Managing Non-DICOM Images

within an Enterprise Imaging Solution

Agenda
• Enterprise Imaging / Non-DICOM Market Trends

• Managing Non-DICOM Images in the Enterprise

• Merge’s Non-DICOM Solution Options

• Questions?
Enterprise Imaging / Non-DICOM Trends

3
 Interoperability Market Drivers

M&A / Consolidation Enterprise Image Management

Clinical and Financial Economies of Scale Comprehensive Image Record

Connecting Providers EHR Optimization

Patient Centric Care Across Sites Unified Patient Image Record

4
 Providers Generate a Flood of Data
Digital Clinical Objects
Specialty MPEG, JPEG Other Most Common Devices
DICOM
A/V, WAV , PDF Clinical
Anesthesia     In Room C-Arm, X-ray, Anesthetic, Record Keeping Reports
Cardiology     CVMR, CVCT, Cath, CVUS, CVECG / Holter / Stress / Pace
Dermatology   Photos, dermatological Reports
Emergency Medicine     X-ray, CT, ECG, Triage Reports
Endocrinology   SPECT / CT, PET / CT, Physician Reports, Voice Dictation Files
Family Medicine     Physician Notes, Reports
Gastroenterology    Barium X-ray, CT, NM, Endoscopes, US, Reports, Voice Dictation Files
Hematology   HT Reports, Voice Dictation Files
ICU Medicine    In Dept C-Arm, X-ray, Patient CIS Flow Chart Reports
Nephrology     US and MRI Angiography, Scintigraphy (Nuc Med) Reports Voice
  
Neurology
iConnect™ Solution
Renal Scans, SPECT/CT, PET/CT, Physician Reports, Renal Grams,
Voice
Nuclear Medicine 
Stored

in

a VNA US, Physician Reports, Voice Dictation Files
Obstetrics    X-ray, CT, US, Reports, Voice Dictation Files, Fetal Strips, Reports
Oncology    • Single Database
FDG-PET, CT, X-ray, Treatment Plans, Densitometry, Biograph Reports
Ophthalmology    Ophthalmology Laser Images, Physician Reports, Voice Dictation Files
Oral Surgery  
• Single Storage Pool
Dental X-rays, Physician Reports
Pathology    • Single Server
Digital & Scanned Pathology, Pathology Reports, Voice Dictation Files
Pediatrics     Nuclear VCUG, DMSA Scans, Reports, Voice Dictation Files
Pulmonology    • Single Admin Tool
CT Gamma, SPECT, PET, Reports, Voice Dictation Files
Radiology     MR, CT, XR, US, NM, Radiology Reports, Voice Dictation Files
Rehab Medicine  
• Single Viewer
Brain Lab Reports, Voice Dictation Files
Rheumatology   • Single Vendor
US, MRI, Rheumatology Reports, Voice Dictation Files
Surgery     In Department X-ray, Endoscopes, Surgery Reports
Urology    MR, XR, Digital Fluoroscopy Reports, Voice Dictation Files
 DICOM + non-DICOM / Dark Data
1,600,000
2017 Forecast
1,400,000
• 1.4B Objects / Year

Annual Volume (000s)

1,200,000
• 51% VNA 5 Yr CAGR
1,000,000
• ~75% are Non-DICOM
800,000

600,000

Key Drivers
400,000

• Increased PACS to
200,000
VNA Attach Rate
0
• Growth in Non-DICOM 2011 2012 2013 2014 2015 2016 2017

PACS Study Volume VNA Study Volume

Managing Non-DICOM Images
in the Enterprise

7
Developing a Non-DICOM Solution
• Managing Clinical Image Content is about workflow

• Non-DICOM Clinical Content is often Dark Data

– Gartner defines dark data as “the information assets organizations
collect, process and store during regular business activities, but
generally fail to use for other purposes”

• Goal: Ingest  Store  View a patient’s complete image record

(DICOM and non-DICOM) within the context of the patients medical
record
 Key Workflow Questions

For each service line:

• Orders or Encounters Based?
• DICOM vs. XDS vs. XDS-I

XDS Object XDS-I Object DICOM Object

Surgical
Encounter Dermatology
Services
Radiology /
Order ENT
Cardiology

XDS vs. XDS-I: XDS-I typically involves DICOM exams stored in

a DICOM Archive (e.g. PACS or VNA) and registered with an
XDS Registry. This provides the benefits of DICOM and XDS.
 Developing a Service Line Workflow

Acquire the
• The Bookends define the Use Case
Content from a clinical perspective
• Create the Content
• Who
Normalize • Device
the Content • Format
• Demographics / Metadata
Start with the
Bookends • Consume the Content
Store the • Who
Content • Workflow System (EMR, HIE, etc.)
• Viewer (PACS, Enterprise, Specialist)
• This information will inform the
View the decision about DICOM vs. XDS and
Content Merge vs. 3rd party Solutions
 Merge’s XDS Capabilities
PIX/PDQ
EA can be a PIX /PDQ Patient Identity Source (EMR,
mrg. when in MPI mode EMPI or PIX/PDQ Manager)

