presentation to nnoha in nashville

Electronic Dental Records and PACS in the Electronic Dental Records and PACS in the Dental Dental

Community Health SectorCommunity Health Sector

NNOHA Presentation 11/04/09Jeff Burgess DDS MSD

Marc CapotsSpecial Markets Technology

ManagerHenry Schein Special Markets

Equipment

Jeff Burgess DDS MSDBoarded in Oral MedicineVice President of Sales and Marketing EBM Technologies

PACSPACS

PACSPACSSvanaes, Moystad, Larheim: Approximal caries depth assessment with storage phosphor versus film radiography. Evaluation of the caries-specific Oslo enhancement procedure. Caries Res. 2000

• 120 extracted human teeth• Storage Phosphor plates with Digora scanner versus Ektaspeed

Plus film• 240 Proximal surfaces for caries, 9 observers, 5 point confidence

scale• Ratings compared with the histological state• Pooled sensitivity and specificity values:

•.48/.94 with film, .61/.86 with phosphor image

Digital Digital SensorsSensors

PACSPACS• Gakenheimer DC: The efficacy of a computerized caries

detector in intraoral digital radiography. JADA 2002

• Navarro F, Puy L, Godoy G: Diagnostic performance of radiovisiography in combination with a diagnosis assisting program versus conventional

radiography with radiovisiography in basic mode and with magnification. Med Oral Pathol Oral Cir Bucal, 2008.

Caries Caries DetectionDetection

Industry StandardsIndustry Standards

• DICOM – Digital Communication in Medicine

• HL7 – Health Level 7• IHE – Integrating the Healthcare Enterprise• HIPPA

• DICOM – Digital Communication in Medicine

• HL7 – Health Level 7• IHE – Integrating the Healthcare Enterprise• HIPPA


DICOM – Digital Communication in Medicine

Standard in Medicine for handling, storing, printing and transmitting medical information in medical

images

DICOM – Digital Communication in Medicine

Standard in Medicine for handling, storing, printing and transmitting medical information in medical

images

• Includes a file format definition and network communications protocol

• Enables integration of scanners, servers, workstations, printers, and network hardware

DICOM


DICOM – Brief History•1985 – First Standard Released•1988 Second Version Released•1992 First Large Scale Deployment by the US Army

and Air Force•1993 Third Version – 3.0•Now recommended using release year: “the 2007 version of DiCOM”•IHE (Integrating the Healthcare Enterprise) + HL-7 completes workflow interoperability

DICOM – Brief History•1985 – First Standard Released•1988 Second Version Released•1992 First Large Scale Deployment by the US Army

and Air Force•1993 Third Version – 3.0•Now recommended using release year: “the 2007 version of DiCOM”•IHE (Integrating the Healthcare Enterprise) + HL-7 completes workflow interoperability


DICOM• Store•Storage Commitment•Query/Retrieve•Modality Worklist•Modality Performed Procedure Step•Printing•Storage in Off-Line Media

DICOM• Store•Storage Commitment•Query/Retrieve•Modality Worklist•Modality Performed Procedure Step•Printing•Storage in Off-Line Media


DICOM

Store• Used to send images or other persistent objects (such as reports, lab results, patient photos) to a PACS workstation.

DICOM

Store• Used to send images or other persistent objects (such as reports, lab results, patient photos) to a PACS workstation.


DICOM

Storage CommitmentThis is used to confirm that an image has been permanently stored by a device such as a disk or back-up media or server. This makes it safe to delete the images locally.

DICOM

Storage CommitmentThis is used to confirm that an image has been permanently stored by a device such as a disk or back-up media or server. This makes it safe to delete the images locally.


DICOM

Query/RetrieveThis function allows a workstation to find the lists of images and other ‘objects’ and then retrieve them from a PACS

DICOM

Query/RetrieveThis function allows a workstation to find the lists of images and other ‘objects’ and then retrieve them from a PACS


DICOM

Modality WorklistThis enables an acquisition device (a modality - x-ray machine) to obtain details of patients scheduled examinations so that the information doesn’t have to by entered multiple times.

