10 Steps to Strategically Build and Implement your Enterprise Imaging System: HIMSS-SIIM Collaborative White Paper.

An enterprise imaging (EI) strategy is an organized plan to optimize the electronic health record (EHR) so that healthcare providers have intuitive and immediate access to all patient clinical images and their associated documentation, regardless of source. We describe ten steps recommended to achieve the goal of implementing EI for an institution. The first step is to define and access all images used for medical decision-making. Next, demonstrate how EI is a powerful strategy for enhancing patient and caregiver experience, improving population health, and reducing cost. Then, it is recommended that one must understand the specialties and their clinical workflow challenges as related to imaging. Step four is to create a strategy to improve quality of care and patient safety with EI. Step five demonstrates how EI can reduce costs. Then, show how EI can help enhance the patient experience. Step seven suggests how EI can enhance the work life of caregivers and step eight describes how to develop EI governance. Step nine describes the plan to implement an EI project, and finally, step 10, to understand cybersecurity from a patient safety perspective and to protect images from accidental and malicious intrusion.

A Web-Based Response-Assessment System for Development and Validation of Imaging Biomarkers in Oncology.

Quantitative imaging biomarkers are increasingly used in oncology clinical trials to assist the evaluation of tumor responses to novel therapies. To identify these biomarkers and ensure smooth clinical translation once they have been validated, it is critical to develop a reliable workflow-efficient imaging platform for integration in clinical settings. Here we will present a web-based volumetric response-assessment system that we developed based on an open-source image viewing platform (WEASIS) and a DICOM image archive (DCM4CHEE). Our web-based response-assessment system offers a DICOM imaging archiving function, standard imaging viewing and manipulation functions, efficient tumor segmentation and quantification algorithms, and a reliable database containing tumor segmentation and measurement results. The prototype system is currently used in our research lab to foster the development and validation of new quantitative imaging biomarkers, including the volumetric computed tomography technique, as a more accurate and early assessment method of solid tumor responses to targeted and immunotherapies.

Factors influencing the selection of a picture archiving and communication system: A qualitative study.

BACKGROUND: Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection. METHODS: This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. RESULTS: Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories. CONCLUSION: The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence.

INTRODUCTION: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS: A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.

Driving Innovation in Radiology: A Summary of the 2015 Intersociety Committee Summer Conference.

The membership of the Intersociety Committee convened to consider how best to continue to stimulate, nurture, and support innovation in radiologic research and education in the face of ever increasing clinical demands and financial constraints. The topic was chosen in recognition that the growth and success of radiology over the past 50-plus years have been driven by spectacular technological developments in imaging and intervention and that the future relevance of the specialty will hinge on how the specialty continues to evolve. To keep radiology a dynamic and vital component of the health care enterprise will require continued innovation in technology and the requisite education that goes with it.

Integrating the Radiology Information System with Computerised Provider Order Entry: The Impact on Repeat Medical Imaging Investigations.

Repeat and redundant procedures in medical imaging are associated with increases in resource utilisation and labour costs. Unnecessary medical imaging in some modalities, such as X-Ray (XR) and Computed Tomography (CT) is an important safety issue because it exposes patients to ionising radiation which can be carcinogenic and is associated with higher rates of cancer. The aim of this study was to assess the impact of implementing an integrated Computerised Provider Order Entry (CPOE)/Radiology Information System (RIS)/Picture Archiving and Communications System (PACS) system on the number of XR and CT imaging procedures (including repeat imaging requests) for inpatients at a large metropolitan hospital. The study found that patients had an average 0.47 fewer XR procedures and 0.07 fewer CT procedures after the implementation of the integrated system. Part of this reduction was driven by a lower rate of repeat procedures: the average inpatient had 0.13 fewer repeat XR procedures within 24-hours of the previous identical XR procedure. A similar decrease was not evident for repeat CT procedures. Reduced utilisation of imaging procedures (especially those within very short intervals from the previous identical procedure, which are more likely to be redundant) has implications for the safety of patients and the cost of medical imaging services.

Open-Source, Web-Based Dashboard Components for DICOM Connectivity.

The administration of a DICOM network within an imaging healthcare institution requires tools that allow for monitoring of connectivity and availability for adequate uptime measurements and help guide technology management strategies. We present the implementation of an open-source widget for the Dashing framework that provides basic dashboard functionality allowing for monitoring of a DICOM network using network "ping" and DICOM "C-ECHO" operations.

[Teleradiological report turnaround times: An internal efficiency and quality control analysis]. / Teleradiologische Prozess- und Untersuchungszeiten: Eine institutsinterne Effizienz- und Qualitätsanalyse.

