A Federated PACS Platform - Towards True Imaging Interoperability
 
Authors:
Rasu B. Shrestha, MD, MBA, University of Pittsburg Medical Center; Nathan Lauffer; Brian Kolowitz, MBA; Dustin Schultz; Gonzalo R. Lauro, MBA; Harry Black, MBA
 
Background:
The University of Pittsburgh Medical Center is spread across a wide geographical area and comprises 20 hospitals and 30 imaging centers. Due to historical reasons and performance concerns, UPMC’s PACS landscape consists of multiple archives of imaging archives, including 12 distinct and separate installations of PACS in radiology that, until now, were distinct silos of information. Additionally, UPMC has several additional distinct repositories for a variety of what we term the “Department of Any-Ology” - with separate repositories for echocardiograms, cardiac caths, and nuclear medicine (Figure 1). We are also rapidly developing means by which any clinical department that captures digital images will be able to, in a streamlined manner, archive the digital imaging studies (such as retinal funduscopic images from ophthalmology and wound images from dermatology) directly to imaging archive. To address this multitude of problems, we have created a standards-based platform called SingleView that federates the PACS enterprise and provides, for the first time, a unified view of all of a patient’s priors and reports from across all hospitals in the federation (Figure 2).

Figure 1

Figure 1

Figure 2

Figure 2
 
Evaluation:
SingleView essentially creates a “Federated PACS” intelligently matching a patient’s MRN and other demographics with his/her other records across the enterprise and presents these in a single view. This platform is integrated directly into our clinical workflow environment, both in radiology, as well as in the other clinical departments across all 20 hospitals at UPMC. We have created a federated timeline of the patient’s studies that visually presents the patient’s exams across all instances of PACS in the federation. We discuss the tremendous benefits, seen in terms of increased clinical efficiency, stemming directly from the immediate and unified access to prior reports and images across the various imaging repositories. We also discuss the operational efficiencies and cost and resource savings as a result of decreased time spent per case. Additionally, we evaluate the various facets of improved patient care stemming from this new platform, including parameters such as increased patient safety and decreased radiation exposure due to a dramatic fall in the ordering of inappropriate studies (enhanced QA, QI and CQI). We also outline the cost savings derived from a clear decrease in NIA denials from a reimbursement perspective - seen as a result of this new platform.

Figure 3

Figure 3
 
Discussion:
On average, 23.1% of patients’ studies were found to have relevant priors in vaults other than the primary vault (Figure 3). Prior to SingleView, radiologists and clinicians were literally unaware of the existence or the location of those prior images and reports. Consequently, patients would get additional unnecessary tests performed, or would get a suboptimal report on a current study. In this paper, we discuss the technical challenges of creating such a federated platform, its applicability in other heterogeneous PACS environments, and share nuggets of lessons learned in this massive effort. We discuss its impact on patient care and how we have streamlined radiology operations and enabled centralized 24x7 radiology services. SingleView has enabled direct interaction with the interoperability platform for our EMRs, such that radiologists are able to get instant and clinically-relevant access to the right information via an uber radiology workspace (Figures 4 & 5). We discuss how we have architected the platform to be a true foundation for Imaging Interoperability by attempting to address facets of:
  • Knowledge Representation,
  • Information Extraction and Structuring,
  • Information Distribution,
  • Information Architectures, and
  • Information Retrieval.

Figure 4

Figure 4

Figure 5

Figure 5
 
Conclusion:
SingleView has provided a seamless platform of workflow integration across multiple PACS implementations in an era of distributed diagnostic imaging, amidst an environment of economic downturn and the need for enhanced clinical efficiencies and streamlined work environments. The objective for the pursuit of the Imaging Interoperability platform is to enable the coalescing of data, knowledge, and tools necessary to apply them in the decision-making process, at the time and place that a decision needs to be made. At UPMC, SingleView has successfully managed to break through the stalemate of what is the current state for most deployments at other hospital systems (i.e., are distinct and disparate silos of images and reports that do not interoperate across traditional jurisdictions).