making radiology work flow
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www.siemens.com/medical
Making Radiology Work FlowLinda DiMeo
The Next Frontier: An Integrated Medical Information Technology PlatformLaura Newman
Reprints from Medical Solutions, RSNA 2006
COVER STORYWORKFLOW
RADIOLOGIST JAMES BUSCH, MD, Director of Informatics for Diagnostic
Radiology Consultants, now also heads the private practice group’s IT arm called
Specialty Networks.
Making RadiologyWork Flow
Having the right information available at the right time and place, linking resources togetherand using them more effi-ciently, accomplishing moretasks in a shorter period oftime – in short, optimizingworkflow to improve qualityand reduce costs – is at thecenter of implementing infor-mation technology in health-care. A group of radiologistsin Chattanooga, TN, USA, notonly recognized this trend,but decided to go for it.By Linda DiMeo
COVER STORYWORKFLOW
During the past ten years, medicine has been
experiencing a trend toward decentralization,
with outpatient care becoming more the
norm. While this has resulted in the desired
cost efficiency, it has unfortunately also
resulted in a loss of communication between
healthcare providers, slower turnaround times
and greater opportunities for medical errors
caused by lost, outdated, or mistranscribed
data. With the aid of Siemens Medical
Solutions technology, Diagnostic Radiology
Consultants (DRC) has managed to integrate
a complex, multistate and multisite radiology
practice into an unified environment, which
has resulted in increased speed, simplicity,
flexibility, profitability, and, most importantly,
improved patient care and safety.
Founded more than 50 years ago, DRC is a
private practice group of eleven radiologists
who read and interpret approximately
200,000 cases per year, generated from
multiple sites across the greater Chattanooga
and northern Georgia region. As they would
travel from site to site to interpret images,
DRC radiologists found themselves changing
IT platforms with virtually every facility they
visited. The variety of radiology information
systems (RIS), picture archiving and commu-
nication systems (PACS), and postprocessing
systems they were using was causing con-
fusion, inefficiency, and delays. To complete
a case, a radiologist could deal with as many
as four different platforms, one for RIS, one
for PACS, one for voice interpretation, and
yet another for postprocessing functions. In
many cases, this involved moving back and
forth among several workstations, each with
a separate log on and password.
Adding to the inefficiency was the fact that
the radiologists were often unable to view
images that were taken at a facility with a
different PACS. And since the transcription
systems were not integrated with the RIS,
the radiologists had to redictate patient
information before even beginning the body
of their reports.
The DRC radiologists began discussing the
benefits of an enterprise-wide integrated
solution at all the facilities they service. They
decided to try to find a vendor that offered a
solution in which RIS, PACS, postprocessing,
and transcription came together in a compre-
hensive package. If such a product existed,
they talked about incorporating it into all of
the facilities at which they interpreted. From
that idea, Specialty Networks was born –
a corporation that would become the infor-
mation technology (IT) arm of Diagnostic
Radiology Consultants.
4 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
COVER STORYWORKFLOW
“We immediately began to assess the tech-
nology that was available to serve our goals,”
says James Busch, MD, Director of Specialty
Networks, and Radiologist and Director of
Informatics for DRC. “Not only did we want to
find a vendor that would be a good partner
and offer an enterprise-wide solution, but
also one that was looking down the path of
integration for the future.” From fall 2004 to
summer 2005, Specialty Networks conducted
vendor evaluations, and in the end, chose
Siemens Medical Solutions.
“Siemens was the only vendor that offered
exactly what we were looking for and was
also interested in continuing to refine the
integration of the various software platforms
that radiologists use to do their jobs,” says
Busch. Specialty Networks chose syngo® Suite,
a comprehensive IT solution from Siemens
that provides integration at the RIS, PACS,
postprocessing, and transcription levels. On
the RIS end, syngo Workflow manages the
processes for the exchange and distribution
of patient data and images from end to end.
The PACS applications for diagnostic prepara-
tion, quality assurance, and diagnostic inter-
pretation are bundled into syngo Imaging.
syngo Voice* is the component of syngo Work-
flow offering voice recognition and transcrip-
tion solutions within syngo Suite. Specialty
Networks chose Siemens strategic partner
NextGen Healthcare Information Systems,
Inc., a leading provider of electronic medical
record and practice management solutions,
to provide its electronic practice management
(EPM) solution. Siemens had been working
closely with NextGen to streamline the patient
experience from patient access through
diagnosis to treatment. The NextGen® EPM
solution has been completely integrated with
syngo Suite, extending the comprehensive IT
solution to include scheduling as well.
Thus, with one keyboard, one mouse, and a
single password-protected log on, syngo Suite
would cover the entire imaging process for
Specialty Networks, from patient registration
and diagnosis to image distribution. With
syngo Suite, the radiologists of DRC would
finally be able to communicate with each
other, and with technologists, clerks, and
referring physicians, in a uniform, consistent
manner, at all times.
