PACS Presentation HIMSS 2015-Roadmap and IHE

7/1/1436

1

Monief Eid BSc, Lean Six Sigma Black Belt, PROSCI, C A P, ITIL V3 Foundation and Prince2 Certified

National PACS Program Director

The National BIG Picture: Tele-medical Imaging, The Vision for Patient Services (modified based on non-disclosing

information about MOH)

7/1/1436

2

Design Strategy

MOH PACS Roadmap & Organization Structure

7/1/1436

3

2020

Stage 4 Will focus on Continuous

Integration & Maintain the

standard

2018

Stage 3 Will focus on

Increasing PACS Deployment

2016

Stage 2 Will focus on Maintaining

Interoperability

2014

Stage 1 Will focus on

Building The Core &

Interoperability

National PACS Program Road Map

MOH PACS Roadmap Main Milestones

7/1/1436

4

(Medical Imaging Services “Radiology, Cardiology Pathology, Dental , Ophthalmology & Breast Cancer)

- Stand Alone image System with Specialty info

System at sites. - Build RFP , standard and

Business process With system

Owner. - Execute projects

and maintain it.

1- Create National Specialty Application Solution on national level i.e. National Cardiac Registry/Repository, National Dental Registry/ Repository, etc 2- This will take MOH to Wider services i.e. Tele-Cardiology, Tele- Pathology Tele- Dental etc

Nati

on

al M

ed

ical Im

ag

ing

an

d T

ele

-Servic

es P

latf

orm

MOH Tele-Medical Imaging Project Overview

7/1/1436

5


Radiology – CT, MRI, PET,

Diagnostic Radiology, Fluoroscopy, Ultrasound, Nuclear Medicine, Breast Imaging, Interventional

Radiology, DEXA

Dermatology - Visible Light Imaging

Cardiology – Cardiac Cath, Echocardiology,

Nuclear

GI Lab Ophthalmology

Pathology Wound Care Otorhinolaryngology Neurosurgery Oncology

7/1/1436

6


Before After

A True Vendor Neutral Archive solution is a single set of software tools to centralize all medical imaging systems into one perpetual repository.

Simpler management

Seamless migrations

Independent of PACS deployment

Scales to meet all MOH capacity needs

7/1/1436

7

E-health Portfolio Management E-health Portfolio Management

PACS Program Assistance

PACS Program Assistance

PACS Program Manager PACS Program Manager

PM coordinator

Based on Western Region

PM coordinator

Based on Western Region

Senior PM (Zone

Manager) Covers

Western Region

Senior PM (Zone

Manager) Covers

Western Region

Technical Director

Covers whole Kingdome

Technical Director


Change

Management & Training Director


Change

Management & Training Director


Senior PM (Zone

Manager) Covers Central

Region

Senior PM (Zone

Manager) Covers Central

Region

ICT PACS Program

Organization Chart

PACS PMs Based in

Central Region

PACS PMs Based in

Central Region

PACS PMs Based in Western Region

PACS PMs Based in Western Region

Admin Support

Admin Support

PACS Technical

Managers/ specialists

Covers Integration, Interface,

DICOM, HL7, IHE, etc. Based in

Western and Central Regions

PACS Technical

Managers/ specialists

Covers Integration, Interface,

DICOM, HL7, IHE, etc. Based in

Western and Central Regions

Change Management

& Training Managers/ specialists

Based in Western

and Central Regions

Change Management

& Training Managers/ specialists

Based in Western

and Central Regions

PM coordinator

Based on Central Region

PM coordinator

Based on Central Region

Senior PM (Zone Manager)

Covers Eastern Region

Senior PM (Zone Manager)

Covers Eastern Region

PACS PMs Based in

Eastern Region

PACS PMs Based in

Eastern Region

PM coordinator Based on Eastern

Region

PM coordinator Based on Eastern

Region

Service Director Covers the whole

Kingdom

Service Director Covers the whole

Kingdom

Service Managers/ specialists

Based in Western

and Central Regions (Divided

by Zones)

Service Managers/ specialists

Based in Western

and Central Regions (Divided

by Zones)

PMO Director, Covers whole Kingdome (This could be Zone Role Manager too)

PMO Director, Covers whole Kingdome (This could be Zone Role Manager too)

7/1/1436

8

Thank You ………. Q & A

7/1/1436

9

PACS Project Integration and IHE

MOH Approach is Cross Enterprise Document Sharing XDS/XDS-I Solutions (Profiles)

IHE

7/1/1436

10

IHE Value Construct (Enterprise Cross Sharing)

Medical Imaging

Exchange

Sharing the Reports

Sharing Images

Referrals

Cross Reporting

Other Government (Non-MOH)

Private Services


7/1/1436

11

Medical Imaging

Exchange

Sharing the Reports

Sharing Images

Referrals

Cross Reporting

Other Government (Non-MOH)

Private Services

Electronic business services

Automated Government Process

Avoided redundant imaging, Electronic imaging ordering

and results delivery

Electronic access, second opinion and

patient travel

Electronic submission of

reportable conditions and

specialty

Electronic referrals, consultation letter

delivery, chart requests


7/1/1436

12

Management & Administration

Referring Community

Radiologists

Radiographers & Technologists

Receptionists &

Secretaries

- RIS streamlines workflow within a Radiology Department by managing every step of a patient's journey through... Order Receipt, Scheduling, Registration, Examination and Documentation.

