Cloud PACS provide all the features you expect in an onsite PACS with additional functionality and benefits, including a reduction in overall cost of operations to improve your return on investment. With a Cloud PACS, there is no need for onsite hardware as data is stored redundantly in a Cloud system, effectively eliminating the threat of data loss in the instance of a disaster at the healthcare facility. Furthermore, with no onsite servers to maintain and software updates performed remotely by Cloud PACS vendors, the need for IT professionals is also eliminated. And, with Cloud PACS being accessible via weblink, physical media, such as CDs, are no longer required, which means there is no risk of data being lost, resulting in HIPAA violations and no money spent on discs which were sometimes burned incorrectly, adding frustration to the initial cost.
Of course, with so many companies offering so many “Cloud” based solutions, differentiating between competitors can be difficult, leading to the misconception that simply moving servers from an on-premises cabinet to a commercial data center is a sufficient solution to storing vital data. Shuffling data from one box to another is not a solution; it is a single point of failure. Your data deserves more; your data deserves PICOM365.com.
ScImage’s PICOM365.com is a completely realized Cloud PACS solution offering a resilient computing infrastructure able to be securely accessed from anywhere utilizing high availability technologies with end-to-end redundancy. Far beyond one instance serving one institution, PICOM365.com’s geo-redundant storage systems with multi-petabyte scalability have the power and flexibility to leverage massive bandwidth for maximum data throughput to simultaneously serve thousands of institutions. Built on Microsoft Azure, PICOM365.com’s secure end-to-end imaging and reporting workflow feature real-time advanced threat analytics along with data encryption at rest and in transit. Additionally, PICOM365.com’s full IT and medical device regulatory compliance capability eliminates all barriers to entry, allowing full functionality with ease. That is Cloud PACS. That is PICOM365.com
Perhaps you are considering using a Cloud PACS solution or are questioning your current system.
PICOM365.com has the flexibility to meet any institution’s demands:
- If you are interested in a pure-cloud data ecosystem, PICOM365.com’s complete order-driven imaging and reporting workflow enables full diagnostic interoperability using simple, small sentry gateway appliances placed on-premises.
- If you are interested in a hybrid solution using existing on-premises infrastructure as well as the Cloud, PICOM365.com offers a complete order-driven imaging and reporting workflow using a local instance of PICOM365 and the Cloud for VPN-less result distribution, EHR integration, remote reading and offsite archiving.
- If you already have an on-premises PACS or a local instance of PICOM365, you can use the Cloud to provide VPN-less image and report access to referring physicians as well as EHR Integration, remote reading and disaster recovery.
- If you currently rely upon an on-premise infrastructure, you can use PICOM365.com’s secure image/report access portal for referring physicians.
- If you are looking for a simpler solution, you can use PicomCloud.com and pay as you go only for the imaging and reporting tools your team uses.
Whatever size and scope best serves your institution, PICOM365.com best serves your data.
Flexible cloud-based PACS platform for fast and accurate reporting.
Synergy Radiology Associates is Houston’s premier radiology team, comprised of more than 75 Board Certified Radiologists and one of the fastest growing radiology groups in the county. We sat down with J. Armando Saenz, M.D. to discuss how the flexibility of PICOM365.com, ScImage’s cloud-based PACS has supported Synergy’s vision for growth and patient care.
Why did you select ScImage’s PICOM365 cloud-based PACS?
With more than 75 radiologists, Synergy provides radiology reading capabilities for more than 100 sites. We serve different facilities with varying needs, some have no PACS of their own, others have systems already in place but they need a quality radiology group to be plugged into their workflow. The robust capabilities of the PICOM365.com architecture give us the flexibility to have arrangements that meet the technology and workflow needs for clients of varying sizes.
Most of our clients are cloud-based, but one of our major clients requires a physical server at each facility. Ultimately, our vision is to have workflow in which radiologists can use a single platform with one window, or at least one monitor – a way to easily look at the worklist and manage the list without necessitating too many monitors or steps, and allows control in terms of how and where the studies are routed.
How does the flexibility of ScImage’s cloud-based PACS help you serve your clients’ needs?
ScImage worked with us to create a master worklist that tied our workflow with other clients and facilities. This included revamping the radiology reading dashboard to create a second worklist for the on-premise exams, giving radiologists two windows on the same screen to watch the different server environments. On our end, our radiologists log into one worklist and are able to see everything they need. We have tags that allow us to know where the studies are coming from but they all show up on one work list, and one system. It has been working well.
The flexibility to use both cloud and physical servers is further enhanced by custom filters to manage which studies go to which rads. As a result, when a radiologist logs in, they only see the studies they need to read, giving us the ability to handle various facilities with different credentialing makeups.
How does ScImage’s PicomSentry Help Support Growth?
Overall, ScImage has supported our growth because it is a very robust system, it is easy to implement, and helps us keep up with, and accommodate client demands. Because we serve so many different facilities with varying system needs, a quick and easy implementation is critical to get plugged into their workflow.
As we bring on new sites, we’ve started deploying ScImage’s PicomSentry, a preconfigured security appliance that enables users to utilize ScImage’s PICOM365 Enterprise PACS with plug and play convenience. Whether a facility has an existing solution or no imaging system place, PicomSentry provides immediate back-end interoperability and they’re up and running with a robust system. It provides our customer with options to leverage the PACS they have already invested or start a sophisticated image management solution. It’s quick and easy, and we can get a site up and running in weeks, not months – it’s one of the fastest implementations in the industry.
Why is the speed of report turn-around time important?
In addition to patient experience, speed and accuracy are critical to the delivery of high quality medicine in the ER setting. Accuracy is a given, we have a process to maintain accuracy and our error rate is well below the national standard. So, why does speed matter? It matters because when the report takes longer, the clinician is waiting – and even, more importantly, the patient is waiting.
We’re very proud that Synergy is able to consistently deliver some of the fastest report turn-around times in the country. That is one of the most important reasons we’ve implemented PICOM365 by ScImage. We did not want exams being sent from server to server or from server to cloud which is going to add time, and therefore, impact the final turn-around time. Speed, accuracy and quality are not only the keys to good patient care, but they are critical to our ongoing success and growth.
