Health IT & Picture Archiving and Communication Systems

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Health IT & Picture Archiving and Communication Systems

Utrecht, May 16, 2013

dr. Rogier van de Wetering

Seminar Medical Informatics

© 2012 Deloitte The Netherlands

Content

1 dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

Introduction

Key health developments

Types of Health IS

A brief history of medical imaging and PACS

Exercise

Introduction to PACS Maturity concepts

Optional: Trends in medical imaging

Preview on lecture (31-05)

Introduction



Background in Information Sciences

Currently Manager at Deloitte Consulting

Former positions:

Senior managing consultant (Deloitte

Consulting)

Lecturer Information Sciences and

Medical Informatics

Phd-student – A Strategic PACS maturity

approach (2007-2011)

Management consultant (Deloitte

Consulting)

Business Analist (Deloitte Consulting)

Short introduction

Key health developments

A perspective on key developments in healthcare using an international lens


Individuals more engaged

in decisions and purchases

Providers develop new services to

clients (product

and quality information)

Innovations to improve

efficiency & transparency

Growing costs of healthcare

Ageing population

E-prevention programs will reduce future

healthcare spending

Providers develop

management information on performance

International Comparison of Spending on Health, 1980–2007


Source: Davis et al., How the performance of the U.S.

health care system compares internationally. The

common wealth fund (2010). See also OECD.org

What is driving health care costs?

Spending on healthcare in all OECD countries are rising faster than economic growth, especially

within the U.S.

Advances in medical technologies improve diagnosis and patient treatment. However, they also

increase health spending

This can be clearly seen from the rapid growth and use of computed tomography (CT) scanners

and magnetic resonance imaging (MRI) units used for diagnostic purposes

Factors include:


Advances in

medical

technology

Population

expectations

Population

ageing

The U.S. and Greece show a big difference in their use per capita as

opposed to the Netherlands


98,191,2

72,3

62,8

53,748,5 47,7

38,8 37,831,2

27,824,2 21,4

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MRI exams per 1 000 population

Data include only exams for out-patients and private in-

patients (excluding exams in public hospitals).

Number of MRI exams per 1 000 population, 2008 (or latest year available)

Developments in healthcare from a hospital CXO perspective


Hospital CXO ICD10/DOT

Governance, risk &

compliance

Horizontal /vertical

integration

Reimburse

ments

M&A Alliances

Order

mngt

Lean

operations

Tele-medicine /

eHealth

Patient

influence

Cloud solutions /

SaaS

Mobile

apps

Information

Management

Patient

engagement

/ empower-

ment

Shared

Services

Integrated

supporting

processes

Information

Security

Medical

Imaging

Technology

Minimal

Invasive

surgery

RFID / Track

& Trace

Regulations

Virtualization

Big Data/

Analytics

Mobility

outpatient

clinic

Business

Intelligence

Customized

care EHR/EPR

Business

IT

Healthcare

Lean

Chain care

Hype Cycle for Healthcare Provider Applications and Systems 2012


Types of Health IS

Overview of various types of IS/IT

• Electronic health records

(ePR/eMR)

• Computerized provider order entry

(CPOE)

• Decision and diagnostic support

(e.g. CAD/CAR)

• Advanced visualization tools

• Surgical simulation and modeling

• Knowledge discovery/mining and

retrieval systems

• Enterprise-wide image

management systems (i.e. PACS)

• Data exchange networks (e.g.

XDS-i, IHE)

• Prescribing systems

• E-Health / consumer informatics /

educational

• Tele-medicine

• Mobile (apps) computing

• Administration

(Cf. Haux, 2010; Chaundry, 2006;

Huang, 2010; Van de Wetering, 2011)


Source: M. J. Schuemie et al., Mapping the Domain of Medical

Informatics. Methods Inf Med 2009; 48: 76–83

Extracted medical informatics clusters/classifications appearing between 2005 and 2008

Organization, application,

and evaluation of health IS

Medical knowledge representation

Signal and data

analysis

There are many possible benefits and costs of implementing health

information technology

Effects of health IS/IT (Cf. Chaundry, 2006):

• Quality

• Efficiency

• Costs

Challenges for the future:

• Interoperability of medical data

• Adoption rates of IS/IT

• Misalignment of incentives for its use

Key question remains: How to apply IT effectively?