- DIRS/TRS Enables the sites without an existing RIS/PACS solution to have order, scheduling , modality worklist and exam documentation capabilities. DITS/TRS will enable facilities to do cross reporting and scheduling.

- DIRS/TRS will improve medical image reporting time especially for CT/MRI.

- DIRS/TRS will create national medical imaging platform


7/1/1436

13

Document Source

Document Repository

Document Registry

Document Consumer

Provide & Register Document Set

Register Document Set

Patient Identity Feed

Query Documents

Retrieve Documents

Patient Identity Source


IHE XDS/XDS-I Principle

7/1/1436

14

Document Source

Document Repository

Document Registry

Document Consumer




Query Documents

Retrieve Documents



IHE XDS/XDS-I Principle

RIS/PACS

Generates and Stores

Images, Image Manifest,

Reports

Stores

Index

RIS/PACS,

HIS or EMR

Interprets/

Retrieves

Images Manifest,

Images,

Reports

Adds/stores

Report

7/1/1436

15

XDS Actors 1. Document Source – Produces and publishes documents – Responsible for sending documents and metadata to a repository 2. Document Consumer – Queries a registry for documents – Retrieves selected documents from one or more repositories 3. Document Registry – Maintains metadata about each registered document in a document entry – Includes a link to the document in the repository 4. Document Repository – Responsible for the persistent storage of documents – Assigns a URI to documents for subsequent retrieval by a consumer 5. Patient Identity Source – Provides a unique identifier for each patient and maintains a collection of identity traits


7/1/1436

16

XDS Concepts * The XDS registry is the cornerstone of the document sharing process – The source registers information to be exchanged in the registry – The registry only maintains metadata for the document (and not the document itself) – Clinical information is not exposed * The XDS repository maintains the actual clinical document – Clinical documents can be kept within the enterprise’s repository or they can be transferred to another enterprise’s repository. – Allows for data encryption. * Source initiates the sharing process and provides the clinical document and the associated metadata * Consumer queries the registry and retrieve the data from the relevant repository


7/1/1436

17

- A Document Source actor initiates the Provide and Register Document Set Transaction. - For each document in the submitted set, the Document Source Actor provides both the documents and the corresponding metadata to the Document Repository. -The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction.


Document Source

Document Repository


Provide & Register Document Set [ITI-15]

Provide and Register Document Set

7/1/1436

18


- A Document Repository actor initiates the Register Document Set transaction. - This transaction allows a Document Repository Actor to register documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.

Document Repository

Document Registry

Register Document Set [ITI-14]


7/1/1436

19


- The Query Registry transaction is issued by the Document Consumer Actor on behalf of a care provider to a Document Registry - The Document Registry Actor searches the registry and returns a list of matching document entries including the locations and identifier of each document in the Document Repository

Document Registry

Document Consumer

Query Documents

Query Registry [ITI-16]

Query Registry

7/1/1436

20


Document Repository

Document Consumer

Retrieve Documents

- A Document Consumer Actor initiates the Retrieve Document transaction. - The Document Repository will return the document that was specified by the Document Consumer

Retrieve Document

Retrieve Document [ITI-17]

7/1/1436

21


Document Registry



- This is IHE ITI Transaction 8, defined as part of the Patient Identifier Cross- Referencing Integration Profile - It conveys the patient identifier and corroborating demographic data. - Its purpose in the XDS Integration Profile is to populate the registry with patient identifiers that have been registered for the affinity domain


Patient Identity Feed [ITI-8]

7/1/1436

22



Feeds identity of known patients to Document Registry

Patient Identity Cross-referencing (PIX) Manager

Index of everything

Index of everything

Can be any type of system, but often a HIS or

EMR


EMR


EMR


EMR

Similar to a Master Patient

Index (MPI)

Similar to a Master Patient

Index (MPI)

Document Consumer

Source

Document Source

Document Registry

Document Repository

Source of documents and meta-data

Initiates search and retrieval for consumer of documents Indexes

documents and supports search (query)

