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Presented to NNOHA National Conference in Nashville, November, 2009.
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Electronic Dental Records and PACS in the Electronic Dental Records and PACS in the Dental Dental
Community Health SectorCommunity Health Sector
NNOHA Presentation 11/04/09Jeff Burgess DDS MSD
Marc CapotsSpecial Markets Technology
ManagerHenry Schein Special Markets
Equipment
Jeff Burgess DDS MSDBoarded in Oral MedicineVice President of Sales and Marketing EBM Technologies
PACSPACS
PACSPACS
PACSPACS
PACSPACS
PACSPACS
PACSPACSSvanaes, Moystad, Larheim: Approximal caries depth assessment with storage phosphor versus film radiography. Evaluation of the caries-specific Oslo enhancement procedure. Caries Res. 2000
• 120 extracted human teeth• Storage Phosphor plates with Digora scanner versus Ektaspeed
Plus film• 240 Proximal surfaces for caries, 9 observers, 5 point confidence
scale• Ratings compared with the histological state• Pooled sensitivity and specificity values:
•.48/.94 with film, .61/.86 with phosphor image
Digital Digital SensorsSensors
PACSPACS• Gakenheimer DC: The efficacy of a computerized caries
detector in intraoral digital radiography. JADA 2002
• Navarro F, Puy L, Godoy G: Diagnostic performance of radiovisiography in combination with a diagnosis assisting program versus conventional
radiography with radiovisiography in basic mode and with magnification. Med Oral Pathol Oral Cir Bucal, 2008.
Caries Caries DetectionDetection
Industry StandardsIndustry Standards
• DICOM – Digital Communication in Medicine
• HL7 – Health Level 7• IHE – Integrating the Healthcare Enterprise• HIPPA
• DICOM – Digital Communication in Medicine
• HL7 – Health Level 7• IHE – Integrating the Healthcare Enterprise• HIPPA
Industry StandardsIndustry Standards
DICOM – Digital Communication in Medicine
Standard in Medicine for handling, storing, printing and transmitting medical information in medical
images
DICOM – Digital Communication in Medicine
Standard in Medicine for handling, storing, printing and transmitting medical information in medical
images
• Includes a file format definition and network communications protocol
• Enables integration of scanners, servers, workstations, printers, and network hardware
DICOM
Industry StandardsIndustry Standards
DICOM – Brief History•1985 – First Standard Released•1988 Second Version Released•1992 First Large Scale Deployment by the US Army
and Air Force•1993 Third Version – 3.0•Now recommended using release year: “the 2007 version of DiCOM”•IHE (Integrating the Healthcare Enterprise) + HL-7 completes workflow interoperability
DICOM – Brief History•1985 – First Standard Released•1988 Second Version Released•1992 First Large Scale Deployment by the US Army
and Air Force•1993 Third Version – 3.0•Now recommended using release year: “the 2007 version of DiCOM”•IHE (Integrating the Healthcare Enterprise) + HL-7 completes workflow interoperability
Industry StandardsIndustry Standards
DICOM• Store•Storage Commitment•Query/Retrieve•Modality Worklist•Modality Performed Procedure Step•Printing•Storage in Off-Line Media
DICOM• Store•Storage Commitment•Query/Retrieve•Modality Worklist•Modality Performed Procedure Step•Printing•Storage in Off-Line Media
Industry StandardsIndustry Standards
DICOM
Store• Used to send images or other persistent objects (such as reports, lab results, patient photos) to a PACS workstation.
DICOM
Store• Used to send images or other persistent objects (such as reports, lab results, patient photos) to a PACS workstation.
Industry StandardsIndustry Standards
DICOM
Storage CommitmentThis is used to confirm that an image has been permanently stored by a device such as a disk or back-up media or server. This makes it safe to delete the images locally.
DICOM
Storage CommitmentThis is used to confirm that an image has been permanently stored by a device such as a disk or back-up media or server. This makes it safe to delete the images locally.
Industry StandardsIndustry Standards
DICOM
Query/RetrieveThis function allows a workstation to find the lists of images and other ‘objects’ and then retrieve them from a PACS
DICOM
Query/RetrieveThis function allows a workstation to find the lists of images and other ‘objects’ and then retrieve them from a PACS
Industry StandardsIndustry Standards
DICOM
Modality WorklistThis enables an acquisition device (a modality - x-ray machine) to obtain details of patients scheduled examinations so that the information doesn’t have to by entered multiple times.
