Can we create values and make success by creating digitized Pathology by only changing the technical platform within the department of pathology? The answer is definitely No. To be able to create values that will pay for the investment of going digital we need to go outside traditional ways of change-management in healthcare. Cooperation before buying the hardware is the key, going there by creating a unique negotiated information-model that spans the whole value chain within the care process in regard of pathology services. This is the core of creating great values throughout the whole healthcare sub process of cancer detection. Region Västra Götaland (VGR), has taken this path and will show that it´s possible working/thinking outside the “box.”
KEYWORDS: Radiology, Image storage, Picture Archiving and Communication System, Magnetic resonance imaging, Medicine, Data modeling, Data analysis, Analytics, Imaging systems, X-rays
One of the challenges of today’s healthcare is that data from radiology is heterogeneous, stored and managed in silos created by PACS vendors. Also seen is a lack of coordinated use of harmonized reference information models and established healthcare standards.
Radiology in Region Västra Götaland has been entering the world of “Big Data” since 2006, 34 departments split into 4 private image center, 2 small-size hospital, 4 middle-sized hospital groups and one University hospital. Using the same information infrastructure as a means of collaborating and sharing information between. As an organization building for the future we must meet the values and requirements of the stakeholders and count the patient as the major actor.
Can ”Big Data” analytics be a valuable asset from a regional management perspective?
Our initial findings indicates that this is the case, based on three different perspectives – work practice changes, understanding data quality when sharing information and introducing new services in work practice. Going from local to enterprise workflow utilizing the power of “Big Data”, not only by volume but also by combining diverse sources and aggregate the information domains, visualize new trends as well as dependencies more effectively. Building trust by the use of Big Data in healthcare involves a long and winding journey, but the persevering infrastructure-oriented organization will give new ways of collaboration for the enterprise it serves. It also involves continuous negotiation with people concerning how and why they should collaborate with new actors within the region to achieve patient centric care. This will nurture a more open-minded, hopeful and life-affirming holistic approach involving all stakeholders, newcomers’ specialists and patients.
KEYWORDS: Medicine, Picture Archiving and Communication System, Telecommunications, Radiology, Data communications, Systems modeling, X-rays, Data archive systems, Document imaging, Lead
Managing different registries and repositories within healthcare regions grows the risk of having
almost the same information but with different status and with different content. This is due to the
fact that when medical information is created it´s done in a dynamical process that will lead to that
information will change its contents during lifetime within the "active" healthcare phase. The
information needs to be easy accessible, being the platform for making the medical decisions
transparent. In the Region Västra Götaland (VGR), Sweden, data is shared from 29 X-ray
departments with different Picture Archive and Communication Systems (PACS) and Radiology
Information Systems (RIS) systems through the Infobroker solution, that's acts as a broker between
the actors involved. Request/reports from RIS are stored as DIgital COmmunication in Medicine
(DICOM)-Structured Reports (SR) objects, together with the images. Every status change within this
activities are updated within the Information Infrastructure based on Integrating the Healthcare
Enterprise (IHE) mission.
Cross-enterprise Document Sharing for Imaging (XDS-I) were the registry and the central repository
are the components used for sharing medical documentation. The VGR strategy was not to apply one
regional XDS-I registry and repository, instead VGR applied an Enterprise Architecture (EA)
intertwined with the Information Infrastructure for the dynamic delivery to consumers. The
upcoming usage of different Regional XDS registries and repositories could lead to new ways of
carrying out shared work but it can also lead into "problems". XDS and XDS-I implemented
without a strategy could lead to increased numbers of status/versions but also duplication of
information in the Information Infrastructure.
KEYWORDS: Radiology, Data modeling, Imaging informatics, Standards development, Systems modeling, Medicine, Picture Archiving and Communication System, Databases, Digital imaging, Data communications
In the Region Vastra Gotaland (VGR), Sweden, sharing of data from 4 PACS system has been done through the Radiology Information Infrastructure that where deployed in 2007, and during 2008 and 2009 also including the information obtained from three different RIS systems installed in the region. The RIS information stored in the Radiology Information Infrastructure is Structured Reports (SR) objects that derivatives from the regional information model. In practice, the Enterprise solution now offers new ways of social collaboration through information sharing within a region.
Interoperability was developed according to the IHE mission, i.e. applying standards such as digital imaging and communication in medicine (DICOM) and Health Level 7 (HL7) to address specific
clinical communication needs and support optimal patient care.
Applying standards and information has shown to be suitable for interoperability, but not appropriate for implementing social collaboration i.e. first and second opinion, as there is no user services related to the standards. The need for social interaction leads to a common negotiated interface and in contrary with interoperability the approach will be a common defined semantic model.
Radiology informatics is the glue between the technical standards, information models,semantics, social ruleworks and regulations used within radiology and their customers to share information and services.
KEYWORDS: Radiology, Software development, Data storage, Picture Archiving and Communication System, Open source software, Information technology, Medical physics, Biomedical engineering, Medical imaging, Imaging informatics
In the Vastra Gotaland region (VGR) we use a Radiology Information Infrastructure containing all information produced
within the Radiology departments (1,2,3). All information is stored as Dicom-objects (4). This means that request and
report information is stored as Structured Reports (SR) -objects (5) together with the images if they exist.
At Sahlgrenska University Hospital (SU) in Gothenburg, Sweden we have radiological workstations that can't display
the contents in the SR-objects and have a working RIS-integration at the same time.
We have developed some software in conjunction with the dcmtk-software package (6) developed by the Oldenburg
University to make it possible to display information from SR-objects on the radiological workstations.
The workstations have the ability to use Web-functionality so the solution is based on web-technology.
