March 2015 HEALTH MANAGEMENTblog.agfahealthcare.com/wp-content/uploads/2015/03/Agfa...We have developed systems leveraging the cloud, mobile usage, interoperability, big data and advanced

HEALTH MANAGEMENT

SPECIAL REPORTMarch 2015

2 SPECIAL REPORT HEALTH MANAGEMENT

In all parts of the world, new communication technologies – whether the internet, smartphone or cloud, to name only a few – are letting us take greater control in our lives and our work. And healthcare is no exception. With value-based care replacing volume-based care, integration is key. Convenient, comprehensive and unified access to information from every source is increasingly necessary, to allow healthcare to evolve into a true collaboration between all stakeholders, including doctors, hospitals and regions, with the engaged and empowered patient in the center.

But this will only succeed if tools are put in place that remove barriers between stakeholders and that allow them to focus on cost, quality and patient care.

Agfa HealthCare has proven and innovative solutions that answer the needs of enterprises and users, built upon our long-term experience in healthcare and our in-depth understanding of the clinical environment. We have developed systems leveraging the cloud, mobile usage, interoperability, big data and advanced analytics. Known for offering both tightly integrated and vendor-neutral solutions, we use standard-based designs to provide the interoperability that health management needs. So you can make the most of your Agfa HealthCare investments.

In this Special Report, you can explore the issues faced by healthcare organizations around the world and discover how Agfa HealthCare is supporting them to succeed – and to take control of their health management.

Katarina van der HoevenMarketing Communications Manager

SPECIAL REPORT March 2015

Taking control of health management

The Agfa HealthCare editorial team would like to thank all those who contributed to this publication.

Agfa, the Agfa rhombus, HYDMEDIA, IMPAX, ORBIS and XERO are trademarks of Agfa-Gevaert N.V., Belgium, or its affiliates. All other trademarks are held by their respective owners and are used for editorial purposes with no intention of infringement. All information contained herein is intended for guidance purposes only. Characteristics of the products and services can be changed at any time without notice. Agfa HealthCare strives to ensure all information is accurate but shall not be responsible for typographical errors.

3 IN PROFILE: LUC THIJS Health Management: bold vision, step-by-step implementation, in collaboration

6 ZERO-PAPER SAFETY NET FOR INFORMATION ACCESS Hospitals CH de Saint-Lô and CH de Coutances, France, speed up and secure access to information

10 IN PROFILE: PROF. WINFRIED A. WILLINEK Not even a Ferrari will get you to your destination without a driver

14 AGFA HEALTHCARE AND M’BOI MIRIM STRENGTHEN COLLABORATION TO ADVANCE TOWARDS A FULLY DIGITIZED FUTUREImplementation of HIS/CIS allows São Paulo hospital to enhance patient care, staff efficiency and management control

18 IN PROFILE: JOOST FELIX AND JÖRG SCHWARZ EHR Portal: The gateway to integrated care

22 NEW APPROACHES TO COMMUNICATION WITH REFERRING PHYSICIANS AND COOPERATION PARTNERS At the Hufeland Klinikum Bad Langensalza, Germany, information is shared quickly and securely, thanks to the ORBIS portal solution

26 MARKET INTELLIGENCE FOR ENTERPRISE IMAGE MANAGEMENT SOLUTIONS Key findings of a study on Enterprise Image Management performed by HIMSS Europe

27 IMAGES – THE MISSING ELEMENT IN TODAY’S EHR Dr. Cheryl Petersilge of MyPractice Imaging at the Cleveland Clinic, Ohio, talks about why adding images into its EHR solution was so important

30 A LONGTERM IT STRATEGY SUPPORTS QUALITY INFORMATION AND QUALITY CARE IT solutions come together to help the Jacques Lacarin hospital in Vichy, France, meet its development program and regulatory requirements

34 IN PROFILE: BRAD GENEREAUX XERO Viewer – Bridging the imaging gap for the electronic health record

36 ORBIS PLATFORM OFFERS LONG-TERM BENEFITS ORBIS upgrade brings new functionalities for meeting ambitious goals of H. Hartziekenhuis Mol, Belgium

40 STEP-BY-STEP DIGITIZATION LEADS TOWARDS THE ULTIMATE GOAL: THE EMR Evangelisches Krankenhaus Mettmann adopts an integrated comprehensive solution from Agfa HealthCare

SPECIAL REPORT HEALTH MANAGEMENT 3

Health management: bold vision, step-by-step implementation, in collaborationFew companies can survive 100 years, and yet Agfa HealthCare today is thriving, offering dynamic and top-of-the-line medical imaging and IT solutions that continue to evolve. How has it done this? Because it is not the same company it was a century ago. It has kept itself relevant by deeply understanding the context and needs of its customers, then using its experience and knowledge to guide them on their own steps to the future. 100 years ago, ‘health management’ could not have meant what it means today. Luc Thijs, President of Agfa HealthCare, explains to us how the company’s vision has progressed in sync with the evolving reality of healthcare, while always staying true to its mission: making its customers successful.

In profileLUC THIJS

President of Agfa HealthCare


Why is health management moving in a new direction?In the last decades, healthcare expenditures have risen consistently and sharply in all OECD countries, outperforming the rate of inflation and absorbing a growing part of GDP. At the same time, a generation of baby boomers is about to retire and chronic disease is projected to further grow as a consequence of aging.

Without a paradigm shift in the way care is provided, the cost of our healthcare delivery systems will soon be unsustainable.

What role will outcome-based reimbursement and integrated care play?There is a growing consensus that current volume-based payment models, as well as the lack of co-ordination of care, are two important root causes to be addressed.

Volume-based reimbursement (fee-for-service) is being blamed for incentivizing over-consumption and for encouraging the build-up of over-capacity. New outcome-based

payment models focus on obtaining efficiency within a fixed payment (or envelope). Moreover, preventable adverse events, such as hospital-acquired infections and medication-related errors, as well as excessive readmissions, are being penalized, contributing to patient safety.

Fee-for-service payment models did not intrinsically motivate care providers to collaborate. In fact, no single care provider was reimbursed to align primary care, acute care, subsequent recovery and community care.

For the new outcome-based models to be really successful, providers need to actively co-ordinate care with other stakeholders in the process. Medical information needs to be transparently shared and patients need to be seriously engaged in managing their own health. The dominant focus on acute care inside the premises of the hospital diminishes, prevention becomes important and the social and behavorial reality of the patient comes into play.

‘Connected’ or ‘integrated’ care becomes essential.

How does Agfa HealthCare contribute?20 years ago, service departments and clinical specialties were focusing on their part of the patient care equation: each independent, each with their own investments and processes. Yes, there was quite a bit of inefficiency, due, among other causes, to the paper-based workflows, but there weren’t really any other options.

While digitalization started out departmentally and dramatically improved productivity in radiology, in the laboratory and in administration, hospitals gradually moved away from investing in departmental systems towards investing in enterprise systems. EMRs today provide an overarching view of clinical and administrative processes in the hospital.

While Agfa HealthCare continues to enrich its own ORBIS* EMR with the most advanced clinical functionality, we decided to also invest in three other areas:

Although imaging is prolific and more imaging data is being created today across the care continuum than ever before, EMR systems generally have not been very good at capturing all types of images

Without a paradigm shift in the way care is provided, the cost of our healthcare delivery systems will soon be unsustainable. LUC THIJS President of Agfa HealthCare


that are relevant to the care process. For every radiology or cardiology image that finds its way to the patient record, an equal number of images from other disciplines (GI, OB/GYN, pneumology, dermatology, ophthalmology, etc.) do not. Together with key customers, we have developed an Enterprise Imaging platform that truly image-enables the EMR. At the level of the different departments generating images, we have built efficient workflows that allow for swift integration of the relevant images with the proper patient record in the EMR. We have completed the patient’s visual info graphic and made it available to all physicians and care providers.

Responding to the needs of hospitals to better engage with their patients, their referring physicians and other stakeholders in the care process (GPs, visiting nurses, physiotherapists, social care workers, etc.), we have recently been developing an EHR portal. Based on its underlying information exchange architecture, it extracts relevant information from different sub-systems (EMR, LIS, PACS, ECM and more) and aggregates it at a higher level for presentation in a user-friendly way. While it now focuses on sharing patient-centric information, the EHR portal is also meant to support activity-driven workflows in an integrated care concept.

Last but not least, we are investing in Clinical, Operational and Financial analytics, so as to be able to provide our customers with actionable insights. Whether at the level of a clinical department, a hospital or an integrated care network, context-aware information, often extracted from different subsystems and residing in different formats, will always be of critical value for decision making.

So what’s next?While potentially disruptive, true integrated care opens the door for new models that manage health for large-scale populations in a radically different way.

We are determined to collaborate with our customers in addressing that challenge, gaining experience from common initiatives, creating new IT solutions on that basis and solving the problems our customers have today and foresee tomorrow.

That’s how we can ultimately contribute to their success. W

* ORBIS is not available in Canada or the U.S.

For the new outcome-based models to be really successful,

providers need to actively co-ordinate care with other stakeholders in

the process. LUC THIJS

President of Agfa HealthCare


Centre Hospitalier Mémorial France États-Unis (CH de Saint-Lô) – Centre Hospitalier de Coutances – France

Zero-paper safety net for information accessHospitals CH de Saint-Lô and CH de Coutances speed up and secure access to information by dematerializing all patient files and “fossilizing” paper archives.INTERVIEW WITH F. BREUILLE, Director of Information Systems for CH de Saint-Lô and CH de Coutances – M. VOISIN, Deputy Director of CH de Coutances – DR. P. BALOUET, Doctor – S. ALLAIN, Archive manager – R. BERNASCONI, Computer engineer – N. BISSON, Health executive

From left to right: Dr. Pierre Balouet,

Francis Breuille and Marc Voisin

As part of the TACTILIS project to implement a single global and shared electronic medical record, begun in 2011 and built around the ORBIS solution, the hospitals CH de Saint-Lô and CH de Coutances have carried out an innovative digitization program of their paper archives, successfully achieving their goal of making access to information smooth and fluid.

HYDMEDIA is to ORBIS what Google is to the internet, providing fast access to a high-performance search tool. DR. PIERRE BALOUET MD Doctor, Director of the TACTILIS project


Located close to one another, in the French department of la Manche, since the end of 2011 the two hospitals Centre Hospitalier Mémorial France États-Unis de Saint-Lô (CH de Saint-Lô) and Centre Hospitalier de Coutances (CH de Coutances) have together formed a Regional Hospital Network, with a shared strategy based on pooled resources and a common medical project. Their ambitious and innovative project to enhance the performance and quality of patient care was introduced by director Thierry Lugbull. As part of this strategy, the information in the patient files, sourced from the hospitals’ ORBIS* solution, has contributed to the TACTILIS project, which aims not only to bring the information close to the patients using touchscreen terminals attached to their bed trays, but also to carry out a vast digitization of the paper archives. With the HYDMEDIA** archive solution, the hospital network launched, in parallel to the TACTILIS project, a massive operation that will support it in evolving towards becoming a zero-paper organization, within the context of a global move towards optimization and security along the course of care.