Implementing syngo SuiteOnce Specialty Networks chose Siemens as
a partner, it began arranging to incorporate
syngo Suite in the facilities where it inter-
preted studies. Specialty Networks selected
Galen Imaging, which is the outpatient imag-
ing center for Galen Medical Group, as the
first site to implement syngo Suite. With a
total of eight locations spread throughout the
greater Chattanooga and northern Georgia
area, Galen was a perfect candidate in which
to conduct volume testing, averaging 22,000
exams per year. In October 2005, Galen
became the first successful go-live of Siemens
»Siemens wasthe only
vendor thatoffered exactly
what we were looking
for.«James Busch, MD, radiologist,
Director, Specialty Networks,
Director of Informatics, DRC,
Chattanooga, TN, USA * Currently available with the U.S. version of syngo Workflow only.
MEDICAL SOLUTIONS RSNA 2006 5
COVER STORYWORKFLOW
University Hospital Erlangen: The Art of Individualizing Standards
Discussing workflow topics with Professor Stephan Achen-
bach, MD, is no easy task. Instead of answering my ques-
tion regarding his department’s workflow in cases of acute
chest pain, the Assistant Medical Director for Cardiology
and Angiology at the Hospital of the Friedrich-Alexander-
University Erlangen-Nuremberg, Germany, asks in return:
“What is workflow?” Considering his following explanation,
“Every patient presenting to the emergency unit with
acute chest pain is different – you can’t just squeeze
them into standardized flowcharts,” he sure is right. Just
think of how differently people experience chest pain in
the first place. “It would be a true piece of art to develop
a workflow that leaves enough space for the individuality
of each patient,“ he says.
Nevertheless, he and his colleagues send patients with
clear acute chest pain, electrocardiograms (ECG) with-
out elevated ST-levels, and inconclusive blood tests to
a computed tomography (CT) scan to exclude acute
myocardial infarction (MI) as the cause of the pain.
Achenbach expects both medical benefits – due to faster
treatment initiation for patients with acute MI – and
economic advantages – due to shorter stays in the emer-
gency room for other patients – from this procedure.
“We have to work economically without practicing sub-
par medicine,” he says, “and I think CT can be very useful
in doing so,” even if standardizations are difficult. With
an early CT diagnosis, the President of the Society for
Cardiovascular CT sees the chance to intervene early on
and put the patient on the right track for treatment. One
major problem he perceives in establishing this new
workflow as a rule once its medical and economic merits
are scientifically proven, however, is staffing: “You need
to have a physician and a technologist available at all
times, who can run a cardiac CT. There are not many
around yet.”
Exploring Data FlowTo Achenbach, like most other physicians, more important
than a standardized, step-by-step patient workflow is data
flow. Having ECG, laboratory, image, and any other patient
data available is key when it comes to determining a
final diagnosis and treatment decision – wherever that
decision may be taken. The Imaging Science Institute (ISI),
a cooperation of the Global Solutions Division of Siemens
Medical Solutions and the University Hospital Erlangen,
provides a platform to investigate possibilities to solve this
issue of seamless data availability, among other projects.
As an interdisciplinary research institution housed within
the university hospital, ISI is dedicated to analyzing treat-
ment processes. It is supported by excellent medical
expertise, a powerful information technology (IT) infra-
structure and the latest generation of diagnostic systems.
The aim is to improve the overall workflow, from patient
admission to discharge, and to define optimized treat-
ment paths for specific diseases. Holistic treatment paths
are developed, tested, and optimized using Siemens work-
flow-oriented software systems syngo and Soarian®.
Implemented within a modern hospital, these treatment
paths enable extensive automation of administrative
processes, so that scheduling, data exchange, and billing
can be done at the push of a button. The result is a
streamlined workflow that allows doctors and hospital
staff to concentrate on what is important – the patients
and their treatment. dpi
THE IMAGING SCIENCEINSTITUTE is dedicated
to looking beyond current
workflow concepts.
6 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
COVER STORYWORKFLOW
RIS/PACS integrated with the NextGen EPM
system.
The implementation was conducted as a
phased installation to minimize the risk of
downtime, and the eleven radiologists of DRC
rotated their time at Galen so they could each
train on the new system. Since then, the
technology is currently being implemented
in the remaining seven other DRC customer
sites, including the largest multi-specialty
medical group in the Chattanooga region, a
300-bed community medical center, and one
of the largest orthopedic groups in the area.
They are in negotiations to add at least two
more clients to their roster.
According to Busch, customers have been
very enthusiastic about implementing the
new technology at their facilities. “Installation
week is always a bit difficult, because staffs
have to learn to use the new technology and
make adjustments to their workflow pro-
cesses,” says Busch. “But they are eager to
roll with it because they know that in the
long run their jobs will be much easier and
they will be more self-sufficient. They like the
idea of having this cutting-edge technology
at their fingertips.”
