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Process optimization in Regionalspital Emmental
Data floods: turning chaos into order
Image distribution with JiveX Web and JiveX Mobile
Flexibility and quality on a high level
18 24 26Digital Imaging Adoption
Model (DIAM):Checklist for modern image management
No. 07 07 | 2017
PACS – ALIVE AND KICKING
www.visus.com
Modern workflows in healthcare facilities require the consolidation of medical data. The JiveX Healthcare Content Management System provides all components necessary to perform this task: tools to convert data into standardized formats, a high-performance viewer, ar-chiving functions and the capabilities to exchange data across departments and facilities.
SYSTEMATIC MANAGEMENT OF MEDICAL DATA
We share one strategy
Editorial
Hans Willi Lohrke
Hans Willi LohrkeSales Director International, VISUS
tion on how to deal with particularly tricky IT issues in your own facility. Looking – or rather reading – beyond one’s nose is always immensely rewarding.
‘Rewarding’, we hope, will also apply to the VIEW Insights, the section where we present exam-ples on real-life usage of VISUS products with regard to mobile process support and cross-facility data exchange. While XDS-based cross-facility data ex-change isn’t exactly standard fare yet, our showcase proves that the technological obstacles have been overcome.
I would like to take this opportunity to thank our distribution partners worldwide. They are the ones who prepare the ground for the many exciting proj-ects we have the privilege to implement with our customers. If you as a customer have questions or comments, please feel free to contact your local distribution partners. They will be happy to answer your questions and you can be sure to receive highly competent advice.
Enjoy reading!
Dear readers, The PACS is dead, long live the PACS! That’s an apt description of the current mood on the PACS mar-ket. Tried and true concepts are being challenged, allegedly new ideas, garnished with buzz words, are being hyped. The result? Among PACS users, confu-sion reigns supreme. For them their PACS is much more than an archive; it is a life support system for their daily workflows. And thus it is the radiologists who are in charge of interpretation.
In this current edition of VISUS VIEW, therefore, we are having a closer look at trends that are slowly spreading across the Atlantic, such as de- and recon-structed PACS. We talked to two seasoned experts from the US and their advice should give JiveX users peace of mind: keep cool, calm and collected. We also wanted to hear from our customers how they see the future of PACS and last but not least we offer a glimpse into the VISUS PACS strategy.
In VISUS VIEW to proudly showcase projects that we are implementing with our customers. While each installation is unique the user reports from Fin-land and Switzerland in this issue might offer inspira-
The Future of PACS
VIEW Content
VIEW Focus
10 PACS – Alive and kicking There is life in the old dog yet
14 The Bowl of cherries – what experts expect from the PACS
16 The future of PACS according to VISUS PACS as a model for medical data management
VIEW News
6 VISUS Symposium VISUS advances healthcare IT
6 Efficientdatamanagement: District Hospital Lienz implements JiveX
7 A new home for ideas
7 Give ‘em a run for their money Charity run
7 #In Brief
Content
10
26
VIEW Content
OverVIEW
18 Digital Imaging Adoption Model (DIAM): Checklist for modern image management
20 Automated diagnoses in radiology
Making the best of your PACS
VIEW Report
22 Vietnam – Healthcare market on the move
24 Process optimization in Regionalspital Emmental
Data floods: turning chaos into order
VIEW Insights
26 Image distribution with JiveX Web and JiveX Mobile
Flexibility and quality on a high level
28 Patient-centered diabetes management via XDS
Ira is calling!
Klaus Kleber‘s Straight Talk
30 I am the owner of my data!
VIEW Services
03 Editorial08 Events09 Abonnement31 Impressum
24 28
22
18
Vietnam Healthcare market on the move
STAGE Analytics DIAMDigital Imaging Adoption Maturity Cumulative Capabilities
7 All three
For stages 5-7, these specialized stages can be adopted in any order:A. Analytics and per-sonalized medicine capabilitiesB. Clinical Decision Support and value-based imagingC. Advanced
6 Two of three
5 One of three
4 Fully integrated and digitized image management
3 Workflow and Process Security
2 Imaging IT Infrastructure available enterprise-wide
1 Imaging IT Infrastructure available in one service area
0 No electric image management
6
VIEW News
Efficient data management:District Hospital Lienz implements JiveX
In the District Hospital Lienz, Austria, the processes surrounding image and medical data management are being completely overhauled. In a two-step project the radiology PACS is being re-placed by the JiveX Enterprise PACS, in a second step all non-DICOM data will be integrated into JiveX. Deep integration of this medical archive into the ‘home-grown’ HIS will enable the clinicians to instantly access all data they need
for diagnostic and treatment purposes. “We were looking for a system with high functionality that can manage non-DI-COM data and make them available. At the same time the new system had to ful-fil certain economic criteria. JiveX with its high degree of flexibility and scalabil-ity perfectly fit our requirements,” said Dr. Lederer, Director of the Institute of Radiology, and Mr. Wieser, Head of IT.
VISUS SYMPOSIUMVISUS advances healthcare IT
On 29 June 2017 VISUS hosted their fourth symposium on current issues and trends in healthcare. This year, Zeche Zollverein, the disused coal mine industrial complex and today a world heritage site in Essen, served as backdrop of “INNOVATIONS-DIALOG 2017”. Innovation is indeed the core idea, as the presentation topics were selected in cooperation with customers, partners and other healthcare IT players. A keynote address as well as a slew of side events such as speed workshops and science slams complemented the program. About 200 guests attended the sessions and the accompanying trade shows.
7
VIEW News
Spring is in the air – time to get movin’. And moving we will, to the new VISUS corporate headquarter on Gesundheits-Campus in Bochum. A year ago, con-struction of the building right next to our current home started with a cornerstone ceremony hosted by the VISUS manage-ment team and in the presence of Thom-as Eiskirch, mayor of Bochum.
VISUS is investing roughly € 7.5 million in the new corporate headquarter which can accommodate up to 200 employees. That the building will be equipped with state-of-the-art IT infrastructure goes without saying. Jörg Holstein, founder and CEO of VISUS, is excited: “With the new building on GesundheitsCampus
Bochum, adjacent to the Ruhr University campus and the Hochschule für Gesund-heit we are creating ideal conditions for forward-looking and application-orient-ed research and development.”
“The success and the growth of VISUS over the past 16 years illustrate the devel-opment of Bochum as a leading location for the healthcare industry. Today, Bo-chum enjoys an excellent reputation as knowledge and technology hub beyond regional and national borders. Solutions made in Bochum provide long-term im-provements of healthcare in Germany and the world,” said Thomas Eiskirch, mayor of Bochum, during the corner-stone ceremony last April.