The following happens when a request is made to display the SR-information:
1. Workstation calls a cgi-script that checks if the archive has any SR-reports for the given study.
2. A c-move request is sent to the archive to send the SR-objects (reports) to a Dicom-receiver on the web-server.
3. The dicom-receiver (storescp) creates html-files with help of a modified version of dsr2html.
4. The cgi-script read the names of the created html-files and returns the names in an javascript-array.
5. The report is displayed on the workstation.
By developing some pieces of software and using open source software we have developed a well functional solution to
display SR-reports stored in a central dicom-archive on workstations that can't show SR-information by themselves.
KEYWORDS: Medicine, Standards development, Radiology, Data modeling, Picture Archiving and Communication System, Telecommunications, Data communications, Transparency, Data storage, Photoacoustic tomography
There is today a lack of interoperability in healthcare although the need for it is obvious. A new healthcare enterprise environment has been deployed for secure healthcare interoperability in
the Western Region in Sweden (WRS). This paper is an empirical overview of the new enterprise environment supporting regional shared and transparent radiology domain information in the WRS.
The enterprise environment compromises 17 radiology departments, 1,5 million inhabitants, using different RIS and PACS in a joint work-oriented network and additional cardiology, dentistry and clinical physiology departments. More than 160 terabytes of information are
stored in the enterprise repository. Interoperability is developed according to the IHE mission, i.e. applying standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level 7 (HL7) to address specific clinical communication needs and support optimal patient care. The entire enterprise environment is implemented and used daily in WRS.
The central prerequisites in the development of the enterprise environment in western region of Sweden were: 1) information harmonization, 2) reuse of standardized messages e.g. HL7 v2.x
and v3.x, 3) development of a holistic information domain including both text and images, and 4) to create a continuous and dynamic update functionality. The central challenges in this project were: 1) the many different vendors acting in the region and the negotiations with them to apply communication roles/profiles such as HL7 (CDA, CCR), DICOM, and XML, 2) the question of whom owns the data, and 3) incomplete technical standards.
This study concludes that to create a workflow that runs within an enterprise environment there are a number of central prerequisites and challenges that needs to be in place. This calls
for negotiations on an international, national and regional level with standardization organizations, vendors, health management and health personnel.
KEYWORDS: Medicine, Radiology, Databases, Web services, Information technology, Standards development, Information fusion, Open source software, Software development, Java
This paper describes how the integration between one of the RIS-systems (Adapt) in VGR and the infobroker in the
central archive is implemented. The project was presented in 2006 with the title Building an IT Healthcare Enterprise by
taking the standards to the limits and sometimes beyond that. The Adapt RIS is used by the Sahlgrenska University
Hospital (SU) in Gothenburg and handles 8 different radiology departments.
The implementation is based on HL7 version 3 and the message exchange is based on Web Services/SOAP.
The base of the RIS-system was developed in the beginning of the 1990:s by a company that no longer exists. SU has
always been able to modify the system by changing the source code and we have been responsible for the system-development
since late 1990s.
We are using IBM Informix Dynamic Server that is running on a Solaris-based cluster with additional software from
Veritas/Symantec.
The communication is planned to be 2-way. Our RIS-system transfers order promises, various status updates during the
workflow and finally reports with various status levels. Our system will be able to receive requests and reports from the
broker. The broker in turn receives these messages from other hospitals in VGR (Vastra Gotalands Regionen).
We use Axis2 to generate skeleton java-code based on WSDL- and XSD-files that defines the Web Services. Axis2 is an
Open Source software that is developed as a part of the Apache project. Eclipse is a development environment for Java
that we use and it is also open source.
Apache Tomcat is the application server that we use to receive messages from the infobroker.
KEYWORDS: Medicine, Data modeling, Picture Archiving and Communication System, X-rays, Radiology, Information technology, Data conversion, Data archive systems, Data storage, X-ray imaging
This paper describes a regional approach to build a healthcare infrastructure beginning with radiology for all radiological information from 17 different radiology clinics in different geographic locations throughout the Vastra Gotalands region in the western part of Sweden.
The focus will be to use healthcare standards to make this infrastructure work between different vendors of expert system for the healthcare. Many of the standards and initiatives such as IHE, HL7, DICOM, kith-XML, VG-XML and more are providing solution to part or whole of the different needs and possibilities in healthcare today. One of the key things is that this solution also handles the conversion of reports and other applicable data from proprietary RIS format or HL7 2.5 to XML to SR object, which it stores on the large-scale archive provided by the main contractor. The project tries to achieve an IT Healthcare Enterprise based on the IHE approach. The producers of the healthcare information stored in the central archive are forced to follow the information model, created by the region (technical framework), based on the worldwide standards data models DICOM and HL7. Opportunities for changing in work roles and work practices are also mentioned. These changes influence communication, information and work flow and create new possibilities and new risks for the user of this infrastructure.
KEYWORDS: Radiology, Picture Archiving and Communication System, Digital imaging, Data archive systems, Telecommunications, Medical imaging, Databases, Medicine, Software development, Internet
In 1998 three hospitals merged to form the Sahlgrenska University Hospital. The total radiology production became 325 000 examinations per year. Two different PACS and RIS with different and incompatible archiving solutions were used since 1996. One PACS had commercial origin and the other was developed inhouse. Together they managed 1/3 of the total production. Due to differences in standard compliance and system architecture the communication was unsatisfactory. In order to improve efficiency, communication and the service level to our customers the situation was evaluated. It was decided to build a transparent virtual radiology department based on a modular approach. A common RIS and a central DICOM image archive as the central nodes in a star configured system were chosen. Web technique was chosen as the solution for distribution of images and reports. The reasons for the decisions as well as the present status of the installation are described and discussed is this paper.
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