“Modernizing the regional network of Saint-Lô and Coutances required modernizing its information system,” explains Francis Breuille, Director of Information Systems for CH de Saint-Lô and CH de Coutances. “Led by our director Thierry Lugbull, who took up his functions in 2008, this program was launched soon after his arrival, with the priority of computerizing the patient record.” After an audit in 2009 the blueprint was created in 2010, and the project began in 2011 with the global implementation of ORBIS, which was selected thanks to its unique ‘agility’. This was a fundamental criterion, as the objective of the project was to achieve a single, global and shared patient record for the two hospitals and all of the specialties. The project was both ambitious – as it was to be implemented in only 4 years – and innovative. “Two options we selected stand out: touchscreens, which enhance the users’ acceptance and adoption, and ‘zero paper’, which avoids the continuation of a paper file in parallel to the EMR,” continues Francis Breuille. “With the extension of the ORBIS project, the patients’ terminals, installed at their bedsides, serve a triple purpose: firstly, entertainment, with Video on Demand, internet and even audio books.

With the mass digitization workshop, the volume of files returned to the archives every day has dropped from 250 before the implementation of HYDMEDIA to 150. SANDRA ALLAIN Archive manager for CH de Saint-Lô and CH de Coutances

Secondly, informative, with both contextualized and medical information, because the medical staff can check or enter data in the patient record via the terminal. Thirdly, as ‘front-line’ communication between the medical team and the patient.”

Integrating archiving from the beginning of the EMR projectWhen the ORBIS EMR was selected in 2011, the HYDMEDIA archiving solution was also chosen. The digitization of the patient file is a global, multi-facetted project, and evolving towards zero paper is a key success factor. “Since the beginning, we asked ourselves how best to handle the digitization of the

paper archives, because all of the files – whether old or new – must be in the same format. We can’t have a ‘double-archive’ of both paper and digital documents,” highlights Dr. Pierre Balouet, Director of the TACTILIS project. “What’s more, inputting information twice creates double work and increases the risk of error, which can cause serious problems of divergence in information. With well-structured files, information only needs to be entered once.” At the same time, reducing the physical access to the paper archives that remain stocked in the basement of Saint-Lô provides a considerable time saving. This “fossilization” of the physical archives is the key principle of the project:


HYDMEDIAW Brings together the patient information in

the form of multimedia content.

W Accelerates the availability of information

via the search tool.

W Enhances the security of information.

W Provides data recovery in case of disaster.

W Reduces the cost of consumables.

ORBISW Sharing of data from patient records

and administrative data.

W Enhanced cooperation between

care professionals.

W Reduced risk of error due to control

and validation features.

W Migration towards paperless hospital.

3 minutes are needed to fill in

the documents for

a newborn baby,

versus 25 in the past.

90%of the hospital practitioners

acknowledge a time savings and an

ergonomic access to information.

4 secondsare needed to access information.

150 filesare sent back down

to the archives every day now,

versus 250 before 2012.

the clearly identified goal is that paper archives no longer go upstairs, even if the physical archive is preserved. New files are digitized from the start. This way of working lightens the workload of the administrative staff, but also of the doctors who can immediately find the information they need with only a few clicks, wherever it may be. Moreover, the patient records must remain accessible and HYDMEDIA provides the necessary backup capability. “This is why the archive, an integral part of the EMR project, is a fundamental axis, the red thread. And why we have carried out this project in parallel with the implementation of the EMR project,” summarizes Francis Breuille.

Meticulous preparationMarc Voisin, Deputy Director of CH de Coutances, and responsible for the ORBIS digitization project, carried out the dematerialization for the hospital network. “As I had experience working on an archive digitization project for the AP-HP hospitals in Paris, I was given this responsibility. It was quickly obvious that it would not be possible to

Archiving is a fundamental axis, the red thread and a key condition for the successful deployment of an EMR.

With HYDMEDIA, we will achieve zero paper. FRANCIS BREUILLE

Director of Information Systems for CH de Saint-Lô and CH de Coutances

digitize everything, i.e. all 4 linear km of archives (300 meters per year): too much information kills the information! With the internal project team, the OPER group, which includes operational staff, a set of specifications was established with the preferences.”

The start of operations began with a ‘housecleaning’ phase, carried out by the archive unit, during which 33 tons of documents were destroyed, which made it possible to gain a clear overview of the situation and avoid duplication. The items that needed to

* ORBIS is not available in Canada or the U.S. ** HYDMEDIA is not available in the U.S.


be digitized for the 300,000 active files were identified and indexed using a barcode system. A strict naming system was put in place. “Two processes were defined,” explains Marc Voisin. “Mass digitization for the archives and ongoing documentation, which is entered by the administrative staff into the EMR when a patient arrives with documents.” A mass digitization workshop was set up in the archives of each hospital. The technical equipment (6 scanners at Saint-Lô and 4 at Coutances), tested and validated by the staff, was used by dedicated teams of 13 archive assistants at CH de Saint-Lô and 7 at Coutances. On each site, the work was carried out under the supervision of an archivist (1.5 FTE at Saint-Lô and 0.5 FTE at Coutances) who verified the digitization and indexed each file in HYDMEDIA. “It was a painstaking work with heavy responsibilities for these teams which have a real medical record culture,” adds Francis Breuille.

HYDMEDIA: a safety net for information accessBefore 2012, 250 files were sent back down to the archives every day at Saint-Lô; that number has now dropped to 150. Buildup has been progressive, with the digitizing of about 200 files per day on average, with the objective of reducing the digitization workload to the bare minimum in 2015.

“We had some initial difficulties in terms of access time in consultation mode, but this was resolved when we moved the module to full web. Today, accessing information takes four seconds,” comments Romain Bernasconi, computer

engineer in charge of processes and IT tools. “It also required compromises in the number of documents included in a file, because too many files complicated access.”

HYDMEDIA can also be used in the event of degraded operation of the main application: fed by ORBIS in daily production, it contains a copy of the documents and becomes the principle source in case of technical problems or a planned shutdown of ORBIS. “The weakness of paper as a storage medium is not always recognized,” adds Francis Breuille. “While the loss of a paper file is accepted, the level of demand rises with an IT solution and the inability to access information is less tolerated. With HYDMEDIA, we have a safety net to ensure access to the patient’s information.”

Time savings and reduced risk of errorsThe EMR created around ORBIS/HYDMEDIA has been a clear success for the hospital network and its staff: 90% of

the hospital practitioners acknowledge “a time savings and a truly ergonomic access to information.” Dr. Pierre Balouet adds, “Before, in the maternity unit, a midwife would have to write the name of a newborn baby 16 times in 16 different documents, and spend 25 minutes filling in the documents. Today, 3 minutes is enough: that’s time saved and the risk of errors reduced.” In terms of the archiving and mass digitization with HYDMEDIA, the processes are mature and efficient.

The return on investment is clear: time savings for nurses, limitation of exam duplication, improvement of productivity for the administrative staff, control of paper consumption and rationalization of the printing systems are a few of the examples which lead to a better resource management for the two hospitals. The fossilization is ongoing, and the solution is both playing its primary role and fulfilling its complementary backup mission. “HYDMEDIA is to ORBIS what Google is to the internet,” concludes Dr. Balouet. W

Agfa HealthCare’s contributionAgfa HealthCare worked in close collaboration

with the CH de Saint-Lô and CH de Coutances

to develop ways to adapt its solutions to the

hospitals’ specifications. Agfa HealthCare

also trained the hospital’s project team in the

applications implemented and transferred the

knowledge so that the project team could

conduct future trainings on-site and create a

help cell for the users.


I think we will see treatments with biologicals becoming more established within the next five years – in combination with new developments in device-based medicine. PROF. WINFRIED A. WILLINEK

In profilePROF. WINFRIED A. WILLINEK Managing Senior Physician and Deputy Director of the Department of Radiology, University Hospital Bonn, Germany, currently working as Chairman, Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Trier, Germany


University Hospital Bonn, Germany

Not even a Ferrari will get you to your destination without a driverRadiology is an interdisciplinary field influenced by virtually all medical innovations. This naturally applies to imaging and image-guided interventions just as much as to diagnostics and data management. We spoke to Prof. Winfried A. Willinek and asked him about present and future challenges.

Prof. Willinek, where do you see current developments in radiological imaging?The trend is moving away from static individual images toward collated image data sets, for example data gained from multiparametric imaging with the option of quantifying the pathological processes, or from moving images (“4D”) that allow dynamic visualization of the kinetics of pathological changes. Today, in oncology, not only are statements about tumor size required, but also information gathered non-invasively, including that concerning a tumor’s metabolic activity or malignancy. For instance, surgeons would like to see in front of them in 3D not only the liver they are going to operate on – to help in planning the operation, including colored display of the liver segments, vessels and metastases – but also data about the size and volume of the remaining parenchyma, and about the function. This means evidence of liver damage or fat content/fibrosis. When treatment is being monitored, increasingly we need functional information about the residual tumor and its vitality. Based on these radiological data, it is possible to plan the best courses of treatment or treatment options. In this process, I see my colleagues and myself more and more in a pioneering position. Radiology should play a crucial role not only in reaching a diagnosis, but also in treatment management and the selection of patients. Ultimately this is based on standardized, structured findings that allow comparisons and can document the success of the treatment.

One major example of the growing requirements placed on radiology is the rising importance of genetic analysis of cancers with a view to immunological

approaches to treatment. Previously the role of radiology was to provide image-guided histological diagnosis of a lesion. Today it is important to document the changes in tumor genetics during treatment.

This requires numerous sequential biopsies over time. And here we find the foundation for the paradigm shift with individualized therapies – for example, moving away from classical chemotherapy to a combination of chemotherapy and immunotherapy, possibly also alternating with locoregional and local ablative radiological treatments.

In what period of time will this paradigm shift take place?I think we will see treatments with biologicals becoming more established within the next five years – in combination with new developments in device-based medicine.

Can you give us an example? With high intensity focused ultrasound, HIFU for short, we do not yet know the areas where it will become a routine clinical procedure in the future. In our Radiology Department in Bonn we have the first device in the German-speaking region that can offer treatment based purely on ultrasound. Initial results are encouraging, especially in the treatment of acute cancers with a poor prognosis, such as pancreatic cancer. The possibility of using HIFU in local and focal therapy opens up many more fields of application. Fibroids already constitute one established indication. In the future I can see additional applications, for example the prostate, but also soft tissue sarcomas or brain tumors.

Therefore, in tumor boards, radiology should promote all innovative treatment options for consideration alongside the others. Here functional information about the tumor is important for correctly categorizing the course of the disease under treatment. Radiology has the task of ensuring that findings are classified correctly and that decisions made on this basis serve the well-being of the patient (and especially to avoid overtreatment). It is not only the quality and standardization of the diagnostic process, but also the marking of crucial lesions over time, which make it possible to demonstrate the images and findings to an interdisciplinary conference.

Have these developments any impacts on the organization of radiological departments and institutes?Sure. To improve our handling of the constantly increasing amount of data and complexity of the imaging, more than anything else we have to have the appropriate personnel, but we also have to work in networks. This may require bringing in several departments together in some cases. Furthermore, the number of interdisciplinary meetings in certification processes is rising all the time.

Radiology is an interdisciplinary field and is, therefore, in contact with other departments through its staff. For instance, in Bonn we have more than 60 meetings a week. This demands that radiology has very good time management and convincing research and image demonstration, so that clinically relevant findings from many patients can be presented within a short space of time.