A new home for ideasWe gave ‘em
a run for their money!
On 21st May 2017 enthusiastic amateur runners fought that inner couch potato and ran for a good cause. During the VIVAWEST mar-athon event in Gelsenkirchen, Ger-many, VISUS scheduled the popular company charity run, where VISUS matches every kilometer run with a donation. In the past years, about 50 clients, partners and employ-ees raised several thousand euros for a welfare organization. Svenja Hooge, who organizes the charity run, was happy to report a similar success this year: “We saw the ‘usu-al suspects’ as well as many novice runners. The race is always about fun and civic engagement, there-fore participants with no or little experience running a marathon or a half-marathon love the opportunity to participate.” The money raised in the charity run – 4,600 euros – will be donated to Evangelische Kinder- und Jugendzentrum Bochum-Laer, a local youth center.
#Welcome on board! Klaus Kocher, Senior Technical Consultant and Jérémy Cuif, Sales Consultant. #RSNA, USA The leading north american radiology congress, will take place in Chicago from November 26 o December 01. We are looking forward to welcome you at the ger-man pavillion.
#In brief
VIEW Services
8
Location:Anaheim, California
JUL09 – 122017
www.ahra.org
Location:Paris, France
OKT13 – 172017
www.jfr.radiologie.fr
Location:Düsseldorf, Germany
NOV13 – 162017
www.medica.de
Location:Chicago, USA
NOV/ DEZ26 – 012017
www.rsna.org
Location:Dubai, UAE
JAN/ FEB29 – 012018
www.rsna.org
Location:Vienna, Austria
FEB/MAR28 – 042018
www.myecr.org
ScantheQRcodetofindout more about our events.
EVENTS 2017/2018
VIEW Services
9
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10
VIEW Focus: The Future of PACS
There is life in the old dog yetPACS
11
VIEW Focus: The Future of PACS
RSNA 2015 in Chicago felt like the funeral of the good old PACS as we know it with the entire market abuzz with new concepts such as reconstructed/deconstructed PACS or vendor-neutral archives. Picture Archiving and Communication Systems suddenly looked old-fashioned and irrelevant. Radiologists neither mourned nor cheered, they didn’t quite know what to make of all this: What’s happening here and how will it affect me and my work? A little over one year later, the answer is straight-forward: Not that much. In fact, PACS is anything but dead, and indeed its future is looking bright as the PACS experts Herman Oosterwijk and Jef Williams predict.
”Obituaries for PACS were definitely pre-mature,” says Jef Williams, partner at Paragon Consulting Partners and a sea-soned PACS insider. But why? Very sim-ple: Because PACS is much more than an archive for digital images; it is the main tool for workflow optimization. ”Ninety percent of what we do in imaging is help on the departmental level to improve the workflows in terms of working condi-tions, quality of care and modern med-ical processes,” he explains.
Herman Oosterwijk couldn’t agree more. For the President of OTech Inc. and another old PACS hand, PACS is
“the tool to make images available at the right place, at the right time and in the right quality. Therefore it is a crucial part of healthcare IT today – and will be so tomorrow.”
Re- and deconstructed PACS: nothing but a storm in the teacup?
If experts and users agree on the im-portance of PACS in modern healthcare scenarios, what was the hype of de- and reconstructed PACS all about? As is often the case in supposedly saturated mar-kets the hype was driven by marketing strategists of huge IT companies. Or as Jef Williams puts it: Those terms are a
“vendor narrative”. A reconstructed PACS is nothing but the common concept of having an enterprise system comprising multiple vendors. “We have always had that. For instance in the US your PACS vendor and your reporting vendor are in most cases different companies,” the ex-pert underlines. For Herman Oosterwijk as well, the idea of reconstructed PACS is old news. Take the IT infrastructures of huge hospital with special requirements for managing and handling data, for ex-ample in terms of research, he says, “The idea to build a software solution from different components is the domain of huge hospitals because you need a lot of experts and knowledge to run such a system. When today people talk about deconstructed PACS, they often mean something different, namely that the PACS becomes more open, with open interfaces allowing systems to be more standardized. Such solutions are still difficult to handle and not recommend-ed for the faint-hearted IT department. That’s why companies came up with the term ‘reconstructed PACS’ since it im-plies the advantages of an open solution in combination with the full service of the company’s support,” Herman Oost-erwijk explains.
12
VIEW Focus: The Future of PACS
The rising demand for so-called deconstructed solutions was triggered inter alia by the healthcare institutions’ endeavors to centralize medical data in only a few systems. And a PACS is the perfect place for storing and handling images institution-wide. Today, many clinical disciplines other than radiology have gone digital – from cardiology to organ-specific fields such as ophthalmol-ogy. For a long time, medical data could only be stored and managed within the device which had acquired them. This of course is a disadvantage when it comes to an integrated diagnostic approach drawing on all medical data that are available for a patient.
The PACS as institution-wide imaging center?
Starting from the idea that the PACS can function as an institution-wide place for images, the term ‘vendor-neutral archive’ (VNA) was coined. ”Apart from the fact that a PACS does more than just ar-chiving data, two challenges we are fac-ing when we work with data of different departments and from different sources are file format and workflow. Outside radiology there is a lack of standardiza-tion in formats, and images are rarely accompanied by meaningful metadata. Moreover, outside the radiology depart-ment you leave orders-based workflows where for example attaching an image to the patient record takes on an entire-ly different dynamics. It is quite hard for one system to overcome those barriers,” Jef Williams says.
Jef Williams Managing Partner Paragon Consulting Partners
Obituaries for PACS were definitely premature.Jef is a well-known and frequently asked PACS Expert in the US and beyond. His background as a leader at GE, COO at Ascendian Consult-ing, combined with 15 years of Healthcare IT experience provides him a diverse and creative approach to problem-solving and solution de-sign. He specializes in assisting organizations with organizational strategy, operational im-provement, software design and selection, and enterprise deployment initiatives. Moreover, the is author of several articles about imaging and archiving solutions and member of organi-sations like the Society for Imaging Informatics in Medicine (SIIM) or HIMSS.
13
VIEW Focus: The Future of PACS
Having said that it might not be nec-essary to store all images physically in one system. The crucial issue is the pos-sibility to access the information via one system. This may well happen via intelli-gent connections and image exchanges.
“As long as you can register the infor-mation, distribution of images is a good option to provide centralized access for decentralized data,” Herman Oosterwijk adds.
