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Best Practices Medical Imaging, RIS & PACS at AIIMS

Sushil K. Meher

ALL INDIA INS TITUTE OF Medical S ciences New Delhi

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Emerging Technologies & Best Practices in Medical Imaging, RIS & PACS

AIIMS need Processes at AIIMS (Business Process Reengineering ) Strategy for Implementation of PACS at AIIMS What is the financial implication What AIIMS have till date

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Total Imaging load in the Main AIIMS (Hospital) :

X-Ray 2,46,151 Mammography 1,441 US ­ (MH) 43,499 (Gastro) 3,420 Endoscopy 5,000 Colonoscopy 700 CT 10,743 MRI 2,327 Bone Scanning 3,000 PET (Whole Body ) 2,848 Thallium Scan 1,272 I-whole body scanning 7,013 Pathology Imaging 1,00,000 Others (Radiology Dept ) 2016+ 7049+329 Total : Investigation

4,36,808

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It has not included the centres & some of the departments

~35% of hospital resources are spent gathering information (USA 12%) ~Up to 25% of doctors' and nurses' time is spent collecting and using information ( USA 5% )

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Trends in Healthcare

Steps

Health care Cure Treatment

Birth

Prevention REHA Acute Elderly medicine Trauma Heart Att. Cardiology

Death

Health Management

Well

Illness

Disease Management

Labor. Intens.

Out

EPR

Plan

In

Patient flow US ... MR

Rö , CT

MR CT

Bttd OP

Workflow Management

Monitoring

Medical Interaction

OP

OP Uro, Gastro, ...

Modality Management

Therapy

Beds

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A full spectrum of Solutions & Services in HIS/CIS/RIS/NMIS/PIMS/PACS required at AIIMS

Operate Transfer System Impleme System Integration Modalities

Imaging

Based on Integrated Solution

Image Solutions Network S/W Applicatio IT H/W

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Problems in Healthcare : Government setup

Government reducing Budget/manpower and Increasing cost pressure Challenges to increase the quality of health care/service Improvements in efficiency through automation Improvement of quality of Health care through International guide line. Process Re-engineering as key success factor Application of IT can reduce the cost and improve the efficiency and reduce the medical error Proper workflow management as key for giving efficient Health care services

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RADIOLOGY DEPARTMENT

Different processes : Well Structure, with a lot of exception conditions that require flexibility Data Integration ( Standards : HL7, DICOM, IHE, SNOMED....) IT solutions are data driven, current standards focus on Data access It installations do not automatically result in efficiency improvement Workflow aspects are expensive and time consuming project We lack systems that deal with processes A typical Multi-vender Environments A typical IT infrastructure : RIS, PACS and Imaging Devices

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WORKFLOW AND BUSINESS PROCESS REENGINEEING

IN

RADIOLOGY

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What is required in Health care System....

...Support access to all relevant data and support the key processes in health care ...Support the redesign, improvement and automation of processes ...Allow the flexible modeling and processes

We want WORKFLOW MANAGEMENT & BPR

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What is workflow is

Automation of Business process (Whole or Part)

During which documents, information or tasks are

passed from one participant to another. For action, according to a set of procedural rules

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Patient Central Admission for Face sheet Ward Investigation Report Collection from various labs OT, if surgery Is necessary PAC Blood Bank OT Post OP Discharge Medical Records PAC for Surgical Procedure Pathology or Microbiology Reports sent to OPD Collect reports from Nurses counter Registration of Old Case Doctors Cabin Referred to Centres or Clinics Investigation Transfer to other ward Blood Bank OPD Registration Concerned OPD for OPD no. and Room no. Doctors Cabin ReReregistration Referred to other OPD Doctors Cabin Notes and Investigation Payment if necessary for investigation

In-patient In-

Casualty Referred to other hospital

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Existing Patient Workflow at AIIMS

PROCESSES

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Functions

Activities & Sub-activities

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Functions Flows Sequence, order of activities

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Functions Flows Equipment appli. System tools

Operations

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Functions Flows Data, documents

Operations

Information

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Functions Flows Staff, roles, positions, hierarchies

Operations

Information

organization

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Functions Flows Patient flow and treatment Information Operations

