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CANS Facility UAB Health System
CANS Facility UAB Health System
Clinical Image Management System (CIMS) for the Electronic Patient - - PowerPoint PPT Presentation
Clinical Image Management System (CIMS) for the Electronic Patient - - PowerPoint PPT Presentation
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
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CANS Facility UAB Health System
Clinical Image Management System
Barton Guthrie, MD Gary York, PhD Eric Backensto, MS Joe Wortmann, MS Chris Price, MS Joanna Zaleski, MS Jason Cooner Richard Martin, PhD Richard Censullo, PhD Lincoln Berland, MD Kevin Junck, PhD
CANS Facility Radiology
Neurology Neurosurgery Pulm Medicine Cardiology Orthopedics Trauma Surgery ENT Surgery Plastic Surgery HSIS
Departments
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CANS Facility UAB Health System
UAB Image Management Today
Many separate image domains - 4 Depts
Image Source Viewer Video Tapes
Cardiac Echo Cardiac Cine
Radiology Angiography OB/GYN US Nuc Medicine
Image Source Viewer CD Shelf
Cardiology Angio Cardiac MRI Rad Onc CT
Image Source Digital Storage Viewer Film Library View Box
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
I m a g e D
- m
a i n s User Domains
Health System Clinical Image Domains
CPR Neuro Ortho Surg
Radiology Cardiology Other
Health System DICOM Archive
Image System of Record
APIR
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CANS Facility UAB Health System
IMS Architecture:
Image Domain Components
Radiology Cardiology OB GYN Rad Onc Other…..
Image Source
Commercial archive CIMS Archive Commercial Server CIMS Server
(Image Routers)
Commercial Viewer CIMS Viewer Domain Archive
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CANS Facility UAB Health System
Image Capture and Archive
Cardiology Rad Onc Radiology
Radiology GE Dicom Archive
Generic Dicom Archive
Dicom Archives Dicom Image Source
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CANS Facility UAB Health System
Image Distribution and Viewing: Query/Retrieve Model
Diagnostic Workstation
PC Unix Station
Dicom Image Servers
Dicom Service DICO M Viewers APIR
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CANS Facility UAB Health System
Image Management System Technical Architecture
Dicom Archive Diagnostic
Cardiology Rad Onc Radiology
Workstation PC CANStation
Dicom Image Servers
Radiology GE
CIMS Dicom Archive
CIMS Dicom Service Dicom Archives CIMS Viewer Dicom Image Source
APIR
G E Y M S C T G E Y M S C T G E Y M S C T SLIDE 13
CANS Facility UAB Health System
Health System DICOM Archive(s)
Image System of Record
Presentation (Viewing)
EPR
Radiology
Image Source
Radiology Archive/ Cache
Cache
RIS
Cardiology
Image Source
Card/Neuro Archive/ Cache
Cache
CIS
Patient Service (EMMI)
Cache Image Web Servers
Film Digitizer
IS
Scan
Management
Cache
VA / PIM
Image Information Distribution
Distribution Network Acquisition Archival Ortho
DICOM Cache Cache
Workstations PC/Mac
Radiol
DICOM Cache Cache
Workstations PC/Mac
Health System Image Management System Technical Architecture
Neuro
DICOM Cache Cache
Workstations PC/Mac
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CANS Facility UAB Health System
Health System Cost Analysis:
Cost of Electronic Image Management
- Capital expense for equipment
- Software/service costs
- Development personnel costs
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
Imaging Cumulative Capital Budget
(Excluding Film Costs)
$0 $5,000,000 $10,000,000 $15,000,000 1998 1999 2000 2001 2002 2003 2004 2005 CIMS No CIMS
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CANS Facility UAB Health System
Cumulative CIMS Expense Capital and Personnel
(Excluding Film Costs)
$0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 1998 1999 2000 2001 2002 2003 2004 2005
CIMS CANS + RAD
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CANS Facility UAB Health System
Annual Film-Related Costs
$0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 1998 1999 2000 2001 2002 2003 2004 2005 CIMS No CIMS
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CANS Facility UAB Health System
Cumulative Film-Related Costs
$0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 $40,000,000 1998 1999 2000 2001 2002 2003 2004 2005 CIMS No CIMS
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CANS Facility UAB Health System
Annual Image Management Cost (Including Film)
$0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 1998 1999 2000 2001 2002 2003 2004 2005 CIMS No CIMS
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CANS Facility UAB Health System
Cumulative Image Management Cost (Including Film)
$0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 $40,000,000 1998 1999 2000 2001 2002 2003 2004 2005 CIMS No CIMS
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
Development Environment and Components developed for CIMS
- Java DICOM
Development Kit (JDDK)
- CIMS DICOM Archive
- CIMS Image Viewers
- Windows, NT
- Java
- CORBA
- TCP/IP, Web
Environment Components
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CANS Facility UAB Health System
Guiding principle for Archive
- 100% software (Java)
- DICOM 3.0 support
- Platform independent
- Commercial database
- Commercial, standard storage
media
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CANS Facility UAB Health System
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
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CANS Facility UAB Health System
CIMS DICOM Image Viewer Specifications
- How will data be used
- Where will data be used
- Performance
constraints
- Interface specifications
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CANS Facility UAB Health System
Specification for CIMS Viewers
- Interpretation would be
sufficient outside the specialty domain
- Images within the
specialty domain
- Images integrated into
context of patient information
- Integrate into office
environment
- On the wards/ICU at the
bedside.
