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Founded in 2011Experts in Medical Imaging, Medical Standards and IHEBased in Belgium, the land of beer, chocolate and healthcare (IT)Founded by 2, evolved to 32 FTE and hiring…Focus on 2 solutions: PACSonWEB and RISonWEBISO27001, ISO13485, CE Medical Device class IIa (full diagnostic use)20-30% growth each yearMember of IHE BelgiumDevelopment / Implementation / Service in Benelux
2. Create pure, uncut web technology
3. Innovate and make things userfriendly
4. Ensure customers are happy
What we love to do :
1. Listen to medical imaging departments
Business and workflow problems that we solve
Patient PortalPhysician Portal
E-Health and XDS Connectivity
Image (& related data) Exchange
Emergency & Homereading
Stroke Workflow
Cloud Archiving
And more …
PACSonWEB Cloud Platform in L4 datacenter
Requesting Physician(generalist/clinician)
E-health infrastructure
PACSServer
RIS/DWLServer
PACSonWEBGateway @ sender
PACSServer
XDS Consumer
PACSonWEB Gateway @ receiver
DICOM
HL7
HTTPS / TLS
What we did in Belgium.
Other
Patient
What we did in Belgium.
Belgian situation
Situation:
Patients and referring physicians can consult studies using PACSonWEB portal and eHealth portals (Cozo, RSW, …)Centralized patient consent, therapeutic link and authentication servicesUntil now, we need to deal with KHMER, a XDS-like standard. The purpose is to evolve to XDS in the future.Hospitals can share studies, but since this year they can also query PACSonWEB using C-Find or XDSi in orderto consult studies in their local PACS without importing them using autorisation rules defined in e-HealthHospitals have the possibility to add other workflows as well: emergency reading with app for voice recognition, archiving, …Direct email & telephone support by Dobco
e-Health and XDSi
DICOM
HL7
HTTPS
Hybrid XDS environment
Admin / Clinician
XDS Consumer
PACSServer
RIS/DWLServer
PACSonWEBGateway
PACSonWEB Cloud Platform
Routing / Fetching
XDS
XDS Registry
XDS Repository
XDSi Source
ATNA logger
XDSi Consumer Other affinity domain
XCA/XUA
CentralizedPatient ConsentTherapeutic link
CT, PIX
DICOM
HL7
HTTPS
Hybrid XDSi environment
Clinician
PACSServer
RIS/DWLServer
PACSonWEBGateway
PACSonWEB Cloud Platform
Routing / Fetching
XDS
XDSi Registry
XDSi Repository
XDSi Source
XDSi Consumer
ATNA logger
Admin / Clinician
XDSi Repository
XDSi Source
Hybrid XDSi environment
Hybrid XDS environment
Advantages:
Combination of sharing methods, meaning no other sharing solutions are neededCollaboration with XDSi and non-XDSi networks within 1 unique platformC-MOVE, RAD-69, WADO supportIntelligent authentication methodFast and diagnostic viewer / XDS consumer when no other consumer is availableDirect email & telephone support by Dobco or local partner
PATIENT PORTAL
PACSServer
RIS/DWLServer
PACSonWEBGateway
DICOM
HL7
HTTPS / TLS
Patient Portal
PACSonWEB Cloud Platform in L4 datacenter
Patient access
Routing / Fetching
Patient Portal
Patient Portal
Advantages:
Easy and straightforward (code + date of birth + OTP / eID / BankID / … )Integration with other platforms (EMR portal, eHealth portals, …)Intuitive viewerImmediate availability of imagesFluidity in departmentPatient empowermentPatient can share with external care provider (physical therapist, medical specialist,…)Direct email & telephone support by Dobco or local partner
HEALTHCARE PORTAL
Doctor reads exam
PACSServer
RIS/DWLServer
Doctor sharesexam
PACSServer
RIS/DWLServer
PACSonWEBGateway
RequestingPhysician(generalist, clinician)
PACSonWEB Cloud Platform in L4 datacenter
DICOM
HL7
HTTPS / TLS
Healthcare Portal
Healthcare Portal
Healthcare Portal
Advantages:
Consolidated view of examsIntuitive zero footprint viewer with clinical featuresDICOM lossless – exportableDirect sharing to peersSupport for group practicesTwo-factor authentication (eg. password + SMS, eID, BankID, …)Direct email & telephone support by Dobco or local partner
Image Exchange
DICOM
