The electrocardiogram (ECG) is one of the most common examinations in medicine. Thanks to modern data compressing it is possible to reproduce the cardiac streams digitally on a monitor and to assess findings. For an optimal workflow the ECG devices will receive information from a patient information system (eg, HIS) and save the final examinations in a clinic-wide available image management system (PACS). With JiveX ECG based on the communication standard DICOM VISUS integrates ECG devices from the leading manufacturers in the market. The exchange with the hospital information system (HIS) will be established via HL7 interfaces.

Fast and effective finding

Doctors have easy-to-use measurement functions available. In unclear waveforms he can blow up the curve at the push of a button, or select a different display on the screen. Also a comparison with preliminary examinations at the same workplace is not a problem. For example the last image of the lung or a cardiac catheterization film may support the evaluation. In addition to saving time, the diagnostic reliability is increased. All results can be documented in the form of a summary report revision-proof and be stored.

Flexible archiving, fast access

Archiving of the images and reports is flexible, it is adapted to meet the individual needs of the house. Thus, the data can be stored on CD or DVD in a single media archive, or stored in network structures in the Storage Area Network (SAN). The newest opportunity offers PACS Storage Service (SSP), in which the data are stored in an external archive. The payment depends on the usage.

Essential support in the practice

In the Augusta-Hospital Bochum, the system is in use for over a year. Dr. Olaf Hagen, head of the Medical and Geriatric Clinic sees substantial benefits for his work: "All the ECGs are provided at any time together with other images, findings and other information. In findings I am able to make electronic measurements and increase the measurement distances easily. Finally, we now have better opportunities in demonstrating the ECG. In a conference it was almost impossible to show the small strip of paper with the ECG trace to the colleagues - at least so that they recognize something."

Today hospitals can realize essential improvements in the clinical procedures by the association of medicine technology and IT. VISUS sees the fusion of both components as an essential key for the process optimization in the hospital. The strategic enhancements of the Enterprise PACS JiveX are orientated towards it.

The Bochum IT service provider is also presenting this at this year's MEDICA. With the integration of DICOM ECG, endoscopy, cardiology, sonography and radiotherapy in its PACS - clinic-wide and also cross-site - the road leads further in the direction of a comprehensive image management. On the basis of the DICOM standard picture and video data, bio-signals as well as documents are integrated smoothly. In detail the data transfer between modalities and IT, the structured finding, the documentation and archiving, the control of working processes as well as the quality assurance and consistency are guaranteed.

The user spectrum of JiveX reaches from PACS departmental solutions for different professional disciplines to the cross-departmental Enterprise PACS with teleradiology up to the complex cross-site network solution with data processing operations.

VISUS' comprehensive offer is extended by JiveX ASP/SSP, the PACS managed services with external archiving. It guarantees audit-proof, highly available long-term archiving in the data center with round-the-clock access. Besides, VISUS makes available everything to its customer from the software to services incl. full service up to the IT infrastructure with archive, servers as well as finding workstations and monitors. The user pays an individual, monthly basic charge according to equipment and scope of the solution, in addition a demand-oriented monthly user fee in dependancy on the agreed services as well as availability and performance guarantees. The advantages for the user are obvious: reasonable operation, payment purely after use, no investments and capital commitment, planable costs, no additional expenditures for migration, administration, servicing.

VISUS introduces a new version of its Enterprise PACS JiveX. With the system the Bochum IT service provider offers a series of functional and strategical enlargements to its users. By the integration of the ECG and the radiotherapy in the clinic-wide picture management for example other possibilities for efficiency increase and workflow optimization present themselves to the hospitals. The integrated picture and findings distribution with Web 2.0 technologies simplifies and accelerates, in addition, the work routines. The new version is rounded off by enlarged possibilities for the hanging protocols as well as a quicker loading speed.

