Electronic Medical Records

1
Electronic Medical Records

• A short tour of existing literature followed
  by commentary
• Part A Introduction and concepts tour in 51
  slides
• Part B Finishing the picture, in 27 slides.
• Plus an outsiders perspective of Bulgarian
  Health status
• Glenn Sanders
• Applications Engineer
• Alba TM / Bulgaria
• for Kodak Health
• Glennushka_at_mail.bg 11 May 2005

2
Source RSNA 2004 Realizing Image Enabled EHR
3
Source RSNA 2004 Realizing Image Enabled EHR
Source RSNA 2004 Realizing Image Enabled EHR
4
Source RSNA 2004 Realizing Image Enabled EHR
5
Two kinds of data Static vs Dynamic

• Static Data
• PACS Images (DICOM data)
• Scanned documents
• Completed Reports
• Audio narration files
• .JPG,.TIFF,.HTML,etc
• Traditional paper Film
• Typically stored as long term data

• Dynamic Data
• Status of patient
• Database information
• RIS Exams/work scheduled
• HIS ADT
• Insurance charge history
• Audit trails
• Medications/Allergies
• Etc
• Typically stored across MANY SERVERS!!!

6
(Static data is easy)

• Kodak VIParchive stores both DICOM and non
  DICOM data files, allowing
• Images
• Reports
• Audio
• Scanned sign off sheets
• Etc
• But since I am not a salesman, lets skip the
  sales pitch and look at the underlying software
  concepts

7
Slide 2 Web Distribution supplies images to
web-enabled viewing station, which automates
email report

• Measurements, 3D rendering using Kodak
  DirectView 3D Workstation product
• Report summary, auto-inclusion of keyed image
  files via Kodak PACS Email distribution module

8
Web Distribution module screen shot 1

• Searchable fields
• notes
• Different accession s
• More important is how data is shared

9
DirectView WEB System V E-mail distribution
JOHN SMITH           1.10.97   Patient JOHN
SMITH DOB 7.19.48 Sex M Patient Loc IN20
Patient Status O Physician DR J.B.
PIERCE3437630 10.1.97 1005AM Requested by
JOHN SMITH MR Brain with intravenous contrast
enhancement History Recent onset of seizures
and headache FINDINGS - There is a large
right-sided arteriovenous malformation (AVM) in
the temporo-parieto-occipital region. It is
fed by the middle and posterior cerebral
arteries. The risk of hemorrhage is considerable
, prior to a treatment decision, further
investigation by CT, MR or catheter angiography
is suggested to more precisely delineate the
anatomy of this malformation.  CONCLUSION - large
right-sided cerebral AVM. Radiologists J.B.
Pierce , M.D.transcribed on 1-Oct-1997 at 1008
AM
Entire Case
Key Images
10
Source RSNA 2004 Realizing Image Enabled EHR
11
But how to incorporate Dynamic data?

• Remember dynamic data is spread across the
  enterprise
• HIS / RIS / PACS / LAB
• Integrated packages from one vendor seem nice,
• but risk becoming legacy systems
• Many systems installed in USA and Europe in the
  previous 20 years
• Upgrades and data migration issues were
  issues
• New modalities imply new features needed
• Integration now requires cross-vendor
  capability

12
Cross vendor support requires standards

• Television sets by different vendors detect
  predefined frequencies (channels) and display
  encoded information consistently regardless of
  vendor, screen size, or added capabilities
• BUT USA uses NTSC, EU uses PAL
• Computer add-in cards from different vendors work
  due to strict specifications detailing precise
  protocol definitions, electro-mechanical
  requirements, behavior on power up, signal
  timing,
• and so forth. The PCI 2.2 specification is
  several hundred pages!
• Health systems have DICOM and HL-7
• HL-7 Health Level 7
  www.HL7.org

13
Source IHE-Europe 03-HL7_the_essentials.ppt
14
Source IHE-Europe 03-HL7_the_essentials.ppt
15
Source IHE-Europe 03-HL7_the_essentials.ppt
16
Source IHE-Europe 03-HL7_the_essentials.ppt
17
HL-7 events emit encapsulated messages, which are
broadcasts, queries, responses, and
acknowledgements