Patient ID Feed
iConnect Access
Query for
XDS Document Documents XDS Document
Registry Consumer

iCEA v11.3
Provide and Register
XDS Source Register
Document Set
Data Conversion to XDS Document
Source XDS Tools Repository

MDM Manifest Retrieve

Documents
Image
Source
iConnect • Retrieve Images
Enterprise Archive • Retrieve Evidence Documents
v11.1 • WADO Retrieve
 IHE Connectathon 2015:
32 Unique Vendors

iConnect Enterprise Archive iConnect Access

24 Vendors 19 Vendors
CDC BHS Athena
Agfa Dell CAREEV
EMC
GE
CERTIFY INFINITT ITH icoserve OpenHIE

ezCaretech
KAROS NEXTGATE QUADRAMET
Hyland
Healthland
OPTUM Perceptive / Acuo SAMSUNG
IntelHealth
INTERSYS Oracle TeraMedica Sandlot

Smarter Summit
QVERA Care Tiani-Cisco
Siemens VSB

iCEA
Merge’s Non-DICOM Solution Options

Non-DICOM  DICOM
Non-DICOM  XDS
Non-DICOM  XDS-I
 Non-DICOM to DICOM
1 Patient Registers
Capture Searches a patient’s
3 record for images
photo
EMR 7
HL7 ORM
2
or ADT
to
MWL Launches 8
Access via
Secure URL
MWL
4 Query

Store
5
DICOM

6
9 Retrieves exam
Availability from VNA
Notification to
EMR

iCEA
 Non-DICOM to XDS:
User Initiated Workflow
1 Patient Registers
Capture Searches a patient’s
3 photo record for images
EMR 10
HL7 ORM
Launch 4 2 Notify
(Order) 9 EMR
5 MDM with
or
Metadata Launches 11
Upload HL7 ADT
File(s) (Encounter) Access via
Secure URL
MWL
to
Query
MWL
6

Exceptions
Worklist
8
12 Retrieves exam
Register from XDS
7
Document with Repository
Store XDS XDS Registry
Object in XDS
Repository

iCEA
 Non-DICOM to XDS:
Polling Workflow
1 Patient Registers
Capture Searches a patient’s
3
photo record for images
EMR
10
2 HL7 ORM Notify
(Order) 9 EMR
or
4 Launches 11
Exceptions HL7 ADT
Worklist (Encounter) Access via
5 Secure URL
6 to
Poll for MWL
Store Content
File MWL
Query
(with Partial
Metadata)
8
12 Retrieves exam
Register from XDS
7
Document with Repository
Store XDS XDS Registry
Object in XDS
Repository

iCEA
 Non-DICOM to XDS-I
1 Patient Registers
Capture Searches a patient’s
3 record for images
photo
EMR 9
HL7 ORM
2
or ADT
to
8 Launches 10
MWL
Access via
Notify
Secure URL
MWL EMR
4 Query

5 Store DICOM to
Image Source
Store KOS in
6 7
XDS Repository
11 Retrieves exam
Register Document from XDS Image
Integrated Source / with XDS Registry Source
Repository

iCEA
Dermatology Workflow
• Encounter Based Workflow
– No Order or Accession # from EMR
– iConnect Enterprise Archive Creates Accession Number

• Infrastructure
– 3rd Party Dermatology Camera App
– iConnect Enterprise Archive
– iConnect Access
– Epic EMR

• Goal: Develop a non-DICOM workflow that could be generalized to many service lines and
facilities
 Provider Provider selects
Patient Provider
Patient visits decides to Patient from
Start “Checked In’ Examines
Derm Clinic acquire Cameras
for Visit Patient
images Worklist

ADT^A01 A04 ADT creates

EA Sends with DEP and Encounter Provider
unsolicited HL7 CSN from Based Order MWL Query Selects Body
ORU Message to EMR on EA MWL Part / Location,
EMR with CSN and Disorder in
Camera

Unsolicited Proc. Match

Procedure Code Images Provider
Record(s) created Accession
applied based on transferred acquires image
against CSN / MWL-R Number
mapping to Study via Wi-Fi to for each body
Encounter Created
Description iCEA part / disorder

No Match
Hyperlink created
in EMR with Proc. End Provider
Description clicks Send
Exception
Workflow

End
19
 Survey

Who has had PACS at their institution for more than 7 years?

Who has migrated their data from one system to another?

When you bought PACS, were you aware that your vendor stored
the data in a proprietary “flavor” of DICOM?

Implications of storing your non-DICOM data in a proprietary format:

1. Can only view the data using that vendors viewer
2. Expensive proprietary migration in the future
3. Can you give that proprietary data to a patient if they ask for it?
4. Vendor Lock-In
 Summary

Integrated Solution with a Single Database

Unified Infrastructure – Storage + Servers

Single Admin Tool for DICOM and XDS

Robust and Proven Business Continuity and

Disaster Recovery Solution

Enterprise Viewer showing all clinical images

Questions?