- In the clinic at the time of
patient visit
- At home as needed
- In the office for case
review, correspondence and teaching file construction, etc.
How will data be used Where will data be used:
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CANS Facility UAB Health System
Specification for CIMS Viewers
- Interpretation would be
sufficient outside the specialty domain
- Images within the
specialty domain
- Images integrated into
context of patient information
- Integrate into office
environment
- On the wards/ICU at the
bedside.
- In the clinic at the time of
patient visit
- At home as needed
- In the office for case
review, correspondence and teaching file construction, etc.
How will data be used Where will data be used:
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CANS Facility UAB Health System
Specification for CIMS Viewers
- Reliable
- Fast less than 5
seconds)
- Responsive with
frequent status reports
- Look like Windows/Word
- Multiple ports/Multiple
studies
- Metrics
- Image processing
– Size – Contrast
- Very visual: vidual
menius, thumbnails, etc.
- PC resolution OK
Performance Functionality
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CANS Facility UAB Health System
CIMS DICOM Viewer
- Java DICOM software
application for image- intensive clinicians
- Java DICOM applet for
quick review anywhere
- User Query/Retrieve
Model
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CANS Facility UAB Health System
CIMS Functional Srtucture
CenterNet CIMS viewers
APIR
Workstation CANStation
CIMS DICOM Archive
G E Y M S C TCardiology MRI Service
G E Y M S C TRadiology Image Source
G E Y M S C TRad Onc CT
1 2 3
CIMS CORBA DICOM Service
Image Data Image Routers
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CANS Facility UAB Health System
CIMS Java Application Viewer PC Specifications
- 350 MHz
- 128 MB RAM
- 4 MB video
- 17 inch
monitor
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CANS Facility UAB Health System
CIMS Viewer: Logon
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CANS Facility UAB Health System
CIMS Viewer: Initial Screen
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CANS Facility UAB Health System
1 2 3
Clinical Image Management System User Query
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CANS Facility UAB Health System
CIMS Image Display: Basic Function
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CANS Facility UAB Health System
CIMS Viewer: Multiple Ports
Ports can show multiple image types The ‘port tool’ allows selection of 1 to 9 ports
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CANS Facility UAB Health System
CIMS Image Display: Features
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CANS Facility UAB Health System
CIMS Viewer: Export images
October 1, 1998
- Dr. Jiri Dubovsky:
We retreated Jane Doe with Gamma Knife today. We have delivered a total of approximately 5,000cGy in two doses to her pituitary. This is in addition to the roughly 4,500 she had previously had in
- 1985. We emphasized that her optic
chiasm would be at substantial risk. She now has a total optic chiasm dose of 1650 centigrade. I would hope that her endocrinopathy begins to subside in the next 6 to 12
- months. We will have her seen back in
the Pituitary Clinic in one month Sincerely, Barton Guthrie, MD Director, CANS Facility BG/kb
CIMS supports exporting selected images in standard graphics
- formats. They
can then be inserted into correspondence, email, charts, etc.
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CANS Facility UAB Health System
CIMS Image Display: Calculations
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CANS Facility UAB Health System
CIMS Image Display: Drawing and Annotation
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CANS Facility UAB Health System
CIMS Online: User Query
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CANS Facility UAB Health System
CIMS Online: Browser-based image display
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CANS Facility UAB Health System
10 20 30 40 50 60 70 80 90 100 Appearance Ease Speed Usefulness Rating
CIMS User Evaluation
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CANS Facility UAB Health System
CIMS Monthly Studies
(Annual Total: 17,841)
1000 2000 3000 4000 5000 6000 Aug-97 Sep-97 Oct-97 Nov-97 Dec-97 Jan-98 Feb-98 Mar-98 Apr-98 May-98 Jun-98 Jul-98 WP MR Diabetes CR KC MR KC CT JT CT
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CANS Facility UAB Health System
CIMS Monthly Images
(Annual Total: 1,113,289)
20000 40000 60000 80000 100000 120000 140000 160000 180000 Aug-97 Sep-97 Oct-97 Nov-97 Dec-97 Jan-98 Feb-98 Mar-98 Apr-98 May-98 Jun-98 Jul-98 WP MR Diabetes CR KC MR KC CT JT CT
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CANS Facility UAB Health System
Projected CIMS Monthly Studies
(Annual Total 174,614)
2000 4000 6000 8000 10000 12000 14000 16000 Aug-97 Sep-97 Oct-97 Nov-97 Dec-97 Jan-98 Feb-98 Mar-98 Apr-98 May-98 Jun-98 Jul-98 WP MR Diabetes CR KC MR KC CT JT CT
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CANS Facility UAB Health System
CIMS Projected Images per Mo.
