Accurate diagnostics have been requiring more than just X-ray images for quite some time. Today, they are supplemented by the viewing of ECG, video sequences, or photographs. In addition to primary diagnostics, physicians require this information for follow-ups. For the purpose of such comprehensive, enterprise-wide image and video documentation, images from the most diverse sources need to be integrated into a uniform image management system (PACS). It is only under this precondition that efficiency potentials of digitization can be tapped to the full extent: work processes can be realized more seamlessly. Costs are reduced thanks to elimination of hardware on the one hand, and thanks to elimination of printouts as well as reductions in search and retrieval times on the other. Overall, this helps improving patient care and, as a result, cut patient stay.
The sources from which images need to be integrated are manifold. Some lend themselves to more or less easy integration today, others present much more of an issue. Frequently, sequences from endoscopy or ECG waveforms with pertinent reports are already to be found in PACS solutions; in quite a number of cases, the PACS will also contain photographs and videos from other medical departments. These will include images for documentation of wounds and decubitus, photographs of changes in the skin in dermatology, as well as images for gait analysis of the type used in neurology, orthopedics, and psychiatry. Images which may turn up less frequently, but which are no less relevant for the big picture in diagnostics, are images from slit lamps in ophthalmology or slice images from microscopy.
Seamless integration into the enterprise-wide workflow supports, among other things, work sharing processes as well as the direct distribution of information. This results in the optimization of workflows with, in the end, faster availability of physician reports.
At the beginning of the workflow, a patient is registered for an exam in the information system. Subsequently, the JiveX solution imports all required data and information via a DICOM worklist. This helps to avoid duplicate and erroneous input and safeguards a fast and smooth workflow. In addition, it serves to prevent a certain problem in the integration of image data: the positive attribution of images to a patient ensures that they have been archived correctly for retrieval at any time. Of course, patients can also be recorded manually without a worklist on-site.
After the exam, the images are passed on, automatically or manually, in DICOM format to the image management system. This is based on the DICOM communication standard. Image sources which do not dispose of a common DICOM interface are digitized via frame grabber. Another option is to import them from a standard format (JPEG, TIFF, etc.) and to convert them subsequently into DICOM. Physician´s letters and reports are an exception; they can be archived as PDF or scanned documents. Analog X-ray film material, too, can be digitized and recorded post hoc this way.
All documents are stored in the PACS archive in a patient- and exam-centered way. They are accessed via the hospital information system or directly via PACS and its archive.
For reporting, the physician has various options at his disposal for post-processing: he can measure, e. g., distances between structures and their dimensions directly in the image, and he can enter the respective scale as well. Enlargements of certain areas of an image support his diagnostic work. Interdisciplinary communication is facilitated by the convenient insertion of annotations. This allows the reporting physician to quickly communicate essential information to the physician involved in the treatment and thus improve subsequent care for the patient. For the writing of the report in the context of the patient, the system can be integrated into the respective module of a hospital information system or clinical workplace system.
For the processing of videos, an integrated video editing workplace with export functions is available for physicians. This allows, e. g., to elaborate the sequences or single images of relevance, or to produce video DVDs. For subsequent editing, the native video sequences can be passed on to dedicated video processing solutions. In this way, the user creates, basically as a byproduct, extensive archives for teaching purposes or in publications. Subsequently, the user can convert the selected images into various formats or just simply print them. There is an option of selecting only the relevant images and sequences for archiving.
Archiving of images and reports is done in a flexible manner, adapted completely to the needs of the individual customer - but always in DICOM format. Data can be stored online, in a Storage Area Network (SAN), on shared hard disk systems in a network (Network Attached Storage, NAS), or on a direct attached hard disk system (RAID). Offline storage is done on DVDs, BluRay discs, or magnetic tapes which are handled either manually or by robots. Before archiving of image data, feedback is given to the leading information system. The reconciliation with the order communication ensures process quality.
A further option for long-term archiving is JiveX Storage Service for PACS (SSP). This service enables the customer to store the data in an external archive operated by a service provider. This type of data storage enables cost-optimized operation for the user. With full orientation of fees towards use, the customer is not required to make investments and tie up capital. Cost can be planned because there are no additional expenditures for migration, administration, or maintenance.