Patients

organization

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Functions Flows Control of consumables Material Patients

Operations

Information

organization

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Functions Flows Work places rooms

Locations Material Patients

Operations

Information

organization

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Functions Controls

Medi. Procedure , time constrain

Flows

Locations Material

Operations

Information

Patients

organization

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Functions Controls Flows

Locations Material

PROCESSES

Operations

Information

Patients

organization

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Workflow Management at AIIMS

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Investigate workflow solution for Radiology Dept. Workflow studies in different centres. Workflow models for Radiology Dept. Implementation for formal Models Designing a system Architectures for Radiology and typical workflow-enabled Application systems Designing a system Architectures for centres and typical workflow-enabled Application systems

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Workflow function

Process Org. Information

RIS Function

Medical & Admin. Inf.

Appli. System RIS Application System PACS Image Inf. Modularity Function PACS Functions Appli. System Modules

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Start Process Schedule exam. Image fetch Pre fetch image Registration Patient Arrival Perform Exam.

Request for Registration Exam. Schedule Patient Arrival Reg. Examination

Image Archiving File Image Read Image /Reporting Image Viewing Transcribe Report Authorized Report Submit Results PACS Activities RIS Modality Functions Seq. of Activities Application Invocation End process Registration Billing

Modality Function

Billing Report transcription Report Authentication Result Delivery

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Workflow for Radiology

Start Process Schedule exam. Image fetch Pre fetch image Registration Patient Arrival Perform Exam.

Request for Registration Exam. Schedule Patient Arrival Reg. Examination

Image Archiving File Image Read Image /Reporting Image Viewing Transcribe Report Authorized Report Submit Results PACS Activities RIS Modality Functions Seq. of Activities Application Invocation End Process Registration Billing

Modality Function

Billing Report transcription Report Authentication Result Delivery

RIS Functions Workflow for Radiology

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Start Process Schedule exam. Image fetch Pre fetch image Registration Patient Arrival Perform Exam.

Request for Registration Exam. Schedule Patient Arrival Reg. Examination

Image Archiving File Image Read Image /Reporting Image Viewing Transcribe Report Authorized Report Submit Results PACS Activities RIS Modality Functions Seq. of Activities Application Invocation End process Registration Billing

Modality Function

Billing Report transcription Report Authentication Result Delivery

Process Workflow for Radiology

RIS Functions

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Start Process Schedule exam. Image fetch Pre fetch image Registration Patient Arrival Perform Exam.

Request for Registration Exam. Schedule Patient Arrival Reg. Examination

Image Archiving File Image Read Image /Reporting Image Viewing Transcribe Report Authorized Report Submit Results PACS Activities RIS Modality Functions Seq. of Activities Application Invocation End process Registration Billing

Modality Function

Billing Report transcription Report Authentication Result Delivery

PACS

Process Workflow for Radiology

RIS Functions

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Org. Structure

Models Models

Process Models

Are instance of

Workflow Management System

controls

Process Instances

are composed of

Activities

Are part of Are Assigned to invoke

Application Data

Workflow Participants

Application Systems

RIS, HIS, PACS Modalities

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Workflow Management

Org. Structure

Models Models

Process Models

Are instance of

Workflow Management System

controls

Process Instances

are composed of

Activities

Are part of Are Assigned to invoke

Application Data

Workflow Participants

Application Systems

RIS, HIS, PACS Modalities

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Workflow Management

Start Process Schedule exam.

Org. Structure

Models Models

Process Models

Pre fetch image

Registration Patient Arrival Perform Exam.

Are instance of

Workflow Management System

controls

Process Instances

are composed of

File Image Read Image /Reporting Transcribe Report Authorized Report Submit Results

Registration Billing

Activities

Are part of Are Assigned to invoke

Application Data

Workflow Participants

Application Systems

RIS, HIS, PACS Modalities

End process

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Workflow Management

Org. Structure

Models Models

Process Models

Are instance of

Workflow Management System

controls

Process Instances

are composed of

Activities

Are part of Are Assigned to invoke

Application Data

Workflow Participants

Application Systems

RIS, HIS, PACS Modalities

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Workflow Management

Org. Structure

Models Models

Process Models

Modality in charge Head Modality in charge Head

Head Of Dept.