Are these types of work and services already reflected in billing?Unfortunately they are not yet included to a sufficient extent in the billing systems, that’s true. But that absolutely has to change, because radiology requires high staffing levels and a lot of time if it is to provide high quality diagnostic work-up – including when services are provided by clinics outside the institute – and to hold meetings with properly qualified staff members. The preparation frequently includes examination and archiving of the patient’s prior images from medical practices or other hospitals. In the case of cancer patients, for example, during the tumor board’s preparation for the Center for Integrated Oncology (CIO) Köln Bonn. I often make a detailed study of the progression over two or three years. Without this preparation and knowledge, I can’t take part in the discussions to identify suitable treatment options. We focus on the patient, and any piece of information can be decisive for him or her.

What do the new challenges in radiology now mean for providers of IT solutions?We are increasingly moving away from purely modality-guided solutions where we examine, assess and process images, towards comprehensive,

network-based solutions from a single supplier. IT providers have to integrate assessment, analysis (like the quantification mechanisms I mentioned) and archiving. In addition, demonstration must be simple and we must be able to find index lesions that are then archived and are at the focus for periods of years when the patients come for check-ups.

An archive of this kind is not least a prerequisite for complex clinical studies that our radiology department here at the Study Center Bonn has a hand in designing. IT companies can be incredibly helpful in this if they allow simplification of the assessment and archiving processes and of data handling, but at the same time make it possible to integrate complex pathways in image analysis by means of standardized reporting templates.

What can you do to support the IT professional?Also act professionally when it comes to IT. My experience is that the supporting systems and data management always work in departments that have specialists looking after the systems. Otherwise, our five-year success story since introducing PACS would not have been possible.

Several years ago my boss, Professor Schild, brought in Dr. Wolfgang Block

to fill the new post of Head of Radiology IT in our department. He takes care of all IT issues and is an important contact person both for the whole hospital and for the employees in radiology. On the one hand, he translates the special needs of radiology and ensures the smooth implementation of internal processes, while on the other he is responsible for integrating and networking the radiological systems, such as PACS, with those of the University Hospital. As a specialist he leads a whole team of employees: at this point the “clinically active” members of staff wish to express their heartfelt thanks to Dr Block and his team!

How will image data management systems have to change?PACS must adjust very rapidly to the changing demands. I have already mentioned the continually growing amounts of data. First, that brings challenges in archiving, and second, challenges in diagnostics. You only have to think of a patient from the emergency center after a car accident who is given a full-body 3D CT scan in multiple trauma diagnostic workup. Here an intelligent and powerful program is needed to quickly reach a reliable diagnosis and valid findings.

Radiology must and will always find new ways to maintain its

key role in diagnostics and treatment.

PROF. WINFRIED A. WILLINEK


What requirements does a PACS have to satisfy in particular, to support you in your work?Alongside quality for compiling the findings, I attach special importance to demonstration of images. This reflects radiology’s selfconfidence as a provider of information on the one hand, and on the other the interdisciplinary cooperation that will become even more important in the future; for instance working together with pathology, radiotherapy, oncology and surgery to arrive at the best possible treatment decisions.

The IT solutions are important here: to save time and emphasize relevant findings, we need simple tools for presenting complex data. When preparing to demonstrate findings, but especially for recommending a treatment and assessing the success of treatment, it is important to have direct access to all the patient’s clinical data. The faster and more effectively the image management systems provide the information, the more able radiologists will be to meet the constantly increasing requirements.

Radiologists influence patient care during examination, diagnostic work-up and imageguided interventions. Aren’t they turning more and more into treatment managers? That is true, but I would not call them that. Actually they actively intervene far too often in the workflows to be considered “treatment managers” – whether it’s with locoregional or local-ablative imageguided therapies. Even if they adopt a central position in the treatment process, they always seek interaction with other specialist departments – and the better this works, the better it is for the patient.

For radiology it is essential to continue to follow the developments occurring in technology so that new roles will always emerge for the therapeutic pathways. I see one of our most pressing tasks in defining – alongside the clinical pathways – relevant imaging pathways that ensure we undertake rapid, effective imaging procedures, but only those that are necessary or expedient. At the end of the process it must be possible to get the patients onto the best lines of treatment for them. That necessitates high quality in diagnostic imaging and image processing.

What conditions are needed for this to happen?Best of all would be to realize this in a central radiology department. It would be advantageous to have the imaging – meaning all modalities – in a single department. In my opinion this structure is the only way to implement the imaging pathways. At the end of the day this can be more cost-effective for the hospital and better for the individual patients, because it enables even more immediate and targeted diagnostic work-up and treatment.

Moving away from technology, how important is the personnel in this?The staff are the most important factor. If you own a Ferrari but have no one to drive it, you’re not going to reach your destination. It is therefore essential to invest in personnel. Staff members must be continuously given support and training, first in relation to the technology, and second in relation to the human and clinical challenges.

In this process, the chief radiologist has an important role as a person who thinks ahead and acts as an intermediary. But as far as I understand, that only works when

they keep their eyes firmly on everyday practice. Of course they have to perform their management duties, but the clinical pathways harbor potential and knowledge that they need for optimizing the organizational structure.

Prof. Willinek, to finish off, let’s take a look into a crystal ball. Where do you see radiology in 2020?Oh, even famous people have been mightily mistaken when looking into a crystal ball. But I’ll have a go. Radiology must and will always find new ways to maintain its key role in diagnostics and treatment. Examples of this would be standardization, networking, image fusion, multiparametric imaging and the quantification of pathways in the body. Furthermore, hybrid procedures will become more significant, just like minimally invasive therapies (including HIFU).

I think that personalized diagnostics and treatment will be part of the standard in 2020. I also think that what I have now formulated as a wish for image management systems (for instance integration of analytical software) will already be reality by that time. Radiology IT will require software solutions to be even more mobile, connected and integrative, so that they form the solid basis for further technical developments in innovative diagnostic and treatment procedures. W

At the time of interview, Prof. Winfried

A. Willinek, was Managing Senior Physician

and Deputy Director of the Department of

Radiology at the University Hospital Bonn,

Germany. He has since taken up a new

position in Trier, Germany.

Prof. Dr. med. Winfried A. Willinek,

MD Chairman Department of Radiology,

Neuroradiology, Sonography and Nuclear

Medicine (Imaging Center) Krankenhaus

der Barmherzigen Brüder Trier, Nordallee 1,

54292 Trier, Germany.

“Our Imaging Center is a place of

interdisciplinary cooperation between

radiologists, internists, nuclear physicians,

surgeons, EDP specialists, physicists and

economists – which means people from

many fields work together. Medical technical

assistants, medical assistants and secretarial

staff are responsible for the organization

and medical technical services.”

PROF. WILLINEK


Hospital Municipal Dr. Moysés Deutsch, M’boi Mirim, São Paulo, Brazil

Agfa HealthCare and M’boi Mirim strengthen collaboration to advance towards a fully digitized futureImplementation of HIS/CIS allows São Paulo hospital to enhance patient care, staff efficiency and management control, as it moves towards adopting Agfa HealthCare technology for all hospital tasks.INTERVIEW WITH DR. FABIANA ROLLA, Coordinator General Medicine and ELDER JUREN, IT Coordinator, Hospital Municipal Dr. Moysés Deutsch


When the Hospital Municipal Dr. Moysés Deutsch was being built in the low-income São Paulo neighborhood of M’boi Mirim, management already wanted a hospital information system (HIS) and clinical information system (CIS) that would deliver the same dynamism and reliability this new public facility sought to provide for its patients. The hospital turned to Agfa HealthCare because the company could commit to implementing the desired solution within the required timeframes.

The results since then have been transformative. As staff members have become more familiar with the new technology, they have reported time savings from having the entire patient histories, exam results and protocols at their fingertips. Patient care is increasingly standardized, and the HIS has allowed greater efficiency in managing not only patient waiting lists but also stocks.

The hospital is now strengthening its collaboration with Agfa HealthCare to replicate the success in the adoption of the initial HIS/CIS solution, now as a pilot for more advanced CIS modules, reaching towards its goal to use information technology in all its procedures, and prepare itself to become totally paperless.

In roll-out, patient safety is paramountEven before the April 2008 inauguration of the hospital, management was preparing the HIS/CIS. As a new-built facility, the hospital’s infrastructure could be made to order, allowing the HIS to be implemented before the hospital opened its doors customizing the performance and availability of the system to the hospital’s requirements. The CIS modules were then gradually rolled out starting September 2008. During this roll-out, patient safety

remained paramount and internal hospital procedures were revised to work with the new technology. Agfa HealthCare provided technical consulting and on-site training during the roll-out.

The hospital’s IT team provided 24-hour support for users’ questions, and answered requests with action plans. As implementation was gradual, workflows had to be redesigned and problems resolved in order to reduce disruptions while supporting procedures related to patient care. Certain units within the hospital were identified as most suitable for the initial implementation of modules,

Agfa HealthCare’s CIS solution allows easy access to the patient’s history from every visit to the hospital: it is easier for caregivers to follow clinical cases, errors in medical prescriptions are reduced thanks to the legible text, and all exam results are available. DR. FABIANA ROLLA Coordinator General Medicine

Agfa HealthCare’s HIS/CIS Optimization of procedures, through

easy access to patient medical records

and exam results.

Improved delivery of patient care,

adopting tools for risk assessment and

creating uniformity in patient care,

thanks to the availability of tools that

allow the adoption of uniform standards.

More efficient management of patient

waiting lists and stocks.


allowing a quick build-up in acceptance of the new system among the hospital professionals and minimizing the impact from an operational perspective. The implementation team included management, medical and IT staff, backed by a directive from senior management.

Reaping the benefits of the digitized hospitalImmediately following the implementation, there was a slight increase in the time required by each process. But this was rapidly reversed as users became familiar with the new technology, and today staff members use all the modules available.

“Electronic processes have contributed to time savings, enhanced access to data and historical records, and provided the strategic indicators management requires,” says Dr. Fabiana Rolla, the hospital’s Coordinator of General Medicine.

The benefits are many: “Agfa HealthCare’s solutions have allowed us to digitize all our patient care and hospital operations. The system helps us implement clinical protocols, manage patient waiting lists

The closeness between Agfa HealthCare and our IT unit was fundamental in allowing us to explore all the potential

of the system. Today the collaboration allows us to create pilot projects, guaranteeing improvements in processes.

ELDER JUREN IT Coordinator

Agfa HealthCare’s Contribution Digitized all patient care, supporting the

hospital to become the first in São Paulo

to win an excellence ranking from Brazil’s

non-governmental medical National

Accreditation Organization.

Agfa HealthCare’s team worked with

the hospital’s IT unit to create custom-

designed solutions that maximize the

potential of the solution in conjunction

with the institution’s procedures.

Agfa HealthCare is now helping to set up

new pilot projects that will provide future

process improvements, with the eventual

goal of eliminating paper.

and control stocks, among other things,” says Elder Juren, IT Coordinator for the hospital.

Nurses can now access a patient’s entire medical record at the hospital, while the emergency room has tools that make it easier to carry out triage protocols. Exam results are ordered and available electronically. There has also been a reduction in errors from using handwritten prescriptions, as prescriptions are now done electronically via the CIS.