(Annual Total: 3,828,922)
50000 100000 150000 200000 250000 300000 Aug-97 Sep-97 Oct-97 Nov-97 Dec-97 Jan-98 Feb-98 Mar-98 Apr-98 May-98 Jun-98 Jul-98 WP MR Diabetes CR KC MR KC CT JT CT
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CANS Facility UAB Health System
CIMS Utilization Patterns
(Day of the week)
5 10 15 20 25 Percent of Exams Viewed Mon Tues Wed Thurs Fri Sat Sun Day of the Week
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CANS Facility UAB Health System
CIMS Utilization Patterns
(Hour of the Day)
2 4 6 8 10 12 14
Percent of Exams Viewed
200 400 600 800 1000 1200 1400 1600 1800 2000 2200 Hour of the Day
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CANS Facility UAB Health System
CIMS Potential
- Support Medical Center
- Support hospital consortiums (Health
Systems)
- Link imaging centers: Virtual Center
- Enhance communications between
clinicians
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CANS Facility UAB Health System
Multi-Center Image Management System: Central Archival Model
Image Viewer
Customer
Image Viewer Image Viewer e-CIMS Viewing System
Remote Clinic
Remote Hospital
Home Other Customers
G E Y M S C TDiagnostic Center A
e-CIMS DICOM APIR and Viewing System
Image Source
APIR e-CIMS DICOM Data Center
G E Y M S C TOutpatient Diagnostic Center
e-CIMS DICOM APIR and Viewing System
Image Source
APIR
G E Y M S C TMedical Center A
e-CIMS DICOM APIR and Viewing System
Image Source
APIR
Internet
Private Network
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CANS Facility UAB Health System
Electronic Patient Record
Xray Transcription Labs Other
Patient Record
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CANS Facility UAB Health System
Visual Patient Record
- Event of Care
- Episode of care
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CANS Facility UAB Health System
Visual Patient Record Episode of Care
User linkage vs. automated linkage (rules)
Patient
Time
Diagnosis Surgery Labs Correspondence Progress Notes Imaging
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CANS Facility UAB Health System
Visual Patient Record Episode of Care
User linkage vs. automated linkage (rules)
Patient
Time
Diagnosis Surgery Labs Correspondence Progress Notes Imaging Episode of Care
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CANS Facility UAB Health System
Visual Patient Record Episode of Care
Patient John Doe
Diagnosis Labs Imaging
HNP 4/8/98 CBC SMA 4/9/98 CBC 4/15/98
MRI 4/15/98 CXR 4/9/98 Lspine 4/11/98 CXR 4/15/98
HNP 4/8/98
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CANS Facility UAB Health System
Visual Patient Record Event of Care
Progress Notes
Progress note 4/10/98 Progress note 4/11/98 Progress note 4/12/98 Progress note 4/13/98
Patient: John Doe User moves progressively deeper into record
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CANS Facility UAB Health System
Health System DICOM Archive(s)
Image System of Record
Presentation (Viewing)
EPR
Radiology
Image Source
Radiology Archive/ Cache
Cache
RIS
Cardiology
Image Source
Card/Neuro Archive/ Cache
Cache
CIS
Patient Service (EMMI)
Cache Image Web Servers
Film Digitizer
IS
Scan
Management
Cache
VA / PIM
Image Information Distribution
Distribution Network Acquisition Archival Ortho
DICOM Cache Cache
Workstations PC/Mac
Radiol
DICOM Cache Cache
Workstations PC/Mac
Health System Image Management System Technical Architecture
Neuro
DICOM Cache Cache
Workstations PC/Mac
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CANS Facility UAB Health System
Visual Patient Record: Images
Patient: John Doe
Images
Chest Xray 4/10/98 CT Scan 4/11/98 Chest Xray 4/12/98 MRA 4/13/98
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CANS Facility UAB Health System
Visual Patient Record Episode of Care
Patient Time
Diagnosis Surgery Labs Correspondence Progress Notes Imaging
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CANS Facility UAB Health System
Visual Patient Record Episode of Care: Linked Events
Correspondence
Patient Time
Diagnosis Surgery Labs Progress Notes Imaging
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CANS Facility UAB Health System
Visual Patient Record Episode of Care: Linked Events
Patient John Doe
Diagnosis Labs Imaging
HNP 4/8/98 CBC SMA 4/9/98 CBC 4/15/98
MRI 4/7/98 CXR 4/9/98 Lspine 4/11/98 CXR 4/15/98
Fever 4/15/98
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CANS Facility UAB Health System
Summary
- Large-volume dicom archive is
feasible
– Multi-specialty storage – Enables reduction of film-base cost
- Web-based Imaging is feasible
– Eliminates geography – Enhances communication
- CIMS viewer brings images into
clinical workflow
- Integration into CPR