Are instance of

Modality in charge Head

Modality in charge Head

Workflow Management System

controls

Process Instances Radiologist Radiologist

are composed of

Radiographer

Radiographer

Technical Assistant

Technical Assistant

Assistant Activities

Technical

Technical Assistant

Application Data

Are part of

Are Assigned to invoke

Clarke

Workflow Participants

Application Systems

RIS, HIS, PACS Modalities

Clarke

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Workflow Management

RIS

Interfaces (DICOM,HL7)

Modality Functions

CT, US, CR,MRI, X-RAY

PACS

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The IHE Radiology Workflow

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The IHE Radiology Workflow

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The IHE Radiology Workflow

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IHE = A Standards Harmonization Approach

H IS H IS R IS PACS M o d a lity HL7 HL7

R IS HL7 HL7 H L 7 / D IC O M D IC O M

PACS

M o d a lity

H L 7 / D IC O M D IC O M D IC O M

D IC O M D IC O M D IC O M

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PROCESSES In

RADIOLOGY

(including Reengineering Process)

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Main Processes (EXITING) in Radiology

Radiology

Allotting Appointment

Radiological test as per request and other investigation if any.

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Patient Appointment Process (Existing)

Radiology

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New Patient Appointment Process

Radiology

Radiology

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Sequence diagram for Existing Process (Investigation CT/MRI/X-ray...)

Technician/Doc tor : Labs 1: Process sample Register : Labs Slides are made if required

2: Get details about test to be performed

3: Perform the investigation procedure

4: Record findings in the register In some cases consolidated report is prepared after referring to the findings of different investigations that the sample has undergone.

5: Refer Register

6: Prepare Report After the preparation of the report it is verified and authenticated by the doctor.

7: Authenticate Report

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Sequence diagram for New Process (Investigation CT/MRI/X-ray...)

Technician/Doc tor : Labs 1: Process sample PCS : AIIMS Slides are made if required

2: Retreive details about test to be performed Findings can be recorded at different places for the same sample and a c...

3: Perform the investigation procedure

4: Record findings 5: Prepare report 6: Authenticate report

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Exiting Process for Dispatching Report

Radiology

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New Process for Dispatching Report

User : Labs

PCS : Labs

1: Record dispatch details

2: Send Generated Report

3: Get aknowledged

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Sequence diagram for Existing process (Duty Roster)

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Sequence diagram for Recommended process (Duty Roster)

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Time Savings for AIIMS X-Ray

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Integration of Activities

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AIIMS's Strategy for Implementing PACS

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Modalities CT MR PICKER Existing & Proposed Non-digital X-RAy

Ultrasound units

Siemens & Phylips Angio labs DICOM Ready

CR for the NonDigital X-ray Systems

Framegrabber_2 DICOM Gateway

Gigabit L3 Switch

Fast Ethernet-Switch

PACS Server

MR/CT WorkStation Leonardo

Magic Web and HIS Clients at different location

CR Reporting Magic View 300 with SIMOMED Radiologist Workplace Softcopy Reporting Area

Laser Camera with DPS (Dicom Print Server) Documentation

ACOM- NET Server

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PACS SOLUTION at CN Center & NMR

PACS SOLUTION at Main-Radiology

NM CTs X-Ray System PLUS 4 MammoGraphy DIGITAL & AR.STAR Non-digital X-RAy CR for the NonDigital X-ray Systems Ultrasound units DICOM Ready

Modalities

DICOM ready Anglo Lab

Framegrabber_2 DICOM Gateway

Gigabit L3 Switch

Fast-Ethernet Switch

PACS Server & DICOM Server

MR/CT WorkStation CR Reporting Magic View 1000 Magic Web and HIS Clients at different location

Laser Camera with DPS (Dicom Print Server)

Radiologist Workplace Softcopy Reporting Area

Documentation

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Modalities

PACS Server

CT Volume Zoom

CT Proposed

Non-digital X-Ray Systems

CR for the NonDigital X-ray Systems

Gigabit L3 Switch

Fast-Ethernet Switch

3D Virtuoso Work Station

Magic Web and HIS Clients at different location

Treatment Planning system, X-knife, Gamma Knife

CR Reporting at Magic View 1000

Laser Camera with DPS (Dicom Print Server)