DICOM

Modality WorklistThis enables an acquisition device (a modality - x-ray machine) to obtain details of patients scheduled examinations so that the information doesn’t have to by entered multiple times.


DICOMModality Performed Procedure StepThis function enables the modality to send a report about an examination which includes data like when it was acquired, beginning time, end time, dose delivered, etc.)

DICOMModality Performed Procedure StepThis function enables the modality to send a report about an examination which includes data like when it was acquired, beginning time, end time, dose delivered, etc.)


DICOMDICOM


DICOMDICOM

More About DICOM

If an acquisition device company says that it is DICOM compliant you should be able to request its DICOM conformance statement. If it does have one, it is not DICOM compliant.


DICOMDICOM

More About DICOM

Just because an image is DICOM compliant does not mean that it can be sent to a medical facility. There must be a functioning DICOM server to make this a true enterprise system.


DICOMDICOM

More About DICOM

For more Information about DICOM, visit:http://DICOM.nema.org


HL7 – Health Level 7HL7 – Health Level 7HL7 – Health Level 7HL7 – Health Level 7• Founded in 1987• Global authority for healthcare information interoperability and standards• 57 Countries • 2,300 members represent 500 corporate members – 90% of the information system vendors.• Supports clinical practice and the

management, delivery, and evaluation of health services.

• ADA signed an Associate Charter Agreement September 2009 to develop dental IT standards


IHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare EnterpriseIHE – Integrating the Healthcare Enterprise

IHE Connectathon Results BrowserOct 11, 2009 ... Browse the results of the IHE (Integrating the Healthcare Enterprise) connectathons that have taken place in Europe, Japan and North America ...connectathon-results.ihe-europe.net/

• An initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information • Several hundred products support one

or more IHE Profiles• Integration Profiles describe clinical information management use cases and specify how to use existing standards (HL7, DICOM, etc,...) to address them• Integration Statements, Technical Frameworks, Connectathons, Showcases

http://connectathon-results.ihe-europe.net/

http://connectathon-results.ihe-europe.net/


On April 14, 2003, the privacy rules promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) changed the way that certain health record custodians (called “covered entities”) will respond to a request for disclosure of a person’s "protected health information" (PHI).

HIPPA – Health Insurance Portability and Accountability Act

Requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers

Yeoh & Muranaka Medical Center, based in Honolulu, Hawaii facilitates three outpatient imaging clinics.

Imaging Center

Exams per year : 50,000

4 Radiologists

Serves pop. Of 900,000

EBM Solution

UniSight™

UniWeb™

EBM PACS Server™

Imaging Devices

2 CT

4 US

2 BMD

4 DR

1 MR

Case Study: USACase Study: USA

The EBM Pangea Dental SolutionThe EBM Pangea Dental Solution


UniGate® WorkstationUniGate® Workstation‘‘To communicate with the non-DICOM devices’To communicate with the non-DICOM devices’

UniSight® WorkstationUniSight® Workstation

EBM Pacs Server®EBM Pacs Server®

UniWeb® WorkstationUniWeb® Workstation

Pangea DentalPangea Dental


• Supports DICOM Worklist• Supports DICOM Dental Tag• Supports DICOM MPPS (Modality Procedure Performed Status)• Supports DICOM Storage Commitment• Allows conversion of non-digital images to DICOM standard

UniGate® WorkstationUniGate® Workstation‘‘To communicate with the non-DICOM devices’To communicate with the non-DICOM devices’


• Acts as QC Station to Preview Images • DICOM Print function • DICOM Portable Media Function (for CD/DVD Burner)• Conversion of Images between DICOM and non-DICOM• Supports DICOM Store (SCU/SCP) Function• Supports DICOM Storage Commitment

UniSight® WorkstationUniSight® Workstation


• Stores DICOM images • Keeps a log of image modifications and deletions• Keeps a log of image query and retrieval by all users • Logs problems• Sends out SMS or email to headquarters (engineers) when a problem occurs• Provides a log that helps track the image route between the modality and the server