Janice Cooke, the RIS/PACS Manager for
Specialty Networks, is amazed at how well
the implementation has gone. “I expected
that it would take at least a year to bring the
first five sites online,” she states. “The fact
that this was accomplished in five months is
incredible.”
Cooke attributes the success of the implemen-
tation to the team Siemens provided to over-
see the project. “Of course, there have been
small hardware and software issues along
the way, but the whole adventure has been
overwhelmingly smooth. I’ve been in radiol-
ogy since 1978, and this is by far one of the
best systems I’ve ever used. It’s easy to use,
easy to fix problems, and easy to train staff
on. It’s just an excellent system.”
Busch also credits the Siemens team for the
success of the implementation. “Siemens was
extremely accommodating and supportive.”
Reaping the Benefits of syngo SuiteAccording to Busch, DRC has already saved
more than one full-time radiologist, and
expects to save even more in the future. “I
don’t think we’ve even remotely reached our
peak efficiency with syngo Suite,” he says.
DRC has also drastically reduced turnaround
time, from an average of 24 hours to one
hour, and in some cases, just minutes. “Now,
when we call doctors to give them reports,
they often already have them in their hands,”
explains Busch. “syngo has really helped us
to differentiate ourselves in the marketplace.”
Busch adds that making their practice more
efficient has also made it more profitable.
“The most expensive part of a radiology prac-
tice is the radiologist, so it is extremely cost-
effective to do more exams with less staff,”
he states.
syngo Suite has also contributed to improving
the overall quality of patient care. “With inte-
grated RIS and PACS, patient demographics
are already in the system and don’t have to
»It’s easy to
use, easy to
fix problems,and easy to
train staff. It’s just
an excellent system.«
Janice Cooke,
RIS/PACS Manager,
Specialty Networks,
Chattanooga, TN, USA
JANICE COOKE (RIGHT) and James Busch, MD, look back at the successful
implementation of syngo Suite at DRC and its customers’ sites.
MEDICAL SOLUTIONS RSNA 2006 7
COVER STORYWORKFLOW
Continuous Improvements: Thinking Beyond Imaging Systems
Siemens Medical Solutions constantly develops new and
improved workflow solutions. Among the most recent
developments are:
■ syngo Chorus MR*, which, for the first time ever, opti-
mizes magnetic resonance imaging (MRI) workflow
beyond the scanner, enabling a perfect synergy between
the modality and the radiology information system (RIS)
and the picture archiving and communication system
(PACS) environment. From the moment the patient is
scheduled in the RIS, syngo Chorus MR goes to work: The
application cross-checks patient data and validates order
entry based upon diagnosis. With the Protocol Planning
functionality of syngo Chorus MR, the radiologists can
plan the MRI exams right out of the RIS –
providing the MR technologist with the exact protocol
that he or she wants to be run – without unnecessary
phone calls or clarifications. Beyond that, if the patient is
scheduled for a follow-up study, using the PhoenixZIP
functionality of syngo Chorus MR, the protocols previously
used can be sent to the MRI scanner, so that exactly the
same parameters are reproduced, and comparative diag-
nosis can easily be made. This saves time and enables
diagnostic accuracy.
Using the Protocol Distribution functionality of syngo
Chorus MR, the RIS can also distribute MRI protocols
from one MRI scanner over the network to all other
Siemens scanners running on the latest MRI software.
This helps ensure standardization of protocols through-
out the different MR suites and optimizes quality.
The new Inline Billing (MPPS) follows the patients’ process
progress. At the end of the procedure, the system bills
automatically. Inline Billing even supplies the associated
codes necessary to report back to the RIS with no manual
entry.
■ syngo WebSpace is a real pace setter. It offers instant,
web-based access to imaging data plus state-of-the-art
2D, 3D and 4D postprocessing tools – enterprise-wide
and beyond. Real-time streaming of reconstructed imaging
data to the server allows up to 20 concurrent users
instant access to data via the PACS or any personal com-
puter (PC)** client throughout the institution, in their home
office or while traveling, by simply connecting to the net-
work.
“For a large institution such as Johns Hopkins, this client-
server solution means that we can offer all our staff
access to computed tomography (CT) data, 24/7. Now
our physicians can have access where*** and when they
need it and not just at the workstations in our 3D lab or
at the scanner. The client server solution expands our
capabilities to deliver outstanding patient care and
improve workflow,” explains Professor Elliot Fishman, MD,
of Johns Hopkins Medical Center in Baltimore, MD, USA.
