Slide 1 Welcome

iSite PACS Introduction and Workflow

Michael Ramos Radiology Informatics February 2008

Slide 1— Philips iSite PACS Introduction and Workflow

Facilitator Instruction

Sample Script

Slide 2 Training Introduction

Our work and the role we play

Why We are in Business • Our work affect others - In the Recovery - On the Floors - Nursery - ICU - Operating Room - Other?

• Our systems Impact - Lives - Treatment - Medical Staff - Financial Impact

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Slide 2— Our work and the role we play

Facilitator Instruction Introduce Philips’ mission to serve physicians, clinics, and hospitals for the benefit of the sick and ailing.

Sample Script At Philips Medical Services and Informatics, we are in the business to service customers and their critical needs. We provide the PACs system, which integrates, relates, and manages all the various hospital systems and radiology imaging modalities. Our customers, the people who really use the system, truly rely on our system to provide life critical information in a timely, accurate, and stable manner. For this reason, your support of our systems is critical to how effective our customers are on the job. Our PACS delivers to patients, technologists, and physicians information which saves lives while promoting the overall quality of life for those in need of care. As you know, lives, trauma, and broken bones need to be treated right away. For iSite PACS stated simply, the response of our systems and our ability to support our PACS affects lives. Our Data Center supports our image on demand technology or PACS, which ultimately services patients by allowing a medical facility to do its job and provide a quality healthcare experience.

Slide 3 Introduction Activity

Activity 1: Introductions and Expectations Overview Open your Activity Book. Answer the questions, and introduce yourself: 1. Name and work experience 2. Position and role at Philips 3. Training expectations

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Slide 3— Activity: Introductions and Expectations

Facilitator Instruction Facilitate the Introduction Activity. You may also want to introduce the Activity Book and how it will be used in context to the course.

Ask the class to introduce themselves to the group and to identify their key expectations for the three days of training. On a flipchart, capture the participants’ expectations and begin collecting a “Parking Lot” of expectations that are out-of-scope of the training.

This activity is two fold. The first is to reinforce the relevance of the training and the other is to ensure participants know when their expectations are met. The other purpose of the flipchart is to identify input, which is clearly outside the scope of the class. This feedback should be identified as such and flagged for the class.

Sample Script Let’s start the class by getting to know one another. I’d like us to go around the room and introduce ourselves. In your introduction please state your name and your expectations for the iSite PACS training.

Flipchart 1 Expectations

Flipchart 1— Student Expectations

Facilitator Instruction Introduce yourself, your experience, and your expectations. Ask the participants to go around the room and do the same. Use the Expectations flipchart as a master “checklist” throughout the training. During the training, when a topic is covered, be sure to “check-it-off” the Expectations flipchart and let the class know the topic was covered. This behavior on the instructor’s parts reinforces their support of the student’s learning and the relevance of the training. Per student, listen to what the participant has to say. When each person is through speaking, rephrase and summarize their expectation. Ask them to validate your synopsis, and then capture on the flipchart the expectation. Complete this step for each participant. After all participants have verbalized their expectations, review the list. In reviewing the list group your feedback according to the day the topics is covered.

Sample Script While you talk to make sure I capture your input correctly, I’m going to write your expectations on a flipchart. Throughout the training, I’ll try to call out your particular areas of interest and keep a running tally of what’s been covered.

Flipchart 2 Parking Lot

Flipchart 2— Parking Lot

Facilitator Instruction While you identify the expectations that will be met during the course of training, you should also keep of “Parking Lot” of expectations and issues that arise during training, which are outside the scope of training. If there is other training available which meets the expectation let the learner know where to find it. If there is no training and some other means for the learner to receive the training, let them know. When you have no idea what a learner should do, let them know.

The “Parking Lot” flipchart is a list of topics and issues outside the scope of training. The Parking Lot may also contain “actions” or topics you commit to research for a class.

Sample Script The interstices and complexities of ConnectR are fascinating and a deeper level of knowledge than we cover in training. On Day 3, there is a ConnectR overview, which may not be to the depth you seek. Right now, there is no ConnectR course offered by RIBU. I will add this to the Parking Lot and see what I can find for you before the end of this training.”

Slide 4 Training Goals, Agenda, and Objectives

Training Goals 1. Based on a customer problem description, quickly identify where in the PACS system an issue is likely to reside and the appropriate steps to resolve it. 2. Working from a customer perspective, install iSite Radiology. In iSite Enterprise and iSite Radiology query, navigate, and set user, system and machine preferences. 3. From a technical support perspective, use iSite Enterprise and iSiteweb to view access, patient, and exam data. Begin to troubleshoot problems and address issues.

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Slide 4— Training Goals

Facilitator Instruction Communicate the goals of the training, which are to: provide an overview of the iSite PACS applications and systems; introduce the basic activities performed in iSite Radiology and iSite Enterprise by our customers and call support professionals; demonstrate how iSite Enterprise, iSiteWeb, and iSuite are used by the technical support staff.

Sample Script More than anything, we hope once the training is over you have a good idea how iSite PACS works, where troubles occur, and the path of escalating an issue through technical support. In addition, we hope you, like our customers, can use iSite Radiology and iSite Enterprise. I’m not saying you will be a radiologist, but rather you will know the types of activities radiologists and medical staff do with our products. In doing so, we hope you become comfortable with the language, terms, and codes used by medical professionals. And finally, we intend for you to be familiar and comfortable with the applications that we use in technical support to diagnosis problems, troubleshoot issues, and resolve Heat tickets. Upon completion of this training to sum it up, you should be able to speak knowledgably to your technical support peers and our iSite Enterprise and iSite Radiology customers about our PACS system.

