Picture Perfect: Imaging Strategies in Pathology

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Picture Perfect Imaging Strategies in Pathology

• Cerner Health Conference 2005
• Orlando, FL
• October 9 12, 2005

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Why Do Imaging in Pathology?

• UPMC Perspective
• Strengthen the reporting of results in anatomic
  pathology
• Provide images for tumor boards and build
  libraries of images for teaching
• Correlation between microscopic appearance, the
  clinical presentation, and gross specimen
  appearance
• Image on reports as A Marketing Tool

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Why Do Imaging in Pathology?

• Cerner Perspective
• Promotes a single, central point of data for each
  specimen
• Temporary states such as tissues during gross can
  be recorded
• Requisitions, diagrams, lab results, consult
  reports, plus other pertinent info are tied
  directly to AP data
• Quicker access to pertinent microscopic
  information
• No need to request retrieval from storage and
  re-locate area of interest on the slide
• Images access from any enabled workstation can
  eliminate tedious slide or paperwork retrieval
  activities
• Images are directed to permanent storage
  immediately, minimizing impact due to misfiling
  or misplacement
• Images on reports are cool our clients want
  cool reports!

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Overview of our Plan

• The 2001 Image Solution Project
• Upgrade UPMCs Imaging Solution to accommodate
• Better integration with AP system
• Improve correlation of different phases of the
  specimen via image use
• Enhance teaching curriculum via image use by
  keeping a file of all interesting cases
• Enhance tumor board presentations exporting
  selected images into PowerPoint
• Include images on patient reports

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Challenges Associated with Imaging

• Software-hardware compatibility
• Gross and microscopic camera types
• Scanner types
• Workflow
• EASE of use
• Image storage
• Local Area Network (LAN) support
• Deployment and support of image capture
  workstations over the UPMC Health System
• Inability of results interface (HL7) or archival
  systems to store and/or manage images

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Meeting Challenges Head-on

• Hardware/Software Compatibility
• Assessment of current hardware
• Grossing Stations
• 5 existing Sony Video cameras at became
  go-forward hardware
• Microscopic workstations
• 11 Existing Sony Video cameras would be used
• Added 12 Spot Insight digital camera workstations
• Scanners
• 3 Scanners used at transcription workstations
• Worked with vendor to find new compatible cameras
• Camera compatibility is on-going issue as
  technology changes

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On-Going Technology Changes

• Researching New Hardware and Compatibilities
• Research cycle generally follows Bills release
  cycle
• Workstation hardware, OS, and acquisition devices
  all need to work together
• Steps undertaken
• Install PICSPlus on designated Test Environment
  workstation
• Acquire new hardware/OS
• Obtain loaner acquisition device of interest
• Test, Test, and Test again!
• Cost justification ever-present challenge
• Staff is happy to get new toys!

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Meeting Challenges Head On (continued)

• Needs and Workflow
• Demands from Grossing Bench
• Easy maintain current standards
• Demands from the Pathologists
• Specific requests for digital cameras in personal
  offices
• New workflows investigated and implemented for
  scanning
• requisitions
• reports

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Meeting Challenges Head On (continued)

• Image Storage
• Image capture predictions were way off
• In actuality, approximately 2300 images are
  acquired per month
• We check storage stats daily!
• Expansion of storage space done
• Local Area Network Configuration
• 12 acquisition devices were added
• Images are captured and viewed from 4 out of 9
  different hospitals
• Storage is on a single image server
• Image Server Maintenance and Backups

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Meeting Challenges Head On (continued)

• Deployment throughout UPMC Health System
• Deployment Plan
• Since we had an existing solution, all
  workstations came on-line at same time
• Educating the end-users
• initial one-on-one training for Spot Insight and
  Scanner users
• Continuous Education
• High turnover in transcription staff
  predominately takes on this training
• Training is on-going for new residents and fellow
• Image Acquisition Go Live

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Meeting Challenges Head On (continued)

• Supporting Imaging Workstations and Users
• Support Needs
• At the beginning, support requests predominately
  due to training issues
• including my own education
• Once things settled down, now I see
• As cameras age, these issues increase most
  cameras are 5 years old
• White balance is most prevalent issue
• found California vendor to refurbish cameras,
  effectively resetting cameras standard default
  setting

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Meeting Challenges Head On (continued)

• Interfaces Other Systems cannot handle Images
• HL7 Result Interfaces are used to transmit
  results to hospital system
• We do not transmit reports with imbedded images
  to other systems
• Printing Reports with Images
• Consulted with other sites using images on
  reports for Printer recommendations
• Lexmark C910 Model
• Our clients are very happy with image-enabled
  reports!

