Danish hospital makes progress with data system

Wireless technology may play an important role in future healthcare delivery. Portable handheld computers such as personal digital assistants (PDAs) and tablet PCs may let clinicians access trauma victims' imaging data or confer with surgeons regarding 3D reconstruction of a CT scan, all while still traveling to the trauma center. Surgical staff may use such devices to access preoperative plans to guide the emergency procedure. The clinician may later use wireless technology to evaluate laboratory results and diagnostic reports at the recuperating patient's bedside, while explaining to the trauma victim and/or family members the injuries sustained and treatments provided.

In an ideal world, such democratizing technology giving clinical users controlled access to relevant data at any location would be highly cost-effective, based on open standards, intuitive, minimally difficult to learn, and integrated rapidly into a facility or across a number of sites. This futuristic vision is now reality at Aalborg University Hospital, a 700-bed facility.

Aalborg is one of eight hospitals in the northern region of Denmark that, between them, have a total capacity of 1500 beds. Regional government is fully responsible for managing these local healthcare facilities. The hospital has implemented an image and data management (IDM) system that in many ways matches up to the ideal, as defined by clinicians and others.

The number of diagnostic procedures performed in hospitals throughout the industrialized world is escalating. Image data generated per procedure is exploding, while the number of qualified radiologists is either dropping or remaining fixed.[1] Radiologists are additionally pressured to provide timely, high-quality services to more parts of the healthcare enterprise, while budgets are increasingly constrained.

Aalborg University Hospital, together with the medical IT department in the regional government, began several review and planning programs in 1998 to assess digital IDM systems. Several conventional systems did not match the criteria. Conventional PACS and RIS solutions proved far too expensive and too difficult to implement, especially when considered for installation across a number of facilities. Other hospitals had begun quantifying the benefits and drawbacks of enterprise-wide and community-wide systems.[2,3] Having already spent significant funds on digital modalities with advanced 2D and 3D capabilities, the hospital sought a system that could provide easy and controlled access to digital imaging data, both within the facility and also remotely, via standard networks and wireless protocols.

Hospital staff became aware of a new IDM system developed by a Danish medical IT company in early 2002. The system, named EasyViz,[4] had not yet been installed or proven at a clinical site. Aalborg University Hospital and the vendor consequently entered into an agreement whereby the hospital purchased a limited version of the system in order to test it fully. Hardware and software installation began in July 2002, and by August the first staff members were using the system. It was fully operational a few months later, and by the end of December 2002, the six-month project was completed, including all independent medical and technical evaluations.

The EasyViz system is currently used by more than 70 staff members from seven clinical departments and covers 75% of the hospital's radiological studies. System acceptance has been rapid and problem-free. This is most likely due to training times of just five to 10 minutes to learn how to access the system's features.

The central server for EasyViz is a scalable Linux-based cluster of multiprocessor computers that acts as a PACS server, a data integration server, and an application server. All medical data and system functions are located on the server and accessed via common Internet connections. Access devices run a client application that connects to the server and allows interaction with the system. These devices include standard PCs running on MS Windows, thin clients (simple terminals/screens), wireless PDAs, and tablet PCs.

The client devices connect to the server, which also runs all operations. Only the final screen image is sent to and displayed on the client device. The Internet connection to the server can simply be regarded as a long monitor cable. A special module controlling communication between the central server and connected client devices covers data security, management of bandwidth, and data compression over the connection.

Although the client-server design may appear to be a step backwards to mainframes and terminals, the system offers numerous advantages. Images or data are never forwarded to any location from the central server, ensuring security and privacy. The configuration also allows images and data to be presented on any access device, regardless of its computing power or the network connection bandwidth. The server is responsible for all compute-intensive tasks. Data loading and access are fast, regardless of the number of studies examined or their size.