Slide 5 Training Goals, Agenda, and Objectives

Training Agenda DAY 1

DAY 2

DAY 3

PACS Concepts

iSite Radiology & Enterprise

iSuite

• Introduction

• Query & Navigate

• Access

• PACS Vocabulary

• Exam Dialog

• Locked Exams

• Informatics Workflow

• Image Dialog

• Statistics

LUNCH

LUNCH

LUNCH

• Imaging Basics

• Overlays

• Linking

• PACS Architecture

• Memos

• Heartbeat

• Preferences

• iSiteWeb • Logs

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Slide 5— Training Agenda

Facilitator Instruction Provide an outline of the week. Introduce the training focus per day.

Sample Script To begin the week, we work hard on developing a PACS and medical vocabulary. These are not always the same. Some terms they share. Some are unique to PACS and some to the medical profession. I’ll also introduce the Informatics workflow from beginning to end. We’ll cover the PACS system flow from the perspective of people, their roles, the information transferred, images captured, and status code changes. After lunch, I’ll introduce imaging basics and you’ll learn how our customers use iSite PACS in a medical environment. Later in the afternoon, I’ll introduce the PACS architecture and we’ll conclude the day with an assessment of what you learned.

Day 2, we really dive into iSite Radiology and iSite Enterprise. To support our customers, you need a clear understanding of how our products are used, because it relates to the way problems are communicated to technical support. Day 3 is focused on iSuite and the administrative and backend support of our products and customers. On this day, we will look at the logs, audits, statistics you reference to identify and diagnose issues. Along with the logs, we’ll look at the tools you use to set access privileges and perform basic iSuite administrative tasks.

Slide 6 Training Goals, Agenda, and Objectives

Day One Learning Objectives Upon completion of this course you will be able to identify and describe: • Key people, processes, and technologies in the PACS workflow • Various medical imaging technologies • Anatomical terms, abbreviations, and positions of location • Clustered, stand alone, and high availability environments • iSite PACS 3.5/3.6 architecture and system flow • ConnectR and the iSite PACS data flow • iSyntax

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Slide 6— Day One Learning Objectives

Facilitator Instruction Identify the learning objectives, performance outcomes, and training intent.

Sample Script Before we dive into the content, let’s take a moment to look at today’s learning objectives. In order to be effective on the job, you need to be comfortable with the people, processes, and technologies contributing to iSite PACS. To be able to communicate to our customers, you must be able to interpret and speak their language. For this reason you must be comfortable in identifying various medical imaging technologies, anatomical terms, anatomical positions of location, and their abbreviations. In addition, you must understand and be able to speak directly to the three iSite PACS environments: Stand Alone, Clustered, and High Availability. And finally, before returning to your regular duties, you will be able to identify where ConnectR, HL7, and iSyntax are used and describe what they do.

Slide 7 Philips Introduction

Introduction Philips’ iSite PACS • Critical patient healthcare application • Institutions distribute, manage and store medical images • Improves the delivery of patient radiological information • Efficient and cost-effective

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Slide 7— Introduction

Facilitator Instruction Communicate Philips iSite PACS is the leading enterprise-wide medical image and information management system on the market today.

Sample Script iSite PACS is an innovative image and information management system that delivers on-demand diagnostic-quality images over existing hospital networks. It includes advanced radiology reading stations for radiologists, and provides "always online" and “always available” long-term storage.

iSite PACS aims to improve the delivery of patient care and safety. The Philips iSite PACS solution enables healthcare institutions to distribute, manage and store medical images and related patient information in an efficient and cost-effective manner.

Slide 8 iSite PACS Introduction

iSite PACS

iSite Enterprise

iSite Radiology

Web-Based Distribution

Radiology Reading Review Software

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Slide 8— iSite PACS

Facilitator Instruction Introduce the iSite PACS solution, iSite Enterprise, iSite Radiology, and the value proposition.

Sample Script Philips' iSite PACS is reshaping the medical imaging and information industry landscape. As one of the fastest growing enterprise PACS in North America, iSite PACS is proving that filmless enterprise distribution is possible — without the prohibitive up-front capital expenditures and limiting technology associated with traditional PACS. iSite PACS integrates into a health care institution's existing infrastructure. With Philips' Enterprise, hundreds of leading hospitals and imaging centers are increasing overall productivity and improving the level of care delivered to their patients.

iSite Radiology is designed to drastically improve reading efficiency and radiology workflow. As you will see, it separates navigation controls from image display on the diagnostic monitors and provides a streamlined interface, which enables quick access to all functions, features, images, and relevant patient information. With iSite Radiology typically, all current and prior exams are presented within three seconds.

Slide 9 iSite PACS Introduction

Day 1 Overview 9 The importance of our work / The Big Picture 9 Introductions and Activity 9 Schedule, Participation, Lunch, and Breaks • Why Philips PACS ? – Technology – Financial Benefits – Exceptional Applications – Support Services • Other PACS – Why we’re special – How we compare • Our PACs – Primary Customers – Work and System flow – Products we support

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Slide 9— iSite PACS Overview

Facilitator Instruction Introduce the topics to be covered in the remainder of this module, i.e., the unique and beneficial aspects of Philips’ technology, financial model, and professional support.

Sample Script Let’s take a moment and look at what we’ve covered and what we are about to cover. Now that we have our introductions covered. Next, we will examine what makes Philips’ iSite PACS special and unique. By special what I mean is our technology, the financial model we offer, and the support we provide is special.

Slide 10 iSite PACS Introduction

What is PACS? • PACS: Picture Archiving and Communication System • iSite PACS: iSite Enterprise and iSite Radiology iSite Enterprise – used throughout hospital, clinic, or medical facility.