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Advances in Imaging Internet Ready Devices

• Nikon COOLSCOPE
• Microscope with built-in digital camera used for
  capturing and consultation over the network

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Internet Ready Devices (continued)

• Nikon DS-U1 PC based camera
• Observation, photography and networking are all
  possible with this single unit

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Our Imaging Solution In Pathology

• The PICSPlus Advantage
• Provides a solution for management of macroscopic
  and microscopic images and related case
  information
• Images can be acquired using a wide variety of
  equipment digital and video cameras and TWAIN
  compatible devices
• Ability to import send-out report files,
  annotated diagrams and imported copies of
  requisitions

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PICSPlus (v2.4) Use at UPMC

• Server Scalability/Multiple servers available
• 1 server, high acquisition rate that might change
• PICSPlus Maintenance Module
• Image Server and Acquisition Workstation Activity
• Used quarterly to monitor usage
• Lost Image detection tools
• Nice to have, hoping I never have to use!
• Selectable image quality for reports
• Default quality setting works well for us
• Updated Acquisition Module Implemented
• Need for this dictated by hardware problem

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Image Acquisition

• Updated Acquisition Features Gained
• Report linkages indicated in Gallery
• Streamlined Matrox acquisition
• Template definition per workstation

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Image Acquisition

• Acquisition of images through the image gallery
  manager window
• Provides a simple key stroke to acquire images
  into the gallery
• Ability to switch options, import from TWAIN,
  import from file or import from Matrox

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Image Gallery Manager
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Image Gallery Manager

• PICSPlus Gallery Manager contains the following
  components
• File Menu close manager and return to
  CoPathPlus
• Edit Menu delete selected image file(s)
• Attachment Menu import from file,export from
  file, import from Matrox, import from TWAIN
• Option Menu select default templates (PICSPlus
  Template Dictionary, gross image, microscopic
  image, etc.) and import action (import from File,
  TWAIN or Matrox) per workstation
• Parameters assigned to selected image file
• Linked to Reports indicates whether an image is
  included on any patient reports and the report
  status

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Importing Reports
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Importing Diagrams
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Image View Manager

• PICSPLus View Manager contains the following
  components
• Zoom controls allows you to increase of
  decrease the size of the image in the viewer
• Annotation feature objects placed on images to
  focus on a specific area of interest
• Copy to Clipboard ability to copy the image
  with annotations to the Clipboard
• Burn Annotations allows you to PERMANENTLY
  apply the annotation to the image

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PICSPlus Report Gallery
No specific guidelines for acquisition volumes
and report assignments
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Images on Patient Report
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Reporting Considerations

• Report Manager Functionality
• Report image gallery displays all the image(s)
  selected to be on the patients report
• To transfer image(s) from the image gallery to
  the report gallery, click and drag!
• Benefits and Cautions
• Image(s) on reports is a very effective marketing
  and educational tool
• Clinicians are warned that image(s) on reports
  are for reference purposes, not clinical
  diagnosis

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Thank You

• Any Questions or Comments?
• We have Cerner experts in the audience to handle
  solution-specific questions

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(No Transcript)
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PICSPlus v2.5 Features

• Preview of Coming
• Attractions

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PICSPlus General Features

• 2 new activities streamline workflow and reduce
  window painting requirements
• PICSPlus Image Entry/Edit
• PICSPlus Report Image
  Select

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PICSPlus Image Entry/Edit
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Updated Image Gallery
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PICSPlus Report Image Select
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PICSPlus Report Manager
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Gallery Review Feature

• Gallery Review functions cycle through slides in
  sequence as found in respective gallery
• Image Gallery Review shows PICSPlus Gallery
  images
• Report Gallery Review shows Report Gallery images
• Use timed review or press spacebar to move
• Display Setup configures
• Timer
• Magnifier height, width, and shape
• Times Magnification

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Image Gallery Review with Setup Window
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Image Gallery Review with Right-Click Menu
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Image Gallery Review with Magnifier
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PICSPlus View Manager Features

• Redesigned Image Review and Annotation features
• Four tabs of data and tools in View Manager
  Marks, Process, Color, and Info
• Updated annotation tools
• Orientation options to Flip and Mirror with
  degrees designated
• Moving magnifier in maximized view Gallery
  Review
• Picture in Picture Mark, can use to add lab logo
• Undo operations

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View Manager Marks Tab
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View Manager Process Tab
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View Manager Colors Tab set Blue
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View Manager Info Tab
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Images on Signed Out Cases
Image on Report
Image not on Report

• Image Annotations
• NOT allowed if image on S/O report
• Allowed if image NOT on S/O report

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Tools and Utilities

• New install is more gentle and straight-forward
• when activating a PICSPlus Add-on in Wkstn Setup,
  the system tells you when to run Workstation
  Add-on Install
• Nothing is assumed, add each desired component
• JPEG-2000 compression schema recovers disk
• Scheduled Background conversion
• Just in Time conversion
• Support of 26 major file formats for import
• Previously just jpeg, tiff, and bmp were
  supported
• Multi-page tiff images supported