Building blocks for a clinical imaging informatics environment.

Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064-1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions.

Informatics in radiology: automated Web-based graphical dashboard for radiology operational business intelligence.

Radiology departments today are faced with many challenges to improve operational efficiency, performance, and quality. Many organizations rely on antiquated, paper-based methods to review their historical performance and understand their operations. With increased workloads, geographically dispersed image acquisition and reading sites, and rapidly changing technologies, this approach is increasingly untenable. A Web-based dashboard was constructed to automate the extraction, processing, and display of indicators and thereby provide useful and current data for twice-monthly departmental operational meetings. The feasibility of extracting specific metrics from clinical information systems was evaluated as part of a longer-term effort to build a radiology business intelligence architecture. Operational data were extracted from clinical information systems and stored in a centralized data warehouse. Higher-level analytics were performed on the centralized data, a process that generated indicators in a dynamic Web-based graphical environment that proved valuable in discussion and root cause analysis. Results aggregated over a 24-month period since implementation suggest that this operational business intelligence reporting system has provided significant data for driving more effective management decisions to improve productivity, performance, and quality of service in the department.

Novel, Web-based, information-exploration approach for improving operating room logistics and system processes.

Routine clinical information systems now have the ability to gather large amounts of data that surgical managers can access to create a seamless and proactive approach to streamlining operations and minimizing delays. The challenge lies in aggregating and displaying these data in an easily accessible format that provides useful, timely information on current operations. A Web-based, graphical dashboard is described in this study, which can be used to interpret clinical operational data, allow managers to see trends in data, and help identify inefficiencies that were not apparent with more traditional, paper-based approaches. The dashboard provides a visual decision support tool that assists managers in pinpointing areas for continuous quality improvement. The limitations of paper-based techniques, the development of the automated display system, and key performance indicators in analyzing aggregate delays, time, specialties, and teamwork are reviewed. Strengths, weaknesses, opportunities, and threats associated with implementing such a program in the perioperative environment are summarized.

Radtracker: a web-based open-source issue tracking tool.

Radiology departments are besieged with a multitude of information systems, each needing significant technical support. Information systems include the dictation system, the radiology information system (RIS), the picture archiving and communication systems (PACS), and every workstation and acquisition modality along with any dedicated system such as a teleradiology solution or specialized reporting tools. Typical radiology departments have very limited resources available to provide support. The challenges facing technical support are in responding to mission critical applications during a failure, building a knowledge base for each system, and providing clear communication with the users of the system experiencing problems. We have constructed a web-based support method that addresses the 3 main challenges of supporting so many different information systems with a formalized response mechanism. The website allows anyone to easily submit issues by describing the problem and selecting a specific category. Each support person subscribes to categories for which they are qualified. High-priority issues will be sent automatically to the alphanumeric pagers of the support personnel with the description of the problem. Drill down capabilities on the website allow searching of resolved and unresolved problems. Automatic emails are sent out to the person submitting the problem every time an action is taken to keep them in a closed loop. This tool pools the limited resources of the department and formalizes response mechanism to provide optimal support to the users.

PACSPulse: a web-based DICOM network traffic monitor and analysis tool.

PACSPulse, an open-source tool, was developed to identify and analyze the performance bottlenecks of picture archiving and communication systems (PACS). PACSPulse provides a graphical Web interface for straightforward analysis of PACS performance on the basis of data acquired by tracking usage by network, server, workstation, type of traffic, and time of day. The PACS archive logs performance and usage data on image traffic being sent to it from the imaging units and study data requested by users. The performance log is sent via file transfer protocol (FTP) to a separate server for analysis. The data are parsed and sent to a database server connected to a Web server. The Web site is used to depict trends in the performance of the entire system to detect signs of degradation. The system was built entirely of open-source components for the operating system, database, charting tool, and Web server. Performance monitoring is an essential tool for analyzing, understanding, and predicting the performance characteristics of a PACS.