SIIM 2017

The Society for Imaging Informatics in Medicine (SIIM) annual meeting will be held on Thu June 1 to Sat June 3, 2017 in Pittsburgh. It has a great program, and by all early accounts, will be one of the best attended in years. See the complete program here. Register to attend here.

Genady and I will be participating.

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Don K Dennison

Weighing the Options: Enterprise PACS vs. VNA for Enterprise-wide Archiving

Thursday, June 1 | 3:00 pm – 3:30 pm
Science & Innovation Pavilion | Exhibit Hall Theater
#AskIndustry Session

Sharing an imaging archive is generally a good thing, but should you implement one archive and connect multiple PACS and other imaging IT systems to it, or should you build an Enterprise PACS and consolidate your various PACS into it? We will get the perspective of vendor staff that are faced with these types of questions from their customers.

TCB: TCO to the CIO for the CIIP

Friday, June 2 | 8:00 am – 9:30 am
Room 301-302
Whiteboard

The ability of a CIIP to accurately model the Total Cost of Ownership (TCO) for imaging IT application investments and operating costs are critical to getting the support of the CIO, and to getting necessary funding.

In this interactive whiteboard session, “Taking Care of Business: Total Cost of Ownership to the Chief Information Officer for the Certified Imaging Informatics Professional”, attendees will be walked through two scenarios — Multiple PACS Replacement and Consolidation and Cost Model for Shared Enterprise Imaging Platform — by faculty experienced in financial analysis and cost model development.

Combining whiteboard discussion and review of some predefined spreadsheets that provide important calculations for each scenario, this session is intended to be highly interactive with Q&A throughout. The spreadsheets used in the session will be made available to members on the SIIM website following the annual meeting.

genady-headshot-round

Genady Knizhnik

Economics of Imaging Informatics

Friday, June 2 | 4:15 pm – 5:15 pm
Pittsburgh Ballroom B
Core Topic Session

Imaging informatics teams routinely embark on new projects and have to support their operations, which depend on the right budget. Budget preparation and justification skills, as well as understanding of the right size and structure of the operational team, are important for securing required financial support. Attendees will examine the fundamentals of preparing well-defined budget requests that CIOs are looking for, as well as how to structure and staff the optimal imaging informatics team.

Medical Imaging Informatics and Teleradiology (MIIT) 2017

The 12th Annual Medical Imaging Informatics and Teleradiology (MIIT) meeting will be held on Friday April 28, 2017 at Liuna Station in Hamilton, Ontario, Canada. This year’s theme is Enterprising Imaging and AI: Welcome to the Future and the program features many fascinating talks by thought leaders, including Drs. Eliot Siegel and Chris Roth.

MIIT 2017 has an all new interactive website and meeting app for increased attendee participation.

Genady and I will each be giving a talk.

Enterprise vs. Diagnostic: Image Viewers Converging?

don-headshot-round

Don K Dennison

As web technologies evolve, the gap between Enterprise Viewers used primarily for accessing images as part of a patient’s electronic medical record and PACS Viewers used for primary diagnostic review is rapidly closing. But how close are they, really? This talk will explore the feasibility of Radiologists using a web viewer instead of a PACS for reading.

Managing Imaging in an EMR Centric Era
genady-headshot-round

Genady Knizhnik

As health systems converge on a common electronic medical record (EMR) system and longitudinal patient record, new requirements and expectations are placed on imaging records and the systems than manage them. This talk will explore the impact that the implementation of a modern EMR has on patient and procedure information within PACS, VNA, and other imaging IT systems.

Program and Registration

See the complete program here. Register to attend here.

Meeting Sponsorship Opportunities

Interested in sponsoring MIIT 2017? Read about the available sponsor packages here, or register as a sponsor here.

IHE Buyers’ Guide Updated for 2017

Interactive IHE Buyers Guide

A new year and another update to the IHE Buyers’ Guide.

This update contains mostly minor changes in the form of some notes regarding some recent or pending updates to IHE integration profiles.

The most notable update is the addition of the Digital Breast Tomosynthesis Extension (DBT Extension) integration profile to the guide for Enterprise Viewer, PACS, and VNA products.

The IHE Buyers’ Guide is a valuable resource when using IHE integration profiles and actors to specify requirements in procurement processes, such as a Request for Proposal (RFP). It does not require you to enter any personal information and is free to use.

IHE Integration Profile Development – Vote Now (Voting Closed)

Update: Voting is now closed. Integration Profiles selected by the IHE committees for development in the 2016/2017 development cycle:

  1. Enterprise Scanner Protocol Management
  2. Critical Finding Follow-up and Communication
  3. Standardized Operational Log of Events

What healthcare use cases do you want addressed? What are the biggest interoperability issues facing our community today?

Provide your input to the IHE integration development process by completing the survey. Simply rank the six proposed profiles. It take 10 seconds.

Dealing with Multiple Terminology Domains in a Consolidated Enterprise

As the number of the PACS consolidation projects grow, I think it is important to explore some of the informatics concepts that need to be addressed to maximize the value of a consolidated PACS’ clinical functionality.

As mentioned in my recent MIIT talk, there are operational, financial and clinical goals that drive PACS consolidation projects. One of those reasons is to enable multi-facility diagnostic reading workflow: acquire anywhere and read anywhere in the enterprise.