Integration of ECG

The integration of ECGs is another, logical step for the implementation of a clinic-wide digital picture management system. With the JiveX ECG Modality Gateway DICOM capable ECG devices are connected to the PACS and integrated into the paperless working process. The JiveX ECG Workflow Module offers hanging protocols with automatically arranged ECG sheets, various examination functions (measurements, magnifying glass), as well as the possibility of a 1:1 paper print and the representation together with other admissions of the patient. The findings text is captured audit-proof in JiveX and therewith is available automatically within PACS. 

Integration of the Radiotherapy 

A clinic-wide picture management assumes among other things the logical support of the picture-giving devices beyond the radiology. The DICOM RT Module guarantees the storage and representation of planning data from the radiotherapy. Users have the possibility to load and process the picture data underlying to the radiotherapy planning, the planned radiotherapy dose data as well as the significant body regions or organ contours. In addition, it is possible to compare the different intensity of the irradiation of a region, e.g., to the target volume. 

Quick Picture Access

JiveX Review Web 2.0 allows the easy and quick access to pictures and findings via a web browser. All picture data are prepared for this automatically on the basis of standards and can be worked on interactively. The special JiveX streaming procedure transfers only the indicated picture information which is calculated on the web server. 

Coupling with the Telephone System

Via JiveX CallManager the PACS is connected directly with the telephone system. With incoming telephone calls the caller is identified and then the finding doctor receives a selection of the last examinations of the caller which he can access very quickly. Outgoing telephone calls are supported by a preselection in the electronic phone book according to the referring doctor of the study in process. The teamwork of information from the telephone system and the JiveX PACS manages the situational adjusted workflow. This saves time for the radiologist and he can work more stress-free.

The international activities are increasingly important for the IT service provider VISUS in Bochum. Today, the company may refer to more than 200 installations outside Germany. These are implemented by regional companies and local partners. Their care was also focused on during the Arab Health in Dubai and the European X-Ray Congress (ECR) in Vienna. "We would like to offer to our partners a drop-in center at which they can welcome their customers and present to them the solutions," explains Peter Rosiepen, with VISUS responsible for international sales and business development.

At the joint stand of the German Healthcare Export Group (GHE) VISUS presented itself to the Arab audience. "Here, by the good preparation of VISUS Middle East, we had some interesting and also concrete contacts," said Rosiepen. In addition, the company used the event to introduce four reseller won anew for the Arab region. At the same time new test installations in medical centers in Saudi Arabia, Kuwait, Qatar and in Oman were announced. "The digitization of hospitals in the region is only at the beginning. A big market with strong financial resources will open. I think that for us IT providers arise real chances in the times of the financial crisis, because by the use of modern IT solutions optimization potential and hence savings can be achieved, "Rosiepen looks confidently into the future.

The international sales manager was also extremely content with the ECR. "Particularly with prospective customers from the central European countries, the coming growth market, there were good discussions. Here we are represented locally by strong partners and the VISUS Central Eastern Europe which are pushing tangible projects. A major issue is the mammography screening, which is under construction in some countries in Central Europe and will run digitally. Also tele-radiological networks are asked for, like those VISUS has already realized in Germany, Finland and the U.S.

VISUS business has expanded and continues to expand

CEO Joerg Holstein is very satisfied when looking back on a successful year 2008 for his company VISUS. "Overall we have 100 new customers for our PACS solutions, 60 of them from Germany. It also reflects our development: Germany remains the main market but internationalization is taking on an increasingly important role."

Innovative Solutions to Convince New Customers

In the domestic market the digitization of the houses of Sana Southwest, the Clinical Center Landshut as well as the equipment of the Army Central Hospital Koblenz belongs to the outstanding projects. "The success in the market not only emphasize the great confidence in VISUS, they also demonstrate that our solutions actually help solve their problems," says Guido Boetticher, since October 1, 2008 as Sales Director responsible for Germany.