A look into the future of PACS
If PACS is anything but dead then where is the development heading for? Ooster-wijk and Williams see two main trends: optimization of workflow and integration. For the latter it is important to have more open systems, i.e. the systems need to be easily interoperable and should “speak” standards. This openness will be crucial to fulfill the need to centralize medical data and to share medical information internally and with external institutions or persons. Another important aspect of centralization and sharing is the fact that data must carry the same name across several systems. In short: semantics must be improved. “And of course one work-flow aspect when it comes to PACS is the continued improvement of hanging protocols so that data are presented in-telligently in order to be able to obtain quick and clear information,” Herman Oosterwijk emphasizes. For Jef Williams there is especially one trend that will shape the PACS debate over the next few years: “The most compelling technolo-gies that will influence the PACS are ma-
Herman OsterwijkPresident of OTech Inc.
chine learning and the deeper technolo-gy that is being developed to strengthen the intelligence of analytic data. This will be fundamental for the data analyzing workflow in radiology. Machine learning will be a perfect complement to the daily routine and it is going to improve diag-nostic results.”
Last but not least there is one import-ant aspect far beyond technological wiz-ardry: the PACS market is by no means saturated, says Herman Oosterwijk: “We keep on focusing on the US, the Euro-pean and the Middle Eastern markets. But we are overlooking those countries in the world that have just begun to im-plement modern healthcare and digitali-zation. They are a huge market for basic PACS solutions that are reliable and sta-ble. So there really is no need to worry about PACS and its future.”
Herman is trainer/consultant based in Dallas, TX who has authored several textbooks on PACS and healthcare IT standards and has been participating in the DICOM, HL7 and IHE standards com-mittees for many years. He has trained healthcare imaging and IT professionals for the past 20 years in over 20 different countries through seminar, webcasts and many publications and lectures.
14
VIEW Focus: The Future of PACS
IT-companies such as VISUS of course have their own look into the future of an IT-system like PACS. More important are the expactations of those working with the software day by day. That is why we asked customers and partners to think about the “bowel of cherries” in radiology. As it seems, reality is very close to wishes.
The bowl of cherries – what experts expect
from the PACS
15
VIEW Focus: The Future of PACS
Algorithms are the major challenge for the next generation of PACS. They will allow to close diagnostic loops and to improve the reporting performance. Therefore algorithms can support doctors and improve the quality in healtchare. Additionally, other modalities like those from pathologies should be added to complete the level of information.
PACS will continue to be the high-quality system for image processing and the asso-ciated workflows. The special PACS functionality cannot be replaced by an archive system such as VNA. In the long run, PACS has to deal with the issue “machine le-arning” which means that superior processing power and algorithms are required to enable automatic or partially automatic reading. The result will be a more objective assessment of the available data – independent of the reader.
I would like to see the future PACS make image data accessible at any time and from any mobile or desktop device. Thus I imagine the future PACS to be cloud-based or web-based in order to overcome the need for local installation. Ideally, image data are usable on any hardware and independently of the operating system; nevertheless there should be a distinction between reading or simply viewing data. While reading data should continue to be limited to certified workstations, unhindered integration of image data in other systems as well as post-processing and storing them ought to be possible. Obviously, uninterrupted data security and integrity in the PACS storage component and during data transfer need to be guaranteed. In such a scenario, the individual user is responsible for the further use of the data.
Given the experiences with different PACS systems and the state of technology to-day, we can envision that 10 years from now, PACS should be the unified zero-foot-print diagnostic imaging and serving platform, gathering all medical science special-ties with an accent to integration of medical imaging into national wide health care system, strongly increasing the accessibility of relevant medical data to end-users of all levels, including the deeply segmented user rights and modern and bulletproof security protocols. Standardization, integration, clinical interoperability and software streamlining should be the key point for future PACS development.
Pablo CambaHealthcare Business
Development Director,T-Systems Iberia
Denis BicanicDirector Veridan Healthstream d.o.o.
Dr. Thomas EgelhofChief Radiologist
Merian Iselin Hospital, Basel, Switzerland
Thilo MohnsHead of IT,
Maxima Medisch Centrum in Eindhoven
16
VIEW Focus: The Future of PACS
In Bochum, the VISUS programmers and developers remain unfazed by all the brouhaha surrounding de- or reconstructed PACS. They are not interested in the current ‘must have’ as their thinking about a future-oriented system moves along a very different path: the PACS remains the PACS, but at the same time the functional strength of the system serves as a model for IT solutions outside of radiology, down to the cross-facility use.
When it comes to digitalization and standardization radiology has long been the uncontested trailblazer. For 20 years now, the images acquired in the diagnostic work-up are being man-aged, processed and archived via IT solutions. In the computer age, that’s eons and consequently PACS have evolved in the course of the years, adding performance and functionality.
Above all, capabilities such as the structured presentation of patient exams, the outstanding post-processing and report-ing options, the hanging protocols as well as compliant and audit-proof archiving made the non-radiology colleagues green with envy. And indeed the PACS principles may well be applied to optimize the workflows in other clinical disciplines, such as cardiology or endoscopy. PACS however reaches its limits the moment it leaves the DICOM data orbit and other data formats from medical technology devices and their subsystems need to be integrated.
PACS and healthcare content management sys-tem: one root, two branches
As one of the leading PACS providers VISUS aims to develop intelligent solutions not only for radiology but also other depart-ments of a healthcare facility. This strategy led to a diversifica-tion of the product portfolio: While on the one hand the PACS stays the PACS – a high-functionality tool which remains indis-pensable in the radiology workflows, the VISUS development team moved PACS beyond PACS. Based on the function and process know-how gathered in radiology, VISUS over the past few years, has managed to develop two solutions for the man-agement of medical data outside of radiology: JiveX Integrated Imaging to integrate functional data from medical technology
devices and JiveX Medical Archive to integrate all medical data and documents. In the meantime, these two products have evolved into a comprehensive system which is so powerful that it no longer fits in the subsystem niche but is now a product category unto itself, a Healthcare Content Management system (HCM). HCM delivers all the advantages of a state-of-the-art PACS, complemented by specific workflow components for the handling of all medical data.
Case in point: viewing. HCM offers a single viewer for all medical data, from the CT image to the report. It does so by making use of excellent concepts tried and tested in radiology, such as hanging protocols. At the same time, the viewer was advanced and now offers specialized functions for the different objects, e.g. measuring functions for wound images or ECGs.
