Unit 8 Data Management

Enterprise Imaging

“A set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record.”

Enterprise Imaging

X-rays, MRI and CT images, photographs, images from arthroscopes etc

Enterprise Imaging

Led to healthcare facilities to pivot away from PACS (MIMPS) by using Vendor Neutral Archive (VNA)

Enterprise imaging allows healthcare members to log on ……account and have access to ……. image not just radiology

one, any

Advantages of Enterprise Imaging

•Incorporation of all medical images into a single archive

•Increase in efficiency help improve patient outcomes

•Reduce storage costs

Vendor neutral

can receive anything from any system

Enterprise imaging

allows us to see any images, one log on resource, can access all images, can look at all images

CD and DVD have been used since the early……

90s

CD and DVD cost

$8-$15 per CD

•Online remote access to PACS (MIMPS) systems and VPN (Virtual Private Networks)

•Provides a login and password, external users can access and review images.

Cloud base exchange

concern with data privacy issues

Integrating the healthcare enterprise (IHE)

An initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information.

Integrating the healthcare enterprise (IHE)

Will help physicians, medical specialists, nurses, administrators and other care providers envision a day when vital information can be passed seamlessly from system to system within and across departments and made readily available at the point of care

BASIC DEFINITION OF IHE

Trying to make a standard how can we make everything work the best, looking at things, how can we best interoperate it together without it having issues or is the best outcome

Health Level Seven standard (HL7)

Accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.

Health Level Seven standard (HL7) manages…………… and provides protocols for exchange, management, and integration of clinical and administrative electronic health data.

non-imaging data

HL7 allows……………. between different systems including patient administration, laboratory information systems, billing systems, electronic medical record and health record systems, and more

interoperability

HEALTH LEVEL SEVEN STANDARD HL7

Allows all the different systems that control patient information to communicate to the software

Billing information is HL7, which allows the computer to communicate with th hospital systems

Keep medical information and record keeping

DICON information to talk to each other-imaging

Allows the communication to communicate with the x-ray equipment that is how we get the worklist

DICON

information to talk to each other imaging

HL7 is the standard communication between……. and ……

HIS and RIS

Cloud based Computing

•Reduces operational and maintenance costs for data storage

•Combines data from different resources

•Flexibility of archive size

•De-identify personal and healthcare information contained in DICOM metadata and pixels

•Cloud computing avoids the need for a company to purchase and invest in new IT equipment

Database health monitoring

The process of tracking and managing the condition, performance, and integrity of databases to prevent downtime, data loss, or workflow delays.

Radiology uses databases:

•Patient demographics

•Imaging orders

•Modality worklists

•Images and reports

Billing information

Example

•RIS database monitoring à Making sure orders, schedules, and reports are synced and available.

Advantages of database health monitoring

•Reduce costs

•Shift from reactive to proactive monitoring

•Improve the overall performance of your database and application

•Analyzes logs and uses this knowledge to improve performance

database health monitoring helps catch issues ……——before they affect technologists, radiologists, or patient throughput

early

easy definition

Watches the system and is saying how can I make this better or catch something before it happens

cyber attacks can …. spread … and compromise…… operations

quickly, malware, vital

A centralized network is more…… to attacks than …….networks

vulnerable, individual

Cybersecurity incidents

•computer virus, ransomware, theft and publication of patient data.

Cybersecurity requires a unified effort.  To prevent attacks:

•Close monitoring

•Staff education

•Operational and strategic plans

•Firewalls

•Whitelisting-good thing, cybersecurity strategy that allows only pre-approved users, applications, or entities to access a system, enhancing security by blocking everything else by default

•User authentication and access rights

System Architecture- summery

Integrates enterprise imaging across the healthcare system

-Uses IHE standards for interoperability and workflow consistency

-Exchanges clinical data through HL7 messaging

-Leverages cloud-based computing for scalable image storage and access

-Maintains performance through database health monitoring

-Ensures protection of all imaging data with cybersecurity controls

LAN

Local Area Network

LAN- local area Network covers a ……geographic area, usually ….and privately managed

small, faster

LAN example

•Computers, printers, and Wi-Fi devices inside a company office connected through a router.

WAN- Wide Area Network covers a very ……. geographic area, often across cities, countrys and continents, connects multiple….. together

large, LANS

WAN example

•The Internet is the largest WAN.

•Takes a little longer to get too, slower

Network Architecture

how devices are organized/communicate

peer to peer

•All computers are equal (no central server).

•Each device can share resources directly with others.

•Simple and inexpensive but harder to manage.

•Example: Two computers sharing files directly over a small home network.

•Inexpensive

Client/Server

•A central server provides services.

•Other computers (clients) request resources from the server.

•Common in businesses and large networks.

•Example: Employees access files from a central file server in an office.

Radiology Information System (RIS)

•Data system for patient-related functions in the department, such as scheduling of x-ray appointments, tracking of patients, storage and distribution of reports

•Makes info accessible from different locations within the radiology department

•Assigns the accession number

Hospital/Health Information System  (HIS)

•Performs same functions for the entire institution (patient's general medical file)

•Assigns a unique identifying number for each patient (MRN)

RIS HIS are …. area networks!!!

