagnostic workflow.

We resisted that path. Our team has long demonstrated our commitment to supporting multiple digital breast imaging modalities on our mammography workstations, and we have fiercely resisted the temptation add new, single-use workstations that might seem alluring because of their “dedicated” nature—when in fact they add costs and create inefficiency. Supporting multiple breast imaging modalities—as well as general radiology exams—enables radiologists to deliver a faster diagnosis to referring physicians and can ultimately enhance patient care.

Our smartly designed tomosynthesis module streamlines workflow by allowing healthcare providers to store, route, display and query/retrieve DBT exams from DICOM-compliant acquisition devices, so radiologists have all the tools they need on one workstation. Comparison tools enable radiologists to use personalized hanging protocols for DBT exams along with other procedures, especially the 2D mammograms. In addition, specialized tools that further enhance productivity include: automatic positioning of DBT and mammograms that eliminates manual manipulations; automatic “same sizing” of DBT and mammograms that aid in comparing changes in anatomy; and concurrent magnifying glasses that provide close-up comparison of pathology across multiple views and procedures.

With our advanced sys­tem, radiologists can quickly and easily read exams from all modalities and vendors at a single workstation. And working smart is an important element in improving patient care.

How do you view or plan to view digital breast tomosynthesis? What do you think about 3D breast imaging?

Webinar: IT Strategies for Imaging Growth & Quality Outcomes

Mary Tierney

Mary Tierney, VP, Chief Content Officer, TriMed Media Group

Earlier this month CMIO Magazine unveiled a new name, Clinical Innovation + Technology, and website, Our new focus mirrors healthcare’s technology-fueled transformation where C-suite executives are tasked with blending clinical and technological innovations to deploy new care processes and practices, evidence-based medicine and decision support, and enhancing communication and information access  across the care continuum through interoperability of clinical devices and IT systems.

Next week in a free Webinar, sponsored by Carestream, we’ll be looking at how this new environment – spurred by the convergence of reform and big data – is impacting the CXO’s approach to operational design in medical imaging.

You’ll hear from:

Kristina Kermanshahche, Chief Architect of Health for Intel Corporation

Maureen Gaffney, RN, the CMIO at Winthrop University Hospital in Mineola, New York


Dr. Eliot Siegel, Professor and Vice Chair University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine, and Chief of Imaging at VA Maryland Healthcare System in Baltimore.

Our panelists will detail how CXOs can collaborate with radiology and IT on intelligent IT strategies that do far more than improve department or hospital productivity and efficiency. These strategies must also facilitate image exchange, mobile access and patient empowerment, while unlocking new financial models for growth and scale and supporting imaging’s inclusion in health reforms like meaningful use Stage 2 and the position within the broader picture of health IT.

Please join us and participate in our live Q&A on September 18 at 2 p.m. EST.  Register for the event today!

New Dashboards Designed to Streamline Workflow Can Also Expedite Meaningful Use Reporting

Rick Sera

Rick Sera, PACS/RIS Administrator, Valley Presbyterian Hospital, Van Nuys, Calif.

One of the biggest changes for PACS administrators is the amount of reporting that’s now required to meet meaningful use initiatives. In the past, most administrators generated individual reports from each system—including RIS, PACS and EHR/EMR—to monitor data on patient exams, equipment and personnel utilization, delivery times/methods for radiology reports and other service parameters.

Meaningful use regulations demand collecting and reporting data on specific areas related to the quality and timeliness of service delivery. This creates a burden for PACS administrators because required data is typically collected by different systems and is not always easy to access, since current reporting systems were designed long before meaningful use initiatives were even on the horizon.Vue Beyond

I spend hours each month compiling data to generate required reports, but fortunately help is on the way. New radiology dashboards not only offer a real-time view of how the department is functioning (and bottlenecks that need attention) but some also have comprehensive reporting capabilities. These systems allow users to design reports and then collect desired information from multiple systems and build the report to order.