AIMS: The teleradiological examinations performed at the Charité were analyzed for the purpose of internal quality and efficiency control. Data included the type and number of examinations performed, the time of day and week the examination was performed and the differences in teleradiologist report turnaround times. MATERIAL AND METHODS: A retrospective analysis of the radiology information system (RIS) database of all teleradiological computed tomography examinations performed at the Charité from 2011 through 2013 was carried out. The search retrieved 10,200 teleradiological examinations which were included in the analysis. The records were analyzed for the time of the day and week the examination was performed, the interval between examination and time of reporting, the type of teleradiological examination and the campus in which they were performed. RESULTS: The number of teleradiological examinations performed increased continuously during the observation period. Computed tomography of the head was the most frequently performed type of examination with 86%. Taking all forms of examination into consideration it took an average of 34 min until a report was written. Over the 3-year observation period the times remained virtually unaltered. CONCLUSION: During the 3-year observation period nearly constant report times could be observed in spite of the increased numbers of examinations. This indicates an efficiency enhancement and rational integration of teleradiology into the radiological workflow.

Multi-provider architecture for cloud outsourcing of medical imaging repositories.

Over the last few years, the extended usage of medical imaging procedures has raised the medical community attention towards the optimization of their workflows. More recently, the federation of multiple institutions into a seamless distribution network has brought hope of increased quality healthcare services along with more efficient resource management. As a result, medical institutions are constantly looking for the best infrastructure to deploy their imaging archives. In this scenario, public cloud infrastructures arise as major candidates, as they offer elastic storage space, optimal data availability without great requirements of maintenance costs or IT personnel, in a pay-as-you-go model. However, standard methodologies still do not take full advantage of outsourced archives, namely because their integration with other in-house solutions is troublesome. This document proposes a multi-provider architecture for integration of outsourced archives with in-house PACS resources, taking advantage of foreign providers to store medical imaging studies, without disregarding security. It enables the retrieval of images from multiple archives simultaneously, improving performance, data availability and avoiding the vendor-locking problem. Moreover it enables load balancing and cache techniques.

The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

The National Cancer Informatics Program (NCIP) Annotation and Image Markup (AIM) Foundation model.

Knowledge contained within in vivo imaging annotated by human experts or computer programs is typically stored as unstructured text and separated from other associated information. The National Cancer Informatics Program (NCIP) Annotation and Image Markup (AIM) Foundation information model is an evolution of the National Institute of Health's (NIH) National Cancer Institute's (NCI) Cancer Bioinformatics Grid (caBIG®) AIM model. The model applies to various image types created by various techniques and disciplines. It has evolved in response to the feedback and changing demands from the imaging community at NCI. The foundation model serves as a base for other imaging disciplines that want to extend the type of information the model collects. The model captures physical entities and their characteristics, imaging observation entities and their characteristics, markups (two- and three-dimensional), AIM statements, calculations, image source, inferences, annotation role, task context or workflow, audit trail, AIM creator details, equipment used to create AIM instances, subject demographics, and adjudication observations. An AIM instance can be stored as a Digital Imaging and Communications in Medicine (DICOM) structured reporting (SR) object or Extensible Markup Language (XML) document for further processing and analysis. An AIM instance consists of one or more annotations and associated markups of a single finding along with other ancillary information in the AIM model. An annotation describes information about the meaning of pixel data in an image. A markup is a graphical drawing placed on the image that depicts a region of interest. This paper describes fundamental AIM concepts and how to use and extend AIM for various imaging disciplines.

[Real-time scheduling. Assistance in resource planning]. / Terminvergabe in Echtzeit. Hilfe bei der Ressourcenplanung.

BACKGROUND: A radiology group practice with 50 physicians in 15 different locations required an integrated appointment planning system. OBJECTIVE: The project aimed at implementation of software for resources and appointment planning in a radiology information system (RIS) and the first complete implementation in the German-speaking world. IMPLEMENTATION: The practical aspects involved the definition of diagnostic features, documentation of personnel knowledge and digitization, definition and establishment of interfaces between the appointment calendar and the RIS and definition of access privileges. CHALLENGES: Problems included a high technical complexity (more than 50 interfaces), complex data material and time-consuming process (approximately 2000 working hours and total duration 9 months). RESULTS: Implementation of the system resulted in faster appointment assignment (90-120 s versus 3-5 min, 6-sigma measurement), higher data quality, excellent stability (as yet no system breakdown), reduced waiting times, higher personnel efficiency and improved utilization of instruments.

A reliable, low-cost picture archiving and communications system for small and medium veterinary practices built using open-source technology.