Local

Accession number helps to ……everything

track

HIS assigns the …….record number

medical

Information Management

shared information over networks

Information management

Electronic medical record (EMR) or

Electronic health record (EHR

Electronic version of a patient's medical history:
  Includes:

demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports 

Benefits of information management

•Streamlines clinician’s workflow

•Support other care-related activities

•Strengthen the relationship between patients and clinicians

Information management is the patients chart in electronic form, accessible though the comupter

Network Connectivity in Radiology

Network Protocols

These protocols help transport medical images, patient demographics, reports, and workflow messages across the enterprise.

Network Protocols

•Network languages computers use to communicate

•Set of established rules that dictate how to format, transmit and receive data so that computer network devices can communicate, regardless of the differences in their underlying infrastructures, designs or standards.

Why Network Protocols Are Important in Imaging Informatics

•Ensure secure and accurate transmission of medical images

•Allow different imaging devices and systems to communicate

•Support fast access to patient imaging records

•Maintain data integrity and standardization

Transmission Protocol

Main communication protocol used on networks to send and receive medical imaging data between devices.

Transmission Control Protocol

TCP

•Can be combined with IP =

Internet Protocol

•Can be combined with IP = Internet protocol Transmission Protocol

•Gives every device on a network a unique address so they can communicate (Ex. 172.811.3.1)

•Think of IP addresses as the street addresses of radiology devices

Communication Standard

- used to move data across networks- including radiology networks

Areas it is used

•DICOM

•Transmitting HL7 messages between RIS & HIS

•Accessing cloud MIMPS/VNA

Without ……….. none of the workflow could occur in Radiology

TCP/IP

internet protocol is the ……… to the radiology department

address

Transmission Protocol is how the

data is moved/delievered

NIC (Network interface Card)

•Hardware component used to connect to a hospital network and communicate using TCP/IP and DICOM

Switch consists of HUB and bridges

Connects devices inside the same network (LAN). 

•A switch is like the hallway of a radiology department—everyone inside can walk directly to each other.

Router

•Decides how to move data between different networks, buildings, or remote sites. (LAN àWAN)

•Uses IP addresses to determine the path 

•Identifies the sender and the receiver

•Ex: Connects the Hospital to the Teleradiologists

Cable

•Transmission media used for transmitting a signal (Ethernet, fiber optics)

Network Configuration

How you set up devices on a network so they can talk to each other.

making sure

•CT

•MRI

•Ultrasound

•MIMPS

All have the correct settings so they can send and receive images and information.

if its set up wrong

•Images won’t reach MIMPS

•Worklists won’t show up

•Radiologists can’t load studies

•Reports won’t return to the EHR

Radiology depends on these connections working smoothly.

network configuration

Raw data file (acquisition data)

•Data that has not been processed yet

•Collected directly by the imaging equipment before any reconstruction

Image data file (reconstructed images)

•Data that is processed created from RAW data via reconstruction algorithms

•What the radiologist sees, image contains:

•Pixel or voxel values representing anatomy or function

•DICOM metadata

metadata

is all the information that belongs to a picture

LAN and WAN support internal and wide area connectivity across the enterprise

Network protocols govern how data is formatted and exchanged (communication)

Transmission protocols ensure reliable delivery, routing, and error checking (movement of data)

Peer-to-peer versus client/server models define how devices share resources and services

RIS AND HIS

lOCAL area

The internet is the largest ……..network

WAN

EHR stands for?

Electronic Health record

Network…..are the languages used by computers to communicate

channels

Which network component connects devices inside the same network (LAN)?

HUB/Bridge

Medical Image Management and Processing System
(MIMPS)

another name for pacs

Medical image managment and processing system

MIMPS

MIMPS

•Comprehensive computer network that is responsible for the electronic storage and distribution of medical images.

•Makes radiographs, CT and MRI scans, US and Nuclear Med images for a particular patient available within the network.

•Allows Radiologists and Technologist to access images from various locations, improving the efficiency of communication

MIMPS ACTS as a

Database

Components of MIMPS

1. Image acquisition

2. Display Workstations

3. Archive servers

Image acquisition

Images are acquired in a digital format

Image acquisition

• Technologists/QA Station are able look at the patient’s images on the preview monitor

•Image quality?

•Patient demographics correct?

•First point of entry into MIMPS

•Information acquired is sent to the archive server

Image aquisition looking at the equipment and if the images are pulled up right!

Display workstations

Any computer used to view, interpret, and manipulate digital images

Display Workstations

Any computer used to view, interpret, and manipulate digital images

Radiologists

Clinical review workstations (ED, ICU)

Technologists QC stations

Most interactive part of MIMPS

Used inside and out of Radiology

Has MIMPS application software that allows minor image-manipulation

Display workstations are the most interactive and manipulation can occur in the workstation; the radiologists can edit the e-images. Radiologists might have more ability to manipulate the images

Common workstation fucntion

•Navigation Functions

•Hanging Protocol

•Study Navigation

•Image Manipulation & Enhancement

Navigation Functions

Customizable worklists dependent on technologists’ selections during a procedure

Hanging Protocol

A set of rules that tells a PACS or viewing workstation how to automatically display images.  It eliminates manual windowing, resizing, and rearranging images every time a study is opened.

• How do you want to see the images come up when looking at them?

Study Navigation

  Allows images to be viewed individually or in a cine run.

Image Manipulation and Enhancement

adding additional things int he PACS SYSTEM or the radiologists doing thingss

Zoom effects the whole image

increases size on the area of an image