Surgery

Emergency

Pediatrics Oncology

iSite Radiology – used by Radiology Cardiology OBGYN CONFIDENTIAL

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Slide 10— What is PACS?

Facilitator Instruction

Sample Script The design of iSite PACS reflects the realities of hospital environments from a clinical, financial, technological and operational perspective. From small community hospitals to large multi-site academic institutions, iSite PACS can scale and integrate into a hospital's existing network. As you can see from the diagram iSite Enterprise touches every department in a hospital, while iSite Radiology provides a “work-horse” tool used by radiology departments.

Slide 11 iSite PACS Introduction

Why Philips? • Our customers choose Philips iSite for a number of Reasons. –

Technology

– Financial

– Services CONFIDENTIAL

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Slide 11— Why Philips?

Facilitator Instruction Answer the question, why customers choose Philips?

Sample Script iSite PACS was designed by clinicians who believe that improved patient care is the most important goal when developing a product. Clinical time should be spent on diagnosis and therapy, not trying to decipher multiple tabs and buttons. From an easy-to-use interface to having all images archived online and immediately available with the click of the mouse, iSite PACS provides tools to deliver the best possible care to patients. And because we believe that PACS can be life critical, Philips provides a 99.99% uptime guarantee and 24/7 access to support professionals. The Philips' delivery model is unique to the industry and so is our financial model. Our customers quite simply pay by the number of images they capture.

Slide 12 iSite PACS Introduction

Slide 12— Traditional PACS System

Facilitator Instruction Describe a traditional PACS system.

Sample Script Current medical imaging systems approach the management of digital images through a "brute force" solution. These systems are built on the assumption that the complete study has to be delivered to the user before viewing. These PACS use dedicated high-end networks, complex pre-fetching and routing algorithms and expensive workstations to deliver massive amounts of data. They are expensive to maintain, require a dedicated support staff, and a continuous growth of hardware and storage. iSite PACS moves these responsibilities from hospitals, clinics, and medical facilities.

Slide 13 iSite PACS Introduction

Slide 13— iSite PACS and iVault

Facilitator Instruction Introduce the iSite PACS architecture and value to customers.

Sample Script The iSite PACS architecture reflects the realities of hospital environments from a technological and operational perspective. From small community hospitals to large multi-site academic institutions, iSite PACS can scale and integrate into a hospital's existing network. Using a standards-based, single database solution, iSite's architecture improves workflow and efficiency across the entire enterprise for clinicians, technologists, the IT department, and administrators. By utilizing a single database, iSite PACS eliminates archaic pre-fetching and auto-routing schema. Faulty interfaces, corrupted data, and exceptions handling no longer require extra effort to ensure PACS and other hospital databases are synchronized. The iSite PACS solution truly makes good on the promise of "images and appropriate information anytime, anywhere."

Slide 14 iSite PACS Introduction

Philips Technology Advantage • Technology – Architecture: open, scalable, and robust – Image on Demand: Intellectual Property (IP) • iSyntax: Proprietary algorithm for distributing images

– Integration: Ensures consistent continuous workflow – Configuration: Easier to trouble shoot and maintain

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Slide 14—

Facilitator Instruction Introduce Philips’ technology advantage and iSyntax.

Sample Script So far we have discussed the architecture, ease of integration, and configuration advantages for our customer. Let’s take a moment to discuss iSyntax our proprietary technology, which makes a lot of these advantages possible. iSyntax is based on mathematical representations of images called wavelets, which enable the on-demand delivery of image data. As a result, users receive instant access to as much imaging data as they require. This advanced technology delivers fullfidelity medical images over existing hospital networks, making large infrastructure upgrades unnecessary. iSyntax provides real-time access between modalities, PACS, and the RIS or the Radiology Information System. It delivers the truly integrated data necessary in a clinical setting.

Slide 15 iSite PACS Introduction

Philips Financial Benefits • Imaging Centers, Clinics, Hospitals, and Enterprises – Sales Model • Customer pays per study

– Cost • Start Up costs are generally less • Cost distributed over time rather than loaded upfront • Support, training, and hardware included in purchase

– Benefits • • • •

Manage cost over time Reduces assets to manage Quality assurance Better customer experience

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Slide 15— Philips Financial Benefits

Facilitator Instruction Introduce the sales and cost model. Describe the benefits to customers.

Sample Script When a hospital or clinic maintains its own hardware and infrastructure, in terms of cost, they have to plan and include managing the lifespan of equipment, upgrades, IT support and maintenance. Philips simplifies these tasks for hospitals, clinics, and their IT organizations. As part of our services, when there are performance issues, Philips takes the initiative. This is the role of the Philips’ CA or Customer Advocate who represents makes decisions and determinations about the customer’s hardware, network, etc.

Slide 16 iSite PACS Introduction

Philips’ Service is Special • Service –

Included in package

–

Immediate Response to Calls

–

24/7 Coverage

 Professional Staff

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Slide 16— Philips Service is Special

Facilitator Instruction Introduce the Philips’ service model, support staff duties, and customer expectations.

Sample Script The Philips’ iSite PACS saves customers in the end. Philips does not measure nor charge by time. All support costs are included in our service. The Philips’ support model may appear a little more expensive at first glance, yet it is more inclusive and less overhead for customers, because our support features short response time, immediate attention, 24/7 coverage, and a dedicated professional staff.

Slide 17 iSite PACS Introduction

Call Center Value Add DESCRIPTION

EXPECTATION

• Call volume

HIGH

• Wait time

SHORT

• Resolution

IMMEDIATE

• Customer satisfaction

HIGH

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Slide 17—

Facilitator Instruction Relate the number of calls, wait time and other Call Center anecdotes.