Enhancing the physician experience and improving patient care.
Founded in 1997, Foothill Cardiology focuses on providing high quality, comprehensive cardiovascular care to patients, their families and the community, within a compassionate and service-oriented environment.
Foothill Cardiology/California Heart Medical Group is Southern California, San Gabriel Valley’s Largest Cardiovascular Practice with 15 board certified cardiologists who specialize in the diagnosis and treatment of cardiovascular disease. Services range from routine cholesterol reduction program to EP Studies, Invasive Coronary Procedures, Structural Heart program, Vascular Services, Nuclear Imaging, and Clinical Research.
Foothill Cardiology, a long time NextGen user, utilized an imaging and reporting solution that was hosted onsite and had limited remote capabilities and limited editing of Structured Reports. Looking for an integrated PACS solution capable of supporting an image-enabled EHR, Foothill Cardiology was introduced to ScImage at a NextGen Users Conference.
ScImage was able to provide Foothill Cardiology with a comprehensive and robust Hosted Solution that fulfilled the vision of minimal onsite service with a completely remote diagnostic venue for reading and reporting all of their exams, including Echo, Vascular, and Nuclear Images.
According to John Gonzalez, Operations Manager, Foothill Cardiology, ScImage was selected to address these needs due to their innovative software approach, flexible architecture, enterprise Web-Based offering and the company’s willingness and ability to accommodate our specific requirements. “It was really the functionality of the PICOM365 Cloud solution and the ability to integrate with our NextGen EMR. The way that it integrates with the order management process is something that I’ve never seen from any other PACS,” added Gonzalez.
In addition to serving its own patients at three locations, Foothill Cardiology supports six regional hospitals. Secure Cloud-based image sharing capabilities and interoperability built into the ScImage platform, enable Foothill Cardiology to upload and interpret diagnostic cardiovascular studies on patients performed at other facilities and largely eliminate CDs for patients that come from outside referrals. “However, in cases where the patients are sent with image CDs, we can upload them to PICOM365. Not only does this give us a permanent record which can be viewed throughout the treatment process, it is much more efficient than having to hunt for CDs every time someone wants to view the images,” said Alex Durairaj, M.D., FACC, President, Foothill Cardiology.
“Anywhere access has been tremendously helpful – both from a viewing and a reporting standpoint. When I’m at a remote site, it’s nice to be able to see the study and not have to call someone to send it to you manually,” said Dr. Durairaj, who also attributes better workforce management to anywhere access. “Not only does this free our clinicians from being tied to one location to read, but when one office is busy, clinicians from another office can pick up the slack by reading studies from the centralized worklist to maintain proper report turn-around times. This flexibility improves our efficiency with no interruption to workflow and helps me better manage staff utilization.”
ScImage’s high availability PICOM365 Cloud solution delivers constant security and encryption enhancements to balance the need to safeguard Foothill Cardiology’s data with the need for easy and consistent access.
“Web-based is absolutely the way to go,” said Gonzalez. “We had Cloud capabilities before partnering with ScImage; however, service for the onsite server and applications needed to be managed daily by internal staff as well as a contracted IT company, increasing costs and decreasing efficiency. Leveraging Microsoft Azure technologies, ScImage adds a layer of security and protection that we may not have been able to accomplish in-house. This helps ensure that our data is protected, private and HIPAA compliant,”
Integrating ScImage’s PICOM365 Enterprise PACS with native EHR information improves clinical collaboration. ScImage’s open SQL database maintains the quality and liquidity of images and patient data in its native format to access, run reports, pull priors, and customize pre-fetching rules. With optimized structured reporting, the open database also provides the ability for Foothill to explore data-mining and analytics capabilities.
Foothill Cardiology and ScImage have continued to work together to enhance the physician experience and improve patient care through technology and collaboration. ScImage has a close working relationship with the both the clinical and IT department and continues to have regular meetings to stay abreast of the latest technology and ever-evolving clinical requirements that a world class institution such as Foothill Cardiology encounters.
Workflow and Connectivity Drives Growth
Neighbors taking care of neighbors, with the technology and clinical expertise equal to or surpassing a big city hospital – that’s the approach that Butler Health System Cardiovascular Services takes as it delivers top-quality cardiology services.
Founded in 1898, BHS has numerous locations throughout Butler, Pennsylvania and surrounding counties. With more than 20 highly educated specialists, BHS provides care for everything from routine cardiac care, interventional cardiology, electrophysiology, open heart surgery, TAVR, and rehabilitation. The 296 bed hospital system has been recognized for receiving a 5-star rating from Health Grades for its cardiovascular surgery program and earning the Apex Award from VHA for Acute Myocardial Infarction and Heart Failure.
“The only way for a small, community hospital to survive in today’s changing environment is by continuing to provide quality care, to expand into new regions, and by adding cardiovascular service lines. You have to build partnerships and demonstrate their value, and you can only do that with image management technology that drives workflow and connectivity well beyond the physical walls of the hospital,” said Thomas W. Raraigh, BS, RT (R) (CT), Director, Cardiology & Imaging Services.
In 1998, in search of an image archive for Cath lab and echo studies, BHS found a cardiovascular information systems (CVIS) provider that approaches partnerships in much the same way. Starting with an archive for Cath lab images in the early years of digital archiving communication systems, the BHS and ScImage partnership quickly expanded to consolidate multiple cardiology data silos within a single database with a single log-in, including Echo, Peripheral Vascular, ECG and Nuclear Medicine.
“The major Cardiology PACS upgrade we completed with ScImage in 2013 has been pivotal in our success over the past three years. For the first time, ScImage gave us the ability to launch cardiac PACS within our EMR, providing full diagnostic viewing and reporting capability for seamless workflow during patient imaging communication. This has resulted in faster clinical decisions and improved our workflow, reducing the length of stay for inpatients by enabling cardiac diagnostic testing interpretations 24/7,” said John R. Falen, PACS Administrator.