“Plus it’s syngo-based, which means we don’t have to
invest time and resources in retraining staff.”
syngo WebSpace is also ideally suited for short-term
storage of thin-slice CT data, giving users instant access
while avoiding the need to send all thin-slice data sets
directly to the PACS, freeing up the CT scanner database
at the same time. It can be fully integrated into an existing
PACS and IT environment. The simple client-server archi-
tecture is highly cost effective not only because of its
multi-user capability, but also because it makes use of
existing computer resources. dpi
syngo WEBSPACE enables 3D reading anytime, anywhere.
* 510(k) pending.** PC must meet minimum requirements.*** Internet connection required.
8 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
COVER STORYWORKFLOW
Battlefield Auxiliary Breast Center: Workflow, Technology, and Tender-loving Care Make a Difference
For many women, the experience of getting even a routine
mammography screening can be a bit unnerving. And for
those who have suspicious breast lumps, it can be downright
nerve-wracking. But for women in northwestern Georgia, the
process is not quite as daunting, thanks to Battlefield Auxiliary
Breast Center.
The first digital imaging center in the northern Georgia
region, Battlefield Imaging of Ringgold, GA, USA, was formed
in 2004 as a joint venture between Hutcheson Medical Center
and Diagnostic Radiology Consultants (DRC). A world-class
imaging center offering a full range of services, Battlefield
Imaging opened its Battlefield Auxiliary Breast Center just 18
months later.
The Comforts of HomeBattlefield Auxiliary Breast Center was designed with the com-
fort of patients as top priority. “Our goal was to create a safe
haven for women,” says John Nelson, MD, Medical Director of
Battlefield Imaging and DRC radiologist. “I think that providing
women with this kind of atmosphere makes a difference for
them in terms of their comfort and privacy.”
Battlefield Auxiliary Breast Center provides a full range of breast
imaging services, such as screening and diagnostic digital
mammography, ultrasound, magnetic resonance imaging, and
positron emission tomography/computed tomography (PET·CT),
to help diagnose breast cancer in its earliest and most treat-
able stages. The geographic layout of the center lends itself to
fluid movement throughout a patient’s visit. The diagnostic
and screening rooms are contiguous to the mammography
suite, which is directly across the hall from the ultrasound
suite. “Once a woman comes into the dressing room, she liter-
ally never has to walk more than five feet to get where she
needs to go for her exams,” says Nelson.
The Battlefield Breast Center’s scheduling procedures have
also been instrumental in making breast imaging a less daunting
experience for women. “It’s very frightening for a woman who
has a symptom such as a lump in her breast,” says Nelson.
“For that reason, we make every effort to accommodate these
patients by getting them into the schedule right away, usually
on the same day that they call to request an appointment.
Once they come in, our staff performs the necessary non-
invasive tests all in that same visit, until we are completely
satisfied that we’ve done everything we can to obtain a
thorough diagnosis. If we determine that an invasive proce-
dure, such as a biopsy, is necessary, then we will schedule that
as soon as possible.”
State-of-the-Art Digital TechnologyBattlefield Auxiliary Breast Center was one of the first to unveil
the latest all-digital mammography technology, the heart of
which is Siemens MAMMOMAT® NovationDR. The MAMMOMAT
NovationDR offers digital mammography, digital spot imaging,
and digital, imaging-based stereotactic biopsy. Its large plate
facilitates more precise imaging of large breasts, and a specially
designed compression plate enables central isocentric breast
positioning. It also helps make calcifications easier to see in
women who have dense breasts. Another benefit of the
MAMMOMAT NovationDR is its significantly accelerated work-
flow. The Center averages about one complete case every
eight minutes, and performs 45 to 50 mammogram screen-
ings and eight to 12 diagnostic mammograms per day.
Once images are acquired with the MAMMOMAT NovationDR,
they are sent to the syngo MammoReport breast care work-
place, which offers two five-megapixel monitors specially suited
for reading and reporting mammograms. The radiology infor-
mation system (RIS) drives the mammograms one at a time, or
up to ten studies can be loaded at a time. Once they are selected,
they can be loaded into syngo MammoReport almost instanta-
neously and then can be filed with the click of a button.
Patients’ old film studies can also be digitized and viewed with
the syngo MammoReport. Nelson says that because of the
magnification power of the technology, Battlefield’s callback
rate has dropped to about 20 percent of what is used to be.
“We rarely have to call patients back in to retake views,” he
BATTLEFIELD IMAGING offers full-field digital mammography
(FFDM), as well as other exams.
MEDICAL SOLUTIONS RSNA 2006 9
COVER STORYWORKFLOW
be dictated again, which drastically reduces
the risk of associating an image with the
wrong patient,” says Busch. “We simply click
on the patient’s name and go. This allows us
to focus on the image interpretation, rather
than being distracted by redundant docu-
mentation requirements. And the sooner
we can make a diagnosis and deliver a report,
the sooner the patient can begin getting
treatment.”
