Clinical Image Management System (CIMS) for the Electronic Patient Record Computer-Assisted Neurosurgery (CANS) Facility Division of Neurosurgery University of Alabama Birmingham, Alabama UAB Health System CANS Facility
Clinical Image Management System Barton Guthrie*, MD Chris Price, MS UAB, Division of Neurosurgery John Fiveash, MD UAB, Department of Radiation Oncology Gary York*, PhD Imageon Solutions, Inc * Financial interest in Imageon Solutions, Inc. UAB Health System CANS Facility
Clinical Image Management System CANS Facility Radiology Departments Barton Guthrie, MD Lincoln Berland, MD Neurology Gary York, PhD Kevin Junck, PhD Neurosurgery Eric Backensto, MS Pulm Medicine Joe Wortmann, MS Cardiology Chris Price, MS Orthopedics Joanna Zaleski, MS Trauma Surgery Jason Cooner ENT Surgery Richard Martin, PhD Plastic Surgery Richard Censullo, PhD HSIS UAB Health System CANS Facility
UAB Image Management Today Many separate image domains - 4 Depts CD Viewer Viewer Video Shelf Tapes Image Source Image Source Radiology Angiography Cardiology Angio Cardiac Echo OB/GYN US Cardiac MRI Cardiac Cine Nuc Medicine Rad Onc CT Digital Viewer Storage Film View Library Box Image Source UAB Health System CANS Facility
Health System Image Environment • Radiology views itself as image management service for Health System • Cardiology acquires and interprets images on a scale equal to Radiology • Clinical Neurosciences interprets own MRI studies • OB/GYN acquires and interprets own images • HIS not yet actively involved in image management policy, but critically important for infrastructure UAB Health System CANS Facility
Health System Clinical Image Management System (CIMS) Goal • Provide images when and where needed for patient care • Provide image and report viewing capabilities for broad clinician population • Develop components that can be integrated into the evolving electronic patient record UAB Health System CANS Facility
Health System Image Management System Process • Involve all stakeholders in imaging • Support local image domain autonomy • Enable global image access to clinical population • Change in paradigm: data integration, not data ownership UAB Health System CANS Facility
Health System Clinical Image Domains Ortho User Neuro Domains Surg APIR CPR Health System DICOM Archive Image System of Record m a g e I Other Radiology a i n s D o m Cardiology UAB Health System CANS Facility
IMS Architecture: Image Domain Components Domain Archive Commercial archive CIMS Archive Commercial Viewer Image Commercial Server CIMS Viewer CIMS Server Source (Image Routers) Radiology Cardiology OB GYN Rad Onc Other….. UAB Health System CANS Facility
Image Capture and Archive Dicom Generic Radiology GE Archives Dicom Archive Dicom Archive Dicom Image Source Cardiology Rad Onc Radiology UAB Health System CANS Facility
Image Distribution and Viewing: Query/Retrieve Model Diagnostic Workstation PC Unix Station DICO M Viewers Dicom Dicom Image Service APIR Servers UAB Health System CANS Facility
Image Management System Technical Architecture Diagnostic Workstation PC CANStation CIMS Viewer CIMS Dicom Dicom Image APIR Servers Service Dicom CIMS Radiology GE Dicom Archives Dicom Archive Archive Dicom Image Source G Y E E G Y G E Y M S M S M S C T C T C T Cardiology Rad Onc Radiology UAB Health System CANS Facility
Health System Image Management System Technical Architecture Management DICOM DICOM DICOM Cache Cache Cache Presentation Cache Cache Cache Cache (Viewing) Image Web Servers Workstations Workstations Workstations Neuro Ortho Radiol PC/Mac PC/Mac PC/Mac Distribution Image Information Distribution Cache VA / PIM RIS CIS IS Cache Cache Patient Acquisition Service Scan Image Image (EMMI) Source Source Film Radiology Card/Neuro Radiology Cardiology Archive/ Archive/ Digitizer Cache Cache Network EPR Health System Archival DICOM Archive(s) Image System of Record UAB Health System CANS Facility
Health System Cost Analysis: Cost of Electronic Image Management • Capital expense for equipment • Software/service costs • Development personnel costs UAB Health System CANS Facility
Health System Cost Analysis: Savings of electronic image management • Cost reduction due to a film-optional policy • Cost savings related to elimination of lost/duplicate film • Increased efficiency for faster care-related throughput • Increased convenience unrelated to cost UAB Health System CANS Facility