ScImage upgrades have also featured structured reporting, providing BHS a fully order-driven imaging solution for all cardiology services and capabilities.“ Previously, cardiology reports were not uniform and turn-around ranged from 24 to 72 hours. Referring physician satisfaction scores have significantly improved now that reports are consistent across all interpreting physicians. Importantly, the structured reporting and seamless access to a unified SQL database offers clinical and operational analytics that play a key role in meeting the stringent requirements of the ICAVL and ICANL accreditation bodies,” added Falen.
In addition to serving its own patients, Butler Hospital supports several small, rural facilities that perform echo exams and contract with Butler to interpret the studies. Previously, this required cardiologists to physically drive to the other facilities to read the exams. Additionally, STAT studies would often have to be deferred to another cardiologist group if the assigned physician was completing office visits off site.
“Our group is extended well beyond the front doors of the hospital, in some cases, 30 miles. The ScImage platform has provided us ability to provide services in these remote locations and still provide quality and timely reporting for studies performed at any one of our outpatient or in-patient facilities,” said the cardiology group administrator.
Secure Cloud-based image sharing capabilities and interoperability built into the ScImage platform enable BHS to upload and interpret diagnostic cardiovascular studies on patients performed at other facilities. Cardiologists have the ability to launch the PACs from anywhere and complete interpretations at anytime, including STAT studies. This allows BHS to provide services to remote sites without the expense and difficulty of setting up multiple cardiology PACS systems at each location.
“With the ScImage system, I can read from anywhere, in my office or at home, making it very efficient, timely and paperless,” said Dr. Prem Kumar, BHS Cardiologist.
According to Dr. Phillip Painley, BHS Cardiologist. “It’s serviceable and cost effective, I utilize the mobile platform frequently while on call and the report tools make delivery of studies more efficient.” “By providing the diagnostic cardiology services at these smaller rural facilities, we help ensure that all patients have access to timely, high quality cardiac care,” added Raraigh. “In turn, we continue to strengthen our relationships and receive referrals for high end cardiology services at our main campus. This investment has helped build our surgical and cath business and resulted in a strong downstream revenue for high end cardiovascular procedures.”
Raraigh attributes some of the success of Butler Health System Cardiovascular Services over the past several years to its partnership with ScImage. “We have been able to improve workflow and efficiency, not just for our cardiologists, but for our entire staff and for our patients. With the ability to get diagnostic testing done faster and generate reports more efficiently, we can treat and discharge patients faster and more cost-effectively. Based on ScImage’s ability to help us reduce report turnaround times, increase access and reduce costs for our cardiovascular services, Butler is now reviewing ScImage’s Enterprise Imaging solution to integrate radiology and other imaging services.”
“As we have grown, ScImage has grown with us. For more than 17 years, they have been more than a vendor, they have been our partner – small enough to be responsive yet big enough to get it done,” concluded Raraigh.
In a healthcare environment that promotes patient engagement, making sure information remains confidential is paramount. Whether information is shared between physicians or with the patient themselves, measures must be taken to insure both the security and integrity of the data.
Every vendor in the healthcare sector offers various levels of security, but how much is enough still has yet to be defined. Hacker attacks increased 600% in the first 10 months of 2014 versus the prior year, and data breaches occur almost daily. Data security is an issue of extreme importance.
The HIPPA Security Rule, which is a subset of the HIPAA Privacy Rule, requires implementation of three types of security safeguards: 1) administrative, 2) physical and 3) technical. These address both the access and confidentiality of the data.
Access means the ability or the means necessary to read, write, modify or communicate data / information or otherwise use any system resource. Confidentiality means that data or information is not made available or disclosed to unauthorized persons or processes.
Administrative safeguards are administrative actions, policies and procedures to manage the selection, development, implementation and maintenance of security measures to protect ePHI and to manage the conduct of the Covered Entity’s workforce in relation to the protection of that information.
Physical safeguards are physical measures, policies and procedures to protect a Covered Entity’s electronic information systems and related buildings and equipment, from natural and environmental hazards and unauthorized intrusion.
Technical safeguards mean technology and the policy and procedures for its use that protect electronic health information and control access to it.
The combination of all of these safeguards are designed to reasonably and appropriately protect the data. Unfortunately there is no clear cut definition of what constitutes “reasonable and appropriate” nor is there a definition of what can be considered “necessary”. This leaves facilities to implement whatever they feel are satisfactory measures.
Sadly, the security used is often not enough, especially given the plethora of breaches that have been publicized, including the latest the Premera record breach that affected up to 11 million records. Given that HIPAA penalties can be as high as $10,000 per record, any breach is one too many and 11 million can be considered catastrophic.
Endpoint encryption provides the most basic level of data security, and most healthcare companies provide some degree of end-to-end packet level encryption in all data transfers. Interestingly though, more than 41% of healthcare organizations do not use endpoint encryption, even though approximately one-third of employees work remotely at least once a week.
Many vendors provide encrypted URL’s within the integration of a secure EMR as well as optional encryption for additional data. A few companies go several steps further though and provide encrypted passwords throughout the ecosystem. Vendors wishing to have their systems used within the federal government (VA hospitals, etc.) need to adhere to a much higher standard. This often entails using the Federal Information Processing Standard (FIPS) 140-2 that provides four increasing, qualitative levels of security intended to cover a wide range of potential applications and environments. An even higher standard is the one mandated by the Department of Defense known as DIACAP (DoD Information Assurance Certification and Accreditation Process) which has since been replaced (in 2014) by the DoD’s Risk Management Framework (RMF) for DoD Information Technology (IT) standard.
So how much is security is enough and how much is too much? A recent study by the Ponemon Institute noted that 43% of security breaches across all industries occurred within the healthcare industry. That is scary.
There are tradeoffs with each security approach. If you make data easily accessible to both clinicians and patients without unduly restricting access, you open up the chance that an unauthorized party may also have access to it. Make data too restricted and it becomes a logistical nightmare to try obtain. Biometrics may provide a cost-effective answer, as may other advanced technologies under development. Until then, each facility needs to conduct its own risk analysis to determine if the security in place meets the minimum standards and protects not only itself, but its patients as well.
