Coming Attractions Future Capabilities for VistA Imaging

1
Coming Attractions Future Capabilities for
VistA Imaging

• Ruth Dayhoff and the VistA Imaging Team

2

• DICOM

3
Patch 69 (Caché)

• Migration of DICOM Gateway from MSM to
  InterSystems Caché
• Supported version of MUMPS
• Same implementation as VistA HIS
• Minimal application code change
• Much better installation procedure

4
Patch 66 (DICOM Query/Retrieve)

• Query/Retrieve is the DICOM Standard mechanism
  used by a medical device to find and retrieve
  studies from another medical device containing
  the desired information
• Query gives a medical device the ability to
  determine a studys existence on the VistA
  Imaging database
• Retrieve gives a medical device the ability pull
  the study from VistA Imaging back to the
  requesting medical device.
• Causes VistA Imaging to send the studies as DICOM
  objects

5
Update Commercial PACS Interface

• Current 1997 commercial PACS interface is
  outdated
• Uses VA-defined non-standard messages
• Migrate to IHE-based PACS interface
• Promotes interoperability
• Improves Patient Safety
• Needed to support the requirement for VistA
  Imaging to be the permanent archive for all
  digital medical images

6
Migrate to IHE-based PACS Interface

• Benefits of IHE-based deployment
• Well-understood, industry-standard definitions of
  data elements and communications
• Enables validation of commercial systems against
  industry profile
• Uses HL7 messaging for orders and demographics
• Uses DICOM messaging for worklist queries and
  images

7
Current state of VistA interfacing to commercial
PACS (1997 vintage)
8
Current state of VistA interfacing to commercial
PACS (1997 vintage)
9
IHE-Based VistA interfacing to commercial PACS
10
IHE-Based VistA interfacing to commercial PACS
11
IHE-Based VistA interfacing to commercial PACS
12
Patch 49 IHE-based HL7 PACS Interface Messages

• Works with RAD5.047
• Study Instance UID generated by VistA Imaging and
  passed to Commercial PACS
• Improves Patient Safety
• Site-specific Accession Number
• Needed for VA enterprise-wide imaging
• Specifications are published on the Web
• www.va.gov\imaging

13
Patch 55 IHE-based DICOM PACS Interface Messages

• Provides industry-standard method for copying of
  images from PACS to VistA
• Image Availability Notification message sent from
  PACS to VistA
• Indicates DICOM objects that can be retrieved
  from the PACS
• VistA will pull these objects to its archive
• VistA will contain an additional capability to
  track the progress of missing PACS studies and
  pull them, when necessary

14
Patch 34 Storing all DICOM Objects in VistA
Imaging in DICOM format

• VistA Imaging is the long-term archive for the VA
  (System of Record)
• Any DICOM object will be able to be stored on
  VistA and accessed via Q/R
• Some DICOM objects stored on VistA may not be
  displayable (e.g., used for processing)

15
Patch 34 Enhanced Duplicate DICOM UID Checking

• Unique Identifiers (UIDs) designate Study,
  Series, and Image entities in DICOM
• Problems have occurred in the VA when UIDs are
  not unique
• VistA Imaging will check for duplicate DICOM UIDs
• Email will automatically be generated used to
  notify people of duplicates
• First part of a comprehensive duplicate UID
  handling scheme

16
Outside Radiology Reports

• Radiology Project that includes VistA Imaging
  enhancements
• Indicator for Outside Reports
• Administratively complete outside radiology
  reports in VistA
• Provide proper workload credit

17
DICOM IMPORTER

• Importing DICOM images from outside institutions
  is labor intensive
• Must place Radiology order on VistA use DICOM
  Modality Worklist
• IMPORTER application will use new radiology
  automated order entry capability
• User time to import a study drops from 7-15
  minutes to 30 seconds
• Will work for both CDs and miss-associated DICOM
  images

18
Select Study from CD
19
Verify Study Selected
20
Select Image to Review
21
Verify Image
22
Select Radiology Procedure for Study
23
Select Patient for Importation of Study
24
Select Additional Studies for Patient
25
Importing Study
26
Studies Available for Viewing in CPRS and VistA
Imaging
27
Clinical Display (P72)

• Clinical Display Demo
• VA/DOD Image Sharing
• Radiology Viewer Changes

28
Patch 72

• DICOM Encapsulated PDF
• Provides a means to obtain computer generated
  reports into VistA Imaging
• Some newer instruments can output these directly
• 3rd party vendors can convert printer output from
  legacy devices
• Complements DICOM Structured Reporting

Original PDF
29
DICOM ECGs (far future)

• ECGs are handled as DICOM objects
• Allows ECG equipment components to be
  interchangeable (carts, interpretation software,
  databases)
• Discrete data permits a variety of processing
  capabilities
• Different kinds of presentation (different leads,
  for example)
• Comparisons between examinations, difference
  analysis

30
Recent Patch Releases

• Patch 59 TIU lt-gt Imaging Enhancements
• Targeted for release August 2007
• Link Image to New Note, Addendum, Existing Note
• Administrative Closure
• Select date of document
• Date/Time of Image lt-gt Note Association  

31
Upcoming Patch Releases

• 62 Imaging Release of Information (ROI)
• Print All/Selected documents and images
• Copy (Burn) Images to CD
• Create PDF from Images for export
• 93 Imaging Display
• Usability enhancements - Image groups
• Filter enhancements
• 94 Imaging Capture
• Multiple page color documents

32
Future Patches

• Watermarking of Rescinded Advance directives
• Placeholder for Deleted Image
• No more scanning placeholder.
• Image Edit functions
• Images scanned/attached to wrong report
• Images scanned/attached to wrong patient.
• Image Index Edit
• Modify index fields

33

• VistARad

34
VistARad

• Patch 76 in field test
• Integration with Voxar 3D
• Section 508 compliance

35
VistARad 508 Compliance and Voxar 3D Integration
36
VistARad 508 Compliance and Voxar 3D Integration
37
VistARad

• End of life Patch 32
• Acquisition Date/Time

38
VistARad User Site Survey

• Establish VistARad priorities
• Collect input from users on needs
• Prioritization of enhancements
• Planning for future patch releases

39
VistARad User Input

• Routing tracking and management
• Auto-route related priors with On-Demand Routing
• Teleradiology improvements
• Ability to read exams from multiple sites
• Multi-site combined worklist features
• Remote image view capability

40
VistARad User Input

• Hanging Protocol Enhancements
• Simplify Master Image Set definitions
• Definitions to display exams in the VistARad
  Browser Window on load
• Export/Import of HP definitions
• Annotation improvements
• Ultrasound measurements support

41
VistARad User Input

• Open images from the series (vs. study) level
• Immediate image display when loading
• Workflow management improvements
• ReadList interactions
• Display images from a Reserved exam
• Flag problem exams interrupted session
• Enhance Integration with Dictation and 3D systems

42
VistARad User Input

• Teaching file support
• Support Mammography screening on mammography
  approved video sub-systems
• Technology upgrades
• 64-bit platform for expanded memory requirements
• Technologist QA/Status tracking function
• Display of scanned documents

43
VistARad User Input

• Mensurated Scale
• DICOM Conformance Updates
• Enhanced CT and MR (Multiframe)
• Process Group 6000 Overlay data
• Grayscale Softcopy Presentation State
• Contrast/Brightness adjustment for color images

44
Thank You!