To provide the highest quality of care possible,
DRC has radiology specialists who are experts
at interpreting images of specific systems of
the body. For example, their neuroradiologist
interprets special images of the brain and
neck. In the past, these images would have
to be saved until the neuroradiologist rotated
through that particular imaging facility. But
now with syngo Suite, radiologist specialists
can access patient images immediately, using
their individual worklists, no matter which
facility they happen to be working at on a
particular day. This is an added benefit for
both the patient and the referring physician.
Since the implementation of syngo, Specialty
Networks has also added syngo Portal Radi-
ologist* to its syngo Workflow RIS technology.
A ’cockpit’ of sorts, syngo Portal Radiologist
lays out on a computer screen all the tasks
that a radiologist needs for his specific work
processes. Every element on the screen is
expandable and collapsible, so the radiolo-
gist can manipulate how much or how little
he wants to see of each item.
syngo Portal Radiologist offers several
advantages over the previous technology
that DRC was using. “Probably the biggest
benefit is that everything is concisely organ-
ized on one screen,” says Busch. “There’s no
need to toggle back and forth between
different views or between old and new
reports. Everything you need is right there
on your desktop.”
states. “Concerning the examination itself, up to 70 percent of
our patients have reported that MAMMOMAT NovationDR is
more comfortable than other systems. Another big advantage
is that we are able to immediately sit down with the patient at
the syngo MammoReport and go over her study. This leaves
patients with a sense that their mammograms have been
thoroughly evaluated.”
All Under One RoofThe fact that Battlefield Auxiliary Breast Center is on the same
campus as a comprehensive cancer center, ambulatory surgical
center, and a physicians’ office complex, also makes quick,
convenient care for the patients possible. “Once a woman is
diagnosed with a malignancy, she will probably require a host
of services involving appointments with various healthcare
providers,” says Nelson. “It’s very unusual for a patient to be
able to obtain all this care in one place, yet that’s what we
offer here on this campus. She can see an oncologist right
here in our physicians’ complex, she can have any surgeries
she needs in our surgical center, she can have radiation therapy
here at the Breast Center, in addition to any follow-up imaging
that needs to be done. It’s hard enough to deal with breast
cancer without having to run all over the place for different
appointments at different locations. Having all this care avail-
able virtually under one roof has been invaluable to our
patients.” ldm
JOHN NELSON, MD, considers patient comfort a top priority in
mammography screening situations.
* Currently available for U.S. market only – under development forother markets.
10 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
COVER STORYWORKFLOW
New York University Medical Center:When Time is of the Essence
There is little doubt that stroke patients are best treated
in dedicated stroke centers. However, at many medical
institutions a stroke center cannot be established, either
due to limited space, or limited financial or personnel
resources. New York University (NYU) Medical Center is
in the ideal situation of not only having a stroke unit, but
also being able to identify the patients that need to be
treated there directly in the emergency room (ER).
“Patients with acute symptoms indicating a possible
stroke go straight to the ER’s 16-slice Siemens computed
tomography (CT) scanner,” states Robert I. Grossman,
MD, Louis Marx Professor of Radiology, Chairman of the
Department of Radiology, and Professor of Neurosurgery,
Neurology and Physiology, and Neuroscience.
The perfunctory CT exam reveals immediately whether
the symptoms are caused by an ischemic or hemorrhagic
stroke, or if the ER physicians need to look for other
causes, such as low blood sugar. A radiologist is present
in the ER 24/7 to provide fast turnaround when time is
of the essence. He or she interprets the images right
on-site.
Reports are usually dictated into a voice recognition
system, but since the radiologist and ER physician work
in close proximity to one another, the radiologist can give
a preliminary oral report before he or she starts dictat-
ing, thereby expediting treatment.
Once the diagnosis is clear, the patient is referred to the
NYU’s stroke center, where further treatment decisions
are made depending, among other factors, on the
patient’s age and condition, and on the type, location, and
expanse of the stroke. Treatment, including, if possible,
intravenous or intracranial thrombolysis, commences.
Treatment results are monitored either by CT or magnetic
resonance imaging (MRI). Both imaging modalities, as
well as ultrasound, also play an important role when it
comes to finding the actual cause of the stroke once the
acute situation is resolved. Examinations also include a
cardiac work-up and a complete blood analysis. dpi
“syngo Portal Radiologist also lets you create
ad hoc workflows, which we weren’t able to
do in the past. If I am sitting at my computer
reading an exam, and a referring physician
calls in for a consultation, I can go into an ad
hoc workflow and call his exam up on the
screen without interrupting the images I’m
already working on or losing the dictation
that I’ve already done. That’s a tremendous
advantage in terms of productivity and time
savings.”
Another functionality accessible in syngo
Portal Radiologist is also contributing to
quicker turnaround and more efficient service.