A further strength of an HCM is the archiving functionality. A PACS archive is compliant and audit-proof and it is equipped with a rights management solution, two crucial advantages. Medical Archive, the archiving package of the HCM, uses these PACS elements; moreover, individual objects can be stored on different partitions, including retention times and deletion dates. Unlike the classic PACS however, HCM not only ‘speaks’ DICOM, but supports all frequently used formats such as HL7, PDF and IHE. This ensures that all medical data within a system are archived and can be managed based on standards – the precondition for vendor-neutral data consolidation and data management and for cross-facility data exchange.
The HCM concept made by VISUS is thus a system which consolidates archives, integrates sub-systems and unlinks and relinks their archiving. But even more importantly, HCM ac-tively takes in data and is thus a comprehensive and leading
The future of PACS according to VISUS
PACS as a model for medical data management
17
VIEW Focus: The Future of PACS
information system in addition to the HIS. This innovation is a development made possible by insights from more than 17 years of development work at VISUS – 17 years of user-oriented solutions that were created in close cooperation with the cus-tomers and always aimed to optimize the customers’ clinical processes and cost structures.
PACS is here to stay
But with all these HCM development activities PACS has not become the unloved stepchild at VISUS. Quite on the contrary: the PACS continuously evolved and it was enhanced to reflect the progress in radiology. Version 5.0 of the JiveX Enterprise PACS for example features an entirely re-vamped user interface that now complies with top notch standards in terms of design and user-friendliness. The new interface offers even more user configuration options and more intuitive operation. Enhanced user-friendliness is but one strength of the new JiveX 5.0, the other one is enhanced performance. Image upload capabilities
to the diagnostic clients were significantly increased. Moreover, the software update to version 5.0.1 allows navigation in dy-namic CT and MRI studies.
Another focus of the most recent development activities was improved support of mobile work scenarios. And here JiveX 5.0.1 once again raises the bar: as per now the web and the mobile clients comply with the same requirements with re-gard to patient safety as the diagnostic client and achieve clin-ical image distribution in reporting quality. This translates into more flexibility – and more confidence – for the physicians and their daily work flows.
Medical data management will profit from these new de-velopments – and in turn radiology will profit from the innova-tions HCM offers. With this cross-fertilization strategy VISUS is perfectly positioned to provide all customers with systems that are future- and growth-oriented, no matter in which clinical en-vironment they are used.
18
OverVIEW
A few years ago, HIMSS developed the Electronic Medical Record Adoption Model (EMRAM), a seven-stage scoring system to assess the degree of digitali-zation achieved in a hospital. EMRAM not only looks at the mere existence of certain IT systems but also takes into consideration their interaction with the aim to improve the quality of care. Last year, a comparable model specifically geared towards image management was launched: DIAM. In an interview with VISUS VIEW Professor Dr. Peter Milden-berger of the Clinic and Polyclinic for Di-agnostic and Interventional Radiology at Johannes Gutenberg University Hospi-tal, Mainz, Germany, explained why he and his colleagues at the European So-ciety of Radiology (ESR) support DIAM.
Professor Mildenberger, assessment of image data management is a component of the EMRAM scoring. Why DIAM, an assessment model specificallyforimagemanagement?
EMRAM asks, for example, whether the hospital has installed an information sys-tem for the radiology department or, if you are aiming at stage 5, whether there is an overarching IT solution which in-tegrates all film-based images in a sin-gle system such as a PACS. The answers such questions yield are inadequate to describe a modern networked image management approach. Technical devel-
opments such as voice recognition, cer-tain analytical tools, quality indicators, cost models or processes are not taken into consideration. We at the European Society of Radiology, which developed DIAM in cooperation with HIMSS Ana-lytics, wanted to create a kind of check-
list that supports strategic decision mak-ing in imaging departments. DIAM helps hospitals to analyze the current state of affairs and understand which strategic decisions need to be taken in order to optimize image management.
What exactly does DIAM look like?
Very similar to EMRAM, DIAM is mod-elled around stages that provide infor-mation on the degree of digitalization in image management. Stage 0 means “zero digitalization”, stage 7 means “advanced maturity”. The assessment is based on ten focus areas for which cer-
tain parameters are evaluated such as overall software infrastructure, patient engagement and level of information ex-change or process security.
Who analyses the results and assigns stages?
DIAM draws on information the facilities themselves provide. During the process the facility is guided through question-naires and the ten focus areas. The an-swers are thoroughly analyzed and the overall stage is determined. Moreover, the respondents receive a detailed as-sessment of their facility for each focus area and sub-area. For example the assessment of “patient engagement” is based on the answers on so-called Action Items, that is whether the pa-tients can make appointments online or whether they have online access to their medical reports and images. The ques-tions are highly standardized for two reasons: Firstly, scoring is much easier and secondly the analysis is reproduc-ible and yields comparable results.
Obviously not all questions and re-sponses can be standardized, such as annual operating expenditures or han-dling of external films and storage me-dia. In certain cases we also contact the facility and ask for clarification. Stage 6 encompasses a validation in a telephone conference and stage 7 requires an on-site visit by HIMSS and ESR experts.
Digital Imaging Adoption Model (DIAM):
Checklist for modern image management
Professor Dr. Peter MildenbergerJohannes Gutenberg University Hospital,
Mainz, Germany
19
OverVIEW
What is the core idea behind DIAM and what added value do the individu-al stages offer?
We wanted DIAM to be barrier-free and we designed the questionnaire in a way that completing them takes a maximum of four hours. Facilities with a good over-view of their infrastructure will be able to go through the process in much less time. The participating institutions see DIAM as a possibility to take stock and figure out what is possible and useful, which objectives have been achieved and where measures need to be taken. We want to provide assistance with de-signing a suitable IT strategy and identi-fying investment potential and we want to show what exactly modern image management can do. The analysis is a kind of high-level roadmap for IT de-velopment geared towards the Heads of IT and the Board of Directors. Upon re-quest HIMSS guides the facility through the implementation of a DIAM-based IT strategy.
At this point however we cannot yet tell whether DIAM will provide compre-hensive information on the general level of digitalization of image management in healthcare facilities and whether there will be differences among countries. Currently, DIAM, which was launched at ECR 2016, is still a pilot project and so far we have assessed only 20 facilities across Europe. Nevertheless we are con-fident that in the long run the model will yield valuable information on digitaliza-tion approaches in the different coun-tries and facilities, very much what the EMRAM score is already doing today.