Sample Script The Call Center is busy. As you can see from the slide, volume is high, wait time is short, and customers expect immediate resolutions. We generally receive over 200 hundred calls a day and customers typically wait about 30 seconds for someone to pick up the call. As we discussed, calls can be urgent, sometimes a matter of life and death, and therefore each is treated with high priority. For email, response time is about 18 minutes.

[NOTE: Information provided by Tony.]

Slide 18 iSite PACS Introduction

Ripple Effect DEPARTMENT Emergency

Surgery

Pediatrics

Oncology

Cardiology

OBGYN

COMPLICATION • Inappropriate Response • Need more surgery • Wrong placement

• Possible misdiagnosis • Treatment less effective • Less accurate • Less precision

• Mother’s health

IMPACT Patient • Longer time to heal • Longer more intense PT • Additional billing • Transportation & lodging costs • Medication Hospital • Staff not as prepared • Additional stress • Time delays • Quality of service

• Fetus’ health

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Slide 18—

Facilitator Instruction Explain how Call Center activities impact medical operations and the quality of patient care.

Sample Script The healthcare industry's critical nature demands the highest in quality standards from its professionals, products, and technology. Philips' mission is to deliver customer-focused, highperformance, medical information solutions through technical innovations and a commitment to total customer support. As you can see from the Ripple Effect, issues with iSite PACS or any PACS system impacts the quality of patient care and cost.

Slide 19 iSite PACS Introduction

Technology and Service • Philips vs. Competitors Technology & Service

Competitor’s Charge

Philips’ Provides

Database

$

9

Gateways/Applications

$

9

Brokers

$

9

Cache Servers

$

9

Web Servers

$

9

Storage Servers

$

9

Backup Devices

$

9

Technical Support

$

9

Training

$

9

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Slide 19— Technology and Service

Facilitator Instruction Distinguish between the iSite PACS model and the traditional PACS.

Sample Script In the traditional PACS, customers must pay for the various support services. With iSite PACS, these services are included in the overall cost per image captured and our support services are available around the clock for every iSite PACS customer in the world.

Slide 20 iSite PACS Introduction Summary

Why Philips? • Technology: Speed and reliable image management • Cost: Distributed over time • Service: Availability of technical professionals included in package

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Slide 20— Why Philips

Facilitator Instruction Summarize the key points covered so far.

Sample Script To summarize what we have covered so far, iSite PACS enables hospitals, clinics, and medical centers to provide fast, accurate patient care. The Philips’ pay-per-image cost model allows our customers to better manage costs over time and reduces the cost and support required by IT departments. Our service, I believe is the best in the business and our support services staff is a large reason why.

Slide 2` iSite PACS Questions?

Questions?

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Slide Title

Slide 2`— Questions

Facilitator Instruction Take questions. Use the Parking Lot if needed.

Sample Script OK. We have covered quite a bit so far. I think understanding our customer model is important, because it sets their expectation every time you pick up the phone. Are there any questions on what we have covered so far?

[NOTE: After you address the questions.]

I think I addressed your questions and I captured a couple of things to investigate in the Parking Lot. Now it is time for you to show what you learned.

Slide 22 iSite PACS Activity

Activity 2: Philips’ Technology Model

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Slide 22— Activity 2: Philips Technology Model

Facilitator Instruction Go around the room and ask the participants for input related to the question.

Sample Script Please open your Activity Book. Who can help me answer this question on the Philips’ technology advantages? Let’s see [First Name], what do you think?

Answer Key •

Real time RIS/HIS synchronized exam status and integration ensuring consistent continuous workflow

•

Immediate access to images

•

Legal storage per HIPPAA

•

Offsite disaster recovery

•

DICOM query archive

•

Architecture: open, scalable, and robust

•

Image on Demand: Intellectual Property (IP)

•

iSyntax: Proprietary algorithm for distributing images

•

Configuration: Easier to trouble shoot and maintain

Slide 23 iSite PACS Activity

Activity 3: Philips’ Financial Model

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Slide 23— Philips’ Financial Model

Facilitator Instruction Go around the room and ask the participants for input related to the question.

Sample Script Great. Thank you. Now, who can help me answer this question on the Philips’ financial model? Let’s see [First Name], what do you think?

Answer Key •

Customer pays per study

•

Cost distributed over time rather than loaded upfront

•

Start Up costs are generally less

•

Support, training, and hardware are included in purchase

•

Better manage cost over time

•

Reduces the total number of assets to manage

•

Better customer experience

Slide 24 iSite PACS Activity

Activity 4: Philips’ Service Model

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Slide 24— Philips’ Service Model

Facilitator Instruction Go around the room and ask the participants for input related to the question.

Sample Script OK, well done. I appreciate your input. Now, who can help me answer this question on the Philips’ service model? Let’s see [First Name], what do you think?

Answer Key •

Customer focused

•

Services are Included in the purchase

•

Immediate Response to Calls

•

24/7 Coverage

•

Professional Staff

Slide 25 End of Section

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Slide 25— Philips

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Slide 26 Workflow: People, Roles, Systems, and Status Codes

iSite PACS Workflow People, Systems, and Status Codes Michael Ramos Radiology Informatics February 2008

Slide 26— iSite PACS Workflow People, Systems, and Status Codes

Facilitator Instruction Introduce the Workflow portion of training.

Sample Script My goal in this next section of training is to introduce to you to the people, their roles, and the different systems involved in the iSite PACS workflow.

Slide 27 Workflow Overview

Overview People, Terminology and Systems

• Workflow • • • •

People and their roles Systems Data Status codes

• Systems and Protocols • HIS • RIS • DICOM • HL7 • PACS

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Slide 27— Overview

Facilitator Instruction Identify the various components of the iSite PACS workflow. Introduce the acronyms and abbreviations used to identify the different system.