A brief history of medical imaging and PACS

A brief history of medical imaging – the Classical time


Careful anatomical lessons in 17th century

The Anatomy Lesson of Dr. Nicolaes Tulp (1632) by Rembrandt

Src: retrieved from Wiki 2012

Revolution came with Röntgen's discovery of the X-ray


• Wilhelm Conrad Röntgen (1845 - 1923)

• German physicist

• Discovered penetrating “X-ray” (invisible beam) on November 8, 1895

• A brief article was published on January 5, 1896

• He earned the first Noble Prize in 1901 in Physics

Src: retrieved from Auntminnie.com

PACS – background and definition

• Due to the changing health care environment, hospitals are obliged to utilize the full potential of

Information Systems and Information Technology and (IS/IT)

• Hospitals have taken on this challenge by moving towards filmless operations and investing in Picture

Archiving and Communication System (PACS)

• The concept of PACS was introduced as early as 1982


Acquire images

Store into central

repositories

Distribute upon

request

Display images

“Workflow-integrated imaging systems”

“Designed to streamline

operations”

“Many interrelated

system components ”

PACS consists of many interrelated system components and is most

efficient when integrated with the Hospital- and Radiology information

system


PACS components

Source: Canadian Association of Radiologist Hospital IT-architecture

Source: Muller et al., 2004

X–Ray Exam without PACS: an inefficient process

Un–Hang Films

& Attach Report

Patient

Registered Exam Performed

Patient Data

Re–Entered

at Acq Device

Previous Exams

hung in Reading

Room

GEYMS

CT

Return Films

to File Room Re–assemble

Film Jacket

Send Films &

Report to Referring

Physician

Retrieve Films &

Report to Referring

Physician

Radiologist Read

Dictate & Approve

Develop

Film Quality

Assurance

Hang

Films


Exercise

1. Develop a X–Ray Exam with PACS: an efficient process

2. Identify possible uses for mobile apps

Un–Hang Films

& Attach Report

Patient


Patient Data

Re–Entered

at Acq Device

Previous Exams

hung in Reading

Room

GEYMS

CT

Return Films

to File Room Re–assemble

Film Jacket

Send Films &

Report to Referring

Physician

Retrieve Films &

Report to Referring

Physician

Radiologist Read

Dictate & Approve

Develop

Film Quality

Assurance

Hang

Films


X–Ray Exam with PACS: an efficient process

Patient


GEYMS

CT

Radiologist Read

Dictate & Approve

Referring Physician

Accesses Report

and Films


PACS Maturity

PACS are thus workflow-integrated imaging systems designed to streamline

operations throughout the entire patient-care delivery process (Huang)

To:

Digital Workflow From:

Film Based Workflow

‘How can hospitals mature their PACS?’


The PMM describes five levels of PACS maturity and towards higher levels

of maturity, operational efficiencies, IT-integration and effective care expand


References:

Van de Wetering, R. and R. Batenburg (2009). "A PACS maturity model: a systematic meta-analytic review on maturation and evolvability of PACS in the hospital

enterprise." Int J Med Inform 78(2): 127-40. &

Van de Wetering, R., R. Batenburg and R. Lederman (2010). "Evolutionistic or revolutionary paths? A PACS maturity model

for strategic situational planning." Int J CARS (in press).

Does this sound familiar to you?


“… we see the computer age everywhere but in the productivity statistics.” Robert Solow, New York Review of Books, 12 juli 1987

Business/IT alignment

A conceptual model was developed combining (1) PACS maturity, (2) PACS

alignment and (3) PACS performance

26

Reference:

Van de Wetering, R., Batenburg, R., Oudkerk, M., Van Ooijen, P.M.A., Brinkkemper, S., and Scheper, W., A situational alignment framework for PACS. Published online 5 March

2011 in the Journal of Digital Imaging

a: PACS is compatible with current international

standards and classifications

b: PACS exchanges information with the RIS and

HIS without any complications

a: End-users affect the decision making process in

selecting a specific PACS vendor

b: End-users affect digital PACS-workflow and

functionality improvements

a: Impact and opportunities for chain partners with

respect to PACS

b: External environment is consciously inquired for

new developments to optimize PACS functionality

dr R. van de Wetering: Health IT & Picture Archiving and Communication Systems

Trends and developments

In search for metrics that allow standardized measurement of productivity,

for comparative evaluation and ongoing efforts to improve efficiency

Source: Hu et al. (2011) Informatics in Radiology.

Efficiency Metrics for Imaging Device Productivity


An illustrative example for automating real-time reporting on Imaging

procedures and productivity monitoring

Source: Hu et al. (2011) Informatics in Radiology.

Efficiency Metrics for Imaging Device Productivity


Questions

Contact me



Email: [email protected]

Tel: +31620789870

mailto:[email protected]

Preview lecture by Erik van der Zijden BSc MBA


• Erik is CEO & Co-founder of Synappz

• Lecture on Medical Apps (31 May)

• Development process

• What would you like to know?

Health IT & Picture Archiving and Communication Systems

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