Worlds above PACS

Successful Story of KSVGH, a medical center in Taiwan

Presenter: Dr. YANGSection Chief in TeleRadiology, KSVGH

2009.12.25

智慧型醫療保健生活在花蓮 - IHE 電子病歷交換架構及其應用服務探討

What’s uncommon to us now is common to our kids!

“ One of the things we’re going tosee in the next five to 10 years is thefirst and second generation of PACS,that were departmental and closed intheir design for use by radiologists,replaced with Web-based enterprisePACS solutions that converge with theentire hospital’s digital system,” saidDr. Thrall. “This is a 20-year revolution,and we’re now about three-quartersof the way through it.”

2006 2006 預言換系統潮預言換系統潮

"You're going to see less emphasis on nuts and bolts and architecture, and more on workflow," said Dr. Paul Chang of the University of Chicago School of Medicine. "In supporting complex workflow, the real issue and challenge is interoperability."

2009 2009 預言工作流整合潮預言工作流整合潮

Filmlessness is only the beginning of Paperlessness!

優質無片只是智慧無紙的開始 !

優質無片只是智慧無紙的開始 !

Client-server PACSBrowser-server PACS

Web-based PACS solutions

XDS-based record exchange

PCC-compatible EHR

The Philosophies

UbiquitouUbiquitouss

CommunicatiCommunicationon

AlertAlert

PlatformPlatform

Squeeze More Out of Lessby ICT

用最少的力作最大的功

IT to ICT

ICT 的Ｃ :

Connectivity, Communication and Collaboration

3I, 3C, 3T

Instant, Interactive, IntuitiveConnectivity, Communication, Collaboration

High Touch, High Technology, HyperThreading

Timeline •Evolving history of PACS development

at Kaohsiung Veterans General Hospital

•Film-less Ultrasound since 1998

•Enterprise-wide Filmlessness in 2002

•ReVamp/Gentrification of PACS since 2003

•Establishment of Web-based PACS solutions in 2006

•Launch of Inter-enterprise PACS solutions in 2008

The lack of integration between clinical applications and various hospital information systems gives rise to a gap that is proving more dangerous than ever when delivering quality patient care!!

系統越多 , 如果沒有整合 , 或是沒有徹底整合 , 會給病人照護帶來災難 !

HIS + RIS + PACS + OLAP + LIS + PIS + CIS + MIRC + HAS + Medical Tourism +

Insurance Reimbursement ?

multiple levels of multiple systems integration

具有影像儲傳系統（ PACS ）之醫療院所，應將影像送到 PACS 伺服器儲存，並應有存放長期影像檔之機制，同時該醫療院所應有完整 PACS 影像作業管理系統的規範。相關規範應就「影像 , 資料多層次的保護」、「依角色區分的身份認證與資料存取權限」、「資料加密與簽章作業」、「分權控管與事件紀錄」、「醫用螢幕校正」加以說明 , 以求達到提升病人安全 ( patient safety) 與員工安全 ( staff safety) 之目的 .

PACS + RIS•Different levels of integration and

functionality in RIS and PACS

• The role of Integrating the Healthcare Enterprise in ensuring smooth integration

• Data synchronization between RIS and PACS

• Integrating with other applications, such as 3D, voice recognition, and computer-aided detection

Is there a single portal to fit all these needs?

Basic and Advanced Links

•User Links

•Patient Links

•Encounter Links

•Conference Links

IHE Profiles•PDI

•CPI

•MAMMO VIEW

•REMRadiation Exposure monitoring

•XDS, XDM

•MIRC

•RID

Non-IHE Profiles• Web-based C-delete for Image Quality

assurance

• Web-based Study Protocol determination

• Web-based Medical Calculator

• Web-based Report keyword notification

• Web-based WADO-enabled image consultation

• Web-based image/report quality assurance

• Web-based issue tracking

• Web-based patient call back service

• Web-based Telemanagement

Link to AVI Clips

Secured Medical Environment

•Secured web-based PACS solutions

•DSG for medical reports

•DSG for medical images

•HIPAA compliant

•Traveling Single sign on with LDAP, Kerberos, SAML support

H.E.L.P.Healthcare Enhancement and Leverage

Platform

XDM, XDSXDM, XDS

XDS 在健康與醫療產業之應用

Cross-Enterprise Document Sharing (XDS)

