Kevin ODonnell, Toshiba Medical Research Inst. Co-chair, IHE Radiology Planning Cmte.

Presenter perceives no conflict of interest with this presentation but discloses being an employee of: Toshiba Medical Research Institute USA, a division of Toshiba Medical Systems

The future is already here, its just not evenly distributed yet – Paul Saffo JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Outbreak Mgmt PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Client Registr y Provider Registry Location Registry Terminology Registry POINT OF SERVICE Hospital, LTC, CCC, EPR Physici an Office EMR EHR Viewer Physician/ Provider Business Rules EHR Index Message Structures Normalization Rules Security MgmtPrivacy Data Config Services Physician/ Provider Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider Longitudinal Record Services HIAL Communication Bus Common Services

and… or…

Easier, perhaps. You may be part of the problem.

IHE Portable Data for Images (PDI) Profile Standardize media IHE Import Reconciliation Workflow (IRWF) Profile Fix demographics, IDs and codes IHE Basic Image Review (BIR) Profile Baseline behavior for viewer software

Compatibility requirements Standard CD format and file system Consistent disc organization Use most generic DICOM media profile Images MUST be present in DICOM o May have copies as web content (i.e. JPEGs) Avoid most common mistakes (highlighted)

Connectathon testing Peer-to-Peer vendor testing Results checked by RSNA project managers 50+ companies tested PDI in the last few years

Endorsed by AMA/ACR/AANS/ACC/… Stopped just short of declaring it standard of care Buying equipment that burns DICOM media? Ask that it support PDI as a Media Creator Receiving media frequently? Ask the provider for PDI compliant media

Additional Media: Compression Optionally allowed; but leave policy to PACS On-board Sender Software recommended. Encryption Optionally allowed; password based Please consider support needs before creating DVD

1) Insert CD; Run SendSoft 2) Enter Password: 5) DICOM Association Negotiation 7) Send Images (C-STORE) 4) Enter Destination: 3) SendSoft Decrypts CD Images 6) SendSoft decompresses & converts CD Images (as needed)

Improvements to consider: Staff pre-load media onto your drive / Import media into PACS Install YOUR preferred viewer / Use your reading workstation Reconcile patient demographics & IDs to integrate with local records

The Images are in the PACS but are messed up The patient ID is wrong, it doesnt come up in a query I cant hang the new images with the old The unknown procedure codes mess up my hanging protocols The images arent linking to the EMR. Patients chart wont come up Impact: Lost time Incomplete data Drags on effectiveness

During image import, details are fixed to match (or not conflict with) local values Patient IDs, Name Procedure Codes, Accession Numbers, etc. Two ways of getting demographics DICOM Worklist HL7 Demographics Feed

Work In Progress BASIC Image Review Defines a Baseline Feature set Look and feel Performance Minimum Platform Advanced Button = Show me what else you can do

Facilities distribute images; Physicians review them Rising frustration; too often the viewer: requires installation on a locked down machine does not successfully run starts up too slowly does not successfully load the images warns the images are non-diagnostic is missing some basic critical function has Yet Another GUI where basic operations are non-obvious Impact: delayed care, inaccessible information, repeat examination and irradiation, and poor use of valuable clinician time.

Trial Implementation Spec. in June Potential applications of BIR Spec. Media Viewer (PDI Option) o Requires a BIR Compliant viewer be placed on media Third party viewer Web Portal

Radiologists may be unaware of the pain suffered by the clinicians (i.e. their customers) Ask for PDI compliance in media & equipment Consider IRWF if you import regularly Watch for BIR in the near future Pursue the future; And have backup plans. Any sites here that didnt use their fax last month?