HL7
HTTPS / TLS
Image Exchange
Admin / Clinician
PACSServer
RIS/DWLServer
PACSonWEBGateway
PACSServer
RIS/DWLServer
PACSonWEBGateway
Physician
PACSonWEB Cloud Platform in L4 datacenter
DICOM import optie
(Semi-)automatic import
Routing / Fetching
Advantages:
Manual or automatic workflowA range of possibilities for importingEasy sharing from mobile devicesFast and reliableLogging and auditingDirect email & telephone support for receiver and sender by Dobco or local partner
Image (& related data) exchange
Emergency and homereading
DICOM
HL7
HTTPS / TLS
Emergency & Homereading
PACSonWEB Cloud Platform in L4 datacenter
PACSServer
RIS/DWLServer
PACSonWEBGateway
RADIOLOGIST using a browser and his own smartphone for real-time voice recognition and diagnostic viewing
Advantages:
Fast, PACSonWEB is built for WANDiagnostic zero footprint viewerClinical toolset, measurements, MIP/MPRCentralized supportConsolidated view, including the patient history – important for the comparison of studiesEvery study can be available online, via POW archiving or POW fetch
Emergency & Homereading
Emergency & Homereading
Archiving & federated queries
1st and 2nd datasource
DICOM
HL7
HTTPS / TLS
PACSonWEB Cloud Platform in L4 datacenter
PACSServer
RIS/DWLServer
PACSonWEBGateway
Besides the archiving functionality, the RADIOLOGIST can define via DICOM Query or as XDSi consumer the “second datasource” on his local PACS. As such he can, from his own workstation, query also the PACSonWEB registry for prior exams from any connected hospital or cabinet. Authorisation* is managed by an eHealth hub. Image display is done through WADO or DICOM C-MOVE.
* where authorisation and patient consent can be managed by central goverment webservice of managed within a certain domain.
2nd datasource
E-health infrastructure
DICOM
HL7
HTTPS / TLS
PACSonWEB Cloud Platform in L4 datacenter
Local cacheNative DICOM nodestudies
Hospital archive POW DICOM node studies
PACSonWEB total databasePOW DICOM nodestudies
2nd datasource
Overview:
Support for DICOM Query/Retrieve + DICOMWeb + XDSiBack-end has autorisationVia fetch / archiving all studies available for a certain patient in the local PACS Full DICOM and no extra load on the local PACS systemsNo VPN required between sender / recepientVia PACS commonview transparant for end-userCan be integrated in the back-end with e-Health
Implementation
Technical installation POW Gateway
Integration with local RIS and PACS
systems
TManage entity in PACSonWEB cloud
Contact and guidance new referring
physicians
Overal user managementT+1 week
Creation of domain name and setup
workflow
(sticker / email / report options….)T+2 week
Training local users and IT
Go live
T+3 weeks
Implementation
« XDS 2.0: the Hybrid XDS framework that finally answers all imaging exchange usecases »
Statistics today :
200+ radiology departments11 million studies per year2.5 million images ingested per day34.500 receivers500,000+ logins per monthActive in 6 countries and expanding
« XDS 2.0: the Hybrid XDS framework that finally answers all imaging exchange usecases »
Statistics today :
200+ radiology departments11 million studies per year2.5 million images ingested per day34.500 receivers500,000+ logins per monthActive in 6 countries and expanding
Programma Elektronische gegevensuitwisseling in de Zorg
(Landelijke) Beelduitwisseling uitdagingen en oplossingenPleidooi voor hybride, praktische aanpak
Resultaat discussie TWIINNVVR/VZVZ/zorgverzekeraars/Medical Phit
• Centrale diensten Overheid1) Authenticatie + Autorisatie API
2) Consent database van/voor Patiënt
3) Therapeutische relatie van arts
Wetgeving/richtlijnen overheid maar afkomstig uit het ‘veld’1) Eenheid van taal (bv procedure name) (hl7 of DICOM is niet genoeg)
2) PACS/VNA label: “klaar voor NL-beelduitwisseling” (eg XDS consumer)
3) Performantie eisen voor beelduitwisseling (decentraal vs centraal of hybride) – eisen vanuit de artsen & radiologie afdelingen
What we did in Belgium.