I did a Google search for “healthcare innovation” and came up with all sorts of hits: “FDA approves novel implanted sensor to watch heart failure”; “Infographics are revolutionizing the patient experience”; “New hepatitis C drug – a priceless breakthrough”; “Big Data has big potential” and wondered just what constitutes something innovative? A lot of that depends on where you look.
Typically, when you use the word “innovative” in the healthcare market sector, it addresses a new drug, a new modality or even a new imaging technique. Yet while healthcare IT may employ new hardware to increase speed or provide a more secure environment for the data that resides on it, the applications that run with the hardware are usually what sets them apart and are considered innovative. That flies in the face of traditional thought processes relating to innovation.
The dictionary says that “innovation is a new idea, device or process,” but that significantly limits how an idea is implemented. Wikipedia’s version is a bit more expansive and includes “…the application of better solutions that meet new requirements, unarticulated needs, or existing market needs. This is accomplished through more effective products, processes, services, technologies or ideas that are readily available to markets, governments and society. The term innovation can be defined as something original and more effective and, as a consequence, new, that ‘breaks into’ the market or society.” Imaging IT often requires better solutions, especially as it relates to new requirements, both those mandated by the “do more with less” mantra along with state and federal standards.
So just what makes an innovative company? Looking at the customer needs and finding a solution that is done better, faster or cheaper than others do it can be considered innovative; but, it’s how and when they do it that makes the difference. Computer-aided diagnosis is an example of an imaging technology that can be considered innovative, while medical image sharing might be considered another.
Most PACS share the same basic display protocols, yet a few vendors display images in a slightly different manner. Many PACS require the entire study to be loaded before images can be viewed, yet some vendors allow for images to be loaded in the background while the current images are being viewed in real time. That’s innovative. Most PACS vendors today talk about using the cloud or having an enterprise-wide solution. That in itself is far from innovative; yet, doing this over a decade ago, when cloud utilization was in its infancy, can definitely be considered innovative.
Integrating radiology and cardiology PACS into a single seamless clinical imaging system without the use of a broker or customized API can also be considered innovative. Using a single common core at the server level that can handle both data management and workflow for multiple departments across the enterprise is considerably different than interfacing a host of disparate systems and giving a new name to the patched solution. Many facilities also have multiple databases they have to query to compile a patient record so anything that unifies a patient record or disparate systems seamlessly can be considered innovative.
Linking documents, waveforms, audio files and more, while still far from commonplace today, was almost unheard of a decade ago. Select vendors were showing the promise of a multi-media PACS that far back, as well as offering a solution for viewing images remotely in the days before cell phones and tablets. All of these too can be considered imaging innovations.
Radiology has made great strides in the years since Wilhelm Roentgen first detected X-rays in 1895. Electronic imaging has made equal strides since its introduction just under 100 years later. Increases in efficiency and productivity have been the hallmarks of PACS leading to improved health outcomes and better overall patient care. Anything that improves either of those two areas is innovative.
With the advent of patient engagement imaging, companies need to provide innovative ways to protect the data while also allowing it to be shared. Several solutions exist now yet many more will be needed as hackers find new ways around data encryption schema firewalls and other devices designed to protect the integrity of PHI.
Innovation is all around us and applying these advances in the right way can change the way healthcare operates.
Ask ten people what big data means and you get ten different answers. Nearly all will agree that it includes data sets that are so large in volume (terabytes to petabytes) or complex in nature that traditional data processing applications can’t be used. The one thing nearly everyone in healthcare will agree on is that data can drive not only marketing and sales, but diagnoses and outcomes as well. That said, having big data and using it are two different entities. Who does the analysis and what the outcomes of that analysis are often determines not only the future of a company, but often the end results of patient care.
In most companies, big data is used to help identify the customer’s needs. Sadly, marketing often remains separate from the rest of the enterprise and may be operating without the benefit of the available data to promote products. While this data can be used to customize the end-user experience and to eliminate the one-size-fits-all solution commonly offered today, customers are still faced with approaches by vendors that only minimally tailor solutions to them – and consumer patience is wearing thin. The information needed to address the specific needs of the customer is becoming more and more available, but getting it into the right hands remains a challenge.
In healthcare, big data remains largely unproven, although that hasn’t stopped companies and vendors from jumping on the big data bandwagon. Big data analytics was a hot topic at HIMSS 2014, and it no doubt will be again this year. The promise has been promoted that big data can provide a better quality of care and reduced expenditures, but the evidence to support those claims – at least to date – is somewhat tentative at best,
Big data analytics takes mounds of data from many disparate sources to discover patterns that could be useful in problem solving. These sources typically include clinical, financial and operational data and often work in the cloud as well. Much of it is designed to allow patient interaction by taking a proactive, or preventative, approach. Clinical data is typically normalized and validated from across the continuum of care to often include not only medications, lab results, vital signs, demographics, hospitalizations and outpatient visits, but also physician notes and lab results, taking advantage of both structured and unstructured data.
One of the more interesting areas where big data is used is pediatric cardiology, where analytics are applied to make patient-specific recommendations for treatment. The Pediatric Cardiac Critical Care Consortium (PC4) uses big data to try and improve the quality of care by collecting data on clinical practice and outcomes from each patient’s medical record and analyzing the data to provide clinicians with timely performance feedback. This fosters a culture of continuous improvement through analytics and collaborative learning. This disease-specific registry is also essential as we move towards a value-based healthcare system.
Big data in radiology is more about decision support than anything else and plays an important role in defining the way radiologists use clinical decision support systems to assist them in reading images. According to a recent survey, nearly 89% of radiologists said they always use the clinical decision support software computer-aided diagnosis (CAD), yet only 2 percent said they often change their interpretation based on CAD. The confidence simply isn’t there because the universe, while seemingly large, isn’t nearly as large as it needs to be to instill the degree of confidence required by radiologists. Rather than relying on individual studies, each clinical course and data would be saved and made available for decision support, capturing not just the data in a patients in electronic medical records but their radiology data, as well. These large data sets could be used in the future in clinical decision support systems like CAD to study patients with similar characteristics and to calculate the likelihoods of malignancies and other diseases. Putting these in a format that allows for data mining requires some additional coding and tagging but in the long run it will make the data easier to organize and search through and should improve both radiology diagnoses and ultimately patient outcomes through improved diagnostic capability – all made possible through the use of big data.