“The multi-functionality of a patient’s electronic record allows us to improve

that patient’s care,” says Dr. Rolla. The system also allows for far greater control over stock management, supporting workflows for tracking of supplies such as medicines. Brazil’s public health system has long faced stock control challenges due to weak stock management systems.

Building a long-term relationship with Agfa HealthCareThe relationship between the hospital and Agfa HealthCare has not ended with the successful initial HIS/CIS implementation. The IT staff is constantly looking for ways to improve internal processes with the


The HIS/CIS solutions have allowed us to digitize all our patient care and hospital operations. They help us implement clinical protocols, manage patient waiting lists and control stocks, among other things. ELDER JUREN

Did you know... Although it is part of Brazil’s public

health service, Hospital Municipal

Dr. Moysés Deutsch is managed

in partnership with the Hospital

Israelita Albert Einstein, a private

institution that is a reference across

Brazil for healthcare excellence.

Each month, the hospital delivers some

450 babies and carries out 15,000

urgent and emergency consultations,

with 1,450 hospital admissions in the

areas of clinical medicine, general

surgery, orthopedics, obstetrics, general

pediatrics and neonatal.

Jardim Angela (where the hospital of

M’boi Mirim as it is informally known

is located) is a poor area on the edge

of São Paulo, with high levels of urban

violence. The hospital therefore treats

a high number of patients with trauma

injuries; it has 20 intensive-care unit

beds for adults and 10 for children.

new systems. “The closeness between Agfa HealthCare and our IT unit was fundamental in allowing us to explore all the potential of the system. Today the collaboration allows us to jointly embrace new pilot projects, guaranteeing continued improvements,” says Mr. Juren.

The target now is to introduce information technology in all hospital procedures in order to become a 100% paperless institution. Other future goals are to implement a mobile system in critical areas such as the hospital’s emergency ward. With this dedication to constantly seeking new improvements, it is no surprise that the Hospital Municipal Dr. Moysés Deutsch has become an Agfa HealthCare show-site in Brazil. W


In profileJÖRG SCHWARZ, Global Business Development Director, Agfa HealthCare

JOOST FELIX, Lead Product Manager, Agfa HealthCare


EHR Portal: the gateway to integrated careWith the launch of its new electronic health record (EHR) Portal, Agfa HealthCare is taking customers on a journey towards an integrated care solution. Easy to implement, yet providing a comprehensive road map, the EHR Portal integrates the experience and knowledge Agfa HealthCare has acquired in its long history, to drive towards the future of healthcare delivery with an architecture that can be extended into the entire care continuum. Co-project leaders Joost Felix and Jörg Schwarz explain…

Can you explain what the EHR Portal is?JOOST: With the Portal, all care providers – physicians, nurses, physiotherapists, etc. – as well as the patients themselves can access health information, using an interface that is easy and clear to read and is focused on the patient. It provides an overview of information coming from different healthcare sources: hospitals, laboratories, imaging centers, etc. That is what it currently does. But there is an underlying Health Information Exchange (HIE) architecture that also allows the information to be aggregated on a higher level.

JÖRG: It can pull and extract the information needed from different individual records and present it together in a very user-friendly way. So if you want the history of the patient’s lipid panel, you don’t have to sift through pages and pages of lab records: you get the most recent results of whatever you are looking for. And the patient or caregiver can see all of the patient’s information in one place.

But that is just the start. This is actually the first product in a new range called ‘Agfa HealthCare 360’. This means that, while the EHR Portal provides excellent and important value now to healthcare providers, we have a planned evolutionary path that will in the future integrate all clinical players, including social services, pharmacies, etc. plus all imaging providers such as mammography and pathology.

JOOST: That’s why we call the EHR Portal the ‘Gateway to Integrated Care’.

What is the technology behind the EHR Portal?JÖRG: The EHR Portal is a web-enabled software platform that can be installed

The EHR Portal is a web-enabled software platform that can be

installed either at the customer’s premises, or we can host it for

the customer, with a service level agreement.

JÖRG SCHWARZ Global Business Development Director, Agfa HealthCare


either at the customer’s premises, or we can host it for the customer, with a service level agreement.

JOOST: It can be integrated with both information systems like ORBIS* and HYDMEDIA** and with Enterprise Imaging. Combined with the XERO Viewer***, it provides high quality images. Radiologists want to see not

only images but all kinds of information, such as lab results and patient diagnoses, which provides a greater context for the medical images. But it is up to the customer how and with what systems they want it to be integrated. That means it is scalable, too. It can be used with their current systems, and then be integrated with new products and solutions as they add them.

How is the EHR Portal answering the specific needs of hospitals and hospital groups?JOOST: Hospitals and hospital networks are asking us “How can we integrate with our referring physicians, how can we get results to them? How can we establish and strengthen our relationship with our patients? How can we keep onboard new patients more easily, for them and for us?” Hospitals don’t want departmental systems, they want enterprise-wide solutions.

JÖRG: Agfa HealthCare has a lot of great IT and Imaging products and solutions. With the EHR Portal, we are providing an umbrella that brings them all together, whatever solutions the customer has or needs. But it isn’t a product that is intended to do just one thing: it has been designed to grow and evolve in order to continue the healthcare story.

JOOST: And it’s not just for Agfa HealthCare products! We are known as a company that makes products supporting standards, such as DICOM, IHE, etc. that allow other vendors to integrate their products with ours. That is true for the EHR Portal, too. A non-Agfa HealthCare picture archiving and communication system (PACS) can

The EHR Portal provides both a Patient View and a Clinical View

PATIENT VIEW:

The patients can:

W Look at their own images, results and

other reports;

W Share results securely with another

doctor to get a second opinion;

W Give access to their results on the

EHR Portal to a caregiver;

W Upload information from e.g.

wearable activity trackers or CDs

provided by another doctor.

CLINICAL VIEW:

Provides the clinician:

W All of the Patient View functions;

W A work list with an easy overview

of all patients;

W Certain key performance indicators

(KPIs) based on embedded analytics;

W Peer-to-peer communication with

other providers;

W A role-based framework that allows

the care providers to operate within the

local legislative framework and their

internal processes.

SPECIAL REPORT HEALTH MANAGEMENT 21* ORBIS is not available in Canada or the U.S.** HYDMEDIA is not available in the U.S.

All functionalities of the EHR Portal are available on mobile devices, thanks to the native mobile interfaces for Google Android and Apple iPhone mobile digital devices. JOOST FELIX Lead Product Manager, Agfa Healthcare

How will the EHR Portal help lead the way to integrated care?JOOST: The first step is the total overview of the patient care, not just of what comes from the care provider’s own hospital or clinic, but all along the care continuum. This is what the EHR Portal will provide. The second step, still to come, will then be to include the activity-driven workflows. JÖRG: Then there is a third aspect: adding social care. Integrated care incorporates not only acute care, e.g., within the hospital, but also preventative and elective care. The caregiver’s goal is to improve outcomes and prevent the patient from coming back to the hospital for the same problem, and to prevent severe escalations, like emergency room visits. So the patient’s information needs to be available not just within the hospital but also to whoever will be involved in the patient’s ongoing wellbeing. This could be a home nurse, a physiotherapist, even a relative who will be making sure the patient takes the prescribed medicine, makes it to the scheduled appointments, everything.

That’s our vision of the way forward, and with the EHR Portal we and the care providers have a road map to achieve it. W

share images, a non-Agfa electronic medical record (EMR) can send results… So it fits into any hospital, regardless of what solutions they have.

JÖRG: The EHR Portal also lets hospitals realize significant cost reductions, by making all information, including imaging, available where and when it is needed, and helping to eliminate redundant procedures. To take one example: if surgeons are preparing an intervention and cannot find an image that was taken three weeks ago, they might have to order another. We have studies that show that with the EHR Portal functionality, a hospital can reduce redundant images by up to 2% of the entire imaging volume. For a high-volume imaging environment, that is an enormous savings; in some cases enough to pay for the portal itself!

Why is Agfa HealthCare the right company to accompany the healthcare provider into an integrated care future?JÖRG: With the EHR Portal, we are taking proven Agfa HealthCare expertise and experience, and turning them in a new direction for our company: a direction that our customers, the healthcare providers, both want and need. Our IT solutions are already about sharing information in multiple hospitals, in a

clinical, relevant way. In imaging, we have multiple regional projects that are also about sharing. Our clinical expertise is demonstrated by the over 1000 hospitals that use our EMR and over 2500 that work with our PACS systems. With our proven experience, we have a broader outlook, vision and capability – which is what you need for integrated care.

JOOST: So on the one hand it is a new product, but it is really built on all the different and proven elements and experiences Agfa HealthCare already has.

Can it be used on mobile devices, smartphones, etc.?JOOST: Absolutely! All functionalities of the EHR Portal are available on mobile devices, thanks to the native mobile interfaces for Google Android and Apple iPhone mobile digital devices. The user experience is adapted to the mobile device, but the functionality is the same. So the screen is sized differently, but the pertinent information, such as lab results, is adapted to fit.

JÖRG: Some smartphones have amazing image resolution these days, great for looking at high quality images. There is also an instant messaging system that is even better than email for a mobile environment, for sending short messages and collaborating with peers.

*** XERO Viewer is pending 510(k) clearance in the U.S. and not currently available in Canada.


Case study Hufeland Klinikum, Bad Langensalza, Germany

New approaches to communication with referring physicians and cooperation partnersAt the Hufeland Klinikum Bad Langensalza information is shared quickly and securely, thanks to the ORBIS portal solution.INTERVIEW WITH DR. UTA KÄSTNER, internist and nephrologist at the Dialysis Clinic, and IVONNE TIPPMANN, Director of the Central Secretariat for Department Heads

Previously my colleagues were always on the phone or using the fax to get records for me. The fact that I can now call up these records online is an enormous advantage for my work. DR. UTA KÄSTNER Internist and nephrologist at the Dialysis Clinic

One of Dr. Uta Kästner’s patients has been admitted to the Hufeland Klinikum (Hufeland Medical Center) in Bad Langensalza. Kästner, an internist and nephrologist working in the dialysis clinic attached to the medical center, is worried: this patient comes to the clinic three times a week for dialysis. At admission a bleeding ulcer is diagnosed. Before the next treatment is administered – by necessity in hospital – several questions have to be answered: How severe is the bleeding? Does it have any effect on the administration of medication during dialysis? How is the patient’s general condition? To obtain an overall impression fast, Dr. Kästner logs into the online portal of the Hufeland Klinikum, where she can see all the data and pictures for her patient. Fortunately, the situation is not as bad as it first appeared and dialysis can be performed the next day as scheduled.


At its two locations, in Bad Langensalza and Muhlhausen, the Hufeland Klinikum offers any physician requesting it the option of downloading all records stored for the 22,500 inpatients and 53,000 outpatients treated at the hospital each year.

The technical side has been solved in a very secure manner. A special computer (application server) retrieves only those data for which the physician is authorized from the hospital information system (HIS) and transfers them to an additional communications computer (proxy server) located in a network sector specially protected by several firewalls and referred to as the ‘demilitarized zone’ (DMZ). From here the information is transmitted to the referring physicians over a secure connection. “This can happen only if patients have previously given their consent to the data transfer,”

explains Ivonne Tippmann, Director of the Central Secretariat for Department Heads at Hufeland Klinikum. Tippmann is responsible for looking after the portal solution and the associated workflow. The patients’ consent is requested at admission. The records of patients who refuse consent to this transfer are sent by normal post, as before.