STAGE Analytics DIAMDigital Imaging Adoption Maturity Cumulative Capabilities
7 All three
For stages 5-7, these specialized stages can be adopted in any order:A. Analytics and per-sonalized medicine capabilitiesB. Clinical Decisi-on Support and value-based imagingC. Advanced HIE and patient engagement
6 Two of three
5 One of three
4 Fully integrated and digitized image management
3 Workflow and Process Security
2 Imaging IT Infrastructure available enterprise-wide
1 Imaging IT Infrastructure available in one service area
0 No electric image management
20
OverVIEW
This, at least, seemed to have been con-sensus at an ETIM (Emerging technologies in Medicine) event that took place in Es-sen, Germany, last February. While the event, hosted by the University Hospital Essen, focused on artificial intelligence and bio-printing, it offered inspiring per-spectives on emerging medical treatment trends. Eyal Toledano, co-founder and CTO of Zebra Medical Vision LTD, illus-trated one of these trends in his presen-tation “How to revolutionize medical im-aging using artificial intelligence and big clinical data”. The Israeli company de-veloped an algorithm for a product called
“radiologic assistant” and is working on expanding the concept to other medical fields. Talking to VISUS VIEW, Eyal Tole-dano explained not only the algorithm but also the vision of his company. What exactly are you working on and how can your products and ideas im-prove patient care?
Our medical vision focuses on the ability to provide automated readings of medical images. One part of that vision is to sup-port the radiologist by offering additional evidence. Our radiologic assistant can find more incidents or more conditions that support the reading and thus increase its quality. The assistant is a kind of plug-in that is integrated in a number of cer-tain PACS for example CareStream PACS.
Thus artificial intelligence takes the PACS to the next level and strengthens their original functions.
Another product Zebra Medical Vi-sion provides is the Imaging Analytics that uses the same algorithm to scan the entire VNA to detect populations at risk, for example those with a high coronary
calcium score since they are at a higher risk for cardiac events. Imagine being able to scan all images available in the hospital archive to detect anomalies of any kind and independently of the original reason for acquiring the image. This cannot be done by humans. But the algorithm can easily do that and issues a message as soon as something abnormal is found. The hospital or care provider can then invite the patient for a diagnostic workup and – if necessary – start preventive treat-ment. In short: the improvement in patient care is about detecting diseases more reli-
ably and in an earlier or even pre-clinical stage.
Is this pie in the sky or close to medical reality?
It is very close to reality. We have al-ready concluded five pilots in major US hospitals and the tool is now introduced in business and can be applied. And al-though a new workflow is required for this kind of automated diagnoses, the way radiologists interpret a study is not affect-ed. Artificial intelligence simply provides insights which the doctor can include in his reading – or not. It complements, rath-er than replaces previous information.
So in the near future, we might imagine the following scenario: a patient pres-ents with lung problems and a CT scan is performed. The scan is read by the radiologist but moreover an algorithm checks the existing data for other anom-alies in the background?
Yes, all studies can be scanned and the algorithm will have a look at cardiac anomalies, bone density in the spine suggesting osteoporosis. It will evaluate your liver tissue to determine if it is fatty which would indicate a blood disease or diabetes. It will look at the texture of the lung and quantify emphysema. The list is theoretically more or less endless. We
Automated diagnoses in radiology
Making the best of your PACSThe idea that computers make decisions about health and diseases troubles patients and doctors alike, the former because of wide-spread mistrust in technology, the latter because they see their jobs in peril. We cannot tell yet whether these fears are justified but in view of the trails algorithms are already blazing towards increased diagnostic security and early detection of common diseases, we have cause to be optimistic rather than skeptical.
Eyal ToledanoFounder and CTO
of Zebra Medical Vision LTD
21
OverVIEWVIEWPoint
The revolution towards personalized medicine is in full swing. Following the
initial hype about the use of Smart Data in healthcare, today the focus is on approaches that highlight practicability and usability.
Smart Data analyses require enormous amounts of data in order to ‘train’ the algo-rithms applied (ground truth).
The PACS, with its standardized interfac-es, is ideally suited to deliver the required raw data to the different Smart Data analysis tools and in turn to receive the structured (classified) data. If needed, the PACS can also provide data to other applications or use data to optimize work flow models. For the PACS viewer these capabilities may translate into augmented views, i.e. image content that corresponds to text found in previous reports is displayed or the user can easily generate structured reports. Moreover, ad-ditional information such as relevant journal articles, classifications or similar cases may be displayed.
Thus, in the world of Smart Data the PACS will continue to perform its traditional tasks: storing and disseminating data and display-ing images optimized for the specific devices used. The difference: the individual work-flows can be streamlined in many more and more subtle ways.
Dr. Marc Kämmerer Head of Innovation Management, VISUS
PACS in the world of Smart Data
»have a few FDA-cleared pilots, including emphysema, fatty liver and osteoporosis. Additionally, some diagnoses are current-ly in the FDA clearance process, for exam-ple for detecting compression fractures in the spine, segmenting and detecting brain bleeds in CT, classification of different lung pathologies within the COPD family, etc..
Arethereanyfiguresyetregardingthefalse positive/negative rate?
We did a very large study at the Clalit Healthcare Services with 196,892 CT cases for the detection of osteoporosis and we have shown that looking at just the imaging data we could increase an-nual osteoporosis diagnose by 50 percent. Those results were double checked by physicians. The accuracy was 85 percent for people suffering from osteoporosis. So we can say that the false positive risk is very low when algorithm was tuned to detect patients with dexa lower than -2.5 we had less than two percent false posi-tives, which really is a good score.
Where do you get your reference data?
We have around 14 million indexed stud-ies that allowed us to develop our algo-rithms. Those data are based on partner-ships, for example with Clalit Healthcare and Intermountain Health
What is the reaction of the doctors at your pilot institutions?
In the beginning they were all skeptical. But after a while they understood that if you have a robot performing routine tasks in a very precise way, you can focus on different, more advanced and more im-portant things such as taking care of pa-tients or concentrating on complex cases. Smart automated algorithms really have the potential to address inefficient pro-cesses in radiology by doing routine work. As a result the radiologist has more time to focus on complicated multimodality stud-ies such as looking for a genome related characteristics of a specific cancer. Doc-tors very quickly recognize this win-win situation.
What is your vision for the next 15 years?
The vision is a kind of autopilot similarly to the one in an aircraft. When you are on a flight you know that most of the flight time, the pilot is only supervising the flight which is actually performed by the auto-pilot. This can be possible in medicine as well if we are able to develop algorithms that improve human accuracy. I guess the role of radiologists is going to change, but in a positive way. They will have more time, for example for science and will fur-ther improve patient care.