The Dynamic Loading function allows images
to appear as soon as they are selected from
the worklist, so radiologists can begin their
interpretation before the entire series loads.
This is especially beneficial with large exams.
And sophisticated postprocessing tools, which
previously would have required moving to
another workstation, are now available in the
same integrated system.
Additional advantages of syngo Portal Radi-
ologist that Busch points out include the
ability to create shortcuts and templates on
the fly, and to obtain real-time feedback on
productivity, improved search functionality,
and better communication between radiolo-
gists and technicians.
With its familiar look and feel for all modalities
and workplaces, syngo Portal Radiologist is
easy to learn, use, and share. “The learning
curve is very short, especially for those who
are already familiar with the syngo environ-
ment,” says Busch.
“I learned it in one day, but even for someone
who had never used syngo before, I’d say the
average learning time would be one to two
days.”
“I like to compare syngo Suite to a stetho-
scope,” explains Busch. “It’s a tool that can
come with me, as a radiologist, wherever I
go, similar to family doctors and their stetho-
scopes. It has also allowed us to provide
a single imaging software solution where
radiologists and other doctors can go to get
everything ‘imaging’ that they need. This has
brought back a sense of community among
physicians that had been lost in recent years
MEDICAL SOLUTIONS RSNA 2006 11
COVER STORYWORKFLOW
due to the decentralization of imaging asso-
ciated with the increase in outpatient care.”
Securing Patient PrivacyAlthough syngo Suite transfers all images
into a centralized PACS architecture, these
images are segregated by location, with each
facility driven by a different master index.
This means that radiologists at DRC can view
images from all the medical practices that
they serve, but each medical practice only
has access to the images of its own patients.
To illustrate, this is akin to someone looking
at the windows of a high-rise building and
being able to see what is going on simulta-
neously on each floor, while the people on
the individual floors can only see what is
happening on their own floors, even though
they are all in the same building.
“This segregation and regulation based on
user privileges is extremely important for
patient privacy, and is not available with any
other imaging technology on the market,”
says Busch.
Integrating Imaging Technology – Now and in the FutureDr. Busch hopes to expand the role-based
workflow allowed with syngo Portal Radiolo-
gist by implementing the syngo Portal Refer-
ring Physician as soon as it becomes available.
A web-based portal, syngo Referring Physician
allows medical practices to link into a hospi-
tal or other imaging provider’s diagnostic and
therapeutic workflow.
“syngo Portal Referring Physician would be a
huge marketing advantage to us because it
would allow us to provide referring doctors
with even greater convenience in terms of
scheduling and obtaining reports,” Busch is
convinced. “These two factors play a great
role in deciding where doctors will refer their
patients for imaging.”
“There is much being said about the need
for greater IT adoption in healthcare and the
integration of imaging and IT, but Siemens
is the vendor that is making it happen and
meeting our business model needs today,”
says Dr. Busch. “From a standalone imaging
center perspective, having RIS/PACS inter-
operating with an EPM system provides a
complete solution for managing our imaging
workflow – from scheduling and registration
to interpretation – and that is what we’ve
achieved through our partnership with
Siemens.”
Author: Linda DiMeo is a freelancer writer, editor, and
proofreader based in Philadelphia, PA, USA. She has
18 years of experience in the communications field, and
holds a BA in English from St. Joseph’s University in
Philadelphia.
»syngo PortalReferringPhysicianwould be ahuge market-ing advantageto us.«James Busch, MD, radiologist,
Director, Specialty Networks,
Director of Informatics, DRC,
Chattanooga, TN, USA
BUSINESSIMAGE MANAGEMENT
12 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
The Next Frontier: An Integrated MedicalInformation TechnologyPlatformBreaking new ground, a partnership betweenSiemens and New York University is driving thedevelopment of new imaging software proto-types that will achieve efficiencies well beyondcurrent industry expectations by focusing on integration over interfacing.By Laura Newman
At last, the barriers to optimized workflow
throughout radiology, cardiology, and oncol-
ogy are coming down. Siemens Image and
Knowledge Management Division is contribut-
ing to this exciting development by focusing
on image and workflow management appli-
cations and computer-aided diagnosis under
the roof of its syngo® software platform.
Ajit Singh, PhD, who is heading the division,
met with Bernard A. Birnbaum, MD, Professor
of Radiology and Vice Chairman of Clinical
Affairs and Operations at New York University’s
(NYU) Department of Radiology, to talk about
NYU’s needs and the innovative products
Siemens has in the pipeline to revolutionize
how work is organized in imaging depart-
ments and medical networks around the
globe.
MEDICAL SOLUTIONS: Until now, workflow
in radiology has been somewhat fragmented.
What strategies do you see as paving the way
to the radiology department of the future?