The future of connected healthcare is here today. End users evaluating a system want to know that they are taking a step forward, not backward, and that a system that works with everyone using standards to interconnect is the only way healthcare can meet its stated goals.
Connected healthcare dates back to the late 1960’s yet has never held more promise than today. Healthcare cost, quality and efficiency are key, as is making healthcare more patient-centric by educating consumers and encouraging their participation in the entire process. The consolidation and sharing of data generated outside of traditional healthcare settings through RHIO’s, HIE’s, and others also creates the need for a comprehensive electronic health record.
Many facilities have realized the need to have a fully integrated system. The IHE (Integrating the Healthcare Environment) infrastructure outlines a host of methods to integrate documents and data, as does HL7 and even DICOM at the modality level. The goal of all these standards is to allow the seamless integration of disparate clinical systems into a single electronic health record (or EHR) that can take advantage of high speed networks and mobile devices.
Many vendors have begun to integrate their clinical imaging systems using a single viewer that displays radiology, cardiology, medical records and other clinical imaging system data using a single off-the-shelf monitor. Archives are moving in the same direction with a single vendor neutral archive (VNA) storing all the data for the required number of years, supplanting the single silos that used to be connected to each system. While a broker can bring together numerous disparate systems, minimizing the number of required integration’s is the name of the game.
By having systems connected, data can be shared and the patient engaged more easily. More importantly, larger health care systems like the HCA, Kaiser, Tenant, CHI, CHS and others, can provide not just a central clearing house for their patients but also allow their patients to use physicians associated with them. This is crucial for these entities to provide high quality care as healthcare moves towards a value-based system.
The fundamental image entry point into a medical imaging ecosystem must use a small footprint with efficient communication capabilities. Images need to be packaged and moved to their destination securely and quickly, leveraging the available bandwidth. When these images arrive, there can be no lag in unpacking and processing the data. Users need access to images right away.
ScImage’s latest development in image capture and delivery is achieving exactly this–image acquisition software that realizes a five to ten fold improvement in speed and efficiency of data upload, while significantly reducing server side database transaction loads.
Besides the obvious transmission efficiency, the study is only available for display after all images are present in the study folder. The result is a greatly improved physician experience by eliminating the confusion with in-progress image displays.
Whether the destination is an on-premises PicomEnterprise server, or our PicomOnline cloud PACS or a PICOM365 Hybrid Cloud solution that combines both, users will experience a more efficient image viewing experience.
Interactive streaming of DICOM image objects into viewers is the fundamental operation driving a quality user experience in diagnostic image interpretation. Unintelligent sequential downloading of images one-by-one is the norm with most current PACS solutions. Physicians are forced and trained to live with sub-optimal performance. Consider CT/MR type modalities with a good number of priors and complex hanging protocols. Image streaming algorithms must work asynchronously and feed images to the viewer dynamically based on hanging protocols and user interactions. For example, user moves the mouse and we need to show image number 450 in a stack of 1450 images within a particular window. Even plain film imaging and mammography can get tricky with a lot of priors. On the cardiology side, it gets more complicated because of the sheer volume of data and multi-frame image sequences. A typical complete Echo exam these days has 90 to 150 sequences and each sequence consists of several seconds of high resolution frames. If the server and the client are on the same local network, it is not a big problem. However in a broadband configuration, for instant access to exams on an ad-hoc basis, intelligent streaming is a must to get the job done.
Medical image streaming is nothing new to ScImage. Since the inception of www.picomonline.com in 2000, image streaming has been an integral part of the PICOM family of products. Speed and stability of the Internet, broadband technologies and even on-premises network infrastructures have dramatically changed over the past fourteen years. Being an innovative company that challenges the status quo, ScImage has continuously enhanced image streaming algorithms to unleash the power of modern network topologies.
Welcome to the third generation PICOM Streaming – SmartStream™
It is fast, it is intelligent, and it predicts user movements. SmartStream™ delivers robust throughput and is completely stealth. It uses different logic patterns for radiology and cardiology viewers to deliver the right content at the right time. It strikes the correct balance between sequential packet transmission and ad-hoc packet transmission. The result is a 50% boost in speed compared to ScImage’s second generation HyperStream™ algorithm. Even with a 100+ sequence echo exam, if there is a decent Internet connection, you should start seeing images in about two seconds. Users will see the same performance with large CTA exams. Plain film and the remainder of medical imaging is a breeze.
Tucson Medical Center (TMC) is a locally governed nonprofit regional hospital in Tucson, Arizona. Licensed at 629 beds, the medical center treats 30,000 inpatients, 122,000 outpatients, and over 80,000 ED patients annually in addition to 6,000 infant births. TMC is Southern Arizona’s leading provider for emergency and pediatric care, and includes the region’s first Pediatric Emergency Department with specialized treatment for young patients. Other specialty areas include women’s health, maternity, cardiovascular, orthopedics, neuroscience, hospice care, imaging and senior services. More than 600 physicians are on staff, representing 60 specialties from anesthesiology to vascular surgery.
Cardiology and radiology images were being captured as DICOM files and stored in their respective imaging systems at TMC. IT administrators were surprised to discover that a number of different systems were being used to store non-DICOM images (such as JPEG, MPEG and AVI files) on a variety of media in many other clinical departments. Some images were burned on CDs, others were on optical discs; still others were copied onto DVDs. Aside from the lack of consistency, managing these images was inefficient and limited the ability to replicate the images at TMC’s disaster recovery site.
Additionally, the non-traditional images were not available to all physicians as part of the online patient record. When IT administrators realized that these images, which were patient content and just as pertinent as the data they had spent years transferring to the EMR, they needed to find a way to integrate the images across the continuum.
TMC also wanted to bring all images online to a digital, filmless system with appropriate support and oversight. It needed to develop a strategy to integrate, manage and store all imaging through a central system that would provide privacy and allow accessibility for important patient data through the EMR.
