Managing Non-DICOM Images within an Enterprise Imaging Solution Agenda • Enterprise Imaging / Non-DICOM Market Trends • Managing Non-DICOM Images in the Enterprise • Merge’s Non-DICOM Solution Options • Questions? Enterprise Imaging / Non-DICOM Trends 3 Interoperability Market Drivers M&A / Consolidation Enterprise Image Management Clinical and Financial Economies of Scale Comprehensive Image Record Connecting Providers EHR Optimization Patient Centric Care Across Sites Unified Patient Image Record 4 Providers Generate a Flood of Data Digital Clinical Objects Specialty MPEG, JPEG Other Most Common Devices DICOM A/V, WAV , PDF Clinical Anesthesia In Room C-Arm, X-ray, Anesthetic, Record Keeping Reports Cardiology CVMR, CVCT, Cath, CVUS, CVECG / Holter / Stress / Pace Dermatology Photos, dermatological Reports Emergency Medicine X-ray, CT, ECG, Triage Reports Endocrinology SPECT / CT, PET / CT, Physician Reports, Voice Dictation Files Family Medicine Physician Notes, Reports Gastroenterology Barium X-ray, CT, NM, Endoscopes, US, Reports, Voice Dictation Files Hematology HT Reports, Voice Dictation Files ICU Medicine In Dept C-Arm, X-ray, Patient CIS Flow Chart Reports Nephrology US and MRI Angiography, Scintigraphy (Nuc Med) Reports Voice Neurology Renal Scans, SPECT/CT, PET/CT, Physician Reports, Renal Grams, Voice iConnect™ Solution Nuclear Medicine Stored in a VNA US, Physician Reports, Voice Dictation Files Obstetrics X-ray, CT, US, Reports, Voice Dictation Files, Fetal Strips, Reports Oncology FDG-PET, CT,• X-Singleray, Treatment Database Plans, Densitometry, Biograph Reports Ophthalmology Ophthalmology Laser Images, Physician Reports, Voice Dictation Files Oral Surgery Dental X-rays,• PhysicianSingle Reports Storage Pool Pathology Digital & Scanned• Single Pathology, ServerPathology Reports, Voice Dictation Files Pediatrics Nuclear VCUG, DMSA Scans, Reports, Voice Dictation Files Pulmonology CT Gamma,• SPECT,Single PET, Reports, Admin Voice ToolDictation Files Radiology MR, CT, XR, US, NM, Radiology Reports, Voice Dictation Files Rehab Medicine Brain Lab Reports,• Single Voice Dictation Viewer Files Rheumatology US, MRI, Rheumatology• Single Reports, Vendor Voice Dictation Files Surgery In Department X-ray, Endoscopes, Surgery Reports Urology MR, XR, Digital Fluoroscopy Reports, Voice Dictation Files DICOM + non-DICOM / Dark Data 1,600,000 2017 Forecast 1,400,000 • 1.4B Objects / Year 1,200,000 • 51% VNA 5 Yr CAGR 1,000,000 • ~75% are Non-DICOM 800,000 600,000 Key Drivers 400,000 • Increased PACS to (000s) Annual Volume 200,000 VNA Attach Rate 0 • Growth in Non-DICOM 2011 2012 2013 2014 2015 2016 2017 PACS Study Volume VNA Study Volume Managing Non-DICOM Images in the Enterprise 7 Developing a Non-DICOM Solution • Managing Clinical Image Content is about workflow • Non-DICOM Clinical Content is often Dark Data – Gartner defines dark data as “the information assets organizations collect, process and store during regular business activities, but generally fail to use for other purposes” • Goal: Ingest Store View a patient’s complete image record (DICOM and non-DICOM) within the context of the patients medical record Key Workflow Questions For each service line: • Orders or Encounters Based? • DICOM vs. XDS vs. XDS-I XDS Object XDS-I Object DICOM Object Surgical Encounter Dermatology Services Radiology / Order ENT Cardiology XDS vs. XDS-I: XDS-I typically involves DICOM exams stored in a DICOM Archive (e.g. PACS or VNA) and registered with an XDS Registry. This provides the benefits of DICOM and XDS. Developing a Service Line Workflow The Bookends define the Use Case Acquire the • from a clinical perspective Content • Create the Content • Who Normalize • Device the Content • Format • Demographics / Metadata Start with the Bookends • Consume the Content Store the • Who Content • Workflow System (EMR, HIE, etc.) • Viewer (PACS, Enterprise, Specialist) • This information will inform the View the decision about DICOM vs. XDS and Content Merge vs. 3rd party Solutions Merge’s XDS Capabilities PIX/PDQ EA can be a PIX /PDQ Patient Identity Source (EMR, mrg. when