Portal solution for rapid transfer of findingsA survey conducted among referring physicians in 2009 revealed, among other things, that they are unhappy about the disparities in how medical reports are treated by different individuals and institutions. The time of dispatch ranges from ‘immediately’ to ‘two months later’, reports Tippmann. “We wanted to standardize this and at the same time find a solution that allowed us to avoid superfluous waiting times and to provide

General practitioners and specialists can review the examination results even before the patients arrive in their practices. IVONNE TIPPMANN Director of the Central Secretariat for Department Heads

better support to the referring physicians responsible for the follow-up care of these patients.” It soon became clear that a portal solution was the only feasible route to this goal. “With this solution the physicians obtain the discharge summary in the fastest and most direct way and also have access to additional records,” she explains.

Installing the technical solution was not enough, however: at Hufeland Klinikum the current workflows also had to be adapted. Today the doctors dictate a short discharge summary into a device with digital voice recognition before the patient is discharged; this summary is then processed by the secretarial service. It can be accessed by the clinician in ORBIS* HIS, printed out, and issued to the patient. In parallel, the referring physician can already have a look in the portal: X-ray images, lab reports,


histology reports and other records are added afterwards, and a signed version of the complete discharge summary is available after two days at the latest.

Referring physicians were initially reluctant and had to be persuadedIn June 2011, the Hufeland Klinikum launched the “Referring Physicians’ Portal” project with a first large information event for the referring physicians.

“Initially traffic on the site was slow to get started,” recalls Tippmann. “To remedy this, the medical center assigned an extra staffer to our office; we then phoned every referring physician and explained the possibilities and advantages offered by the new solution. We even visited many of these physicians and presented the portal to them on their premises.” This enormous effort was repeated in September 2011, when the solution was activated for the outpatient and inpatient nursing care facilities in order to facilitate patient transfer management.

For Tippmann the modest participation figures are a generational issue. “We succeeded in convincing the younger doctors, in particular, very quickly.

This group is generally open to technological innovations. Often, they have already heard of our portal and are eager to use it to save time and expenditures. However, there are also doctors’ practices that are completely analog and work with paper files, X-ray films in paper envelopes, etc. It is simply harder for us to gain a foothold there,” she says about one of the most difficult parts of her job.

By September 2014, 109 – i.e. nearly one-third – of the referring physicians were using the portal solution. The participation rate is higher at the inpatient and outpatient nursing care facilities.

This group does include 43 referring physicians who, as of January 2012, have only been able to obtain records via the portal. Two other institutions completely integrated into the portal solution are the Hainich Ecumenical Medical Center (a specialized hospital for neurology, psychiatry and psychotherapy) and St. Elisabeth Hospital in Lengenfeld unterm Stein. “St. Elisabeth Hospital works with ORBIS HIS; this naturally made the introduction and operation of the portal much easier,” reports Ivonne Tippmann happily.

Nevertheless, Tippmann and her colleague personally visited all the new participants, set up access to the portal on their premises, and trained office staffers. Tippmann adds: “This service is important: we don’t want acceptance of the project to be sabotaged by incorrect operation of the portal.”

Peace and quiet plus higher efficiencyThe dialysis centers at the Bad Langensalza and Mu hlhausen sites of the Hufeland Klinikum have now been using the ORBIS portal solution for a full year. It is estimated that the four staff doctors call up the records of about 60 percent of their patients on the portal. The objective was to give them faster access to the medical findings of their patients who have been admitted to hospital. Dr. Kästner elaborated: “The patients spend about five hours at one of the dialysis centers for each treatment. During this time I have to collect all the important findings and make therapeutic decisions on the spot.”

She comments that, “This is distinctly easier now than it was in the past.” Previously, the nephrologist had to make multiple phone calls, read a lot of faxes,

* ORBIS is not available in Canada or the U.S. SPECIAL REPORT HEALTH MANAGEMENT 25

and drive many kilometers to pick up records at the Medical Center. “Those days are over. I can now obtain all the information I need with a mouse click, and can begin or modify treatment much faster,” says Dr. Kästner.

This fast and secure access to all the information in the patient’s record is precisely what Hufeland Klinikum wanted to offer referring physicians and cooperating partners with the ORBIS portal solution. “The general practitioners and specialists can already review the examination results before the patients appear in their offices,” says Ivonne Tippmann.

Dr. Kästner especially enjoys the peace and quiet that descended on her unit about a year ago. “Previously my colleagues were always on the phone or using the fax to get records for me. The fact that I can now call up these records online is an enormous advantage for my work. And the patients benefit not just from the shorter waiting times but also from the peace and quiet which speeds their recovery!” she adds. Dr. Kästner has only praise for the portal solution. “The system runs smoothly and without problems. It is accepted by everyone working at our dialysis centers and lightens their workload noticeably.”

For other users – and in particular for patients – it has an additional advantage: it helps prevent duplicate examinations, since all images are available – or can be made available – whenever needed.

Communication in both directionsThe ORBIS portal solution is also not a one-way street: referring physicians can upload their patients’ records onto the server at the medical center. These records – on previous lab studies, allergies to medication, and previous illnesses – provide more information to aid caregivers

in determining the treatment administered in the hospital. “It also means that the hospital now has a complete patient record,” comments Ivonne Tippmann.

And the portal is continually being expanded and optimized. “After one of our annual physician surveys, for example, we added the health insurance number to the details provided,” says Tippmann. “Requests and suggestions are always welcome; we are happy to implement them!” she adds. “This also contributes to further acceptance and widespread use of the solution.” W

This service is important: we don’t want acceptance of the

project to be sabotaged by incorrect operation of the portal.

IVONNE TIPPMANN

Market Intelligence for Enterprise Image Management Solutions (EIMS)


HIMSS Europe recently undertook a qualitative study on Enterprise Image Management. Carried out between August 2014 and October 2014 in Europe and the Middle East, the survey’s objective was to gain a comprehensive understanding of the perceptions of CIOs and clinicians in terms of expected and generated return on investment using Enterprise Imaging Solutions and higher EMR integration deployment in hospitals.

Market intelligence for Enterprise Image Management Solutions

Based on qualitative phone interviews with persons involved in the decision making process to purchase an Enterprise Image Management Solution (EIMS) for public, private and university hospitals, the survey also invited users of EIMS to complete a short Excel questionnaire quantifying realized benefits. All respondents were asked to provide insights into their pain points and expectations, their perceptions regarding concrete improvements they are experiencing by having an EIMS solution, and future trends they foresee.

etc. are a result of the above mentioned benefits.

REALIZED BENEFITS FROM EIMS USAGEW Workflows and information

exchange improvements are the most visible benefits realized by the introduction of EIMS.

W Financial savings were highly expected, and have also been realized. However, straightforward figures are difficult to obtain since hardly any monitoring exists and some savings are made in one department, but therefore add costs in another one.

Hospitals typically save costs due to:

W Less time needed to find and access images.

W Increase in billable services. W Increased speed of diagnosis and

results/turnaround.

W Patient safety and quality of care have often been improved after the introduction of enterprise-wide imaging. Typically this comes as a result of improved workflows.

W Patient and staff satisfaction also have often improved after implementing an EIMS. W

KEY FINDINGSThe key findings of the research were as follows:

CURRENT PAIN POINTS AND EXPECTED BENEFITS REGARDING EIMSKey pain points in image management today:W Integration of Image Management

Solution (IMS) with EMR (Electronic Medical Record) / HIS (Hospital Information System).

W Integration of IMS with image-generating modalities.

W System performance, especially when using mobile devices (long waiting times to retrieve/access images, especially for CT/MRI).

Expectations regarding EIMS:W Across all countries IT staff and

clinicians expect that deploying an EIMS will help to improve quality of care and patient safety (better access to (more) images, reduce unnecessary (duplicated) exams and radiation exposure, faster turn-around time of results), save costs (less analog film, printing, CDs, reduce staff in archives, efficiency savings) and enhance workflows (enable continuity of care and interdisciplinary co-operation, secure access to data, faster access to images).

W IT staff in hospitals also expect general improvements in terms of system interoperability and software management.

W Most other expected benefits, e.g. improved staff and patient satisfaction, better research capabilities, compliance with legal requirements


MyPractice Imaging, Cleveland Clinic, Ohio, USA

Images – the missing element in today’s EHRCheryl Petersilge, Medical Director of MyPractice Imaging at the Cleveland Clinic, Ohio, USA, talks about why adding images into its EHR solution was so important.

INTERVIEW WITH DR. CHERYL PETERSILGE, Medical Director of MyPractice Imaging at the Cleveland Clinic, Ohio, USA

DICOM images such as X-ray, CT and MRI scans are often essential to discovering and communicating clinical intelligence that helps both the ordering physician and subsequent care providers understand what’s at issue with a patient. Yet for all the progress in implementing the means for a patient-centric approach to finding, viewing, and being able to act on the sum of information gathered throughout a continuum of care, something important is currently missing: pictures.

What we needed was a ‘thinking VNA,’ which could do several things. It had to manage, in one place, the context of all the images, their indexing, where they came from, and where they should appear in the EHR. DR. CHERYL PETERSILGE Medical Director of MyPractice Imaging


Recognized as one of the US’s most forward-thinking hospitals, Cleveland Clinic is a fully integrated health system comprising 1,440 beds at its main campus and more than 4,450 total beds throughout its system of family health centers, community hospitals and regional and international hospitals. Its MyPractice Imaging program recently initiated an EHR optimization project that provides physicians access to medical images generated by any participating Cleveland Clinic imaging service line. This innovative service redefines the electronic health record by making virtually all medical data, including most images, regardless of capture modality, available to the clinician, inside the EHR, at the point-of-care. Because, as Cheryl Petersilge, M.D., medical director of MyPractice Imaging Solutions at Cleveland Clinic explains, “Images are data about the patient. If we don’t have all of that information in the chart, we haven’t really created a comprehensive medical record. Without images, the EHR is missing clinically important information.”

As Dr. Petersilge recalls, “For Cleveland Clinic and MyPractice Imaging, the ‘enterprise imaging opportunity’ was recognized when we had to replace our PACS. At that time the opportunity

to have, and the value of having, an enterprise archive was recognized.” The team at Cleveland Clinic began to evaluate vendor neutral archive (VNA) technologies because of their ability to store images from a variety of imaging formats, including DICOM and non-DICOM, as well as digital photos to serve the images up to software-based or web-enabled viewers accessible from workstations throughout the hospital.

As the team closely weighed available VNA options, it became clear that providing ‘enterprise storage’ was only one piece of the enterprise imaging puzzle. To truly deliver the power and value of an enterprise-wide image platform, the MyPractice Imaging team realized that workflow and indexing standards had to be established across all departments and clinicians who utilize the system.

“What we needed was a ‘thinking VNA’, which could do several things,” says Dr. Petersilge. “It had to manage, in one place, the context of all the images, their indexing, where they came from, and where they should appear in the EHR.” The ‘thinking VNA’ Cleveland Clinic selected was the Enterprise Imaging Suite developed by Agfa HealthCare.

Agfa HealthCare’s Enterprise Imaging portfolio automatically pulls medical images into the patient’s EHR, from virtually any device, in virtually any file format, and tags it with clinically relevant metadata so that information is securely accessible throughout the enterprise. From digital camera photos to MRIs, from videos of CT scans to colonoscopies, medical images, along with the accompanying metadata information, are made viewable in a centralized, patient-centric context that enables quick searches and fast consolidations of desired values.