•Cross enterprise document sharing

•XDS-I ( RSNA 2006, 2007,2008 demonstration)

•XDS-MS

•Online solution

•Offline solution

•XDMedia

•XDReliable interchange

Cross-Enterprise Document Sharing (XDS)

• 分享文件影像

•建立分享管道

•多層級醫事機構分享

•標準查詢與文件取回機轉

第一個想法•一個住高雄的洗腎病人 , 如何享受

none-stop 環島民宿 (B&B) 之旅的樂趣 ?

•墾丁 , 台東 , 花蓮 , 宜蘭 , 台北 , 苗栗 , 彰化 , 嘉義

第二個想法

•Long-stay Hopping 如何吸引銀髮族在不同長宿中” 跳躍” 式居住 , 而不須擔心醫療上的不可銜接性( unlinkability) ?

第三個想法

•Metabolic disorder 或是 coronary artery disease 的病人 , 如何減輕不定時炸彈的威脅 ?

•醫院如何縮短這兩類病人急性病症期間的住院天數 , 但不犧牲醫療品質 ?

第四個想法

•如何讓 Medical IT in home ? 在家做復健 , 也有” 人” 監督 , 打分數 ?workouts on the web

•老人吃藥 , 有“人“監督 , 不但定時 , 適量 , 而且有回饋機制 ?

第五的想法•如何讓 VIP 們在健康產業中進行消費 ,

或查詢資料時 , 一個帳號到底 ?

•高榮

•福華

•高鐵

•溫泉業者

•美容 SPA

•健身房

•了解資訊科技在醫療產業的發展經驗

•以 medical tourism 為例 , 了解如何利用資訊科技擴大健康產業市場

•Medical record

•objective record

•subjective record

•Billing record

•Insurance record

•Touristic record

多采多姿 , 多型性的病歷

Patient Care Coordination

•Patient

•Sweet home

•Nursing home

•Family clinics

•Specialty clinics

•Medical institutes

XDS

To Fit the requirements of PCC

Profile

PCC: Patient care Coordination

Patient care Coordination

• Medical Summaries (MS)

• Exchange of Personal Health Record Content (XPHR)

• Emergency Department Referral (EDR)

• Basic Patient Privacy Consents (BPPC)

• Pre-procedural History and Physical (PPHP)

• Antepartum Care Summary (APS)

• Functional Status Assessments (FSA)

• Emergency Department Encounter Record (EDER)

• Query for Existing Data (QED)

PCC and XDS 的重要工具

•WADO: Web Access to DICOM Objects

•JPIP:JPEG 2000 Interactive Protocol

•RID:Retrieve Document for Display

XDM 安全影像資訊可攜式媒體

•進階版 DICOMDIR 光碟

•內容含影像 , 報告 , RID內容

•兼顧病人隱私與資料完整性

•可與 XDS 完整整合

•案例說明

XDM: Cross-enterprise Document Sharing in

Media

A truly sublimated version of medical information carrier to complement or even replace

DICOMDIR in the future

A Patient-driven Platform for Requesting-and-Delivering of Medical-Purpose Portable Media

either online or offline

What’s the unrecognized

need?

Next 10 Years•Self-assessment training tool using MIRC

•EMR-based Geriatric Long-term care solutions

•Medical IT in home

•Virtual Medical Civility/Avatar

•Nursing informatics solutions/De-paper engineering

•Medical Broadcasting solutions

•Digital Transformation of Operation Units

•EMR-based Ambulance, mobile clinics

•Medical Tourism Solutions

•Medical Display Records

The Whole is much larger than the

Sum of the Parts!Through the ICT Through the ICT

Alchemy!Alchemy!

Thanks and Free Discussion

PACS INFO CENTER @ KSVGHSection of TeleRadiology

Initial Experience of Coupling De-paper Engineering

and Digital signage broadcasting for a Modern

Radiology Department

RSROC, AOCR 2010