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In 2015, the government earmarked US$ 11.6 billion to improve the quality of care. Over the past five years the coun-try recorded major successes with regard to life expectancy and the reduction of child mortality und child malnutrition. Increased life expectancy and stronger purchasing power however bring about their very own challenges, be it health-care for older people or changes in dis-ease patterns with diabetes and cardio-vascular conditions on the rise. At the same time people expect better health-care. German Trade and Invest estimates that about 50 percent of the overall healthcare spend are direct payments by the patients themselves and they want their money to be invested wisely.
Vietnamese healthcare system in brief
Vietnam counts 1,300 hospitals that ad-mit a total of 146 million patients per year, approximately 13.5 million as in-patients. Overall, the Vietnamese healthcare system recorded important progress over the past few years, particularly with regard to re-duction of child mortality and increasing life expectancy. The latter is currently at 76 years, higher that in most Southeast Asian countries.
Basic healthcare data for Vietnam (as of 2012): Sources: Ministry of Health, General Statistics Office, World Bank
These factors help to explain the in-creasing number of private healthcare facilities: in 2015, approximately 200 private hospitals were opened with a medical service offering that is geared towards the needs of the growing – and self-paying – middle class. These new facilities tend to opt for modern and high-quality medical technology, mostly foreign-made. But public and military fa-cilities as well are updating their diagnos-tic and surgery equipment. While there are endeavors to use more domestic medical technology, still about 90 per-cent of the devices are imported, making the Vietnamese healthcare system an immensely attractive market for foreign med tech and IT companies. The number
Vietnam – Healthcare market on the moveTourism continues to boom in Vietnam: The coastal state on the Gulf of Tonkin is one of the most popular vacation destinations in Southeast Asia. Heartened by overall economic growth the people in this socialist country expect their healthcare to improve as well. The administration was quick to react. It not only adopted several laws and regulations to expand the healthcare sector but also invested heavily.
of import licenses issued by the Vietnam-ese Ministry of Health has been increas-ing steadily over the past few years and reached 5,500 in 2014.
In high demand: solutions made in Bochum
Next to Japan, Germany is an important partner of Vietnam for medical tech-nology and IT. In 2014, the country im-ported products worth US$ 113 million
– among them the JiveX family by VISUS. The local distribution partner is Vegastar Technology Company, one of the lead-ing Vietnamese enterprises specialized in technological applications in security and medical technology. As a provider of PACS, Vegastar is a trail blazer in Viet-
1.751
85
74 Physicians/100,000 inhabitants
Per capita healthcare spend (US$ per year)
Per capita income (US$)
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97
nam, where only very few healthcare facilities have an image management system. And those that do want one, are looking for innovative and future-proof solutions. Case in point: Hospital No. 354 which is funded by the military. It is the very first Vietnamese hospital to choose JiveX for PACS – a system with future-oriented technology. In Hospital No. 354 JiveX not only consolidates ra-diology image data acquired by CT, MRI and mammography scanners but also non-radiology data such as ultrasound and endoscopy. This image management strategy can easily compete with that of any Western hospital.
For Hans-Willi Lohrke, in charge of international sales at VISUS, Vietnam is
much more than just another econom-ically interesting market; he is simply fascinated by the country: “If you look at the developments on the Vietnamese healthcare market over the past 15 years, the results are really amazing. They are trying to systematically improve the qual-ity of care – full throttle. Highest stan-dards are applied for the implementation of medical technology and IT systems, and consequently many facilities start from a very high technological level.”
Notwithstanding the immense prog-ress, medical care across the country cannot be perfect. In particular the marked divide in healthcare provision between urban and rural areas is cause for concern. And after all, technology
is not the panacea: every single Viet-namese hospital is struggling with the shortage of professional medical staff. Currently the labor situation is character-ized by low salaries, non-standardized education and training as well as poor working conditions.
Despite these challenges, the Viet-namese efforts over the past few years have resulted in a healthcare system that is excellently positioned compared to countries on a similar level of economic development. The future looks promis-ing.
90,01,0
Below 15 years (%)
25,2Over 65 years (%)
5,5
73
7,0
2493
Healthcare spend as percentage of GDP
Physicians/100,000 inhabitants
private (share in %)
public (share in %)
Average life expectancy at birth (years)
Population
Population growth (% p.a.)
Age structure of the population
Hospital beds/100,000 inhabitants
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The hospital management was partic-ularly keen to clearly separate admin-istrative and medical data. “Previously we worked with a so-called universal archive which was designed to consoli-date all data. But we had to realize that this approach is not useful because the systems that are currently available are either made for clinical content, which means they are much too big for admin processes, or the focus is on workflows geared towards management of finan-
cial processes which means they cannot deal with clinical processes,” says Ste-fan Beyeler, Chief Information Officer at Spital Emmental in Burgdorf. At the end of the day, he says, it’s the users who bear the brunt when IT compromises compli-cate rather than simplify their work.
Clinical data: a room of their own
In view of this experience there was only one way to go for the management at the
Process optimization in Regionalspital Emmental
Data floods: turning chaos into orderSwiss healthcare facilities have three more years to introduce the electronic patient record which integrates patient medical data and makes them available across facilities. Regionalspital Emmental, though, is far ahead of the official schedule: with the imminent introduction of VISUS Medical Archive the two sites of the district hospital comply with all requirements in terms of data structuring and standardization. But that is not the only advantage the Swiss healthcare institution expects JiveX Medical Archive to deliver.
Emmental hospital: in the future all clini-cal data pertaining to a patient are to be archived in a medical archive while ad-min data are managed separately. Look-ing for a suitable solution that can bundle the different types of clinical informa-tion and formats, Stefan Beyeler and his team came across VISUS JiveX Medical Archive: “The primary user group of the medical archive are obviously phy-sicians and to some extent nursing staff. They are familiar with systems that work
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more or less like a PACS that is systems that display all data for a given patient on a single viewer and that offer certain post-processing capabilities. This is an important consideration in favor of JiveX Medical Archive. And indeed the staff immediately took to the systems during the pilot phase since handling JiveX is intuitive and does not require extensive training.”
Another advantage of JiveX Medical Archives is its suitability as a long-term archiving and backup solution for ra-diology images. Upon acquisition all images are immediately sent to the PACS and to JiveX. After a user-defined peri-od data are automatically removed from the PACS and deposited in a compliant manner in the VISUS long-term medical archive. In the legacy system loading ar-chived data, for example in order to view previous exams, often took several hours. An untenable situation. Already in the test phase JiveX proved that calling up data from a long-term archive can be a matter of seconds, a precondition for an efficient radiology workflow.