This next generation dashboard could quickly become a PACS administrator’s best friend. It can collect and track required data, present  create accurate presentations of real-time workflow, and save dozens of hours spent on tedious reporting tasks every month.

From my perspective, this new technology couldn’t have come at a better time.

Editor’s Note: Do you already have a method that collects and automates meaningful use reports? Are you in the market for a more efficient way to generate reports? Come talk to us at  AHRA 2012 about real-time business intelligence and departmental reporting.  

Spire Healthcare Gives Clinicians On-Demand Access to Imaging Data

Robert Ashby, Carestream

Robert Ashby, European Communications Manager, Carestream Health

The IT director and Imaging Manager at the UK’s second largest private healthcare provider, Spire Healthcare, had an interesting challenge. How do you use technology to provide better service for both patients and referring physicians, who have a choice of where to go for care, when your 37 hospitals are on different PACS platforms?

To differentiate their services, Spire sought a secure, PACS and archive-agnostic image viewer that would be accessible from almost any device—predominantly iPads and other tablets—running a Web browser with no local installation or download.

Since January, Spire has been using Carestream’s Vue Motion viewer to allow radiologists and referring physicians to see PACS images from all 37 sites in the Spire network—on the way to the operating room, at the patient bedside or even from home.

I recently had the opportunity to sit down with Stephen Hayward, IT Director, Andrew Milne, Imaging Manager, and Dr. Qaiser Malik, Consultant Radiologist, to talk about their experience with Carestream Vue Motion:

Three professionals with different views on the value of freeing images from the PACS workstation.

IT Director, Stephen Hayward

“There is certainly a huge future in mobile health. Having access to care records and reports on a mobile device at the clinician’s finger tips will be a great boom going forward.”

Imaging Manager, Andrew Milne

“Our consultants can access the system remotely, download, and print without any interaction with my staff. This reduces the traffic into the imaging department and makes our service much more efficient. Staff is free to deal with other matters directly involving patient care.”

Consulting Radiologist, Dr. Qaiser Malik

“The clinician may come across a report and he may want to discuss it with me when I may not actually be there.  I can log in to the system wherever I am.  He can log in from the hospital and we can both look at the same images at the same time.”

At UKRC this week? Come see Vue Motion in stand 99. 

The New Normal: Faster Reporting, Ability to Integrate Data into EMR Systems

Editor’s Note: Carolina Radiology Associates in Myrtle Beach, S.C., recently installed a CARESTREAM RIS+PACS System  for its teleradiology business. We asked Michael Brown, M.D., a CRA radiologist, to discuss his group’s ability to deliver faster, more efficient reporting while simultaneously communicating data to healthcare provider EMR systems.

Like many radiology groups, manual tasks impeded our efficiency and we experienced challenges in exchanging patient information and reports with the healthcare providers we serve. Our new RIS+PACS streamlines data exchange and offers advanced reading features for our teleradiologists.

Mike Brown

Michael Brown, M.D., Carolina Radiology Associates

Our 18-member group provides on-site radiology services for hospitals and imaging centers and teleradiology services for a variety of practices. Radiologists at the main office conduct after-hours and weekend reading for hospitals and urgent care centers, as well as daytime teleradiology services for physician practices.Thanks to our technology upgrade, we now have a global patient worklist that equips radiologists to read urgent exams first, followed by exams in their specialty and then general reading. This expedites reporting because all radiologists—regardless of their location—can read exams from the list.

Thanks to smooth communication with different vendors’ RIS and PACS, our practice enjoys a streamlined workflow that automatically delivers patient information and prior exams to radiologists and then automatically transmits a report to each provider’s RIS.

This workflow allows us to achieve significant service improvements:

  • We offer immediate reporting for urgent studies and provide final reports to clinicians—even after-hours;
  • Routine reports are usually issued within several hours; and
  • We can populate data fields in each facility’s EMR.

In addition to integrating our reports with EMR systems, we have structured our reports to address each facility’s specific needs.