Says Dr. Petersilge, “You can display all these different modalities together and compare the findings from one modality to the next – not just an Ultrasound and a CT but a photograph and the CT or… an arthroscopy image of a meniscal tear right up against the MRI,” says Dr. Petersilge. Having a highly efficient image capture system ensures that accurate, protected patient information is available where and when it is needed. Instead of taping USB drives or CDs to patients as they are moved about (often a standard procedure within and between networks), images are available via the EHR and can be easily accessed by practitioners at every hospital within an enterprise. The result is that at Cleveland Clinic all patient information is accessible at any of their more than 35,000 workstations.

Cleveland clinic & Agfa HealthCare – innovating togetherIn implementing its enterprise imaging strategy, the MyPractice Imaging team prioritized the order in which departments would be integrated into the system. Radiology was the first to go on line, given its importance as an imaging leader within the hospital. Following radiology, the MyPractice Imaging team deliberately chose to get other departments involved rapidly as it did not want the new system to be perceived incorrectly as ‘radiology-only’. The rationale was clear to Dr. Petersilge and the MyPractice Imaging team. “An enterprise imaging system, much like a system-wide EHR, is intended to be used across multiple departments and medical disciplines. If there are significant disconnects or disagreements in how the system will function, then it will never operate as intended. As a result, cross-departmental support is a must for an enterprise imaging strategy to succeed.”


Workflows needed to be developed for each new department that was brought on board. We did not want to use a one-size-fits-all approach.”

Agfa HealthCare’s enterprise workflow engine is designed to accommodate these variables by coordinating the individual department workflows (where images are generated) with enterprise and regional workflows (where images are accessed and collaboration occurs), while its Enterprise Imaging Suite is able to ‘connect the dots’ from an image to a report, building a reference that feeds back into the EHR and is ‘understandable’ across the entire enterprise.

Says Dr. Petersilge, “Workflow encompasses everything from creating a work list on a modality, to order generation, to notification to the EHR that a study exists. It is critical that the workflow fits into the operational foundation established at the enterprise level. It is also important that the workflow enhances and does not encumber the work of the person generating the image, otherwise

Second to come on line was Cleveland Clinic’s gastroenterology service, due to its position as one of the largest and most highly rated departments in this field in the United States. Additionally, with endoscopy, colonoscopy, and other image-rich procedures, the gastroenterology service line would particularly benefit from increased collaboration between their clinicians and referring physicians. Gastorenterology was then followed by women’s health, pulmonary function and ophthalmology and then dermatology, as it necessitated the implementation of workflows for relatively simple, but prolific, digital cameras.

As more departments were integrated, the value of Agfa HealthCare’s workflow and indexing capabilities became even more profound. Dr. Petersilge noted, “Developing a foundation for indexing was a big challenge. New types of orders and new types of reports would be coming in to the EHR, and this incorporation needed to be done in a thoughtful and systematic fashion.

they are likely to find work-arounds which can lead to failure to properly store images or failure to properly index images.”

The enterprise imaging differenceSince its implementation, Cleveland Clinic’s enterprise imaging solution has benefited the hospital in number of areas. Most strikingly, it has enabled significantly greater efficiencies in turn-around time – how quickly information gets back into the hands of the physician who ordered the tests. The results have been dramatic. A process that used to take hours is now accomplished in minutes.

Image acquisition – the process by which an image is initially acquired – has also witnessed marked improvement, with the primary ‘rate-limiting factor’ now the time it takes for the patient to physically travel to and from the department where the images are taken.

Less easy to measure, but no less significant, is the time gained by the physicians who would otherwise have to engage in ‘hunt and search’ activities to locate images as every user knows exactly where the images are located. Additionally, Cleveland Clinic has virtually eliminated the physical delivery of paper-based medical records, films or CDs, creating both cost and efficiency benefits.

Another notable benefit has been to back-office concerns such as risk mitigation. The Platform allows the hospital enterprise to take control of protecting medical imaging information in a secure, vendor neutral environment, enabling business continuity and disaster recovery services. In executing its enterprise imaging strategy, Cleveland Clinic is now able to increase value of its medical images by removing the shackles that once rendered the images prisoners of the department that created them.

As to what the future holds, Dr. Petersilge says, “I believe there will be new ways to display all of the images that enhance a clinician’s ability to organize and consume the information. Additional tools will be incorporated into the universal viewers to support needs of a wider spectrum of imaging modalities. Greater interaction beyond simple co-display of images and text information will take an image enabled EHR to the next level.” W

Cross-departmental support is a must for an enterprise imaging strategy to succeed. DR. CHERYL PETERSILGE

Our relationship with Agfa HealthCare allows us to take advantage of the opportunities from technical evolutions, to anticipate things, and ultimately to expand our vision of the future of healthcare IT. PATRICE JAMES Director of Information Systems, Centre Hospitalier Jacques Lacarin de Vichy, France


Centre Hospitalier Jacques Lacarin de Vichy, France

At the Jacques Lacarin hospital in Vichy, a long-term IT strategy supports quality information and quality careAgfa HealthCare’s IT solutions come together to help the hospital meet its development program and regulatory requirements.INTERVIEW WITH PATRICE JAMES, Director of Information Systems, Centre Hospitalier Jacques Lacarin de Vichy, France


For many years, the Centre Hospitalier Jacques Lacarin de Vichy (CH Vichy) and Agfa HealthCare have collaborated in creating an IT infrastructure that will support the hospital’s development program. Agfa HealthCare IT solutions – from the HEXAGONE* hospital information system (HIS), to the ORBIS* clinical information system (CIS), through the IMPAX radiology information system/picture archiving and communication system (RIS/PACS) and now the upcoming adoption of the HYDMEDIA** enterprise content management solution – are helping it to achieve its long-term goals for patient care and management.

“My vision for our hospital IT infrastructure is to have a solution that covers almost all the major, computerized functions at the enterprise level – from administration (especially everything regarding the patient), to managing our financial and economic resources, through to human resources,” says Patrice James, Director of Information Systems for CH Vichy. “And of course we need a strong medical IT part – including all medical AND nursing information.”

Partnering to solve the real needs of real hospitalsFor fifteen years, CH Vichy has been a pilot site for the HEXAGONE HIS, working in close partnership with Agfa HealthCare and its development team. With the HIS up and running, the hospital turned towards eliminating the information silos that existed throughout the enterprise. “We were already implementing our clinical information in the 1990s,” explains Patrice James. “But computerizing the patient files was done individually by department or service. That’s the problem ORBIS has been solving for us, decompartmentalizing each activity within our hospital, and bringing everything together to create a true medicalized information system.” CH Vichy now has a number of ORBIS functionalities and modules, including the patient record (diagnoses and procedures), medical information, PMSI (the French medicalized information system program), prescriptions, medication workflow and supply management, canteen management, office/administration and business intelligence.

Rolling out ORBIS, step by stepThe first ORBIS modules to be implemented were the patient record (diagnoses and procedures) and the

such as the operating theater and emergency department.”

Patrice James highlights that one of the most important success factors has been bringing together into a single activity pole the IT services and the department of medical information, finance and patient management. “This collaboration allows us to optimize the interface with the healthcare professionals and to focus the discussions on the real optimization issues for our HIS.”

The roll-out process for each ORBIS functionality or module is essentially the same. First, the team selects a ‘pilot site’ within the hospital. “We have found that

HYDMEDIA integrates with both ORBIS and HEXAGONE. Plus,

the flexibility of the parameterization and the powerful search engine were

critical decision factors. PATRICE JAMES

Director of Information Systems

office/administration module. During these initial installations, the Agfa HealthCare team supported the CH Vichy implementation team. But for the rest of the modules the Vichy team was able to act autonomously, explains Patrice James. “We set up an internal ORBIS implementation team consisting of three IT professionals and a nursing manager, who knows the functioning of the services much better than the IT staff! Including a ‘field expert’ in the implementation team has been a big factor in our success. For example, when we implemented the administration/office functionalities, we brought in a secretary to provide that insight. We continue to do this for each new module,


a unit with around 15 beds is generally a good size for the pilot,” comments Patrice James. Once the pilot site is going well, the module is launched department by department.

However, the length of time it takes to implement a module can vary a lot, explains Patrice James. “The functionality for inputting diagnoses and procedures was implemented across the hospital in 15 days. The administration/office module was completed in two months. On the other hand, the medication circuit is very complex: we are talking about the prescription by the doctor, then the verification by the pharmacist and finally the administration of the medication by the nurse. So that module took over a year to fully implement. You have to be a bit flexible with the timing: ensuring a good quality of implementation is the most important thing.”

CH Vichy will be putting the ‘final ORBIS brick’ in place later this year, comments Patrice James: the module for the nursing record will be piloted in September, with the full implementation expected in October/November.

Towards the paperless futureNow, CH Vichy is taking its next step in digitization, with its project to eliminate paper documentation. “The challenges we faced had to do with how to manage the ever-growing archive, how to access files once they were archived and how long it would take to access them. We did an evaluation, based on archiving and accessing documents from external consultations only, and found it would require six medical administration staff

Agfa HealthCare’s contributionAgfa HealthCare and CH Vichy have a

long-term and very close relationship.

Agfa HealthCare works as a partner

with CH Vichy in helping the hospital

to achieve its healthcare and IT goals

and vision.

HEXAGONE hospital information system Patient administration management.

Financial management.

Human resources management.

ORBIS clinical information system Provides access to shared patient

record and administrative data

anywhere, anytime.

Allows better patient management

and security.

Improves collaboration between

healthcare professionals.

Reduces the risk of administrative

errors, and increases administrative

productivity.

HYDMEDIA enterprise content management solution Facilitates information sharing through

integration with ORBIS and the HIS.

Negates the need for paper and

film-based documentation.

Reduces physical archiving space.

Speeds information retrieval times.

Reduces costs and increases

productivity.

Improves disaster recovery capabilities.

Solutions that help improve patient careCH Vichy has now been using ORBIS for five years, and the biggest changes for Patrice James are in the traceability and the quality of information. “It’s not just about productivity, although we do see gains in terms of administration and secretarial work. For example, structured documents, such as release letters that automatically include the patient’s history, obviously save time and effort, and reduce the risk of error.”

“But the big benefits are more qualitative: better patient management and security, which lead to better care. Take the medication circuit, which completely secures the management of the patient’s medication. That’s key! Having access to all the relevant information about the patient in real time also improves patient care. Finally, being able to see the entire history when a patient comes to the hospital, for example to the emergency department, allows the physicians to make informed decisions about e.g. which exams need to be performed, potentially allowing us to eliminate repeated exams.”

Drugprescriptionvia globalformulary

Medicationadministration

Resupplyat pharmacy

and wardlevel

Pharmaceuticalvalidation

ORBISMEDICATION

1 2

34

* HEXAGONE and ORBIS are not available in Canada and the U.S.** HYDMEDIA is not available in the U.S.


Did you know...W The Jacques Lacarin hospital in

Vichy, in the Auvergne region of

France, serves a population of around

140,000 inhabitants, and has a capacity

of 826 beds. In 2012, it counted

over 33,500 emergency room visits

and consultations, almost 20,000

hospitalizations, and over 92,000

outpatient consultations.