Sample Script To understand the iSite PACS system, you must know the various people who touch the system, their roles, and the type of data the input, review, and interface with. In addition, as data moves through the system, various Status Codes are either automatically or manually changed. For the different systems, must have an acronym or abbreviation associated to it. Let’s take a moment to look at the primary ones. They are HIS, RIS, DICOM, HL7, and PACS, which you will learn more about in the next activity.

Slide 28 Workflow Activity

Activity 5: PACS Terminology

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Slide 28— PACS Terminology Facilitator Instruction The objective of this activity is to identify the “best” response for each term. Ask participants to complete the activity in their workbook on the own. Give the class five minutes to complete it. When time is up, review the answers. After each term ask for a show of hands of who identified the term correctly and whether there are issues with the answer and discuss the term. Sample Script Please open your Activity Book and complete the next activity. You can either draw lines to connect the term to the correct description or write the Description’s “letter” next to the term. Answer Key C = ConnectR: HL7 interface. G = DICOM: Digital image standard for medicine. A = DMWL: Modality Work list. F = HIS: Manages Hospital Information. B = HL7: Communication standard and protocol. D = Modality: Image capturing device. H = RIS: Manages radiology exams. E = Status Codes: One letter code found in HIS, RIS, and PACS.

Slide 29 Workflow Terminology

Terminology • H.I.S (Hospital Information System) – Patient records: registration, billing, and order entry • R.I.S (Radiology Information System) – Exams (orders), including filling orders and scheduling • PACS (Picture Archive and Communications System) – Manage, store and distribute images and related information • HL7 (Health Level 7) – Standards and protocols supporting clinical practice – Management, delivery, and evaluation of health services

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Slide 29— Terminology

Facilitator Instruction Review the systems and their descriptions.

Sample Script The last activity included brief descriptors for the various technologies and systems contributing to the iSite PACS workflow. Let’s review these terms. Would anyone like to read the first one, HIS or H-I-S?

[NOTE: HIS is pronounced “hiss” like the sound a snake makes.]

Slide 30 Workflow Terminology

Terminology (continued) • ConnectR – Interface engine that receives outside data messages, processes or translates this data and then updates this data into the database • Modality – Medical term for a variety of medical image capturing devices. – Some types include CT, MR, US, RF, CR, DR, NM, MG, XA • DICOM – Digital Image Communication in Medicine. – Imaging equipment communication standard • DMWL – DICOM Modality Worklist – Scheduled list of patients for a modality • Status Code – Single letter representing exam status in HIS, RIS, and PACS CONFIDENTIAL

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Slide 30— Terminology

Facilitator Instruction Review the systems and their descriptions.

Sample Script Would anyone like to continue with reading the description for ConnectR?

Modality is the “camera”. It’s the machine used to take an image or make an image capture.

How about DICOM, DMWL, and Status Code? Can I have a volunteer to read?

Slide 31 Workflow People and Roles

Radiology Operational Roles PACS Administrator: • Primarily oversees PACS system for the department. • Reviews and helps maintain image integrity. • Sets up users • Helps create or works closely with a R.I.S. Analysts • First line person to help troubleshoot issues pertaining to PACS. • Provides or assists in Training of Staff on PACS. Radiology Technologist Supervisors: • Manage day to day operations • Quality control of films • Can Assist PACS Administrator as a “Super-User” Radiology Technologist: • Acquire images from patient. • QA and complete exams. CONFIDENTIAL

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Slide 31— Radiology Operational Roles

Facilitator Instruction Introduce the key people who use iSite Radiology.

Sample Script The PACS Administrator is the IT person or organization responsible for the image distribution system. These people provide user access and. work closely with the RIS analysts regarding schedules, orders, and charges. RIS analysts are most often clinical. They may not have the IT level of knowledge, because they are clinical technologists rather than IT specialists. A Radiology Technologist Supervisor manages operations. They are the first to look at an image and determine whether the quality, clarity, etc. is technically satisfactory or “unsat” as they say for images that are not. The Radiology Technologist Supervisor works closely with the PACS administrator. A Radiology Technologist is the person who most likely will capture an image. They are the one’s who interface with the modality and patient.

Slide 32 Workflow People and Roles

Radiology Operational Roles Radiologists • Review studies on PACS, can transcribe or dictate their medical interpretation of the study. • Can perform image acquisition on specific modalities. • Many Radiologist specialize I.E. Muscular Skeletal, Neurology, Interventional Radiology...

Clinicians • They can be specialist or General providers. These are customers of the Radiology Department, as they send their patients to the department for services.

Film Clerks/File Room Clerk • Manage and maintain Radiology studies (Hard Copy Film) • Distributes copies of patients studies (Hard Copy or on CD/DVD)

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Slide 32— Radiology Operational Roles

Facilitator Instruction Continue reviewing the people and their roles related to iSite Radiology.

Sample Script Radiologists are doctors. They are the only one who review the studies, transcribe, or perhaps, if their system includes voice recognition, dictate their interpretations into the medical record. Clinicians place orders. They are the “customer” of the radiology department, because radiologists complete work for clinicians. The clinician provides the requests to the radiologists who fulfill it. Film Clerks and File Room Clerks maintain and manage the film or hard copies. They also distribute patient studies on CD, DVD, and film.

Slide 33 Workflow People and Roles

People, Roles, and Responsibilities ROLE

DESCRIPTION

Patient

Person requiring services.

Registrar

Registers and admits patient.

Physician

Doctor, clinician, or healthcare professional.

Scheduler

Schedule patient exam.

