Virtual Tour HUSpacs

September 1, 2003



A virtual tour: PACS in the hospital district of Helsinki and Uusimaa (HUSpacs)

HUSpacs is an ambitious project that aims to link all 21 hospitals within the hospital district of Helsinki and Uusimaa (HUS). By the end of 2002, 17 of these institutions will be running a filmless radiology service. The remaining four hospitals will join the network in 2003 along with 53 primary healthcare centers, nine primary healthcare hospitals, and private clinics.

Töölö Hospital, a 300-bed hospital specializing in orthopedics, traumatology, hand surgery, plastic surgery, and neurosurgery, became the first hospital in HUS to go filmless in 1999. PACS was then installed in the oncology department of Helsinki Central University Hospital in 2000. Three more hospitals connected to the network during 2001 and the next 12 in 2002.

HUSpacs will handle over one million new imaging examinations each year once the system is completely up and running. This represents an estimated 20 TB of data collected from more than 300 connected modalities. Imaging data will be stored locally for short-term use and on one central regional database for long-term and backup archiving.

The multimillion euro project is based on Agfa's Impax PACS.

 

"We aim to have seamless radiological services throughout the community, in hospitals, in the whole organization. We need images and reports to be available so there is no need to move our patients. We can have centers of excellence for medicine because we can retrieve reports from different places." Anita Suhonen, HUSpacs project leader

Welcome to Finland

Fast facts on Finland:

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Healthcare organization

The 450 local authority municipalities responsible for Finnish healthcare can:

Each municipality must belong to one of 21 hospital districts, which provide specialist healthcare services.

The hospital district of Helsinki and Uusimaa (HUS), the biggest in Finland, provides services to 32 separate municipalities.

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HUS

The hospital district of Helsinki and Uusimaa (HUS) is home to almost 1.5 million people, a quarter of the total Finnish population. The region is served by 21 hospitals, seven of which are grouped together on a central campus in Helsinki. These include Meilahti Hospital, the largest hospital in HUS, and several smaller hospitals dedicated to different specialties (e.g., oncology, women's health, ophthalmology, and otorhinolaryngology). A total of 130,000 examinations are performed annually at Meilahti alone.

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Countdown to completion

The ambitious HUSpacs project is one of the largest in the world.

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RIS/PACS link assists pre-exam administration

Credit: Yrjö Tuunanen/Agfa

The Helsinki Central University Hospital was the second hospital in the system to become filmless in its oncology department. Workflow at the cancer clinic is now close to the HUSpacs vision for digital integrated healthcare.

Requests and scheduling information are relayed from the hospital's RIS (one of seven different systems operating in HUS) to broker computers as HL7 messages. An integration platform buffers these messages. The brokers store requests on a database and produce work lists for each connected modality or individual room. The RIS also produces an accession number for each scheduled imaging examination.

The night prior to examination, the broker computers request previous imaging studies from the archive (via a workflow manager). Predefined criteria dictate exactly which studies are prefetched.

 

"At HUSpacs we have a technical architecture that is both distributed and centralized. This means that we have certain local components in every hospital or group of hospitals, and we have regional components that are shared by all these hospitals." Dr. Hanna Pohjonen, HUSpacs consultant

Department of Oncology

Fast facts on the oncology department:
 

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Digital imaging aids workflow

Credit: Yrjö Tuunanen/Agfa

Data from new imaging studies are transferred first to the workflow manager, which verifies and updates patient information and examination information via a broker. New images are then transferred to local RAID archives and routed to relevant radiological workstations and Web servers. The completed HUSpacs project will have over 100 radiological workstations and 15 Web servers.

 

"There are short-term and RAID archives in every hospital group. This is for archiving from one to two years." Dr. Hanna Pohjonen, HUSpacs consultant

Last few films?

Credit: Yrjö Tuunanen/Agfa

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Prefetching matches past with present

Credit: Yrjö Tuunanen/Agfa

New images routed from the local RAID can be viewed instantly on diagnostic workstations and compared with the prefetched studies. At the cancer clinic, radiologists check for new metastases and monitor the spread of preexisting cancerous areas. All nuclear medicine divisions in HUS are being integrated into the PACS as well, so that anatomical, metabolic, and radiological data can be compared side by side.

Backup and long-term storage of radiological reports and images is provided in an offsite centralized archive, run by an application service provider (ASP). Storage charges favor a large-scale project. The ASP would be paid approximately €3.5 per examination to store 20,000 studies per year, dropping to around €1 per examination for annual storage of 500,000 new studies.