W ‘Vichy’ became synonymous with

health in the time of the Romans,

who recognized the therapeutic benefits

of the natural springs in the area.

W The mayor of Vichy, Claude Malhuret,

is a past President of Médecins sans

Frontières/Doctors without Borders

(1977-78) and played a key role in

the current form of the association.

Medical information was not circulating between departments.

ORBIS has been solving that for us, step by step: decompartmentalizing

each activity within our hospital, and bringing everything

together to create a medicalized information system.

PATRICE JAMES

(full-time equivalents) doing only that all day long. So we looked around at available solutions. HYDMEDIA could best integrate with our IT infrastructure: it integrates with both ORBIS and HEXAGONE. Plus, the flexibility of the parameterization and the powerful search engine were critical decision factors. We began the project mid-2013, and had our first implementation meeting in the first quarter of 2014.”

In any case, it is clear that this won’t be the last technological evolution for CH Vichy. Already, the hospital is

collaborating with Agfa HealthCare to develop further improvements to its solutions. “We’re working on a pilot for a touchscreen tablet for ORBIS canteen management which will put all patient information at the fingertips of the dieticians, during consultations. It’s a very interesting way to use new technology, and it highlights to me how our relationship with Agfa HealthCare allows us to take advantage of the opportunities from technical evolutions, to anticipate things, and ultimately to expand our vision of the future of healthcare IT in our hospital.” W


In profileBRAD GENEREAUX Product Manager, Enterprise Imaging, Agfa HealthCare

XERO Viewer – Bridging the imaging gap for the electronic health record With new features and functionality, the XERO Viewer is adding even more value to imaging across the hospital ecosystem.

“There is a wealth of images being created all over the hospital, and we want to make sure that this wealth is being put to good use,” says Brad Genereaux, Product Manager, Enterprise Imaging, Agfa HealthCare. “If images can’t be accessed, they don’t add value. We want to bring all images to the forefront of the electronic health record (EHR) so clinicians can unlock their potential. By getting the imaging information to where it is needed most, we will increase diagnostic comprehension, decrease unnecessary repeat imaging and, ultimately, significantly improve patient outcomes.”

The XERO Exchange Network can even be used to visualize imaging data together from different hospital sites. BRAD GENEREAUX Product Manager, Enterprise Imaging, Agfa HealthCare

And that’s what the XERO Viewer* sets out to do, he says. By unlocking access to all of the patient’s images – not only from radiology or cardiology, but from every image generating department – caregivers can finally see the patient’s entire imaging story. “It makes imaging a real part of the patient-centric healthcare model. What’s more, it brings imaging to all the different players engaged in patient care: people who haven’t been able to see or use images in their workflows will directly benefit. It has never been more true that an image is worth a thousand words.


XERO Viewer is a game changer – leveraging the internet revolution to support the physicians and enable them to improve the delivery of patient care!”

Images where you want themThe XERO Viewer is built on zero footprint technology, and is strictly web-based: it requires no Java, no ActiveX, no Flash, no plug-ins, downloads or installs whatsoever. “All of the image processing is done on the server, so the browser only has to display the images,” explains Brad. While that offers plenty of flexibility for the traditional desktop computer, the advantages are even clearer when using mobile devices.

“More and more, people are using their own mobile devices for work; managing clinical hospital software on these devices is very challenging. Too often we hear how protected patient data has been compromised by the loss of a tablet, phone or laptop. What’s more, mobile technology evolves so fast! Zero footprint means the user doesn’t have to keep up with every new platform: hospital IT departments can keep pace with the changes, resting assured that their viewer is future-protected in this respect. Plus, we are able to enhance the user’s experience using the native controls of the mobile device, like pinch to zoom on the touch screen.”

Zero footprint also allows the XERO Viewer to integrate easily into the hospital’s IT strategy. “It embraces centralized user management: all acts of provisioning – creation, modification, disabling and resetting passwords – are all done by existing hospital systems. So CTOs can leverage their hospital systems with the peace of mind of knowing that their investments in security and identity control are fully utilized. It just snaps right into the existing security infrastructure.”

Images how you want themNew features are extending the value of the XERO Viewer even further. “In the previous version of the viewer, the images were ‘reference-only’: you couldn’t use them for diagnosis, because of the impact of the lossy compression used.” Lossy compression produces a much smaller compressed file, more suited for quick, referential viewing.

Making a case for wearablesWith all the hype about wearable technology**, it isn’t yet clear what impact it will have or how it can best be used in any domain. Brad, however, sees real potential for wearables in healthcare and predicts that, for this technology, healthcare might lead the way.

“We have been looking at how to integrate the XERO Viewer with armbands that let you control the viewer without touching the screen. In operating rooms, for example, that would be a huge benefit. Combining a Google** Glass™ wearable computing device with the XERO Viewer could add another brick to building patient safety by backing up the patient ID process. Take a photo of the patient when they check in. Then before any sort of procedure, the caregiver scans the patient barcode and the patient’s image pops up so the caregiver can physically see if it is the correct patient.

It’s a question of finding the right fit with the wearable technology; but once unlocked, healthcare is poised to become the primary benefactor in the

wearables revolution!”* Pending 510(k) clearance in the U.S. Not available in Canada.** Google Glass™ and other wearable computing devices mentioned are for illustration purposes only.

Not validated for use with Agfa HealthCare products. Google is a registered trademark of Google Inc. Glass is a trademark of Google Inc.

Yet with all the benefits, the XERO Viewer is so intuitive to use, it is almost invisible to the user. “Robust application programming interfaces (APIs) allow us to customize the viewer as the customer sees fit, so it embeds right into an application like an EHR; users won’t even realize it is separate from their EHR. It becomes their tool. It’s another way XERO is helping to demystify the image viewer and make it more ‘natural’ for non-radiologists. And that’s critical for Enterprise Imaging.”

Part of the EHR experience “When we look at the direction of healthcare, towards a patient-centric model, towards collaborative care, the XERO Viewer fulfills a major role. It brings all the players in the patient care continuum closer together, by allowing them to access and collaborate on all of the patient’s imaging studies, no matter where they are. When you have connected hospitals, with one investment in XERO Viewer, clinicians can view, upload and share images, with a natural user experience. XERO Viewer becomes a natural part of the EHR experience, and it puts images where they belong – at the heart of healthcare.” W

“Now, with the upcoming release of the next XERO Viewer, users will be able to choose Full Fidelity View* which uses lossless compression, resulting in diagnostic quality when images are displayed.”

Collaboration is enhanced, too, with real-time sharing and chat. “A physician reviewing a patient’s study can interact in real time with other physicians on the system,” Brad says. “She can chat, ask questions – and now, share her screen in real-time with her colleagues. They see the same images, share the same cursor, use the same measuring tools, make mark-ups and more, regardless of whether they are in the same building or across the continent.”

“It’s their tool”The XERO Viewer is also making good use of harnessing technologies perfected in other industries, Brad explains. “One example is the new patient-centric, interactive timeline. It looks like the event timelines you might find on news magazine websites, so it’s a familiar concept to clinicians. But it is really a big leap forward in understanding the patient story. Instead of presenting simple textual lists of studies, it offers a rich, thumbnail-enabled, longitudinal view of all of the patient’s images, study by study, over time. The user can choose any two studies, for example, from any point in time and compare them. For caregivers who aren’t intimately familiar with the depths of a radiology PACS (image management) system, this makes image viewing a very natural process.”

Other enhancements include being able to view and interact with DICOM ECG waveforms alongside any available reports. Import functionality, called XERO Capture, enables the uploading of patient-centric content right into the EHR, captured on the desktop or from the camera of a mobile device. Another feature is the XERO Exchange Network. “With the XERO Exchange Network, users can query many imaging systems simultaneously, such as a radiology PACS, a cardiology PACS and a VNA, and see all of the studies available for a patient together, creating a true longitudinal record. It can even be used to visualize imaging data together from different hospital sites.”


H. Hartziekenhuis Mol, Belgium

For H. Hartziekenhuis Mol, the flexibility of the ORBIS platform offers long-term benefitsORBIS upgrade brings new functionalities for meeting hospital’s ambitious goals.INTERVIEW WITH BENNY PEETERS, CIO and DR. IVO JACOBS, Chief Physician and abdominal surgeon, H. Hartziekenhuis Mol, Belgium

Integration: that summarizes it all. We have one central record in which all of the patient’s information is collected. The data is secure, in a single repository, but accessible to authorized users. BENNY PEETERS CIO, H. Hartziekenhuis Mol, Belgium


This 193-bed hospital, with 70 physicians and 600 staff, has a detailed IT strategy laid out to address the requirements of patients, hospital management, physicians and staff. “Our IT has to support us in the evolutions and trends that affect the hospital,” explains Benny Peeters, CIO. “For example, increased specialization and professionalization, information overload, digitization, the tight labor market, limited budget maneuverability, strict government oversight, empowered patients… The list goes on.”

EPR is a priority in evolving healthcare environmentIn 2008, the ICT Steering Committee and clinical advisory board jointly decided to introduce an electronic patient record (EPR). “This was one of the priorities of our IT action plan,” comments Benny Peeters. “So the solution had to meet strict criteria: firstly, it had to serve the needs of the medical, nursing and paramedic staff. Secondly, it had to be fully integrated into one central patient record, in which all patient data would converge.”

The hospital chose to implement ORBIS. “ORBIS met the extensive specifications and requirements drawn up by the steering committee,” Benny Peeters recalls. “In addition, Agfa HealthCare’s strength as an international player, plus our own very positive experience with the company’s IMPAX RIS/PACS solution in our hospital, supported this decision.”

Careful project management for a smooth processThe hospital and Agfa HealthCare worked out an implementation plan. “We created three projects/work groups: for the medical record, the nursing record and the technical infrastructure and interfaces. Every department had representatives or key users in each working group.” Key users were trained directly by Agfa HealthCare on how to use ORBIS. They then taught the other users, using the ‘train the trainer’ concept.

“Our experience has been very positive,” explains Benny Peeters. “Our strict policy for managing the implementation of new versions of the solution plus the thorough testing have helped to ensure that we can limit any disturbances to end users.”

Since 2008, the H. Hartziekenhuis Mol has relied on information systems such as ORBIS* to help it address the evolution of the Belgian healthcare environment. Economies of scale, increasing complexity, higher expectations – from the government and the patients – have all combined with the hospital’s own growth to create new needs. Needs for which information technology (IT) can play an increasingly important role.

Thanks to ORBIS, I can work in an almost paperless way… And wherever I am in the hospital, I always have ‘my record’ at my disposal: I can search for data, print or forward letters, check results or the complete medical history and medication list. DR. IVO JACOBS Chief Physician and abdominal surgeon


Flexible data accessibility and a streamlined workflowThe big benefit of ORBIS for H. Hartziekenhuis Mol, says Benny Peeters, is the integration. “That one word summarizes it all. We have one central record in which all of the patient’s information is collected. The data is secure, in a single repository, but accessible to authorized users. Each type of user – physician, nurse, paramedic, etc. – has access to the part of the patient’s record they need. All data is entered only once, and is digital – so no more errors from illegible notes! The system offers referring physicians advantages, too: structured discharge letters, access to a more complete patient record, better communication and collaboration, etc.”