SINGH: If I think ahead, our end goal is to
have all the relevant information and knowl-
edge – which is context and role sensitive –
in the right place at the right time. By that, I
mean at the point of decision making and the
point of care.
That is our fundamental goal. To make this
happen, you need to optimize end-to-end
workflow – from the time patients come
into the system to the time they leave the
system. Imagine any end-to-end patient flow
– all the necessary information and knowledge
would be available right at the fingertips of
each clinical stakeholder, such as radiologist,
technologist, or referring physician.
MEDICAL SOLUTIONS: Could you take a
step back and reflect on the problems that
need to be overcome in order to optimize
MEDICAL SOLUTIONS RSNA 2006 13
workflow for each clinical stakeholder and
across the network?
SINGH: Right now, diagnostic and therapeutic
information are poorly integrated. You have
information from imaging and pathology –
vast amounts of data. All the data is in the
system, but it is not organized or immediately
accessible. Also, you cannot convert laboratory
and radiology data into high-level constructs
at the patient and disease level. Multiple
users cannot access it. To overcome these
challenges, we’ve made knowledge-driven
solutions a top priority in our agenda.
Role-based ApproachBIRNBAUM: If I look at our department at
NYU, we still have multiple IT systems. We are
currently using IDX® version 9.92 as our radi-
ology information system (RIS). We use
Siemens for our enterprise picture archiving
and communication system (PACS), but have
3D post-processing systems from both
Siemens and non-Siemens vendors. We also
use different vendors for our document scan-
ning and speech recognition systems. We
cannot cleanly integrate these systems as is.
As such, we are currently working to replace
the IDX RIS with syngo Workflow. Subse-
quently, we plan to drive maximum integration
between all of these systems by incorporating
syngo postprocessing into our integrated
syngo PACS imaging suite. Integration wins
over interfacing every time. Also, what we
want to achieve – and I am confident we will
achieve through Siemens syngo products –
is the ability to log onto the system at any
place and time. When I log on, I immediately
want to see a radar map of my own work-
flow.
This may include cases that need to be proto-
colled, preliminary reports that need to be
finalized, and all outstanding examinations
that need to be read. Moreover, I would
like my clinical section chiefs and those with
executive responsibility to be able to view
the workflow of individual sections or the
entire department, respectively. By seeing
who is in the ’green, yellow or red zones’, we
will be able to redistribute the clinical work to
optimize our workflow.
MEDICAL SOLUTIONS: Siemens innovative
syngo Suite is a pacesetting product that is
setting the bar for the industry. Can you offer
a snapshot of the system and how Siemens
customers will benefit from using it?
SINGH: The syngo Suite offers all the diag-
nostic and therapeutic information collated on
the same IT platform to integrate all steps:
patient registration, scanning, interpretation,
archiving and billing. All tasks that a radiologist,
technologist, or referring physician performs
are organized into portals. The syngo-based
platform makes sure that all the tasks
share a common environment and intuitive
user interface. Self-explanatory icons make it
easy to use. We are also eliminating the time
these people spend moving from one work-
station to another. With syngo-based products,
doctors will be able to access the system
from any personal computer (PC) in the net-
work. This allows them to perform the full
array of reporting, reading and dictating tasks
from one workstation. Our product develop-
ment group is also gearing up to include
oncologists and cardiologists into the net-
work, enabling them to configure the system
based on their clinical focus. Ultimately, we
are aiming to streamline workflow not only
across disciplines throughout the institution,
but also between a hub and satellite facilities.
With this unique bundling of competencies,
we are helping our customers maintain their
competitive advantage.
MEDICAL SOLUTIONS: Can you describe
how medical device data will be integrated
into RIS, PACS and postprocessing systems?
SINGH: Medical devices are data sources.
We need to collate all their information into
an integrated platform. Like any other data
source, medical devices are enablers. This
idea marks a very important paradigm shift.
These very disparate data sources integrate
into one IT platform. If you think of it in terms
of functionality, the scanner could be sitting
three miles across town, but I could be view-
ing it on my PC or on any workstation in the
network.
MEDICAL SOLUTIONS: Siemens 64-slice
computed tomography (CT) and SOMATOM®
Definition scanners are among the most
BUSINESSIMAGE MANAGEMENT
14 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006
Siemens/NYU Laboratory: Building the Next Generation of RIS and PACS Products
Radiologist Bernard A. Birnbaum, MD, Vice Chairman of
Radiology at New York University (NYU) Medical Center,
says that the partnership between his team and Siemens
has been fruitful. By the end of the year, a laboratory
housed at NYU will open with the goal of jointly developing
and testing Siemens next generation radiology informa-
tion systems (RIS) and picture archiving and communica-
tion systems (PACS) products.