Technologist

Radiologist

Prepare modality, position patient, and capture image. Capture and interpret images. Refer as needed.

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Slide 33— People, Roles, and Responsibilities

Facilitator Instruction Summarize the roles. Introduce the icons, review the chart, and initiate the presentation on workflow.

Sample Script Let’s look at the roles of people and their duties in a PACS system. I will use these roles and the images in just a minute to outline the workflow and duties so you can see the different contributors and where their inputs occur. Before we do that, let’s review the various people and their roles.

[NOTE: Physician may include nurse practitioners.]

Slide 34 Workflow People and Roles

People and Work Flow

Registrar

Technologist

Technologist

Physician

Registers Patient

Queries Worklist

Begins Procedure

Views Study & Report

Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 34— People and Workflow

Facilitator Instruction Identify the various contributors, their inputs, and the flow of work through the PACS system.

Sample Script From the diagram, you can see how work flows through the PACS system and the people doing the work. Let’s start with the Registrar. This is the person who admits or enters the patient into the system. The patient is of course the person for whom the exam or a procedure is schedule. The physician or perhaps a nurse practitioner requests that an image of some type is needed. The scheduler schedules the event and coordinates the actions of the patient and the radiology department or group. The patient appears for the appointment and the technology must review the work list and prepare for the procedure. The technologist is also the one to do the image capture and complete the procedure. The radiologist is the one who must review, dictate, edit, and finalize the report for the physician who made the original request. OK, simple enough. Let’s continue.

Slide 35 Workflow Systems

Hospital Information Systems (HIS) • Departmental system databases typically store a combination of redundant and unique data • Patient IDs and demographics are common redundant data • Health care organizations usually assign primary responsibility for correctly identifying patients to a single department that manages the data in a single system

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Slide 35— Hospital Information Systems (HIS)

Facilitator Instruction Introduce and explain HIS.

Sample Script Now that we have identified the people and their contributions, let’s look at the first system of input the HIS or Hospital Information System. A HIS may be one or more information systems which store and manage all of the information regarding patients and their medical records. These systems are complex and may have multiple databases and applications to manage the entire patient profile across the various hospital organizations. For this reason, there is typically one organization at large hospitals and medical organizations who “own” this duty. By own, what I mean is they are the primary custodians, guardians, and keepers of the information for the entire organization.

Slide 36 Workflow Systems

Introduction of Hospital Information System • The department(s) with primary responsibility for patient ID usually use(s) a system commonly referred to as a Healthcare Information System (HIS) • Typical HIS functions are registration/admitting, and billing • Order entry, claims, clinical viewing, decision support, and other functions may or may not be supported by the HIS • The HIS is regarded as the master system

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Slide 36— Introduction of Hospital Information System

Facilitator Instruction Identify data that is in the HIS and not in the HIS.

Sample Script The HIS typically contains all the information related to registration, admission, and billing. Order entry, claims, clinical review, medical reports, and physician diagnosis are not kept in the HIS. This information is maintained and managed elsewhere, which we will discuss. One final and important point, the HIS is regarded as the master system for all patient demographic information. Let’s take a moment to look at the HIS, the contributors, and the types of information they work with.

Slide 37 Workflow Systems

Human Workflow System Data Stream

People and HIS Work Flow

Registrar

Technologist

Technologist

Physician

Registers Patient

Queries Worklist

Begins Procedure

Views Study & Report

Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 37— People and HIS Workflow

Facilitator Instruction Identify the HIS contributors and their inputs.

Sample Script If I could have you attention on the slide, you see in the PACS workflow the registrar, patient, and physician are the primary contributors into the HIS. The registrar ensures the patient has a medical record number and is in the system. The patient is the customer requiring treatment. Their profile must be in the HIS for the process to continue. The physician places the order into the HIS and from there the HIS data will continue with the patient’s image request record through the workflow.

Slide 38 Workflow Systems

Radiology Information Systems (RIS) • Radiology Information System (RIS) is a subsystem of the HIS. Orders can be created in HIS and RIS. • What are the components of RIS? – Schedule exams to specific modalities – Used to Complete Exams – Stores and distribute Reports – Billing generated from this system

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Slide 38— Radiology Information Systems (RIS)

Facilitator Instruction Identify components in a RIS. Introduce how the HIS and RIS work together.

Sample Script The Radiology Information System or RIS is the system, applications, and databases used by a medical radiology department or group. The RIS enables the staff to schedule exams to specific modalities and manage the data and files created during the exam and image capture. As I stated early, Philips is paid on a per image basis. So the RIS also generates or initiates the billing that results from the session.

Slide 39 Workflow Systems

HIS, RIS and Modality Work Flow

Human Workflow System Data Stream

Registrar

Technologist

Technologist

Physician

Registers Patient

Queries Worklist

Begins Procedure

Views Study & Report

Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 39— HIS, RIS, and Modality Workflow

Facilitator Instruction Identify the inputs into and from the RIS and modalities.

Sample Script Picking up with our workflow and systems diagram, you can now see where the inputs to the RIS occur and by whom. The scheduler, usually someone in the radiology department schedules the even for a specific modality. The modality is the type of image and machine used to make the capture. I will speak more on this next. The modality in addition to the capture of the image it provides the work list for the technologist along and the image’s data files. Once the image is captured by the modality, the RIS is also where the radiologist dictates, edits, and finalizes the report, which then becomes available to the physician through the PACS.

Slide 40 Workflow Systems

Examples of Common Modalities

Magnetic Resonance Radiographic Printers

Computer Radiography

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Angiography

Mammography

Floroscopy

Ultrasound Digital Radiography

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Slide 40— Examples of Common Modalities

Facilitator Instruction Introduce and identify some common PACS modalities.

