1. Integrating external data in your PACS or EPR Jan Willem Kuiper, Kees Broekman Leen de Baat, Peter Speksnijder Rotterdam, The Netherlands A patient with data on CD, now what?

2. INTRODUCTION The Rotterdam situation Data production radiology: 10 Tb year Full redundant environment installed over 2 Main Equipment Rooms (MER) in separated buildings Mirrored working storage with uncompressed data: 15 Tb and counting …. SAN archive (compressed) data: 10 Tb and counting …. 45 modalities including 64-, 16- and 4-slice CT scanners 35 diagnostic viewing stations at radiology >1200 medical workstations >1200 potential EPR users EuroPACS-MIR 2004

3. 160.000 annual first outpatient visits Estimate: 10% with data from referring hospitals 70% of Dutch hospitals with a full radiology PACS Amount of incoming digital data is increasing dramatically That means: a lot of CD’s! INTRODUCTION general reference data EuroPACS-MIR 2004

4. Security/Administrative: no CD drive in medical workstations Images cannot be viewed in doctor’s office, but only in private quarters on personal PC’s Many different user interfaces in viewers Some viewers don’t work The clinician’s need to archive images temporary or permanent can’t be fulfilled Images not available in Radiology PACS for comparison or second-opinion consult PROBLEMS external data on CD EuroPACS-MIR 2004

5. Some patients not registered in HIS Patients not registered in RIS Results in extra administrative work (radiology) Images not always in DICOM available Radiology is not responsible for storing these images (producer’s responsibility) More need for temporary storage, deleting images in radiology PACS not possible after archiving (legal issue) 16.000 CD’s annually is a lot of work and data PROBLEMS ”just archive the data in your PACS” EuroPACS-MIR 2004

6. SOLUTIONS ”short term solutions in Erasmus MC” EuroPACS-MIR 2004 Extra PC’s in clinic and ER with CD player for reviewing images, stand-alone systems In Radiology extra PC’s for reviewing images drawback Results in extra cost for hardware Clinicians need to be able to handle various viewers Still no solution for storing images in EPR Current ß-version PACS viewer (Philips MS IDS5-web) not yet available as standard viewer Standard for storing radiology data on CD (vendors)?

7. SOLUTIONS ”current solutions in Erasmus MC” EuroPACS-MIR 2004 Locally developed ‘shell’ for Hospital Information System incorporates viewers for various clinical applications including PACS data.

8. External data on CD’s In Erasmus MC PC Medical Docter HIS Registered? Administrator 8-5 new X Readable? Archive needed? No Yes End NoYes DICOM workstation CD drive HIS Registration No Adapt DICOM header with HIS patient ID Yes PACS Server HIS SOLUTIONS ”Data flow in Erasmus MC”

9. SOLUTIONS ”CD Data integrated in EPD” EuroPACS-MIR 2004 Locally developed ‘shell’ for Hospital Information System incorporates viewers for various clinical applications including PACS data. Video animation showing external data radiology viewer

10. FUTURE NEEDS ”for solving the CD problem” EuroPACS-MIR 2004 Awareness that there is a problem with data on CD One web based viewer for all radiology images Possibility to use viewer in stand-alone situation Standardization needed for CD Data –DICOM and no proprietary vendor specific formats –DICOM Dir in main directory Connecting all local and national hospitals and implementing nationwide unique patient ID number Have “old-fashion” hardcopy films available as long as needed.