• By design, many systems may get the same
  broadcast, and each act on that message
  differently
• Message type A01
• will contain patient name, HIS-assigned
  Patient ID, time of admission, etc
• Note certain fields are needed for synchronizing
  data between systems

Diagram IHE-Europe 03-HL7_the_essentials.ppt
18
Messages are formatted for IT systems, and look a
little strange
Diagram IHE-Europe 03-HL7_the_essentials.ppt
19
Except, HL-7 is not enough

• Diagram IHE-Europe ihe_rsna_2004_purchase_integ
  rated_systems.ppt

20
A new organization IHE was born
Diagram IHE-Europe ihe_rsna_2004_purchase_integ
rated_systems.ppt
21
Source IHE-Europe 01_IHE Education part 1 IHE
essentials_Claeys.ppt
22
IHE Integration Profiles
Source IHE-Europe iheyr3_integration_profiles.pd
f
23
Source IHE-Europe 01_IHE Education part 1 IHE
essentials_Claeys.ppt
24
Source IHE ihe_rsna_2004_product_planners.ppt
25
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
26
Scheduled Workflow Registration, order
Scheduling, Acquisition, Image Storage
Retrieval
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
27
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
28
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
29
Source IHE-Europe ihe_rsna_2004_purchase_integra
ted_systems.ppt
30
A subset exists to support integrated RIS/PACS
Diagram IHE-Europe 04-IHE_an_overview.ppt
31
Workflow (SWF) is a core component of modern PACS
Source IHE ihe_PacsToNextLevel_SCAR03_nagy.ppt
32
What? Your RIS/HIS doesnt support IHE?

• Use a PC between systems to act as a broker
• This allows modalities to be given DICOM modality
  worklists
• And thus eliminate manual patient entry at the
  imaging modality.

Diagram IHE 07-An_overview_of_PACS-RIS_procureme
nt.ppt
33
Real world protocols need a way to handle
exceptions and glitches
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
34
Source IHE ihe_rsna_2004_product_planners.ppt
35
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
36
Or seen slightly differently
Source IHE_Europe 04-IHE_an_overview.ppt
37
Source IHE-Europe 02_IHE_RAD-Established_Ips_SWF
_PIR_Wirtz.ppt
38
Source IHE ihe_rsna_2004_realizing_image_enabled
_EHR
39
Source IHE-Europe 01_IHE Education part 1
IHE Essentials-claeys.ppt
40
Source IHE ihe_rsna_2004_whats_new.ppt
41
Source IHE ihe_rsna_2004_product_planners.ppt
42
Source IHE_Europe 04b_IHE-RAD-ARI.ppt
43
Queries need defined key fields (metadata) which
can be used to link data
Diagram IHE-Europe 04b_IHE-RAD-ARI.ppt
44
Remember this home picture?
Searches use the IHE Access to Radiology
Information profile patient name,
accession, Modality, Report_exists,
Template are searchable Web Distribution
module uses this metadata (key fields) to locate
long term histories of patients from data silos
such as tape libraries and move them to disk.
45
Which explains why how this diagram mentions
prefetch
46
Lets pause for a moment while I demonstrate yet
another example of interoperability allowing
drop-in replacement of obsolete software modules,
even where tightly integrated
Source Mozilla.org address
www.ihe.net
47
By the way, is IHE just the stuff of dreams?
Source ihe_rsna_2004_purchase_
integrated_systems.ppt
Source 05-SWF_PIR_BIR.ppt
48
Its the EU, its the future, and its a pity
Bulgaria isnt more involved
Sources IHE IHE_rsna_2004_initiative_worldwide.
ppt
49
Bulgaria is not alone other countries have
similar issues

• Cyrillic font support
• Local RIS/HIS But Will it work?
• Bulgarian-unique Market issues
• Politics as usual
• secret winning bids
• open?! tenders
• ??????? ?????
• Different style / history
• of procurement in Balkans
• At least there are few legacy systems! ?

50
With so many vendors, how are they doing as of
Feb 2005?
51
Time check

• We have only looked at 1/3 of the IHE profiles
• But at least we dont need to dissect them
• So shall we make a fast tour of the remaining?
• There are two more report cards for vendors
• Did you know another round of testing finished 2
  weeks ago? Latest Results available from IHE in
  June 2005!
• My business card has my email address