Our group is positioned for the future now that we are equipped with technology that enables us to deliver a higher standard of reporting along with the ability to integrate reports and data into healthcare providers’ EMR systems.

Taking Vendor-Neutral Archiving a Step Further

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Vendor-neutral archiving is a hot topic because it promises to help healthcare providers improve image and sharing  while simultaneously reducing costs. An article just published by Auntminnie Europe  outlines five advantages (below) of vendor-neutral archiving. Here are some practical examples of how archiving platforms and other tools are being used by healthcare providers worldwide to fulfill these objectives:

1. Enhanced business continuity
: Archiving services via the Cloud should also offer secure, yet accessible disaster recovery that ensures data availability when a local site is down. Data can also be delivered using a vendor-independent, zero-footprint viewer so clinician workflow is not interrupted.

2. Reduced storage cost
: Applying clinical lifecycle management techniques enables purging of old data that no longer requires retention by national or regional regulations. This allows healthcare facilities to maximize their storage resources.

3. Reduced migration cost:
Why not eliminate migration costs altogether? For example, Carestream offers a “take over” capability that can index a legacy DICOM archive and present a single worklist seamlessly to the end user. This equips users with rapid, easy access to a patient’s entire clinical portfolio that is stored on a variety of servers throughout a healthcare system.  Learn about the experience of St. John Medical Center in Tulsa, Oklahoma:

4. Image sharing: A fully-featured zero footprint viewer can present medical images, reports and clinical notes on mobile devices such as iPads as well as workstations. This vital tool delivers rapid, easy access to information, which enables greater collaboration among radiologists, clinicians and referring physicians.

5. Non-image sharing: In addition to images, a universal viewer should be embedded with an EMR to support non-DICOM data such as JPG, MPEG, PDF, BMP, DOC, and XLS formats so clinicians can view the entire patient clinical portfolio within a single window. This creates a holistic view of the patient, which is a major focus in enhancing patient care.

Healthcare facilities that are evaluating this valuable resource need to select a supplier that offers futuristic capabilities today, with a flexible platform that can accommodate continued expansion of service options. Carestream was named the world’s second largest supplier of vendor-neutral archiving solutions in a April 2012 report issued by InMedica, a division of IMS Research.

Are you evaluating vendor-neutral archiving for your healthcare facility? What are the primary benefits you hope to gain? 

SIIM 2012 Scientific Poster – CAPTCHA Challenge-Response System To Assess Monitor Performance

Eliot Siegel

Eliot Siegel, M.D.

Editor’s Note:  At events like SIIM 2012 attendees must juggle learning sessions, networking activities and exhibits. Hopefully you had time to tour the scientific posters displayed throughout the meeting space that feature the innovative research being done in the field of imaging informatics. If you missed the poster presentations, Dr. Eliot Siegel , Professor and Vice Chair at the University of Maryland School of Medicine, Department of Diagnostic Radiology, as well as Chief of Radiology and Nuclear Medicine for the Veterans Affairs Maryland Healthcare System, shares an overview of his team’s poster on testing monitor performance.

Repurposing a Traditional CAPTCHA Challenge-Response System

to Assess Monitor Performance Metrics Including Contrast and Spatial Resolution

Jigar B. Patel, MD1; Stephen J. Siegel, BS2; Joseph J. Chen3, MD; Eliot L. Siegel, MD1,3

Baltimore Veteran Affairs Medical Center, Baltimore, Maryland1

University of Maryland Baltimore County, Baltimore, Maryland2

University of Maryland School of Medicine, Baltimore, Maryland3

The most frequently asked question over the years, and this SIIM 2012 was no exception, has been about the use of “off the shelf” in comparison to “medical grade” monitors.  There has been a substantial trend to cut costs not only outside the radiology department but also within the radiology department and utilize these much less expensive “off the shelf” monitors.