DICOM
Modality WorklistThis enables an acquisition device (a modality - x-ray machine) to obtain details of patients scheduled examinations so that the information doesn’t have to by entered multiple times.
Industry StandardsIndustry Standards
DICOMModality Performed Procedure StepThis function enables the modality to send a report about an examination which includes data like when it was acquired, beginning time, end time, dose delivered, etc.)
DICOMModality Performed Procedure StepThis function enables the modality to send a report about an examination which includes data like when it was acquired, beginning time, end time, dose delivered, etc.)
Industry StandardsIndustry Standards
DICOMDICOM
Industry StandardsIndustry Standards
DICOMDICOM
More About DICOM
If an acquisition device company says that it is DICOM compliant you should be able to request its DICOM conformance statement. If it does have one, it is not DICOM compliant.
Industry StandardsIndustry Standards
DICOMDICOM
More About DICOM
Just because an image is DICOM compliant does not mean that it can be sent to a medical facility. There must be a functioning DICOM server to make this a true enterprise system.
Industry StandardsIndustry Standards
DICOMDICOM
More About DICOM
For more Information about DICOM, visit:http://DICOM.nema.org
Industry StandardsIndustry Standards
HL7 – Health Level 7HL7 – Health Level 7HL7 – Health Level 7HL7 – Health Level 7• Founded in 1987• Global authority for healthcare information interoperability and standards• 57 Countries • 2,300 members represent 500 corporate members – 90% of the information system vendors.• Supports clinical practice and the
management, delivery, and evaluation of health services.
• ADA signed an Associate Charter Agreement September 2009 to develop dental IT standards
Industry StandardsIndustry Standards
IHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare Enterprise
IHE Connectathon Results BrowserOct 11, 2009 ... Browse the results of the IHE (Integrating the Healthcare Enterprise) connectathons that have taken place in Europe, Japan and North America ...connectathon-results.ihe-europe.net/
• An initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information • Several hundred products support one
or more IHE Profiles• Integration Profiles describe clinical information management use cases and specify how to use existing standards (HL7, DICOM, etc,...) to address them• Integration Statements, Technical Frameworks, Connectathons, Showcases
Industry StandardsIndustry Standards
On April 14, 2003, the privacy rules promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) changed the way that certain health record custodians (called “covered entities”) will respond to a request for disclosure of a person’s "protected health information" (PHI).
HIPPA – Health Insurance Portability and Accountability Act
Requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
Yeoh & Muranaka Medical Center, based in Honolulu, Hawaii facilitates three outpatient imaging clinics.
Imaging Center
Exams per year : 50,000
4 Radiologists
Serves pop. Of 900,000
EBM Solution
UniSight™
UniWeb™
EBM PACS Server™
Imaging Devices
2 CT
4 US
2 BMD
4 DR
1 MR
Case Study: USACase Study: USA
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
UniGate® WorkstationUniGate® Workstation‘‘To communicate with the non-DICOM devices’To communicate with the non-DICOM devices’
UniSight® WorkstationUniSight® Workstation
EBM Pacs Server®EBM Pacs Server®
UniWeb® WorkstationUniWeb® Workstation
Pangea DentalPangea Dental
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
• Supports DICOM Worklist• Supports DICOM Dental Tag• Supports DICOM MPPS (Modality Procedure Performed Status)• Supports DICOM Storage Commitment• Allows conversion of non-digital images to DICOM standard
UniGate® WorkstationUniGate® Workstation‘‘To communicate with the non-DICOM devices’To communicate with the non-DICOM devices’
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
• Acts as QC Station to Preview Images • DICOM Print function • DICOM Portable Media Function (for CD/DVD Burner)• Conversion of Images between DICOM and non-DICOM• Supports DICOM Store (SCU/SCP) Function• Supports DICOM Storage Commitment
UniSight® WorkstationUniSight® Workstation
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
• Stores DICOM images • Keeps a log of image modifications and deletions• Keeps a log of image query and retrieval by all users • Logs problems• Sends out SMS or email to headquarters (engineers) when a problem occurs• Provides a log that helps track the image route between the modality and the server