PIX Manager PIX Manager

Document Consumer Document Consumer

Document Source

Document Source

Document Registry

Document Registry

Document Repository Document Repository

Patient Identify Feed

Query Documents

Retrieve Document

Register Document Set Provide &


Stores documents, requests indexing in Document Registry, and supports retrieval

Documents stored here Documents stored here

Overview: XDS Actors

and Transactions


7/1/1436

23





Document Consumer


Document Source

Document Registry

Document Repository





Document Consumer Document Consumer

Document Source

Document Source

Document Registry

Document Registry


Patient

Identify

Feed Query Documents

Retrieve Document


Provide & Register

Document Set

Stores documents, requests indexing in Document Regi

Stuff Going In

Stuff Coming

Out

Stuff Stored & indexed


7/1/1436

24



A DICOM image viewer, such as

PACS


PACS

This is where the images are stored This is where the images are stored

Document Consumer

Source

Document Source

Document Registry

Document Repository

Overview: XDS-I Actors

and Transactions





Imaging Document Consumer*


Imaging Document Source

Imaging Document Source

Document Registry

Document Registry


Patient Identify Feed

Query Documents

Retrieve Document


Provide & Register

Document Set

Image Manager/Archive

Image Manager/Archive

Retrieve Images & Related DICOM Objects

(C-MOVE, Web Service (SOAP) or WADO-URI)

Stores documents, requests indexing in Document Registry, and supports retrieval



*XDS Document Consumer not shown, but would be present


7/1/1436

25




PACS


PACS

This is where the images are

stored

This is where the images are

stored

Document Consumer


Document Source

Document Registry

Document Repository







Imaging Document

Source

Imaging Document

Source

Document Registry

Document Registry


Patient

Identify

Feed Query Documents

Retrieve Document


Provide & Register

Document Set

Image Manager/Arc

hive

Image Manager/Arc

hive

Retrieve Images & Related DICOM Objects

(C-MOVE, Web Service (SOAP) or WADO-URI)



These Parts are

Different for Imaging

These Parts are Different

for Imaging

These Parts are the

same for XDS & XDS-I


7/1/1436

26


7/1/1436

27


7/1/1436

28


7/1/1436

29


7/1/1436

30

Integration Profile Implemented Actors Implemented

Scheduled Workflow (SWF) Image Manager/Image Archive

Patient Information Reconciliation (PIR) Image Manager/Image Archive

Consistent Presentation of Images (CPI) Image Manager/Image Archive

Access to Radiology Information (ARI) Image Manager/Image Archive

Key Image Note (KIN) Image Manager/Image Archive

Post-Processing Workflow (PWF) Image Manager/Image Archive

Evidence Documents (ED) Image Manager/Image Archive

Mammography Image (MAMMO) Image Manager/Image Archive

Consistent Time (CT) Time Client

Imaging Object Change Management (IOCM) Image Manager/Image Archive Change Requestor

Audit Trail and Node Authentication (ATNA) Secure Node

Patient Identity Cross-Reference (PIX) Patient Identity Cross Reference Consumer Patient Identity Cross Reference Manager

Patient Demographics Query (PDQ) Patient Demographics Query Patient Demographics Query Manager

Cross-Enterprise Document Sharing (XDS) Document Source Document Repository Document Registry Document Consumer Cross-Community Access

Cross-Enterprise Document Sharing for Imaging (XDS-I)

Imaging Document Source Document Repository Document Registry Imaging Document Consumer Cross-Community Access


7/1/1436

31

Consumer Registry

Repository

1. Sources post document packages to the Repository

2. Repository registers the documents metadata and pointer with the Registry

3. Consumers search for documents with specific information

4. Consumers retrieve selected documents from Repository (-ies)

XDS Document (Metadata):

Class

Patient Id

Author

Facility

Date of Service

…

XDS Document (Metadata):

Class

Patient Id

Author

Facility

Date of Service

…


7/1/1436

32

• Achievements: 1. Having MOH Sharing Image/Report Use Cases.

2. Having MOH IHE Imaging/Reports profiles.

3. Having MOH Radiology procedures exam codes.

4. Having MOH HL7 Specification for all HL7 integration with all information require to have the best connectivity quality.

5. Having MOH HL7 test environment and simulation to be use by deferent companies and minimize the time of integration.

6. Setup Business Intelligence center where we can improve the quality of work within PACS / RIS in all MOH hospitals.

7. Having business Intelligence central data warehouse for all PACS / RIS systems, neutral vendor based on MOH with maximum security ,low internet connectivity and high quality.

8. Run MOH Business Intelligence application to analyze all systems and workflows across MOH PACS / RIS systems.

9. Monitoring systems performance through dashboards and interactive tools

10. Monitor all suspicious or mess usage of the system by Business Intelligence indicators.

11. Generate Daily, Weekly, Monthly And Yearly Report

MOH PACS Project Integration and IHE

7/1/1436

33

Thank You ………. Q & A

PACS Presentation HIMSS 2015-Roadmap and IHE

Documents

Transcript of PACS Presentation HIMSS 2015-Roadmap and IHE