EasyViz addresses differing clinical needs. An orthopedic surgeon, for example, does not require access to the same data and analysis functions as a radiologist or a nurse working in the intensive care unit. Clinical application modules consequently provide patient data in a form suitable for different clinical specialties and procedures. User custom settings (profiles) define exactly how the data and diagnostic functions should be presented. These are based on user ID and location, time and date, examination type, and other preferred settings and rules defined by the user. Users can access relevant data in the required format with a single click of the mouse after smart-card logon. Because the clinical application modules plug into an open and standard interface, the system's clinical capabilities can be extended easily.

The IDM system promotes rapid and easy communication among clinicians, owing to applications designed to promote conferencing and remote working. Clinicians can also use wireless technology at the bedside to communicate with patients regarding disease and treatment plans. This has been shown to produce a greater level of patient satisfaction in many cases.[5]

If an IDM system is to be adopted throughout an entire institution, it must be extremely easy to use, be available in the native language of the facility, and require minimal training times. New users with no prior computer or technical skills need just five to 10 minutes of training on EasyViz, due to the the system's intuitive way of interacting.

The EasyViz system includes full PACS archive and storage capabilities, key RIS functions, and integration with other data systems. Cost and size scale linearly with the amount of data handled and the number of users. This scalability applies both within a single site and across multiple integrated sites. Cluster hardware from IBM has full backup features, and archived data are always online. Studies at Aalborg University Hospital have verified that the system's cost is well below that of conventional systems, resulting in substantial savings.[6]

It is essential for an IDM to integrate with the PACS, RIS, and HIS, as well as other data systems. Such integration must be flexible, effective, and based upon open standards whenever possible, another advantage of the EasyViz system. The PACS server supports all storage and handling functions under DICOM 3.0, while integration interfaces support HL7 and technical frameworks specified under the Integrating the Healthcare Enterprise (IHE) initiative. Built-in security features allow configurable encryption levels and access control, which are essential when remote access or wireless access is provided on the central server.

Constant budget constraints make it necessary for an IDM system to pay for itself through measurable efficiency improvements. Overall system costs need to be significantly less than those for conventional systems. This is not an unreasonable prerequisite, given that IT costs have dropped dramatically, while costs for conventional PACS and RIS have remained relatively stable and high.

We performed a medical technology assessment during the last few months of the project at Aalborg University Hospital. Several committees of independent experts assessed the system thoroughly before concluding that it fulfilled its claims of cost-effectiveness, ease of use, clinical relevance, scalability, and technological superiority.

The EasyViz system could also increase the return on investment of future acquisitions of diagnostic imaging equipment via greater utilization and broader distribution of scanner capabilities. In other words, as more clinicians and other nonradiologists can directly access the full diagnostic images from scanners, capital investment in these scanners becomes more cost-effective. Clinicians, technicians, and management have all been highly receptive, owing to the IDM system's ability to address their diverse and ambitious needs.

Aalborg University Hospital, with the related region in Denmark, is in the process of implementing a medical image and data management system that promises to fulfill the requirements of an ideal IDM system. Our vision of an ideal medical IT system is becoming a reality. In the future, other hospitals may not need to settle for less.

DR. GREGERSEN is a radiologist and DR. SOHOLM is chief of radiology at Aalborg University Hospital of angstrom rhus University in Denmark.

References

1. Amis ES. Current and future status of radiology human resources in the United States. Invited presentation at Management in Radiology meeting, Paris, September 2002.

2. Navein J. The north-west region community PACS study (UK). J Telemed Telecare 2002;8 Suppl 2:67-69.

3. Cox B, Dawe N. Evaluation of the impact of a PACS system on an intensive care unit. J Manag Med 2002;16(2-3):199-205.

4. Medical Insight A/S. www.medical-insight.com.

5. Wadley BD, Hayward U, Trambert M, et al. Are referring doctors ready for enterprise and community wide immediate image and report access? J Digit Imaging 2002;15 Suppl 1:140-143.

6. Aalborg Hospital Planning Department. Medical technology valuation of the EasyViz IDM system. Internal Report (in Danish), February 2003.