In an effort to bring a higher level of service to its physicians, TMC expanded the capability of the PICOM365 platform previously implemented by ScImage that consolidated five cardiology workflows (cardiac catheterizations, echo cardiograms, ECGs, and vascular imaging) onto a single platform. TMC found this to be a cost-effective, efficient and seamless way to add non-DICOM images.
- All cardiology and non-DICOM images are displayed in a single patient folder, improving clinician access and patient care
- Images can be viewed directly from PICOM365 from anywhere, or through the EMR
- Staff productivity is improved
- Departmental resources and space are freed up
- Images are managed, secure and in compliance with the TMC Disaster Recovery Plan
Zero hardware failures and five nines of uptime after several millions of imaging exams and after several hundred terabytes of storage – it is a nice proof statement for the ingenuous architecture of BrickStore™ storage, developed and implemented by ScImage, at the PicomOnline (www.picomonline.com) Cloud PACS and healthcare image interoperability portal. Massive scalability, cost-effective storage, low power consumption and low maintenance are the salient characteristics of BrickStore™.
Understanding the life of imaging objects acquired during medical imaging procedures is the key to the design of a storage system to provide the most efficient image life cycle management (ILM). A typical image object gets written to the storage system once, followed by several reads during the first couple of weeks and then gets accessed occasionally. Effectively it can be characterized as a small number of mostly reading transactions of large files. Issues such as single point of failure cannot be simply solved by purchasing expensive generic RAID units. And contorted multi-tier storage systems with black box middleware simply make things complicated without solving the real problem. Too many moving parts result in too many places to break. BrickStore™ understands image lifecycle management of medical image objects better than most generic commercial storage systems. It provides ForeverOnline™ functionality by maintaining an array of individual storage systems. Individual storage units go into a standby state when not in use to prolong the life of spinning drives and to reduce power consumption. And when needed, it pushes the read-write rates to very close to the raw drive speed.
ScImage is proud to have developed this unique technology to better serve our customers ranging from big hospital networks to small physician practices. We are excited about new growth opportunities in this new category – CloudPACS for anyone from anywhere.
Critical alerts workflow requires disseminating alerts via text messaging and email distribution and running a clinical imaging web portal that is exposed to users outside the firewall. Most institutions with IT departments do have proper infrastructure for text messaging and email distribution but are subjected to local domain and security restrictions. Even when dealing with cooperative IT departments, things may get cost prohibitive or over complicated. Running a clinical imaging web portal in the DMZ requires more IT support and costs add up. On top of all this, for a comprehensive implementation, an enterprise quality secure screen sharing infrastructure is required to provide consultation to physicians outside the domain of a health institution. The screen sharing requirement is beyond the scope of services provided by most hospital based IT departments.
PICOM365 to the rescue…
The beauty of a hybrid cloud model is all the critical components required for instant access are kept on premises, while the components that need to talk to the outside world are moved to the cloud. If we move text messaging, email distribution, clinical imaging web portal and screen-sharing to the cloud, the on premises infrastructure becomes streamlined without compromising security, while lowering support costs. Moving alert processing to a cloud infrastructure drives flexibility and effectiveness to serve users both inside and outside the institution. Ultimately, cloud infrastructures powered by robust servers and managed by bigger teams provide reliable service and economic efficiency through cost sharing.
We call the activity of remotely managing critical and non-critical alerts, Remote Alerts Service (RAS) for PICOM365. This service is now available to all ScImage customers that have a PicomEnterprise on premises and are subscribed to PicomOnline.
Modern PACS is not just an independent imaging box anymore that can only do acquisition, storage and distribution of images. It needs to coexist and stay connected with rest of the workflow components of imaging service. The workflow starts with an ordering system, goes through various clinical components and activities and ends with result distribution and a billing system. If all the components are within the same location, it becomes straightforward. Certain deviations such as ordering and billing systems not being at the same location, do not affect the imaging workflow. Also location independent reading environment for images generated at fixed locations is also well understood and practiced.
What if we need to make everything location independent – Ordering system, DICOM Modality worklist infrastructure, actual modalities, image acquisition, native or external diagnostic reading, native or external diagnostic reporting, workflow triggers, report distribution via email and fax, fax copies to multiple related parties, HL7 report distribution, image pointers to third-party EMR and billing triggers. And do all this securely in the public cloud.That is imaging ingenuity for smarter patient care and that is PICOM365.
This is not a theoretical exercise. The need is real for mobile imaging solution providers. Imaging equipment goes to patient homes or care facilities and acquired images are instantly sent to a cloud storage using 4G/LTE type broadband connections. The imaging solution providers generally use a custom EMR/business system to create orders and for billing. They may use several trucks with imaging equipment to perform imaging procedures. Within a few minutes after image acquisition they would like their primary reading physicians be able to read and report using native toolset. They also may like to engage external reading physician groups that may use other third-party PACS for reading and reporting. Once a report gets signed, they would like to fax the report to the referring physician, referring care facility that ordered the service and additional copies to other physicians and/or institutions that are involved with the patient care. Finally they need to get the report via HL7 ORU interface back into their EMR/business system for record keeping and billing purposes. They want to accomplish this with zero hardware footprint because they do not want to have in-house IT support or infrastructure.
PICOM365 cloud services connected to on-premises interfaces has accomplished this challenging functionality with uncompromised security and with no on-premises hardware footprint. This cost effective software as service model allows imaging service providers to dynamically scale their operations.
Patients visiting multiple specialists at multiple institutions are a common occurrence throughout the healthcare ecosystem that needs some special consideration from an information exchange perspective. When it comes to exchanging data, on the surface and under ideal conditions things may appear simple and straightforward. Institutions, however, face various implementation challenges and spend a lot of time and resources when bridging gaps between assumptions and realities. The amount and type of data collected during each patient visit dictate complexities and compromises involved in possible solutions. Transporting imaging exams in particular makes the task even more challenging.