Dr. Ivo Jacobs, Chief Physician and abdominal surgeon, adds: “Thanks to ORBIS, I can work in an almost paperless way. My desk is always neat during patient visits. And wherever I am in the hospital, I always have ‘my record’ at my disposal: I can search for data, print or forward letters, and check results or the patient’s complete medical history and medication list.”

He continues: “The tasks of my administrative staff have also changed considerably. They used to spend most of their time archiving documents and preparing patient visits. Now they have more time to help the patient and to coordinate a good preparation of the patient’s discharge, for example. In this

way, the EPR has led to an enormous gain of time, as well as to quality improvements.”

Creating new possibilitiesNow, the hospital is implementing the latest ORBIS version, which will create additional opportunities. “This new version is based on an international software code. So functions developed in other countries will be available to all the ORBIS users, including us.”

The upgrade process went very smoothly, confirms Benny Peeters. “By following our version management procedures, everything went according to plan. The support by Agfa HealthCare’s team was excellent. We started by performing the upgrade in a test environment. After validation, it was fine-tuned, then implemented in a live environment. After a few hours, it was up and running. We had a back-up and recovery plan in case of emergency, but we didn’t have to use it.”

ORBIS is now installed in over 20 departments and wards throughout the hospital, where it is used on a daily basis. The hospital has several modules, including Nursing, Operating Room (OP) and Composer.

Surgery planning tool is the connecting link“We are the first in Belgium to use the OP module,” comments Benny Peeters. “In a lot of ways, this is the connecting link for our whole story. In our hospital, we organize surgical procedures around the available resources, time slots, etc. The physicians plan the procedures, and then the wards must follow that planning, for example reserving a bed. So a planning module for the surgery department, integrated in the EPR, is essential. The tool also includes functionalities such

ORBIS clinical information systemW Provides access to shared patient record

and administrative data anywhere,

anytime.

W Allows better patient management and

security.

W Improves collaboration between

healthcare professionals.

W Reduces the risk of administrative

errors, and increases administrative

productivity.

ORBIS and its modules fit very well into our IT policy,

especially in our goals of supporting primary care processes and

generating data that supports management decision making.

BENNY PEETERS


Agfa HealthCare’s contributionAgfa HealthCare has worked closely

with H. Hartziekenhuis Mol for the new

upgrade, to develop the solution to

meet the hospital’s needs. Together

with H. Hartziekenhuis Mol, the Agfa

HealthCare team implemented ORBIS,

using Prince II project management

principles.

as a safety checklist. Since everything is electronic, potential errors can be avoided.”

“The module also helps us keep track of resources used, such as time or consumable materials used. More and higher quality information is available, giving us better management oversight of the surgery unit.”

Tailoring ORBIS with the ComposerWith the ORBIS software upgrade, the hospital has also been able to make use of

the Composer module. “This allows us to develop custom forms, which can then be bundled into a ‘record’,” comments Benny Peeters. “For example, we configured our emergency care record, including the Manchester triage system (which sorts patients based on the seriousness of their condition). This took some time from the functional analysis to installing it in the live environment, but we are very happy with it! ”

With the ORBIS upgrade up and running, the hospital is looking at additional modules that will help it

achieve its IT goals. “We’re investigating all the new modules that are now available to us. The integration offered by ORBIS is a big advantage for new functions.”

He concludes: “ORBIS and its modules fit very well into our IT policy, especially in our goals of supporting primary care processes and generating data that supports management decision making. We’ve had a good experience with the Agfa HealthCare team: they are professional, experienced and accessible.” W

*ORBIS is not available in Canada or the U.S.


Case study Evangelisches Krankenhaus Mettmann, Germany

Step-by-step digitization leads towards the ultimate goal: the electronic medical recordEvangelisches Krankenhaus Mettmann adopts an integrated comprehensive solution from Agfa HealthCare.INTERVIEW WITH BERND HUCKELS, Managing Director, and HANS PETER KLAUS, IT Director


Evangelisches Krankenhaus Mettmann (Mettmann Protestant Hospital) is taking a step-by-step approach towards achieving an electronic medical record (EMR). “With the EMR, we aim to put the finishing touches on the concept of the paperless hospital,” is how Managing Director Bernd Huckels described this ambitious goal.

“We repeatedly encounter obstacles, however, either on the technical side or the data protection side,” he says. Nevertheless, Huckels is convinced that the hospital is on the right path; a view shared by IT Director Hans Peter Klaus: “I believe that we have now overcome most of the hurdles. There are hurdles to integrating with referring physicians, in particular, that we cannot simply eliminate. However, we have covered about 80 percent of the distance to our goal so far.” To achieve this, the hospital has made large investments in recent years. The construction of the new hospital building was an important step, as was the annexation of a nearby doctors’ clinic. “Most recently, we were able to move into the new hospital building and new hospital annex. Today Evangelisches Krankenhaus Mettmann has almost 300 beds.”

During this entire period, the digitization of the hospital was one of the main areas of activity. “We always kept our focus on optimizing all the hospital processes – from admission to discharge. Profitability is important here, as are quality and documentation,” says Huckels. He is convinced that “We

cannot realize all of this on the highest level without IT support.” The fact that the IT department employs five people attests to the important role IT plays in both primary and standard care. For Huckels this is quite normal: “Our hospital operations would come to a standstill without an IT department performing on a very high level. To ensure this, we have to invest in the smooth operation of this department.”

Integration: a central decision-making criterionSince 2003 the hospital has been using the ORBIS* hospital information system (HIS) in the administrative

and medical units. In 2009 it adopted Agfa HealthCare’s RIS/PACS solution. “Ultimately, the seamless integration with the HIS, especially of ORBIS RIS, was the deciding factor,” recalls IT Director Klaus. The PACS used by the radiology practice attached to the hospital is also integrated, so that the images can be viewed by the doctors on the wards. “The system is very fast and reliable and thus enjoys a high degree of acceptance among the doctors,” reports Klaus. To eliminate paper as far as possible, Evangelisches Krankenhaus Mettmann launched the current IT project a year ago. This project entailed the introduction of a digital document

The data are available earlier,

which leads to faster diagnosis and treatment

and ultimately to faster discharge

of the patient. BERND HUCKELS

Managing Director


The aim here was not to simply reproduce the usual workflows, but rather to continue them in an intelligent way into the HIS. For example, if a patient is admitted to the emergency department and vital data are collected, these data are transferred automatically to all of the related forms, preventing duplicate recording and eliminating sources of error.

management and archiving system (DMAS). “In the medium term we want to eliminate mixed-media usage and make sure that the digital workflows are being used consistently,” says Huckels. Previously, it took a day to get hold of the records of the hospitalized patients; today the medical and nursing staff can obtain a rapid and complete overview with a few mouse clicks. To achieve this, all data collected from 2004 onwards have been imported from the old record management system from DVD into HYDMEDIA**, Agfa HealthCare’s content management system.

Any paper records collected during a patient’s stay at the hospital – e.g. reports from external sources, referrals, medication instructions, etc. – are promptly digitized. “We have set up a dedicated workstation controlled by the secretarial service. Once the record is closed, it is handed over and scanned. Our goal is to have no more than, say, two pieces of paper in the file,” explains Klaus.

Precise preparation for reaching goalsThe EMR was introduced according to a precise plan. First, the various processes were defined within a project group consisting of doctors and members of the nursing staff. Afterwards, the participants explored how these

processes and the accompanying paper records could be transferred to the IT system. “To do this in a manner close to actual hospital practice, we created a position in the IT department for a member of the nursing staff who was familiar with the processes and could design the corresponding forms,” explains Klaus.


The responsible personnel at Evangelisches Krankenhaus Mettmann have followed this procedure to look critically at the current workflows. The aim has always been to establish meaningful processes with the support of the IT department. The procedure therefore had to be one that could be implemented with the aid of electronic data processing (EDP). For example, the piece of paper at the patient’s bedside was replaced by the documentation trolley.

High-performance software supports stable operationThis preparation shows clearly that the introduction of the EMR was also an infrastructure project. Therefore, the hospital had to create the technical prerequisites. Regarding the most important investments, Klaus recalls: “We set up a closely meshed and secure WI-FI network throughout the hospital and purchased two to three documentation trolleys for each ward.” He continues, however, that these steps alone were not sufficient: “Our new computing center constitutes the foundation for the secure operation of the IT systems. We had to make sure that the doctors and nursing staff could access the information on their patients 24/7. In this situation a system failure is not acceptable.” From the point of view of risk management as well, data security and protection against failures play a very decisive role.

As was already the case for the selection of the RIS/PACS, ‘integration’ was a critical factor in the decision in favor of HYDMEDIA. It is Huckels’ conviction that “interfaces to external systems always involve high expenditures and great effort. Only a system from one source can provide genuinely continuous workflows with no discontinuities.”

Klaus emphasized, however, that the high satisfaction that has characterized the collaboration with Agfa HealthCare to date also played an important role: “The Agfa HealthCare solutions are founded on consistently good programming. A doctor who is new to our hospital rapidly learns to work with the system. Moreover, the quality is high and the technology used is always state of the art. Looking back, we can see that the decision we made 11 years ago was exactly the right one.”

This is also shown by the gains in efficiency that Huckels increasingly observes: “The data are available earlier, which leads to faster diagnosis and treatment and ultimately to faster discharge of the patient. And when the already short times in hospital become even shorter, it is very important that doctors and the nursing staff can devote themselves intensively to the patient during this period. To allow more time for human interaction, administrative activities have been minimized and workflows automated, via the EDP; this is something the patients appreciate.”

Klaus points to a quantifiable success: “Today we have a good 25 percent less paper in circulation. This results in lower expenditures for printer paper, toner, printer maintenance, etc.”

And that’s not the end of the storyEvangelisches Krankenhaus Mettmann is currently closing another gap with digital voice recognition. At the beginning of November, the first department heads should be able to use the system on a trial basis. Another project in the pipeline is to further specify and expand the range of services offered by the hospital. The importance of medical collaboration, with maximum care facilities as well as other hospitals, is another supporting pillar.

In this way Mettmann Hospital is always able to offer its patients the best possible medical care. In this context as well, IT plays a vital role – in the area of telemedicine, for example. Not only are images sent back and forth: there is also a bidirectional flow of patient data.

“With HYDMEDIA we are able to transmit complete electronic patient records – while observing the current data protection regulations – to the invoicing centers of the healthcare insurance companies, for example. A pilot project is currently underway,” says Huckels, providing a glimpse into the hospital’s present planning. W

Our hospital would come to a standstill without high-performance electronic data processing. Therefore we have to invest in the smooth operation of this system. HANS PETER KLAUS IT Director

* ORBIS is not available in Canada or the U.S.** HYDMEDIA is not available in the U.S.

Learn about Agfa HealthCare at www.agfahealthcare.com

Integrated care is becoming a reality, and hospitals need systems and solutions that give them a full overview of the patient, while sharing and collaborating with all stakeholders in the patient care continuum. The Portal is the first step to achieving that full integrated care model. It provides an easy-to-integrate and -use portal for image and results delivery. With the Portal, Agfa HealthCare has taken the knowledge and experience it has built up with proven solutions that share images and other data and is extending it beyond the hospital walls, to eventually integrate all players in healthcare delivery.

Agfa HealthCare PortalA gateway to integrated care

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