Data are available where they are needed
With VISUS Medical Archive physicians and nursing staff can access all relevant treatment documents of a patient right from the HIS since JiveX will be the home of all image, functional, diagnos-tic, lab and various document data. They can be called up and processed by case or patient on the JiveX Viewer. Data in-tegration is achieved via an Enterprise Service Bus (ESB) as central interface.
“The high degree of standardization on the VISUS end makes such an architec-ture extremely simple because the sys-tem accepts, processes and displays all standard formats such as DICOM, PDF, PDF/A or JPG. With all non-DICOM data the required meta-data are transported via HL7 – that’s all,” the CIO explains.
This simple communication via HL7 enables the Emmental hospital to dig-italize previously analogue processes and to feed paper documents into JiveX. When a patient presents at one of the two Emmental sites, his or her data are either downloaded from the HIS or a new record is created in the HIS. Then the documents the patient produces, such as the referral, are identified and refer-enced using a detailed catalogue, and in a final step a barcode is created. Then
the paper document is scanned and sent to the JiveX Medical Archive via ESB as an HL7 MDM file. “The entire process is standardized and decentralized. We in-stalled scanners at the relevant points in order for the scanning to be performed right from the admissions work station. This is very important in terms of process optimization because it ensures that all patient documents and data are available in JiveX the moment the first physician looks at the patient,” Stefan Beyeler re-ports.
Excellently prepared for the electronic patient record
The Emmental IT experts meticulous-ly categorized all potential documents that might crop up – from the referral to the lab report. As Stefan Beyeler points out the catalogue already “encompass-
Stefan BeyelerChief Information Officer at Spital
Emmental in Burgdorf
es approximately 200 different types of documents. Thus our structure is much more fine-grained than that of the man-dated electronic patient record.” In all as-pects JiveX complies with the prescribed structure to link with a network since it is based on IHE standards – just like the EPR architecture. This immensely facili-tates using external data. “From a tech-nological point of view the implemen-tation of JiveX Medical Archive enables us to start transferring data from and into the electronic patient record at short no-tice. Thus the new system was clearly purchased with a view towards future re-quirements. We are well positioned and as far as we are concerned the actual launch of the electronic patient record in the year 2020 will be a piece of cake,” a very relaxed Stefan Beyeler says.
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Today, a web viewer for facility-wide distribution of radiology data and a solution for accessing images on mobile devices are standard functionality offered by any renowned PACS provider. The sticking point with image distribution, as with many other medical software solutions, is not whether it can be done but how it is being done. If the clients for image distribution and mobile working do not offer process and workflow optimization they are useless.
In order to achieve noticeable process improvements in healthcare facilities so-called web and mobile clients, i.e. the solutions for image distribution via a web viewer and for viewing data on mo-bile devices, have to offer a high degree of integration capabilities. Case in point: the VISUS mobile viewer, JiveX Mobile, is integrated in the app of the HIS pro-
Image distribution with JiveX Web and JiveX Mobile
Flexibility and quality on a high level
vider which allows accessing images in the patient record from any tablet – any-where – in full compliance with all priva-cy requirements. The image data are not stored locally on the device rather than on the server and only users with the ap-propriate rights can access the data.
“With our web client we not only aim to integrate with other systems such as the
HIS but to offer easy-to-handle cross-fa-cility image distribution since data ex-change with external partners such as referring physicians is increasingly im-portant,” explains Melanie Dessel, Prod-uct Manager at VISUS. When radiology findings have to be transmitted quickly to the GP or a specialist physician a link can be created in JiveX and sent to the
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partner. This link automatically opens the image viewer of the HTML-5 client and the data can be viewed – compli-ant with all privacy regulations. “This obviously requires our software to be available without installation time,” Ms. Dessel adds.
Referring physicians who are in fre-quent communication with the health-care facility can be granted direct access to the patient data via a web client and the assignment of access rights.
Functionality beyond findings
In terms of functionality the mobile and the web version have to meet specific requirements. When designing a solu-tion with broad functionality within the frame of a lean architecture developers have to be very clear on their priorities: which functionalities make sense for which scenario? JiveX Mobile does not need printing and export functions, on the web client, however, they are very useful. Easy data exchange via DICOM E-Mail and DICOM Send – for exam-ple when a second opinion needs to be obtained – is handy in mobile environ-ments and therefore provided on the mo-bile iPad version.
A particular highlight of both JiveX Web and JiveX Mobile is the ability to display and measure ECGs. “This is an-other area where interoperability is key. Our clients can display and measure ECGs of virtually any manufacturer – that’s pretty much unique on the mar-ket. In everyday clinical life this rather inconspicuous function is indeed highly relevant. In view of the fact that an ECG is one of the most frequently performed exams one can imagine the time-saving potential such a function offers: the phy-sician can view the ECGs from any work-station and even from his tablet at home,” the Product Manager explains.
Moreover, different exams and data types can be called up in parallel on
JiveX Web and JiveX Mobile. Thus users can easily compare new and previous exams or they can view a medical report and the accompanying images at the same time.
Always the perfect view
For any web and mobile client to be a success with the users, easy operation is
a must. Usability is important, particu-larly with mobile devices as only those apps will be adopted that really make life easier for the users. Melanie Dessel points out that this was the reason for VISUS to “develop products for desktop and mobile use. The different operating systems and the touchscreen operation of mobile devices require completely different approaches. Simply adapting mouse-based used to a mobile device won’t suffice as it doesn’t add value for the user. On the mobile client, the users
much rather need to recognize the envi-ronment they know from mobile devices for private use. With JiveX Mobile we really succeed in meeting this expecta-tion – as the feedback we receive from the users underlines.”
While on the one hand the clients have to differ significantly, on the other hand they have to be similar in the per-ception of the user. The developers have to find a programming way out of this dilemma: the clients have to be designed to meet the specific operation require-ments but at the same time they have to be designed in a way that the users un-derstand them intuitively and the moves stored in their muscle memory can be used on different hardware.
The development efforts and the know-how VISUS invests in the optimi-zation of JiveX Mobile and JiveX Web bears witness to the priority intelligent, quick and secure image distribution enjoys in the company, as the Product Manager confirms: “Diagnostic imaging has very specific requirements which for the time being can only be met at a fixed work station. But as far as the distribu-tion of clinical images is concerned, the domains of JiveX Mobile and JiveX Web, workstation-tied ways of working do no longer reflect the preferences and needs of a modern workflow. We want our products to meet these needs and pref-erences in the best possible ways to sup-port our users in their everyday work.”