EBM Pacs Server®EBM Pacs Server®
The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution
• Allows WEB Access to review Image (Internet Explorer)• Web Access to DICOM Objects (WADO)• Robust Viewing Tools• Scalable Concurrent License• Used for Teaching
UniWeb® WorkstationUniWeb® Workstation
HIS/RIS with HL7/non-HL7HL7/non-HL7 Broker (EBM)
DICOM Worklist Server (EBM)
UniGate UniGate (EBM)(EBM)
Teleradiology
Acquisition modalities support
DICOM worklist
EBM PACS Server/EBM PACS Server/Pangea Dental
CliniciansCommunication
DICOM Printing
Diagnostic/Viewing Station
Acquisition modalities
Non-DICOM
Hanging ProtocolHanging ProtocolHanging ProtocolHanging Protocol
Multimodality – Device NeutralMultimodality – Device NeutralMultimodality – Device NeutralMultimodality – Device Neutral
Web BasedWeb BasedWeb BasedWeb Based
DICOM 3.0 Standards DICOM 3.0 Standards DICOM 3.0 Standards DICOM 3.0 Standards
Pangea Dental HighlightsPangea Dental Highlights
Integration with RIS SystemsIntegration with RIS SystemsIntegration with RIS SystemsIntegration with RIS Systems
Dynamic Analysis FunctionsDynamic Analysis FunctionsDynamic Analysis FunctionsDynamic Analysis Functions
Hanging ProtocolHanging ProtocolHanging ProtocolHanging Protocol
Pangea Dental Hanging Capability
• FlexibleFlexible• CustomizableCustomizable• Supports mouse Supports mouse dragging for dragging for tooth tooth selectionselection• Supports image Supports image display of display of selected selected study study date resultsdate results
Pangea Dental DICOM TagsPangea Dental DICOM Tags
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
PACS software provides many analytic features that plain films cannot duplicate.
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
The ZOOM function allows the viewing of two or more images taken over time to document potential change.
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
The measurement functions allow for a gross calculation of the length, ratio, area, angles and a value based on the density of the location (area or single point) being viewed
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
In this case the length of the maxillary sinus and a TMJ defect is calculated. There are many more analytical features associated with Pangea Dental
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
CBCT Images CBCT Images
Pangea Dental – CBCT ImagesPangea Dental – CBCT Images
Pangea Dental – CBCT ImagesPangea Dental – CBCT Images
Sectional Images can be reformatted into axial, coronal, sagital, and 3D views
Pangea Dental Analysis FunctionsPangea Dental Analysis Functions
Export/Import to DICOM Export/Import to DICOM Portable Media CD/DVD Portable Media CD/DVD
Viewer On CD® Viewer On CD®
Pangea Dental System RequirementsPangea Dental System Requirements
•Needs assessment•Financial issues•Creating a request for
proposal•Selecting a vendor
Pangea Dental System RequirementsPangea Dental System Requirements
Needs assessmentshould be consistent with the goals of the clinic or institution
Pangea Dental System RequirementsPangea Dental System Requirements
• Doctor Efficiency• Improved Annotation Capability• Medical Communication• Insurance Billing• Office Space
Needs Assessment
Pangea Dental System RequirementsPangea Dental System Requirements
• Cost Reductions• Savings on development costs• Savings related to storage• Savings in assistant time
Financial Issues
Pangea Dental System RequirementsPangea Dental System Requirements
• Increased Income• Efficiency•Community Perception• Improved consultation acceptance• Referrals
Financial Issues
Pangea Dental System RequirementsPangea Dental System Requirements
• PACS, A Guide to the Digital Revolution, Second Edition. Springer. Keith Dreyer, David Hirschorn, James Thrall, Amit Mehta, Editors. 2006.
Creating a Request for Proposal
Pangea Dental System RequirementsPangea Dental System Requirements
• DICOM Compliance• Features• Service/Support• History• International
Standards
Selecting a Vendor
•Scalable Software• Modality Independent• Reliability•Training
Take Home PointsTake Home Points
• DICOM Compliant PACS are the future of Dental Imaging communication
• A DICOM Server is going to be necessary for true browser based teleradiology and web based communication with Medical EMRs
• Discuss carefully with your EDR provider whether they can integrate or are integrated with a true PACS company that has a DICOM Server.