Picture Archiving and Communications Systems (PACS) are the most needed system in a modern hospital. As an integral part of the Digital Imaging and Communications in Medicine (DICOM) standard, they are charged with the responsibility for secure storage and accessibility of the diagnostic imaging data. These machines need to offer high performance, stability, and security while proving reliable and ergonomic in the day-to-day and long-term storage and retrieval of the data they safeguard. This paper reports the experience of the authors in developing and installing a compact and low-cost solution based on open-source technologies in the Veterinary Teaching Hospital for the University of Torino, Italy, during the course of the summer of 2012. The PACS server was built on low-cost x86-based hardware and uses an open source operating system derived from Oracle OpenSolaris (Oracle Corporation, Redwood City, CA, USA) to host the DCM4CHEE PACS DICOM server (DCM4CHEE, http://www.dcm4che.org ). This solution features very high data security and an ergonomic interface to provide easy access to a large amount of imaging data. The system has been in active use for almost 2 years now and has proven to be a scalable, cost-effective solution for practices ranging from small to very large, where the use of different hardware combinations allows scaling to the different deployments, while the use of paravirtualization allows increased security and easy migrations and upgrades.

Design and implementation of disaster recovery and business continuity solution for radiology PACS.

In the digital era of radiology, picture archiving and communication system (PACS) has a pivotal role in retrieving and storing the images. Integration of PACS with all the health care information systems e.g., health information system, radiology information system, and electronic medical record has greatly improved access to patient data at anytime and anywhere throughout the entire enterprise. In such an integrated setting, seamless operation depends critically on maintaining data integrity and continuous access for all. Any failure in hardware or software could interrupt the workflow or data and consequently, would risk serious impact to patient care. Thus, any large-scale PACS now have an indispensable requirement to include deployment of a disaster recovery plan to ensure secure sources of data. This paper presents our experience with designing and implementing a disaster recovery and business continuity plan. The selected architecture with two servers in each site (local and disaster recovery (DR) site) provides four different scenarios to continue running and maintain end user service. The implemented DR at University Hospitals Health System now permits continuous access to the PACS application and its contained images for radiologists, other clinicians, and patients alike.

Imaging informatics: essential tools for the delivery of imaging services.

There are rapid changes occurring in the health care environment. Radiologists face new challenges but also new opportunities. The purpose of this report is to review how new informatics tools and developments can help the radiologist respond to the drive for safety, quality, and efficiency. These tools will be of assistance in conducting research and education. They not only provide greater efficiency in traditional operations but also open new pathways for the delivery of new services and imaging technologies. Our future as a specialty is dependent on integrating these informatics solutions into our daily practice.

[Managing digital medical imaging projects in healthcare services: lessons learned]. / La gestión de proyectos de imagen médica digital en los servicios de salud: lecciones aprendidas.

Medical imaging is one of the most important diagnostic instruments in clinical practice. The technological development of digital medical imaging has enabled healthcare services to undertake large scale projects that require the participation and collaboration of many professionals of varied backgrounds and interests as well as substantial investments in infrastructures. Rather than focusing on systems for dealing with digital medical images, this article deals with the management of projects for implementing these systems, reviewing various organizational, technological, and human factors that are critical to ensure the success of these projects and to guarantee the compatibility and integration of digital medical imaging systems with other health information systems. To this end, the author relates several lessons learned from a review of the literature and the author's own experience in the technical coordination of digital medical imaging projects.

[The 'Surgical Deck': a new generation of integrated operational rooms for ENT]. / Das "Surgical Deck": Eine neue OP-Generation für die HNO-Chirurgie.

BACKGROUND: Existing operating room concepts do not meet modern technological opportunities anymore. The "Surgical Deck" is supposed to represent a prototype for a new operating room generation. The objective of the project is to achieve a better integration of functions and to develop an innovative concept for a highly developed surgical workstation. MATERIAL AND METHODS: 3 working areas are defined: Surgical, Airway and Technical Cockpit. The evaluation was conducted on 284 surgeries carried out from 01.08. 2011 to 31.01. 2012. The evaluation team consisted of 6 surgeons, 3 surgery nurses, 3 anesthesiologists and 4 anesthesia nurses. Within a detailed analysis, the data of 50 FESS surgeries were compared to those of a control group. RESULTS: Within the FESS group, the average slot time was reduced by 13%. 88.2% of those questioned assessed ergonomics as being better than in the conventional OR. 71.5% stated that the Surgical Deck provided an added value with regard to the surgical procedure. 91.3% confirmed that the system control required additional training. 79.3% described the cost-benefit-ratio as appropriate. For 96% of the surgeries, respondents said that they were feeling adequately supported by the technology. CONCLUSION: The results show a clear advantage of the system architecture. The Surgical Deck may present a solid foundation with regard to the transfer of the system into the clinical practice. This is relevant for new assistance functions such as process control software or navigation-based collision warning systems. It is to be expected that the project will significantly contribute to further develop the future surgical workstation and its standardization.

Putting image-sharing in the patient's hands .

A new digital technology has been developed by researchers at Wake Forest School of Medicine to allow unaffiliated institutions to transfer medical images, thus avoiding the hassle of CDs. Could the PCARE system offer a model for others to follow?