One of the key informatics prerequisites of a successful PACS consolidation project is dealing with Patient Identities in a Consolidated Enterprise to establish patients’ longitudinal imaging record. Once that fundamental challenge is addressed, dealing with the normalization or mapping of the exam terminologies used by different RIS systems across the consolidated enterprise is the next critical informatics area to tackle. Often, PACS consolidation projects do not include the unification of the facility RIS, which forces the PACS to deal with multiple terminology domains.

In this series of the blog posts, I will examine this challenge in detail and describe the imaging informatics industry’s current capabilities to deal with it.

The Challenge

First of all, let’s define the problem and why it is important.

The anatomical and procedural information for a radiology exam is used by the PACS to primarily: 1) determine relevancy across patients’ historic studies; and 2) establish the correct display protocol for the PACS Workstation. As different ordering systems (EMR/RIS) may use different values to describe the same ordered procedure, the consolidated PACS will have to use a value normalization or mapping method to properly process the information.

The following diagram conceptually illustrates the difference between normalization and mapping methods.

terminology

Mapping

This approach relies on keeping many-to-many translation tables where each term has a corresponding defined value under each terminology domain. This approach is feasible only with a very small number of values and terminology domains.

Normalization

This methodology creates a “canonical” representation of each term and establishes a one-to-one relationship between each value in each terminology domain and the corresponding value under the “canonical” representation. This approach can accommodate a very large number of values and terminologies, as the translation from one terminology to another is always done through the canonical value.

In the next post, I will describe the imaging informatics use-cases that have to deal with this challenge.

SIIM 2016: Where’s Don

SIIM2016

SIIM 2016 is almost here. If you are attending this year’s Annual Meeting, you may find these sessions that I am chairing of interest.

Developing an Imaging Record Quality Policy
Thursday, June 30 | 1:15 pm – 2:45 pm
Portland Ballroom 256

Strategies and Tactics for Capturing and Sharing Images
Friday, July 1 | 8:00 am – 9:30 am
Portland Ballroom 256

Strategies for Dealing with Patient Identities in a Consolidated Enterprise
Friday, July 1 | 1:15 pm – 2:45 pm
Portland Ballroom 256

Basically, just park yourself in Portland Ballroom 256 and I will come to you.

I will also be participating in the:

Hackathon Project Showcase (#SIIMHacks)
Friday, July 1 | 9:45 am – 10:45 am | Portland Ballroom 254

I look forward to catching up with some old friends and making some new ones over some craft beer!

Developing an Enterprise Imaging Strategy—What is the best approach?

In my last post, we explored the current state-of-the-art of the Enterprise Imaging (EI) industry. In this post, I will zoom in on storing and managing non-DICOM images and videos. This can be ambiguous and may confuse providers who are trying to procure an EI solution. It also results in different schools of thought among vendors.

Currently, EI content can be stored and managed in one of the following formats:

  • Original object (e.g. jpg) stored in a solution’s database and/or filesystem using the vendor’s API (Application Programming Interface)
  • Original object (e.g. jpg) stored using the IHE Cross-Enterprise Document Sharing (XDS) integration profile in a solution’s XDS Document Repository component
  • Original object (e.g. jpg) stored in a solution’s database and/or filesystem using HL7’s FHIR® Media Content specifications
  • DICOM object stored in a solution’s Image Manager/Archive component; for example, using the IHE Web Image Capture (WIC) integration profile
  • DICOM object stored in a solution’s Image Manager/Archive and XDS Document Repository components using the IHE Cross-Enterprise Document Sharing for Imaging (XDS-I) integration profile

The following diagram depicts the main steps that take place during information capture activity for each method.

storage methods

All of the above methods have corresponding pros and cons, which leads to the current divergence of opinions regarding the best option to use. Having said that, it is clear that, irrespective of the chosen method, there is a need to properly collect and manage patient, administrative and clinical context (aka metadata) for the acquired EI content.

Metadata

Each of the above methods offer different levels of metadata rigidity and extensibility which impact the interoperability:

  • DICOM, FHIR and XDS-I based methods offer a level of certainty for the vendors with respect to what information should be captured and how it should be encoded.
  • XDS takes an approach of developing specific content profiles that address specific types of content; for example, the IHE XDS-SD (Scanned Document) integration profile. At the moment, there is no content profile that is specific to the Enterprise Imaging domain. Additionally, XDS allows the original object to be wrapped in a CDA Document to capture additional metadata in case the specified XDS Document Entry attributes are not sufficient.

Is there one “right” answer?

There are two overarching clinical reasons to capture EI content:

  1. To enrich patients’ clinical record
  2. To provide reliable, authorized access to it across the enterprise (and beyond)

As the following diagram suggests, the way EI content is stored is less important then the flexibility of an EI solution’s “Capture” and “Discovery and Access” components, because it is hidden behind those interfaces.

EI Access

It seems that, currently, there is no single answer for the best EI content format given the informatics complexity of healthcare provider’s enterprises. In order to adapt and compete, vendors will be pressured to support multiple inbound and outbound methods (such as FHIR, DICOM, DICOMWeb, XDS, proprietary APIs, etc.) and only time will tell which approach will become a de-facto standard.

Working on an Enterprise Imaging project? Leave us a comment with your thoughts, or contact us.