The information technology (IT) and the installation of
latest whole-body MRI, dual-source, and 64-slice CT enable
NYU and Siemens to investigate strategies to optimize
high-volume reading, workflow, and data mining. They will
give top priority to building new medical IT solutions with
an extremely intuitive user interface. There are benefits
to both partners. Siemens views the laboratory as critical
in helping them provide new prototypes for medical IT
products that will eventually become available across
the globe. NYU wants to contribute to that vision and
believes that Siemens has the outstanding capabilities
and foresight to help NYU devise a medical IT solution
across its enterprise-wide network, extending it from its
hub in the radiology department to all satellite facilities.
sophisticated in the industry. syngo Suite
collects data from the CT-imaging studies
and optimizes workflow. Can you tell us about
your experiences with these modalities and
your expectations regarding syngo Suite?
BIRNBAUM: Let us use an example. A physi-
cian orders a coronary CT angiography study
for a patient with atypical chest pain and
inconclusive prior tests. The patient would be
interviewed by our staff and prepped. He or
she would lie down in the machine and
would not require a beta blocker.
While the actual data acquisition on the
SOMATOM Definition scanner takes only
a few minutes, interpretation of this high
volume data set remains a cumbersome
process. Multiple dedicated workstations are
typically used to analyze the data set, post-
process the study and archive the appropriate
3D views. However, the integrated syngo-
based platform will enable users to open
several task-oriented software applications
simultaneously. With a minimum number of
mouse clicks, the study could be interpreted,
dictated, and archived at a single workstation.
MEDICAL SOLUTIONS: How does NYU
handle the high-volume data generated by
these powerful scanners?
BIRNBAUM: Because these scanners may
generate thousands of images per study, we
need to modify our workflow accordingly. We
typically archive thicker – at least four milli-
meter – slices and send the thinner slices
to our 3D workstations. Doing so enables us
“ALL TASKS that a radiologist, technologist, or referring physician performs are organized into
portals,“ explains Ajit Singh.
»When you improve
workflow, you also
improve quality
while reducing costs
– that’s a fact!«Ajit Singh, PhD,
Image and Knowledge
Management Division,
Siemens Medical Solutions
BUSINESSIMAGE MANAGEMENT
MEDICAL SOLUTIONS RSNA 2006 15
to interrogate an optimized data set to create
high-resolution postprocessed images that
we then archive without sacrificing band-
width and archive space.
One Intuitive PlatformMEDICAL SOLUTIONS: In previous conver-
sations with NYU, you mentioned that the
ideal system would integrate RIS, PACS, and
postprocessing into one intuitive platform. Is
there anything more you would like to add to
that concept?
BIRNBAUM: We really know exactly what
we want. What we are going to do here is
ensure that Siemens builds just that product,
because it will achieve these goals and more.
At this point in time, ideally, we would like to
add on speech recognition and document
scanning, and probably additional software
that would allow us to immediately access
information via the Internet that would pro-
vide decision support.
MEDICAL SOLUTIONS: To what extent will
syngo be an out-of-the-box solution? How
close to ’one click’ will it be?
SINGH: For 80 percent of the users, the
system will be out of the box. However,
recognizing that some users will want to con-
figure the system differently, we will build in
flexibility for customizing the system. We are
striving for a one-click system because the
closer to one-click you are, the less invasive
you need to be. With our portals for the radi-
ologist, the referring physician, and more
planned, we have already come a long way
toward achieving this.
MEDICAL SOLUTIONS: Do you expect there
will be resistance to moving towards an inte-
grated IT platform that optimizes workflow?
SINGH: Yes. Doctors have been trained to
use paper and film for the last 100-plus years.
It is so embedded in the curriculum. Only now
the curriculum is changing to incorporate
structured reporting and image handling
into a computerized system. What will make
it hard is this: If you make a computerized
system too complicated, it will impede the
thought process. You want a computer to
think with you and not for you. You have to
make it as transparent as possible so doctors
can think about their patients and not the
technology. There is also a mindset in health-
care that you cannot improve quality while
reducing costs. That is simply inaccurate. If you
look at every other industry, you see that these
goals are co-optimized. It does cost less. When
you improve workflow, you also improve
quality while reducing costs – that’s a fact!
“INTEGRATION wins over interfacing every time,” says Bernard A. Birnbaum.
»We will ensure
that Siemens builds
the very product we
envision, because
it will achieve our
goals and more.«Bernard A. Birnbaum, MD,
Professor of Radiology,
Vice Chairman of Clinical Affairs
and Operations, Department of
Radiology, New York University
Medical Center, USA
Author: Laura Newman is a freelance medical journalist
based in New York City. She has contributed articles to
the Journal of the National Cancer Institute, The Lancet
and the Institute of Medicine (part of the National
Academy of Sciences), among others. She is also author
of Developing Technologies for Early Detection of Breast
Cancer (National Research Council and the National
Cancer Policy Board).
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