Sample Script On the slide you can see several examples of the different types of modalities contributing to the PACS. The modality you may be most familiar with is Computer Radiography. This is an x-ray. Other modalities include magnetic resonance, angiography, ultrasound, digital radiography, nuclear medicine, fluoroscopy, and let’s not forget radiographic pictures, scanners, and printers.

Slide 41 Workflow PACS

Picture Archive Communication System (PACS) • PACS computers, networks, and systems dedicated to the storage, retrieval, distribution and presentation of images. – Medical images are stored in an independent format. – Most common format for image storage is DICOM (Digital Imaging and Communications in Medicine) – Includes images from various medical imaging instruments: • • • • • • • •

Ultrasound Magnetic resonance PET Computed Tomography (CT) Fluoroscopy Mammograms X-rays Scanners

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Slide 41— Picture Archive Communication System (PACS)

Facilitator Instruction Introduce PACS and

Sample Script In medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. The medical images are stored in an independent format. The most common format for image storage is DICOM (Digital Imaging and Communications in Medicine). Most PACS handle images from various medical imaging instruments such as the one’s we just saw. This includes ultrasound, magnetic resonance, PET, computed tomography, endoscopy, mammograms, etc.

Slide 42 Workflow: People, Roles, Systems, and Status Codes

Activity 6: Name the System

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Slide 42— Activity 6: Name the System

Facilitator Instruction Facilitate the activity. Have participants open their Activity Book and complete the activity.

Sample Script OK. Can you open your Activity Book to the sixth activity and complete as much as you can? If you do not know the answer, that’s OK. We will cover it next. Right now I am interested in learning what you already know.

Answer Key S = Scheduled I = In Progress C = Completed D = Dictated P = Preliminary F = Finalized Addendum

Slide 43 Workflow Systems

DICOM Overview • Digital Imaging and Communications in Medicine • Predominant communication protocol between imaging equipment throughout the Healthcare Enterprise – Object-Oriented Design uses tags to represent patient, modality, and image information – Entity-Relationship Model relates to the Application Entity (AE) Title – Client-server based protocol allows for communication between DICOM applications across the network.

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Slide 43— DICOM Overview

Facilitator Instruction Introduce and describe DICOM.

Sample Script Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system. The different devices come with DICOM conformance statements which clearly state the DICOM classes they support. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists' and doctors' offices.

Slide 44 DICOM Workflow

Human Workflow System Data Stream DICOM Data Stream

DICOM PACS Work Flow

Registrar

Technologist

Technologist

Physician

Registers Patient

Queries Worklist

Begins Procedure

Views Study & Report

DMWL

PACS Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 44— DICOM PACS Workflow

Facilitator Instruction Identify the DICOM inputs and DMWL data flow.

Sample Script Let’s look again at the workflow diagram. I would like to call your attention to the red arrows. The red arrows, as you can see from the key in the upper right hand corner, represent the DICOM data stream. The arrow on the left represents the DICOM Modality Work List or DMWL coming from the PACS. The technologist queries the PACS and retrieves the DMWL. When the DMWL is retrieved, it includes the patient’s medical record, scheduled procedure, and the modality used for the image capture. The technologist

Slide 45 Workflow and HL7

Health Level 7 (HL7) Introduction • Hospitals use many different computer systems • Systems communicate with each using HL7 – Consists of flexible standards, guidelines, and methodologies for communicating in a uniform and consistent manner – Allows for the easy sharing of clinical information – Makes medical care highly available regardless of locale • HL7 Messages and Templates – ADT (Admin, Discharge, Transfer) – ORM (Order Message)

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Slide 45— Health Level 7 (HL&) Introduction

Facilitator Instruction Introduce and describe HL7.

Sample Script HL7 is an organization providing a framework and related standards for the exchange, integration, sharing and retrieval of electronic health information. These standards support clinical practices and the management, delivery, and evaluation of health services. The HL7 international community of healthcare subject matter experts and information scientists collaborate to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all. HL7 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can do communicate. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information.

Slide 46 PACS HL7 Workflow

Human Workflow HL-7 Data Stream DICOM Data Stream HL-7 PACS feed

PACS and HL7 Work Flow

Registrar

Technologist

Technologist

Physician

Registers Patient

Queries Worklist

Begins Procedure

Views Study & Report

DMWL

ADT

PACS Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 46— PACS and HL7 Workflow

Facilitator Instruction Identify the PACS HL7 inputs and workflow.

Sample Script As you can see from the key in the right hand corner, the blue arrows represent the HL7 PACS feeds. These feeds occur primarily in three places. The first is when the event is scheduled in the RIS. The second is when the technologist completes the procedure and the third is after the radiologist dictates t he report. Notice, all three HL7 PACS inputs come through the RIS.

Slide 47 DICOM and HL7 Workflow

Activity 7: Identify DICOM and HL7 Flows

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Slide 47— Activity 7: Identify DICOM and HL7 Flows

Facilitator Instruction Facilitate the activity. Ask the participants to complete the diagram by indicating on the flow diagram where the DICOM and HL7 inputs occur.

Sample Script Please open your Activity Book to the seventh activity. Next to the appropriate arrows, indicate the HL7 and DICOM system and data flows. For arrows indicating human workflow, leave them blank.

Slide 48 PACS Workflow

Slide 48— PACS Workflow

Facilitator Instruction Review the PACS Workflow.