In this connection he singles out three solutions. With the function DICOM e-mail, users can build up an independent DICOM network over several locations. This creates a highly efficient image communication over secured data lines for non-time-critical applications such as image transfer to referring doctors and aftertreatment hospitals. In the context of a comprehensive PACS, VISUS focuses on the special solutions for endoscopy and cardiology. Both are consistently based on the DICOM standard and can easily be integrated into existing Networks. With JiveX Cardiology angiography and ECG recordings can be integrated, JiveX Endoscopy suits the purpose of DICOM video acquisition as well as image and video documentation. With both solutions the idea of a fully digital electronic patient record moves a significant step closer.

Well Established for Challenges

In future, the hospitals will even more be busy with two challenges: the amount of data will continue to grow and the information has to be made available in even higher security standards. To cope with this, VISUS, together with Telekom's subsidiary T-Systems, expands the services of external archiving (Storage Service Providing, SSP). "We guarantee the communication and data transfer for the hospital, archiving is done in the computer center of T-Systems. The solution combines installation, services and maintenance of the necessary systems. The service allows for flexible customer's payment depending on the usage. They pay per study or data unit (e.g. gigabytes) or simply a fixed price for each year of archiving. They do not have to invest in their own hard- or software", Holstein explains the model.

For 2009, Peter Rosiepen, since October 1, 2008 responsible for International Sales and Business Development, expects a long-growing international business". Emphasis will surely be on the US market but also the Middle East is developing well. In the Eastern European countries we will become more active by new partnerships."

Workflow Optimization with Universal PACS Solution

MEDICA pulls positive result for VISUS

Bochum, December 2, 2008 - "We could observe on this year's MEDICA again a strong inquiry for our solutions and have carried on many high interesting conversations with decision-makers from hospitals", Peter Rosiepen, responsible for the international distribution and business development at VISUS, draws a positive conclusion for the 40th world forum of the medicine. Besides, he sees the demand as a reflexion of the risen number of PACS biddings and decisions in the running off year. "In the focus of the interest stands the subject workflow optimization. In times of invariably growing data amounts hospitals are anxious for taking the rising pressure from the radiologists by a suitable IT support. By structured processes the finding for example should thus be accelerated and the picture distribution clinic-wide or even across houses be realized", Germany sales manager Guido Bötticher complements.

Comprehensive image management

Thereto a comprehensive, digital image management is necessary. That is what VISUS has presented with the JiveX Enterprise PACS on the MEDICA. With it hospitals can implement comprehensive solutions, beginning from the image acquisition, image distribution including digital diagnostic report up to x-ray rounds and picture archiving. All important applications are provided with a universal platform on the basis of modern web technologies for every workstation in the house. Thus it is possible to integrate other image sources beside data from the radiology, cardiology, endoscopy and sonography also.

With JiveX Radiology the communication is expanded facility wide. Thus can be set up easily the teleradiological services with which explicitly time and money can be saved for the transport of the x-ray images. Because all images and findings are constantly available, the diagnostics is improved and a therapy can be initiated faster. Another aspect is the realisation of the medical background service from home. With the function DICOM e-mail an independent DICOM network across several locations can be built up at a reasonable price. Thus a highly efficient picture communication via secure data connections originates for not time-critical applications, for example, the picture transference to referring doctors and further treating medical centres.

The product range of VISUS is complemented by JiveX ASP/SSP (Application Service Providing / Storage Service Providing). This gives the customer the ability to outsource the PACS with longterm archiving into a data center. This pay-per-use model offers the customer to run a cost-efficient business. Because the payment is purely charged after the degree of utilization, there are no investments necessary and therefore no binding of capital. The costs are predictable, because no additional expenditures incur for migration, administration or servicing.

Hospitals have to digitally keep medical documents audit proof with a lot of material and personnel efforts. Telekom subsidiary T-Systems - together with VISUS - now offers a solution, which will relieve you of installation, maintenance and services for the necessary systems according to the principle "Software as a Service". Customers are able to rent Services on a flexible basis. They will pay per examination respectively per data unit (e.g. Gigabyte) or they simply pay a fixed price for each year of archiving. So they do not have to invest in their own hardware and software.