in MPI mode EMPI or PIX/PDQ Manager) Patient ID Feed iConnect Access Query for XDS Document Documents XDS Document Registry Consumer iCEA v11.3 Provide and Register XDS Source Register Document Set Data Conversion to XDS Document Source XDS Tools Repository MDM Manifest Retrieve Documents Image Source iConnect • Retrieve Images Enterprise Archive • Retrieve Evidence Documents v11.1 • WADO Retrieve IHE Connectathon 2015: 32 Unique Vendors iConnect Enterprise Archive iConnect Access 24 Vendors 19 Vendors CDC BHS Athena Agfa Dell EMC CAREEV GE CERTIFY INFINITT ITH icoserve OpenHIE ezCaretech KAROS NEXTGATE QUADRAMET Hyland Healthland OPTUM Perceptive / Acuo SAMSUNG IntelHealth INTERSYS Oracle TeraMedica Sandlot Smarter Summit QVERA Care Tiani-Cisco Siemens VSB iCEA Merge’s Non-DICOM Solution Options Non-DICOM DICOM Non-DICOM XDS Non-DICOM XDS-I Non-DICOM to DICOM 1 Patient Registers Capture Searches a patient’s 3 photo record for images EMR 7 HL7 ORM 2 or ADT to MWL Launches 8 Access via Secure URL MWL 4 Query Store 5 DICOM 6 9 Retrieves exam Availability from VNA Notification to EMR iCEA Non-DICOM to XDS: User Initiated Workflow 1 Patient Registers Capture Searches a patient’s 3 photo record for images EMR 10 HL7 ORM Launch 4 2 Notify (Order) MDM with 9 EMR 5 or Metadata 11 Upload HL7 ADT Launches File(s) (Encounter) Access via Secure URL MWL to Query MWL 6 Exceptions Worklist 8 12 Retrieves exam Register from XDS 7 Document with Repository Store XDS XDS Registry Object in XDS Repository iCEA Non-DICOM to XDS: Polling Workflow 1 Patient Registers Searches a patient’s 3 Capture photo record for images EMR 10 2 HL7 ORM Notify (Order) 9 EMR or 4 Exceptions HL7 ADT Launches 11 Worklist (Encounter) Access via 5 Secure URL 6 to Poll for MWL Store Content File MWL Query (with Partial Metadata) 8 12 Retrieves exam Register from XDS 7 Document with Repository Store XDS XDS Registry Object in XDS Repository iCEA Non-DICOM to XDS-I 1 Patient Registers Capture Searches a patient’s 3 photo record for images EMR 9 HL7 ORM 2 or ADT to 10 MWL 8 Launches Access via Notify Secure URL MWL EMR 4 Query 5 Store DICOM to Image Source Store KOS in 6 XDS Repository 7 11 Retrieves exam Register Document from XDS Image Integrated Source / with XDS Registry Source Repository iCEA Dermatology Workflow • Encounter Based Workflow – No Order or Accession # from EMR – iConnect Enterprise Archive Creates Accession Number • Infrastructure – 3rd Party Dermatology Camera App – iConnect Enterprise Archive – iConnect Access – Epic EMR • Goal: Develop a non-DICOM workflow that could be generalized to many service lines and facilities Provider Provider selects Patient Provider Patient visits decides to Patient from Start “Checked In’ Examines Derm Clinic acquire Cameras for Visit Patient images Worklist ADT^A01 A04 ADT creates EA Sends with DEP and Encounter Provider unsolicited HL7 CSN from Based Order MWL Query Selects Body ORU Message to EMR on EA MWL Part / Location, EMR with CSN and Disorder in Camera Match Unsolicited Proc. Procedure Code Images Provider Accession Record(s) created applied based on transferred acquires image MWL-R Number against CSN / mapping to Study via Wi-Fi to for each body Created Encounter Description iCEA part / disorder No Match Hyperlink created in EMR with Proc. End Provider Description clicks Send Exception Workflow End 19 Survey Who has had PACS at their institution for more than 7 years? Who has migrated their data from one system to another? When you bought PACS, were you aware that your vendor stored the data in a proprietary “flavor” of DICOM? Implications of storing your non-DICOM data in a proprietary format: 1. Can only view the data using that vendors viewer 2. Expensive proprietary migration in the future 3. Can you give that proprietary data to a patient if they ask for it? 4. Vendor Lock-In Summary Integrated Solution with a Single Database Unified Infrastructure – Storage + Servers Single Admin Tool for DICOM and XDS Robust and Proven Business Continuity and Disaster Recovery Solution Enterprise Viewer showing all clinical images Questions? .