Patients carrying their images on physical media works, but comes with drawbacks such as wasted time and money, as well as issues with security and confidentiality. Third party cloud-based image sharing services are becoming popular for one-on-one sharing. For limited numbers of exams, they do provide a good solution. However, between the source and the destination, there are several unknowns with respect to confidentiality, audit trail, and the number of copies that are left behind in the transfer. Furthermore, costs involved in manual or semi-automatic means of image ingestion into destination PACS are not insignificant. In high volume reading environments, imported external exams without optimal tag morphing pose challenges in hanging protocols and relevant priors, driving reading physician productivity down.
How do we automate this for a large number of exams across multiple institutions?
Conventional wisdom suggests creating an MPI strategy to transport images among subscribers. In an ideal environment, that works fine with a known MPI reference. However, strategic discussions between competing parties usually end up with no real solution. Simple things get complicated for a variety of reasons, especially when dealing with independent (and sometimes competing) institutions and multi-specialty groups. The ideal solution here is to have an independent and intelligent translator that can provide fast and automated image transfer across multiple institutions.
PICOM365 provides end to end image transfer with an adaptive translator.
It all starts when a new imaging order comes into the system from a facility. It triggers an event in our translation logic engine. The translation engine makes the decision based on an existing knowledge base and latest information from all connected sites. It then automatically pulls all relevant priors from all facilities and makes the prior exams ready at the originating facility. All this happens before the current exam reaches the local PACS. When the reading physician opens a new exam for reading, prior exams from one or more external facilities naturally appear in the viewer. End result – quality of care, productivity and physicians’ confidence in reporting increase due to this new access to comprehensive information. And every time a new mapping is formulated, it adds that piece of knowledge to the knowledge base and the system keeps learning.
Under the hood, this intelligent engine keeps pulling and pushing images across multiple facilities and keeps the entire clinical workflow productive with comprehensive reading packages.
Automated just-in-time priors need not be an item in your wish list, you can make it a reality with PICOM365.
A picture is worth a thousand words. Image pointers bring richness to EMR content. Whether it is physician to patient consultation or physician to physician consultation, images elevate comprehension to a higher level. Insertion of image pointers into an EMR may be a luxury for now but is fast becoming a necessity. In many institutions, implementation of image pointers is thought to be somewhat of a routine streamlined process. A web link is displayed next to the findings of a diagnostic report. When clicked, it takes the user to a little imaging world created by the image content provider. Click, drag, move and flip – you can see images of the exam in question.
Are all image pointers created equal? Not necessarily…
A one size fits all type of universal viewer clamped onto black box VNA infrastructures can only show the content in a generic fashion. Clinically meaningful image content presentation sometimes moves beyond the scope of VNA capability. For them a chest x-ray and a beating echocardiographic image may look the same – a DICOM object. However, there is a world of difference as to how they need to be presented from a clinician’s perspective to be useful and effective. What about non image objects that are specific to imaging workflow? Robotic, DICOM minded universal viewers tend to conveniently ignore such clinically relevant information. Non radiologic and non-imaging ECG type exams are generally viewed as inconvenient deliverables for most universal viewing solutions. You may have to settle for a link to a PDF at best.
In summary, solutions that think imaging through radiology and with DICOM only tunnel vision are bound to produce inferior image pointers from an enterprise level patient-centric perspective. To fix the situation, fortunately, we don’t have to spend a lot on some high priced special solutions. We just have to invest in smarter solutions that understand both image content delivery and clinical workflow.
PICOM365 by ScImage is a unique solution in the industry that combines multi-departmental end to end imaging workflow with clinically relevant image content delivery and with an optional built-in VNA. At the department level, it provides complete PACS functionality along with robust tools for diagnostic reading and reporting. Auto discrete data capture during imaging procedures creates a clinically rich environment for advanced diagnostic reporting. All reporting workflows are natively built into the core foundation that include traditional dictation-transcription, voice recognition based self-reporting, evidence based structured reporting and institution specific custom reporting. In addition to various flavors of HL7 report distribution, it is easier to output discrete data to an EMR to meet meaningful use requirements from an imaging workflow perspective. Obviously, image pointers produced by such a system have comprehensive diagnostic information. Static radiology images, dynamic cardiology images, endoscopic videos, various audio clips, ECG like waveforms, Holter like modalities that capture information in documents, pathology microscopic images, and other generic pictures from ophthalmology, dermatology like departments are presented the way physicians appreciate. Delivering this type of rich content to all modern computing devices with varying form factors is the value PICOM365 brings to your institution.
Investigate all your options before making that strategic decision on how to implement image pointers in your EMR.
For the Enterprise
- Leverage your VNA investment with comprehensive cardiology integration.
- Go beyond cardiology to all other ‘ologies that need data storage.
- PICOM365 can handle DICOM, non DICOM, documents, videos and binary files.
- Provide a single source universal viewer to image enable your EMR.
- Create intelligent end to end clinical imaging workflow with PICOM365.
PICOM365 – The only solution with native, end to end cardiology integration
- Reading and reporting radiology exams continues to get more complex.
- Interoperability, collaboration and an intelligent global worklist tools alleviate your workflow challenges.
We help solve your complex workflow!
- From diagnostic to interventional procedures.
- Cath, Echo, ECG and everything in between. All in one native imaging platform.
Cardiology image/info management, the best in class.
For other ‘Ologies
- Pathology, endoscopy, ophthalmology and more.
- Store images and videos from any source with clinically relevant meta data
- Store documents, reports, procedure notes and all other proprietary files
20 years of Imaging Ingenuity for Smarter Patient Care
The modern healthcare paradigm demands location independence to bring imaging from anywhere, to radiologists at anyplace.
- New reimbursement models encourage “care teams” that share images and reports.
- Reimbursement reductions are forcing practices to extend service boundaries.
Rethink your imaging strategy!
- PACS interoperability is the key to service growth.
- A smart global reading worklist provides seamless access and reading efficiency.
PICOM365 has redefined reading interoperability
- Keep your existing diagnostic viewer or use PICOM365 and work from anywhere.
- Keep your existing worklist. No need to change your familiar dashboard.
- Eliminate co-mingling of data from different facilities in a single archive.
- Configure your workflow with intelligent business rules and imaging tools.