Imaging Cumulative Capital Budget (Excluding Film Costs) $15,000,000 $10,000,000 CIMS No CIMS $5,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Cumulative CIMS Expense Capital and Personnel (Excluding Film Costs) $20,000,000 $15,000,000 CIMS $10,000,000 CANS + RAD $5,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Annual Film-Related Costs $5,000,000 $4,000,000 $3,000,000 CIMS No CIMS $2,000,000 $1,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Cumulative Film-Related Costs $40,000,000 $35,000,000 $30,000,000 $25,000,000 CIMS $20,000,000 No CIMS $15,000,000 $10,000,000 $5,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Annual Image Management Cost (Including Film) $8,000,000 $7,000,000 $6,000,000 $5,000,000 CIMS $4,000,000 No CIMS $3,000,000 $2,000,000 $1,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Cumulative Image Management Cost (Including Film) $40,000,000 $35,000,000 $30,000,000 $25,000,000 CIMS $20,000,000 No CIMS $15,000,000 $10,000,000 $5,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 UAB Health System CANS Facility
Clinical Image Management System Ideal Characteristics • Economically justifiable • Use any image source (CT, MRI, CR, etc.) • Integrates into user work environment • See images when, where and how needed • Runs on WEB/Internet • Multi-platform, affordable, secure • Integrates into electronic patient UAB Health System CANS Facility
Image Management System (CIMS) Design Objectives • 100% software, platform independence • Use existing hardware and support ‘best of breed’ solution • Use existing standard: DICOM • Use Inter- and Intranet (web) • Open architecture for integration into existing PACS and EPR systems • Provide scalability as image management system grows • Provide single point of access for electronic patient record UAB Health System CANS Facility
Development Environment and Components developed for CIMS Environment Components • Java DICOM • Windows, NT Development Kit • Java (JDDK) • CORBA • CIMS DICOM Archive • TCP/IP, Web • CIMS Image Viewers UAB Health System CANS Facility
Guiding principle for Archive • 100% software (Java) • DICOM 3.0 support • Platform independent • Commercial database • Commercial, standard storage media UAB Health System CANS Facility
CIMS DICOM Image Viewer Specifications • Service the clinician • Provide images when, where and how needed for patient care • Interviewed 12 image intensive clinicians representing Neurosurgery, Neurology, Cardiology, Trauma, Surgery, Orthopedics, Pulmonary Medicine and ENT UAB Health System CANS Facility
CIMS DICOM Image Viewer Specifications • How will data be used • Where will data be used • Performance constraints • Interface specifications UAB Health System CANS Facility
Specification for CIMS Viewers How will data b e used Where will data be used: • Interpretation would be • On the wards/ICU at the sufficient outside the bedside. specialty domain • In the clinic at the time of • Images within the patient visit specialty domain • At home as needed • Images integrated into • In the office for case context of patient review, correspondence information and teaching file • Integrate into office construction, etc. environment UAB Health System CANS Facility
Specification for CIMS Viewers How will data b e used Where will data be used: • Interpretation would be • On the wards/ICU at the sufficient outside the bedside. specialty domain • In the clinic at the time of • Images within the patient visit specialty domain • At home as needed • Images integrated into • In the office for case context of patient review, correspondence information and teaching file • Integrate into office construction, etc. environment UAB Health System CANS Facility
Specification for CIMS Viewers Functionality Performance • Look like Windows/Word • Reliable • Multiple ports/Multiple • Fast less than 5 studies seconds) • Metrics • Responsive with • Image processing frequent status – Size reports – Contrast • Very visual: vidual menius, thumbnails, etc. • PC resolution OK UAB Health System CANS Facility
CIMS DICOM Viewer • Java DICOM software application for image- intensive clinicians • Java DICOM applet for quick review anywhere • User Query/Retrieve Model UAB Health System CANS Facility
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