Radiologist Workplace Softcopy Reporting Area

Documentation

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PACS SOLUTION at IRCH & Gamma Knife

Modalities

Non-digital X-Ray Systems CR for the NonDigital X-ray Systems

PACS Server

Gigabit L3 Switch

Fast-ethernet Switch

CR Reporting at Magic View 1000

Magic Web and HIS Clients at different location

Radiologist Workplace Softcopy Reporting Area

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PACS SOLUTION at Dr. RP Center

Deep Archive of 30 TB for whole hospital

HIS and Magic View 300 Clients at Critical Places

Gigabit L3 Switch

HIS Servers Magic Web Servers Magic View 300 Servers ( 8 Clients per Server)

Fast-Ethernet Switch

HIS and Magic Web clients at non-critical places

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PCS and PACS Image-Viewing Stations

Neuro-Radiology Dept ( CN Center & NMR Dept)

Main-Radiology Dept ( Main Bldg)

PACS Server & ACOM Server Reporting & Viewing Switch Workstations

PACS Server & ACOM Server Reporting & Viewing Workstations

Gigabit L3

Gigabit L3 Switch

Giga bit Back-bone (Gigabit L3 Switch)

Gigabit L3 Switch

Radiology Dept ( IRCH)

Gigabit L3 Switch

RP Center

PACS Server Reporting & Viewing Workstations

PACS Server Reporting & Viewing Workstations

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PACS SOLUTION

Financial Implication

The total financial implication of the project is Rs. 33.846 Cr. Non - Recurring:

Item Hardware, Networking & System Software Application Software PACS/RIS

Facility Management/ others appli.

Amount in Crores 1.2 8 1.83 0.80 2.8 0.40 5 12.76 1.056 8.056 Cr - 23.560 Cr 2.230 Cr

Year 2009 - 10 2010 - 11 2011 - 12 2009 - 10 2010 - 11 2011 - 12 2009 - 10 2010 - 11 2009 - 10 - 23.8% - 69.6% - 6.6%

% of Total 3.5 23.6 5.4 2.4 8.3 1.2 14.8 37.7 3.1

Year 2009 - 10 Year 2011 - 12 Year 2012 - 13

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Item PACS

Amount in Crores

17.76

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Database Web Servers Application & Development Server Domain Controller Server OLAP Server MS Exchange E.M.S.

Server and Softwares

Intrusion Detection System

Security Scanner

Total 2.014 Crores

CISCO Firewall

0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

0.485 0.057 0.247 0.022 0.05 0.042 0.871 0.167 0.009 0.063

Patient Care Systems' Cost

4 3.5 3 2.5 2 1.5 1 0.5 0

Servers & Softwares UPS

3.753 3.443

4

2.014

0.689

0.445

Printers

Networking

Clients

HIS Application Software

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Total 14.82 Crores

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Central Components

3.232

CNC

0

2.739 4.68

Main Radiology

1

1.503 0.19 0.394 0.169 0.616

2

3

4

5

6

IRCH

RPC System Engineering CR Reader

PACS

5.204

Laser Camera

Total 18.72 Crores

Servers

a) Data base server Magic Store P Professional RH b) Radiology Information System Magic SAS 30 Users c) TIER 3 storage system Deep Archive upto 30TB data storage d). Image Distribution for Non-Critical places like Wards, OPD etc. Review station Magic Web with cardio option with 50 user license e) Magic View f) Image Management System g) Angio-Management System h) CR reader I) Laser camera

1

1

1

1

2

1

17 1

3 1 1

1 0

2 1

6 1

2

1

2

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Manpower Requirement

No additional manpower is required for the project at the technical level. The Facility Management services shall be obtained from the firm which shall post the required manpower from time to time as per requirement of the project.

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2009

2010

2011

2012

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PACS at AIIMS

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PACS Storage/ Server

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Express of Interest has been Advertised For more information

VISIT WWW.AIIMS.EDU WWW.AIIMS.AC.IN

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Thank You

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Information

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