Sample Script This diagram represents the PACS workflow. iSite PACS 3.6 provides clinical information any time, any place to optimize patient care. In the diagram you see, the DICOM Modalities send images to the PACS using the DICOM service provided by the PACS. The modalities include some essential information from the RIS when sending images to the PACS. This information includes patient ID, accession number, study information, and procedure codes. The intent with iSite PACS is to streamline the complex workflow so clinicians can better focus on patient care. To streamline workflow, Philips uses its’ patented iSyntax technology which delivers advanced visualization capabilities such as integrated Maximum Intensity Projection (MIP), Multi-Planar Reformatting (MPR), and 3D rendering; advanced hanging protocols and mammography softcopy reading support; conference presentations; and teaching files support.

Slide 49 Workflow Status Codes

Exam Status Codes CODE

DESCRIPTION

Meaning/Comment

S

Scheduled

• Exam scheduled but not begun.

I

In Progress

• Patient arrived and exam begun.

C

Completed

• Exam completed and pending a report.

D

Dictated

• Diagnostic report dictated by radiologist.

P

Preliminary

• Diagnostic report transcribed for the exam.

F

Finalized

• Diagnostic report signed.

A

Addendum

• Addendum received and attached.

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Slide 49— Exam Status Codes

Facilitator Instruction Introduce and identify the workflow Status Codes.

Sample Script Status Codes refer to the status of the exam record throughout the workflow process. In some cases, a Status Code will automatically change such as when the procedure is scheduled. In other cases such as when the record is saved as a Presentation, the use action triggers the change from In Progress to Completed. Before we look at where the various Status Code “triggers” occur, let’s look at what they are, the Code, and what each means.

[NOTE: Read or ask for a volunteer to read through the Codes, Descriptions, and Meaning.

Slide 50 Workflow Status Codes

People, System and PACS Status Flow

Registrar

Technologist

Registers Patient

Queries Worklist

DMWL

Human Workflow HL-7 Data Stream DICOM Data Stream HL-7 PACS feed

Technologist

Physician

Begins Procedure

Views Study & Report

“I”

“F” “C” PACS Patient

Patient

Technologist

Radiologist

Admitted

Arrives

Completes Procedure

Finalizes Report

“S”

“D” “P”

Physician

Scheduler

Radiologist

Radiologist

Places Order

Schedules Procedure

Dictates Report

Edits Report

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Slide 50— People, System and PACS Status Flow

Facilitator Instruction Identify where the iSite PACS Status Codes are triggered.

Sample Script On this slide in the upper right corner you will notice the HL7 PACS feeds are added to the diagram. These feeds, the HL7 PACS feeds, are what change the Status Codes. Let’s go through the flow and Status Codes changes. As you can see, once the exam is scheduled, the status code changes to “S” for scheduled. Once the procedure is initiated and in progress, the status code changes to “I” for In Progress. This is automatic. After the technologist completes the image capture, the status code changes to “C” for Complete. “D” indicates the radiologist dictated the report and “P” shows that a Preliminary Report is available. The Status Code “F” means the report is finalized and available for the physician to review. As you may notice, “A” for Addendum can occur anywhere in the process and does not impact the workflow. For this reason, it does not appear on the diagram.

Slide 51 Workflow Status Codes Activity

Activity 8: Identify the Status Code

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Slide 51— Identify the Status Code

Facilitator Instruction Ask the learners to write a one or two word descriptor for each PACS Status Code. Give the class a few minutes to complete this activity then review the answers. Call on the students to provide the descriptions for each code.

Sample Script Please open your Activity Book and let’s look at the eighth activity and fill in the missing word or description for each code.

Answer Key S = Scheduled I = In Progress C = Completed D = Dictated P = Preliminary F = Finalized A = Addendum

Slide 52 Workflow Questions

Questions?

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Slide 52— Questions?

Facilitator Instruction Solicit questions from the group.

Sample Script OK, we have completed the iSite PACS workflow training. Before we continue does anyone have a question that they would like to ask?

Slide 53 Workflow Activity

Activity 9: Fill in the Flow Diagram

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Slide 53— Activity 9: Fill in the Flow Diagram

Facilitator Instruction Facilitate the workflow diagram activity. Have the class complete the activity and the Match the Terms (see next slide) activity. Once students fill in the diagram, ask them to please see the next slide and match the terms to its correct description. When everyone is finished, review each activity with the class.

Sample Script On the diagram, identify the missing people, roles, systems, protocols, and status codes. Where you see a line inside of quotes, i.e., “_____”, enter the PACS Status Code.

Review Ask for a volunteer to identify a portion the missing answers such as “who would like identify the People and their Roles?” Ask different participants to provide the answers Systems, Status Codes, HL7 feeds, etc. After you complete the workflow diagram, review the terms.

Slide 54 Workflow: People, Roles, Systems, and Status Codes

Activity 10: Identify the Terms

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Slide 54— Identify the Terms

Facilitator Instruction Facilitate the activity. Ask the class to indicate the “best” response for each term by writing the letter next to the term it describes or drawing a line to connect a term to its’ description. To review this activity, go around the room and ask the participants. Call on each participant at least once. Ask the class, if anyone had problems, concerns, or questions about the answers.

Sample Script Can someone tell me the description that goes with the term? For ConnectR. Who can help me?

Answer Key C = ConnectR: HL7 interface providing DMWL. G = DICOM: Object oriented, entity relationship, and client server. A = DMWL: List of scheduled patients on a modality. F = HIS: Creates Medical Record Number (MRN). B = HL7: Makes medical information highly available. D = Modality: CR, DR, RF, CT, US, NM, MG, PT, and XA. H = RIS: Schedules exams to modality. E = Status Codes: One letter code found in HIS, RIS, and PACS.

Slide 55 End

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Slide 55— Philips

Facilitator Instruction Thank the class and take a break.

Sample Script Thank you for the help and participation this morning. Let’s take a short ten minute break. Ok, please be back here at “00:00” [NOTE: provide the time the training resumes.]