The compelling argument for the “off the shelf monitors,” of course, is that they can result in major cost savings, especially in a medium to large healthcare facility.  The strong argument for “medical grade” monitors is the image consistency, ability to more easily calibrate using the DICOM grayscale presentation function, higher luminance, and easier monitor testing which could provide documentation in the event of a medicolegal challenge.

The difference between the best “off the shelf” and medical grade monitors is probably relatively small, but there are no diagnostic imaging consumer reports and manufactures of the “off the shelf” monitors can vary significantly as vendors change manufacturer or other components.

We presented a poster that describes a rapid and easy way to test any type of monitor and this has allowed us to see surprising variability in the monitors that we use in our own department, whether they are medical grade or “off the shelf.”  The solution is based on a challenge test that can be given to a user to determine whether he/she can use a PACS workstation or, alternatively, could be used to report to a PACS administrator that the monitor is not meeting a given standard for display.

Rather than using the SMPTE (Society of Motion Picture and Television Engineers) pattern that we are all familiar with (below) we used a challenge similar to the CAPTCHA challenge that is meant to distinguish a human from a computer in order to get access to data or programs on web sites.

Users are presented with a six letter word that is written in almost black on a black background and almost white on a white background as well as a six letter word written in a small font.  The PACS administrator can determine for various types of users (e.g. Radiologists, technologists, clinicians), locations, or monitor types what percentage of deviation the black writing is from the black background (e.g. The SMPTE pattern uses 5%), the percentage difference of the almost white on white background, and the size of the font.

So when a user first signs onto the system, the user is asked to read and type in the three 6-letter words corresponding to the black, white, and small font challenges. The administrator gets the results of this challenge test which could be used to block use of the workstation or more likely to audit and identify sub-optimal monitors.

We have found the tool to be very sensitive to small differences between monitors and it has been surprising how much of a difference it can make to look at a monitor from above in comparison to below or from the side in being able to pass these three tests.

This could be a very useful test for many purposes but especially to alert users as to the performance of a monitor which can vary considerably depending on whether or not it has “warmed up” or on the angle in which the images are reviewed.

Top 10 Imaging Informatics Blog Posts on Everything Rad

Erica Carnevale

Erica Carnevale, Digital Media Manager, Carestream

Today kicks off the 2012 Society for Imaging Informatics in Medicine (SIIM) Annual Meeting. Radiology and health IT administrators and practitioners are convening in Orlando under the timely theme of “Strategic Innovation Through Enterprise Image Management.” Diagnostic imaging trends are converging—an explosion of big data, system consolidation and scarce IT resources is erupting at the same time as the emphasis on accountable care and value-based purchasing—making innovation in enterprise image management crucial to the transformation of healthcare.

What innovations, best practices and enterprise image management solutions will SIIM veterans and newbies (like me) be on the hunt for this week? The educational program is packed with sessions like:

These topics come as no surprise to me, as they mirror our top 10 most popular imaging IT posts on Everything Rad (in no particular order):

  1. Don’t Fear Migrating PACS Data from the Cloud
  2. Stage 2 and the Health Affairs IT Study Debate
  3. Inside IT Strategies – Moving Radiology Workflows to the Cloud
  4. What Are You Spending on Image Management?
  5. Consumerized Healthcare: HIEs Will Only Succeed with Patient Access to Imaging Data
  6. Cloud Security in the Medical Imaging Environment
  7. Radiology Workflow, Data Transmission and Storage in the Age of Meaningful Use
  8. Reviews the CARESTREAM Vue Motion Medical Image Viewer
  9. Loire Region Cloud Project Draws Attention
  10. Q&A with Intel’s Chief Architect of Healthcare

SIIM LogoSo if you’re at the show waiting for the opening general session, these posts are a great primer for the themes that will guide us in the next few days. If you’re not in Orlando, stay tuned to Everything Rad for more coverage from SIIM 2012.

Come armed with questions to booth #505 for our imaging IT experts or ask for me to share your best practices or image management opinion on Everything Rad.

Not at the show? That’s what the comment section is for. Leave your questions or opinion below – we look forward to the discussion!