This solution is already successful in the market. At present VISUS and T-Systems are taking over external long term archiving for three hospitals of the Evangelischen Stiftung Augusta in Bochum, Germany, starting with a data amount of more than ten terabyte. A user hotline comes with the offer of T-Systems and VISUS. Also included in this service is the necessary data and/or hardware implementation within the scope of the stipulated term of safekeeping. The digital long term archiving solution has been developed according to the regulations of the IHE (Integrating the Healthcare Enterprise). It aims at unifying data exchange in using standards like Health Level 7 (HL7) and DICOM (Digital Imaging and Communications in Medicine). With that the development, awarded and prize - given by the State of North-Rhine Westphalia, ensures a high degree in investment security for customers.

Sana Southwest will little by little provide its five houses in the region with the digital picture communication and archiving system (PACS) JiveX by VISUS. The central PACS component will be implemented in the Karl-Olga-Hospital in Stuttgart. After finishing the project the Sana heart surgery clinic Stuttgart, the hospital of the Red Cross in Bad Cannstatt, the Sana clinic Bad Wildbad and the Sana clinic Zollernalb will have at its disposal a local, highly available and independently usable systems. All data -  a volume of about eleven TeraByte per year is expected - will be transferred to a mirrored, audit proof long term archive.

The Bochum IT service provider VISUS looks back on a successful year 2007, as Joerg Holstein, CEO, says, "All in all we were able to win 90 new customers for our solutions and to increase our return by almost 40%. Germany will always be our main market however internationalizing is taking up a more and more influential role."

Internationalization goes forward

Therefore, together with a partner, the joint venture VISUS USA was founded at the beginning of this year. It started with the Radiology Associates in Lethbridge, Alberta
as customers and since then is successfully working on the North American market.

On the strategically important future market of the Middle East VISUS has also won a first project, "The Bahrain Defense Force Hospital will set up the Enterprise PACS JiveX clinic wide. The military hospital in the capital Manama with its 400 beds is he second largest clinic in the country and is equipped with more than 13 specialty departments.
At present we are planning to enlarge the sales area in this region", Mr. Holstein says. Still, sales are locally taken on by a partner.

Business in the European countries is continually developing, especially in Scandinavia, Eastern Europe and the Benelux Countries. In 2007 new customers in Southern Europe and Turkey joined.

According to Mr. Holstein the high interest in these markets was also reflected during several fairs. "We were highly content with our participation at the Arab Health, the RSNA and the European Radiology Congress. Aside from looking after our customers and partners we were able to make most useful contacts and to present our products in new markets. "

PACS for varied applications

But also with its other solutions VISUS is well positioned. This can in particular be seen in mammogram screening where by now the company provides nearly 30% of the German screening units, entirely with its solutions for image logistic and findings.

Currently JiveX evolves far beyond radiology and - with corresponding special functions - also covers the fields of endoscopy for DICOM video acquisition and image and video documentation as well as cardiology for integration of angiography and ECG images.

The IT service provider VISUS in Bochum has been assigned by the armed forces of the Kingdom of Bahrain to endow the Bahrain Defense Force Hospital with a picture communication and archive system (PACS). The Military Hospital in Riffa was opened in 1968. Today, with its 400 beds, it is the second biggest General Hospital of the country in the Kingdom of Bahrain. The hospital covers the whole spectrum of medical care in 13 specialist wards.

"In this first big PACS project in Bahrain we realize the entire picture management in the hospital. With our highly deployable Enterprise PACS JiveX we enclose the whole imaging including digital mammography," says Peter Rosiepen, sales manager at VISUS. The installation is supposed to be completed in October. "For us as provider the project represents an important reference in the attractive market of the Middle East and it is also a pioneering project for the region," Mr. Rosiepen underlines. In the Middle East VISUS is represented by its partner company Yousuf Mahmood Husain Co. W.L.L. which developed the PACS plans for t he Bahrain Defense Force Hospital and from now on will decisively be involved in the installation of the JiveX components as well as on the spot services.