Melanie DesselProductmanager, VISUS
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32-year-old Ira Beddingfield has type II diabetes mellitus. As part of his disease management program he regularly visits different healthcare facilities, from his GP to an ophthalmologist. All medical data that are collected during these visits as well as the blood glucose values Ira measures himself are fed into Ira’s electronic patient record. Ira is the owner of his data and grants access to the data as the need arises.
Sounds like science fiction? Well, right now it still is. Indeed, Ira Beddingfield is the creation of seven companies, amongst them VISUS‘ Dutch partner Al-phatron. Ira‘s disease history was created to show-case the potential of IHE profiles such as XDS (Cross Enterprise Document Sharing) for real-life health-care. Ira’s “case”, initiated by IHE, was presented at the 2016 eHealth Week in Amsterdam. And while it is “fiction” the networking capabilities Ira illustrates are technically feasible today. In many countries, it is simply the framework that’s missing for Ira to be-come reality.
Document exchange with JiveX
In Ira’s case JiveX handles data retrieval from the pa-tient record and makes new exam results available. JiveX XDS Consumer allows the patient record data to be accessed and viewed. Sounds straight forward but indeed the process is still fraught with – exter-nal – challenges such as the lack of interoperability between IT systems of different manufacturers due to the fact that many systems are not yet equipped with IHE interfaces. Moreover there are a number of unresolved privacy issues that prevent implementa-tion in many countries, i.e. how the patient is sup-posed to grant permission for third-party access or how the patient decides when and which data are to be deleted and whether it is in fact the patient who decides and initiates deletion. Another techni-cal problem is unambiguous patient identification
Patient-centered diabetes management via XDS
Ira is calling!
across medical facilities and disciplines.Despite these snags VISUS is busy implementing
the IHE XDS profile. One of the beneficiaries of the development is Elizabeth Tweesteden Ziekenhuis in Tilburg, the Netherlands. Here VISUS, via partner Alphatron, provides a pilot XDS solution for trauma care and for simple data exchange with a coopera-tion partner in radiotherapy. In the Netherlands, two factors facilitate data exchange: firstly, regional care networks are in place and secondly nation-wide patient IDs are assigned which allow cross-facility patient identification.
The foundation for XDS has been built
For Elizabeth Tweesteden Ziekenhuis creating a net-work with healthcare partners via XDS was a logi-cal step since internally the prerequisites had been established: digitalized image management – even outside of radiology – with JiveX PACS II Integrated Imaging means that the relevant data exist in digital form, in a system that is strictly standards-based and thus allows the data to be easily transmitted to ex-ternal systems using the IHE profile.
The example of the Tilburg hospital shows the relevance and currency of “Ira Beddingfield”. And the good news is: the successful demos at eHealth Week showed the technical feasibility when – and if – the parties involved create the necessary frame-work and cooperate.
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Profile: Ira BeddingfieldShowcase at eHealth Week, 8 to 10 June 2016 in Amsterdam
1 Ira Beddingfield regularly measures blood glucose levels and enters the results in the patient record.
2 Ira Beddingfield’s visus deteriorates therefore Ira sees his GP: the ensuing exams mandate re-ferral to a specialist in a Delft hospital. The GP’s exam results and the referral document are entered in the patient record.
3 Ira Beddingfield presents at the specialist at the Delft hospital and authorizes access to his data. The specialist at the Delft hospital performs further exams (retina scan and fundus examination). The exam results and the referral to an eye clinic in Rotterdam are entered in the patient record.
4 Ira Beddingfield presents at the eye clinic in Rotterdam and authorizes access to his data. Note: the Rotterdam eye clinic is outside the Delft care region. ⇒ Eye surgery is performed at Rotterdam and the report is entered in the patient record.
5 Three-months follow-up in the Delft hospital. The results are entered in the patient record.
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Klaus Klebers Straight Talk
know-how and experience regarding data handling and privacy issues can offer such applications, trans-fer the data to the patient, manage and store the data, trigger their transmission to physicians and make them available for commercial or scientific Smart Data purposes. A gigantic market!
In practice, however, this theory falls at the same hurdle as institutions do in their attempt to manage data: currently it is impossible to make all healthcare data available across institutions in a structured way and on a unified semantic and syntactic foundation. This is why we at VISUS are working full throttle on removing this obstacle and make Smart Data a reality. How are we doing that? For starters, we developed JiveX Medical Archive, the foundation for consolidat-ed and standard-compliant data management that is the precondition for data exchange. Going forward, we will not only offer the necessary infrastructure for institutional data exchange – which will no doubt continue to be highly relevant – but we will also help to enable healthcare institutions to make these cumu-lated data available to the patient, who, after all, is the legal owner of the data.
Klaus KleberChief Technical Officer, VISUS
Every once in a while I need to say this sentence loud and clear to assure myself of its simple truth since there are many people who are planning the future of healthcare with my data – and we here at VISUS are among them.
The brain power that’s currently being invested in the intelligent use of the enormous amounts of data is extremely important, if not vital for the future of healthcare delivery. Many approaches to Smart Data are based on the idea that health data are pulled from the institutions and collected at a central point for further analysis. In such a scenario, I personally am not only the beneficiary – as potential patient – of Smart Data, I am also the owner and supplier of the
“goods” that make Smart Data possible. As the owner I might want to make my CT images or ECG data, if only temporarily, available for scientific purposes or to a commercial provider. In order to be able to do so, I must be the master of my data – maintain them and grant access to them, let’s say via a smartphone app.
From the point of view of a highly innovative IT company this idea opens up very exciting perspec-tives. Providers of hospital IT with the necessary
I am the owner of my data!
Publisher
VISUS Health IT GmbHGesundheitscampus-Süd 15-1744801 Bochum, Germany
Fon: +49 234-936 93-0Fax: +49 234-936 93-199
EditionNo. 07, 07/2017
Editorial ServicesMeike Lerner Healthcare Communication
TranslationAnette Bus
LayoutVISUS Health IT GmbH,Christiane Debbelt, Sabrina Köhl
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RADIOLOGY – SIMPLE AND EFFICIENT
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We share experience
Powerful. Workflow-optimized. User-friendly. Whether in the doctor‘s office or in clinical radiology, JiveX PACS offers efficient and versatile solutions for every scenario. Flexible interfaces, modular design and high scalability make it possible to establish a tailor-made image-data management system. In addi-tion, extensive DICOM support provides the ability to interface with the equipment of any manufacturer and creates the freedom that is necessary to be able to work efficiently.