- Get a complete reading package with prior images and reports, where you need it.
20 years of Imaging Ingenuity for Smarter Patient Care
Imagine the backstage of a high school symphonic band concert, ten minutes before the start. This is how imaging modalities are playing together in many cardiology departments today. Interestingly, the larger the institution, the greater the fragmentation and chaos. Your experience sitting in the audience once the concert starts is much different. This is how radiology departments are organized. And in this case, the bigger the institution, the more organized it appears. Why is this and how does one handle the situation from a big picture IT perspective?
Historically, invasive cardiology, for variety of reasons, has claimed the privileged seat at the table. Physicians, nurses and techs have developed a nice workflow centered around Cath Lab imaging and Hemodynamics systems. Manufacturers of these systems have fused required image/info components call this a “CVIS.” Echocardiography claimed the second seat at the table with its huge datasets, abundant measurements and complex reporting statements that are triggered by measurements. Nuclear cardiology claimed the third seat with its own specialized procedures, workstations and reporting. ECG was never given a real seat at the imaging table and they got comfortable in their own little silo. Modalities like Holter monitoring were not even invited to the discussion. Meanwhile multi-modality procedures such as Stress Echo and Nuclear Stress were forced to go into “whatever is available” mode. Vascular Echo shows up sporadically within the cardiology domain. Pediatric echo, congenital heart reporting and such, demand specialized advanced reporting tools. CTA and MRA take us to a totally new discussion on department silos. Instead of sharing the budget, they broke the budget and built their own silos for the right clinical efficacy reasons. Over time, the workflow in cardiology became so fragmented that now no one wants to touch it for concern over making the physicians using these systems unhappy.
With an EMR company there are charges for each HL7 feed on the inbound (Orders or ADT) and for each image pointer and report feed on the outbound. Typically, radiology interfaces require one of each these for a total of four interfaces. Cardiology is much worse because of all the silos. Add professional services fees for implementation and yearly support contracts for these interfaces and then ponder the costs involved in managing different archive destinations and their disaster recovery mechanisms. Consider stability issues with all these moving parts. What if it were possible to consolidate all this without losing clinical efficacy and without making physicians unhappy?
An easy way out is to invite your big iron vendor (or the so called CVIS vendor) to extend their solution to the entire department. They will happily patch together a solution using different products from various acquired companies. The result will be an eloquently sold system that is bulky and inefficient on the inside and nicely dressed on the outside. Financially you are consolidated but technically you are exactly where you stared, with different silos.
Let’s rethink the cardiology imaging and pick a solid foundation (not a patched solution) that has most of what you want and then add the last few missing pieces.
Pick a foundation that can:
- manage all imaging and waveform exams.
- provide single point archive and offsite disaster recovery
- provide complete diagnostic viewing tools accessible from anywhere
- do the job without multiple interfaces for the same info.
- provide Modality Work List for DICOM and non-DICOM modalities
- provide concurrent licenses that are not bolted down to individual workstations
- capture all measurements from Hemodynamics to echo to vascular to ECG
- can provide structured reporting for all your exam types
- can send discrete data to your EMR for Meaningful Use
- seamlessly support external specialty reporting applications
- natively support universal viewing on all device types from anywhere
- support Cath Lab information and inventory management either natively or via third party
- support Registry and accreditation modules
- support 3D echo visualization either natively or via third party
- provide deep integration with quantitative nuclear cardiac software
- provide end to end ECG management natively available
- handle multiple modalities within an exam such as Cath-IVUS, stress echo, nuclear stress
- handle new cardiac modalities such as cardiac CT, CTA and MRA.
- provide a single database to harvest all data points and provide an open platform for Analytics.
Look around. Research what is available and don’t forget to take a look at PICOM365 by ScImage.
We are very confident you will end up with the right imaging strategy for your cardiology department.
ScImage is proud to solidify its leadership in delivering complex collaborative reading solutions to institutions of varying sizes. This is not a statement about what is logically possible. It is based on the knowledge and experience gained by operating several complex environments that have been operational for several months to several years. Our PICOM365 framework is empowering ScImage to architect and deliver complex solutions that bring harmonious interoperability among imaging and information platforms from various third party vendors. PICOM365 is truly vendor neutral interoperability.
Collaborative reading is not just for a few privileged institutions anymore. It is becoming a basic necessity for most modern practices. For patient care and economic reasons, Institutions and physician groups must come together, share their data and expertise to provide an efficient diagnostic reading environment. The result is patient exams are read at the right time, by someone with the right expertise is an important building block for better patient care. It is a win-win situation all around.
When one physician group is reading for one institution, things are simple with one order feed, one image feed and one report feed. Things becomes exponentially more complicated when multiple institutions are engaging multiple physician groups to get the job done with very little human intervention. There are several challenges in play here:
- Rules of engagement are different for different situations. Administrators must be able to define and change the rules based on contractual obligations, personnel availability and ad-hoc decisions.
- Compiling a reading package that includes current exam, prior images and prior reports and making the reading package seamlessly travel around the collaborative network is the basic task that has to happen on-demand and just-in-time.
- Different institutions have different patient identifier and accession number schemes. Seamless normalization of information is crucial when data enter the collaborative network, as well as when the results go back to respective institutions.
- Many reading groups are entrenched with their own reading and reporting tools. Delivering a reading package seamlessly and grabbing the report when it is ready is something that needs to be custom crafted for each reading group.
- The concept of a “Report Bank” is vital to infer business intelligence for the prior pre-fetch logic.
In addition to facing all these challenges with ease, ScImage’s PICOM365 brings other unique advantages:
- PICOM365 is an excellent and economical way to recruit outside expert reading physicians.
- PICOM365 is an end-to-end diagnostic reading environment providing a redundant reading platform when the local reading system is down.
- PICOM365 cloud infrastructure can send image pointers and dispatch reports to any external system.
- PICOM365 can naturally be used as a vendor neutral archive (VNA) in the cloud.
- PICOM365 is the ideal neutral zone to offer physician and patient portals with a consistent universal web viewing experience on any device.
Embrace location independence, liberate data and embrace imaging workflow beyond your boundaries.