 

"The vendor has committed to store the images for 20 years. That's Finnish law. In Sweden, for example, it is 10 years." Dr. Hanna Pohjonen, HUSpacs consultant

Widening access to images

Credit: Yrjö Tuunanen/Agfa

Clinicians and radiographers have instant access to new imaging studies, routed via a Web server. An HL7 message sent from the RIS indicates when a radiological report has been written.

 

"We have a lot of discussion about prefetching. It is a common tool. Clinicians have images from the Web server so that they don't have to wait before they get them. Clinicians are always in a hurry, and five seconds is too much for them."
-- Dr. Hanna Pohjonen, HUSpacs consultant

"Sometimes, patients need to have films if they are returning to a hospital where clinicians do not have monitors. Workflow only speeds up when the system is fully implemented."
-- Dr. Sören Bondestam, radiologist, Helsinki Central University Hospital

"You can't do anything if you don't have the right personnel. You have to get some clinicians with you, otherwise you will fail. They have to be keen on IT, and understand the importance of IT implementation in healthcare."
-- Dr. Jaakko Kinnunen, medical director of imaging for HUS

Homework is less of a chore

Credit: Yrjö Tuunanen/Agfa

Remote reporting is proving popular with consultants, especially those wishing to cut down on travel to and from HUS hospitals. Dr. Sören Bondestam, a radiologist, connects to HUSpacs from home through a virtual private network. Teleconsultations could also reduce the number of doctors needed on call and allow specialists to direct certain imaging procedures or operations from a distance.

 

"We think it is safe to say that point-to-point telemedicine is dead. Information is not sent and received any more, it is viewable." Dr. Hanna Pohjonen, HUSpacs consultant

working from home

Handheld devices are opening up greater opportunities for remote working. Dr. Jaakko Kinnunen, medical director of imaging for HUS, uses a PDA to view radiological report data from his boat.

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Ensuring smooth operation

Credit: Yrjö Tuunanen/Agfa

Each hospital connected to HUSpacs has a designated expert to deal with software, hardware, and administration glitches. Errors with patient ID or modalities, for example, can hold up digital workflow.

Problems with the network (HUSnet), which is based on asynchronous transfer mode technology, are the vendor's responsibility. Hospitals on the Helsinki Central University campus are connected with 155 Mbps bandwidth. Other hospitals have a bandwidth of 40 Mbps.

 

"A network should be very resilient, without doubt. The vendor has committed to a usability of 99.98%. This means 1.7 hours downtime every year." Dr. Hanna Pohjonen, HUSpacs consultant

Bringing general practitioners on board

Credit: HUSpacs

Networking primary healthcare units is a central part of the HUSpacs project. Examinations requested from primary healthcare physicians will be routed to the unit's Web server from whichever radiology departments within HUS they were obtained. The ordering physician will then view these images on a PC. Previous examinations performed in HUS, but not requested from that particular unit, will be retrieved from a regional "reference database." Finnish law demands that patient consent is needed for these requests.

Researchers are in the process of developing a strong authentication procedure for remote login, using a wireless public key infrastructure (PKI). The proposed system will take advantage of mobile phone SIM cards. PKI has yet to catch on in most countries outside of Scandinavia. Most existing strong authentication PKI solutions in Finland rely on smart cards, which are issued and regulated by local authorities.

 

"We trust explicitly in these PKI solutions. We should also have digital signing of requests and reports. That is something we are very keen on." Dr. Hanna Pohjonen, HUSpacs consultant

Virtual services for professionals and patients, anytime and anywhere

Technological infrastructure now in place throughout HUS may be used to provide services further afield. A centralized image processing service to hospitals outside the region, a virtual center for pediatric services, and a global reporting scheme using radiologists in Canada and Australia, are all under consideration.

 

"PACS is software and hardware and recording media. In order to utilize this PACS in clinical services, you have to reengineer your workflows and maybe build virtual services that extend beyond the hospital, and maybe beyond national borders or countries. We should have virtual services for professionals and for patients, anytime, anywhere." Dr. Hanna Pohjonen, HUSpacs consultant

"Forget savings from films and chemicals -- it's only 5%. The change in clinical workflow and the added value products -- build on these. They will bring the most economic benefits." Dr. Jaakko Kinnunen, medical director of imaging for HUS

Global vision

The HUSpacs vision of virtual healthcare extends far and wide.

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