Elektronische gegevensuitwisseling in de
zorg: Wat?
Functies:
Raadpleging en inzage: Patiënt, specialist, huisarts kijkt naar een onderzoek van medische beeldvorming via UI PACSonWEB, Lokale XDS consumer, enzovoort..
Veilig mailen en appen: Eenvoudig en veilige uitwisseling tussen zorgverleners en zorgverleners en tussenzorgverleners en patiënten, …
Sturen en Ophalen: Zowel het push model (Ik stuur mijn beelden naar…) als het pull model (ik stel dezebeelden ter beschikking van …) is beschikbaar én noodzakelijk voor verschillende workflows.
Authenticatie, autorisatie en logging: Via onze identity provider kunnen alle authenticatie methodieken worden ingericht (UZI, tokens, active
directory, …) Autorisatie: centrale integraties voor patient consent / BPPC, therapeutische relatie, via patiënt, … Logging: Alle acties worden gelogd, eventueel via ATNA
…
What we did in Belgium.
Elektronische gegevensuitwisseling in de zorg: Onze
specialiteit?Beelduitwisseling en visualisatie: Elke usecase buiten de muren van de instelling
Radioloog, Specialist, (huis)arts, patiënt, …
Medische beeldvorming, maar registry en repository kunnen ook andere zaken worden aangemeldindien noodzakelijk
Beschikbaarheid: Datacenters met eigen infrastructuur in Nederland met 99,99% beschikbaarheid, 24/7 service, centrale helpdesk voor eindgebruikers, …
Uitbreiding van PACSonWEB platform met ordercom voor huisartsen, uitwisselen van onderzoeken via pseudonimisatie/anonimisatie schema’s in het kader van research, specifieke regionale ontwikkelingen, uitbreiding van viewer, …
Security: ISO27001, ISO13485, https 2048 bit RSA key, TLS v1.2 Identity provider strong authentication Pentests, auditing, logging, …
Standards: XDS, DICOM, HL7, IHE, REST, …
Elektronische gegevensuitwisseling in de zorg:
Uitdagingen en oplossingen?
Oplossen met XDS-I wat kan, maar ook pragmatisch zijn om elke workflow te ondersteunen om de CD Brander echt van de afdelingen te kunnen verbannen. Wij zijn overtuigd van een hybride benadering, echter steeds gebruik makend van open standaarden.
Centrale aanpak waarbij de meeste data bij de bron blijft, maar waarbij sommige data tijdelijk centraal kan geplaatstworden om performantie te waarborgen. Wie naar beelden kijkt weet dat snelheid en performantie uiterst belangrijk is. (praktijk vs concept)
Centrale patient consent en therapeutische link is zeker een toegevoegde waarde.
Een centrale helpdesk is ons inziens een must voor elke eindgebruiker van de oplossing.
Flexibilieit voor nieuwe ontwikkelingen en innovatie. Bereidheid om regionaal specifieke development te doen is onsinziens een must. Binnen elke regio is dit noodzakelijk, zeker in het kader van authenticatie en autorisatie. (future proof systeem)
Er wordt ons inziens te wenig aandacht geschonken aan de viewer (XDS consumer) en de snelheid ervan. We gaantevaak uit dat alles wordt gedaan met de lokale ziekenhuis viewer wat in de praktijk niet altijd kan. (cfr PACS readiness)
Demo of our patented technologyPACSonWEB Emergency Reading
References
Questions & answers