EBM Pacs Server®EBM Pacs Server®


• Allows WEB Access to review Image (Internet Explorer)• Web Access to DICOM Objects (WADO)• Robust Viewing Tools• Scalable Concurrent License• Used for Teaching

UniWeb® WorkstationUniWeb® Workstation

HIS/RIS with HL7/non-HL7HL7/non-HL7 Broker (EBM)

DICOM Worklist Server (EBM)

UniGate UniGate (EBM)(EBM)

Teleradiology

Acquisition modalities support

DICOM worklist

EBM PACS Server/EBM PACS Server/Pangea Dental

CliniciansCommunication

DICOM Printing

Diagnostic/Viewing Station

Acquisition modalities

Non-DICOM

Hanging ProtocolHanging ProtocolHanging ProtocolHanging Protocol

Multimodality – Device NeutralMultimodality – Device NeutralMultimodality – Device NeutralMultimodality – Device Neutral

Web BasedWeb BasedWeb BasedWeb Based

DICOM 3.0 Standards DICOM 3.0 Standards DICOM 3.0 Standards DICOM 3.0 Standards

Pangea Dental HighlightsPangea Dental Highlights

Integration with RIS SystemsIntegration with RIS SystemsIntegration with RIS SystemsIntegration with RIS Systems

Dynamic Analysis FunctionsDynamic Analysis FunctionsDynamic Analysis FunctionsDynamic Analysis Functions

Hanging ProtocolHanging ProtocolHanging ProtocolHanging Protocol

Pangea Dental Hanging Capability

• FlexibleFlexible• CustomizableCustomizable• Supports mouse Supports mouse dragging for dragging for tooth tooth selectionselection• Supports image Supports image display of display of selected selected study study date resultsdate results

Pangea Dental DICOM TagsPangea Dental DICOM Tags

Pangea Dental Analysis FunctionsPangea Dental Analysis Functions

PACS software provides many analytic features that plain films cannot duplicate.


The ZOOM function allows the viewing of two or more images taken over time to document potential change.


The measurement functions allow for a gross calculation of the length, ratio, area, angles and a value based on the density of the location (area or single point) being viewed


In this case the length of the maxillary sinus and a TMJ defect is calculated. There are many more analytical features associated with Pangea Dental


CBCT Images CBCT Images

Pangea Dental – CBCT ImagesPangea Dental – CBCT Images

Pangea Dental – CBCT ImagesPangea Dental – CBCT Images

Sectional Images can be reformatted into axial, coronal, sagital, and 3D views


Export/Import to DICOM Export/Import to DICOM Portable Media CD/DVD Portable Media CD/DVD

Viewer On CD® Viewer On CD®

Pangea Dental System RequirementsPangea Dental System Requirements

•Needs assessment•Financial issues•Creating a request for

proposal•Selecting a vendor


Needs assessmentshould be consistent with the goals of the clinic or institution


• Doctor Efficiency• Improved Annotation Capability• Medical Communication• Insurance Billing• Office Space

Needs Assessment


• Cost Reductions• Savings on development costs• Savings related to storage• Savings in assistant time

Financial Issues


• Increased Income• Efficiency•Community Perception• Improved consultation acceptance• Referrals

Financial Issues


• PACS, A Guide to the Digital Revolution, Second Edition. Springer. Keith Dreyer, David Hirschorn, James Thrall, Amit Mehta, Editors. 2006.

Creating a Request for Proposal


• DICOM Compliance• Features• Service/Support• History• International

Standards

Selecting a Vendor

•Scalable Software• Modality Independent• Reliability•Training

Take Home PointsTake Home Points

• DICOM Compliant PACS are the future of Dental Imaging communication

• A DICOM Server is going to be necessary for true browser based teleradiology and web based communication with Medical EMRs

• Discuss carefully with your EDR provider whether they can integrate or are integrated with a true PACS company that has a DICOM Server.

presentation to nnoha in nashville

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