Transcript Deploying a Department or Enterprise-Wide Image Service J. Mark Tuthill, MD [email protected] Department of Pathology & Laboratory Medicine Henry Ford Hospital, Detroit, MI Pathology Informatics 2010

Deploying a Department or Enterprise-Wide
Image Service
J. Mark Tuthill, MD
[email protected]
Department of Pathology & Laboratory Medicine
Henry Ford Hospital, Detroit, MI
Pathology Informatics 2010
Widespread Uses of Digital Imaging in
Pathology
• Documentation
– Medical Legal
• Education and Training
– Interesting cases, teaching sets, learning modules
• Clinical Communication
– Tumor boards, inter/intra departmental conferences,
reporting
• Diagnostics
– Telepathology, automated pap screening
– Digital Pathology; whole slide scanners
Microscopic Input Station
Gross Workstation with Imaging
Robotic Telemicroscopy
Milestone MacroPathD ®
Gross Pathology Instrumentation
Other image
Other image
Historical Approaches to Supporting
Digital Pathology
File and Folder Based Storage
• Personal
• Departmental, networked
• Hierarchical organization
– Require careful management
• Naming conventions
• File sizing
• Monitoring
• Lots of work
• Performance issues
– Thousands of images in thousands of folders and files
gets slow
HFHS Process
• All images are stored on a central pathology department
server
– Tape back up
• Becoming impractical
– 1 Terabyte of space consumed
– User access and security challenges
• Use consumer image management and viewing software
– ThumbsPlus
– Take 4-5 minutes to load
• Image editing via Adobe Photoshop
Introduction to Apollo PathPACS
Image Storage
PACS Like Systems
• Image databases software
– input and catalog images
– search
– retrieve
• Ideally needs to be integrated with clinical databases for maximum
utilization
– critical component of a clinically useful system
– very few out there that work well
– difference between cottage and turn key imaging
systems
Apollo’s Pathology PACS Solution
Apollo provides comprehensive Pathology PACS Solutions
Pathology PACS in your institution
Apollo’s PathPACS® Solutions integrates into your LIS/HIS Systems
Apollo Digital Pathology Solutions
Pathologist Remote Access
Apollo PathPACS® software
Enterprise PACS
Acquisition Devices
Information Systems
Microscope
Robotic
Microscope
PathPACS®
Whole Slide
Scanner
Grossing
Station
Apollo
PathPACS®
client software
on
Desktop PC
LIS
Image
Management
Workflow
Radiology
Information
System
Hospital
&
Clinical
Information
Systems
HL7
Data Access
IS System
Interfaces
Electron
Microscope
Document
Scanner,
Other
DICOM
PathPACS® Pathology Image Storage
PACS Radiology Image Storage
Case is Accessioned in CoPathPlus
Apollo launch button can
be painted on any
specimen window.
CoPathPlus Attachment Edit/Entry
Interface Manager
Interface Engine provides sophisticated management capability
Metadata/Images from
Apollo into LIS via Apollo
TCP IN associated with
patient/accession
Orders leave LIS via Apollo
TCP Out with patient/
accession data
Project Planning and System Architecture:
Hardware Design
Review
Current file/folder format:
Finite/ non-expandable storage capacity
Slow file access times
Lack of security/ user restrictions
PathPacs will provide:
Expandable EMC file share of 750 GB
Access and management for all existing image-generating devices
Access
Permission-based logon
Thick-client and Thin-client access
Interfaces for ADT and images
Images to be shared via EMR
IT Infrastructure
Requirements/ Design/Access/Architecture
Server Setup - VM cluster
Remote vendor access via VPN
Database Setup
Polyserve setup (SQL database)
Network Connectivity
File Storage - EMC (750 GB)
IT Infrastructure Team
Wide range of expertise to support project development
PathPACS Administrative Module
Administrator software used to maintain the PathPACS dB
PathPACS Administrative Module
•
Administrative access levels:
– Tier 1 - Highest admin access level - create, modify, activate and
inactivate databases in the Apollo PathPACS® archive
– Tier 2 - Maintain specimen classes amd image classes. permission
groups; create, modify, and maintain users
– Tier 3 - Maintain client, device, lookup, pathologist lists
•
HFH - No access for end-users
Apollo configuration
Systems Options
Apollo configuration
Specimen classes
Apollo configuration
Image classes
Lookups
Case Search in Apollo
From CoPath Accessions
Apollo Lookups
Image Flag Search
Viewing Images in Apollo
Viewing Images in Apollo
PathPACS Configuration
Permission Group
PathPACS Configuration
Specimen permissions
Image and Specimen permissions come
from group membership
Secure Login
ADT Import/ Data Conversion
Conversion – ADT
• Need a patient demographics base in Apollo to convert
against
• ADT “dump” in CoPath
• Sunquest has no provision for how to do this
Conversion – ADT
•
•
•
•
Accession log includes most of required patient
demographic imformation
Created HFH ADT extract report
Download demographic information for all cases in a
given date range
Apollo imports to PathPACS
File/ Folder configuration
Specimen class code (LS)
Year
Sequence #
Conversion Effort
Pre-conversion
ADT extract
Folder naming convention verification
Folder/ Image cleanup
Post-conversion
Exceptions resolution
Conversion exceptions resolution
Conversion exception rate 0.3%
• More than 200, 000 cases
– Approximately 500, 000 images
MRN length vs. client standard
Client defined in CoPath missing in Apollo
Creative accessioning by users
Exceptions broken into related data sets
Apollo script run once data set rules are established
Summation
Where Are We Now?
• Test and Live interfaces created and validated
• All ADT created in Apollo for CoPath cases from 20042010; production ADT active
• All images imported 2004-2010
• All CoPath workstations upgraded to Windows XP SP3
with active directory security primary
• CoPath 4.1 upgrade completed
• Application deployed to desired workstations
• Training being designed
• System activation on schedule for October
2010
The End!
Questions?
J. Mark Tuthill, MD
[email protected]
Department of Pathology & Laboratory Medicine
Henry Ford Hospital, Detroit, MI
Pathology Informatics 2010