picture archiving and communication system
Digital Pathology Systems Gear Up for Prime Time
Digital Pathology
Simply put, digital pathology is the utilization of digital photography to capture images on microscope slides. In the past (the early 1990s), there were a number of technical problems with digital imaging of anatomic pathology samples. Digital cameras captured the microscope slide images and stored them. However, the resolution of the digital photographs was not competitive with microscope optics and storage space was limited. A massive amount of data storage was required if the images of an entire microscope slide were to be archived. In addition, the task of capturing the entire microscope slide contents was time-consuming and laborious.
Dick Soenksen, CEO of digital pathology company Aperio Technologies, Inc., believes there are four requirements for effective digital pathology systems. They are:
1. Scanning ability.
2. Software to manage digital slides. In digital radiology they are called PACS (picture archiving and communication systems).
3. Information management systems.
4. The ability to perform image analysis on the digital slides.
Aperio Technologies, Inc.
If there is a leader in digital pathology systems–and it’s not clear that there is one–Aperio is probably it. Their headquarters is in Vista, California, with a European office in Bristol, U.K. Dick Soenksen, CEO of Aperio, says, “We are focused on digital pathology. That’s the only thing we do and it’s the only thing we’ve ever done. From our perspective, digital pathology is managing the information that’s generated by being able to digitize entire slides.”
One of the more interesting components of Aperio is their Digital Slide Scanning Service. Rather than invest in a system, the pathologist can ship their slides to Aperio and the company will use the ScanScope Scanner to digitize the slides, which are then returned along with a CD or DVD or via Internet access. Although the digital pathology market’s goal is undoubtedly to have all pathologists, labs, and hospitals using their technology in-house, this is a potential way to get pathologists to digitize early.
BioImagene
Cupertino, California-based BioImagene focuses on imaging systems for life sciences and digital pathology solutions. Mohan Uttarwar, President and CEO of BioImagene, says that their core competencies are, “The digitization of microscope slides, bringing in high-resolution image management, searching, mining of imaging data, and image analysis. Finally, the power of the Internet can be used to manage information, whether it’s a clinical report, educational content, peer reviews–formal or informal–or second opinions. All these pieces put together are something we as a company have focused on.”
Uttarwar cites four issues that are slowing adoption.
1. Lack of standardization.
2. Psychology, or resistance on the part of pathologists.
3. Ease of use and high quality.
4. Pricepoint.
Psyche Systems Corporation
Psyche Systems (Milford, MA) is not a digital pathology company per se, but a laboratory information system. They offer a number of different solutions for information management in a variety of laboratory areas, including anatomic pathology. Their AP solution is called the WindoPath Anatomic Pathology Information System, which has a modular, customizable design and can be integrated into several different laboratory information systems.
MIMvista Corporation
Based in Cleveland, Ohio, MIMvista recently made the news–somewhat contrary to Psyche’s comments about PocketPath–because of their development of a pathology imaging system specifically for Apple’s iPhone. MIM stands for Multi-modality Imaging, which has its roots in a digital radiology system dubbed Fusion.
Omnyx
As mentioned earlier, in June 2008, GE Healthcare and the University of Pittsburgh Medical Center entered into a joint agreement to start a digital pathology device company called Omnyx. Omnyx will be headquartered in Pittsburgh and also have a site in Piscataway, NJ, in addition to facilities in Israel and in Albany, New York. As yet, Omnyx does not have an actual product, although they plan to have a prototype device developed by the end of 2008 and expect to launch a product in 2010. Gene Cartwright, CEO of Omnyx says, “We believe it will be a little less than two years before we have a product. I think that we’ll be able to describe it in high level detail by the end of this year, but it’s the sort of product that needs FDA approval and that adds a certain amount of time to it.”
Cartwright believes the reason the field of digital pathology is receiving so much interest at the moment is that some of the technical hurdles are close to being solved. “The main ones are speed of acquisition of an image, quality of the image, ability to navigate around the image without having to wait for the image to come up, and then the ability to stream images. The cost of storage has dropped by 30 to 40 percent a year.”
Educational Use
John Woosley, MD, PhD, Professor of Pathology at the University of North Carolina at Chapel Hill, notes an increased use of digital slides in medical education. He sees it as an opportunity for medical schools to cooperate and share teaching materials, primarily because once a slide has been scanned, it costs nothing to duplicate
Conclusion
As noted, pathology is one of the last areas of clinical medicine to become digitized, following radiology and cardiac imaging. Typically the domain of microscope companies like Nikon, Zeiss and Olympus, a number of small companies have entered the market with new optics technology and digital information management software.
Although a number of companies and researchers have approached digital pathology over the last ten to fifteen years, they were hampered largely by the difficulty of acquiring high-resolution images of the entire microscope at high enough quality to be clinically useful. As digital image capture technology improved along with increased digital storage capacity at lower prices, digital pathology may have reached a tipping point where the technology is available at a reasonable cost.
It’s not clear how large that market may actually be. Omnyx’s Cartwright says, “The assumption is the market will adopt digital pathology at the same rate that digital radiology was adopted. So in several years we believe–and at the price points we’re assuming the market will support–that the market will be worth about $2 billion.”
Aperio’s Soenksen is more optimistic. “We’ve looked at the market and we’ve made a hypothetical full-adoption in the market and say it’s close to $4 billion a year. That’s about twice the size of what GE had in their analysis. We see more value in digital diagnosis that could be applied to automate things that pathologists are currently spending time on.”
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EHR data re-use: A new perspective
The use and re-use of EHR data in the healthcare information segment is always accompanied by various drawbacks. These drawbacks accompanying re-use of data vary from lack of legal and technical standards to uniformity of use. We need proper standards and protocols of data collection and the re-use. Only a properly collected piece of information whether primary or secondary can help in achieving research objectives. The re-use of data, generated by a medical software be it an EHR or any other record keeping system, should be cost-effective. Clinical experiments or trials done with re-use of EHR data is a cost effective way than collecting the data afresh. The uniformity in approach in re-use of data from medical software (EHR) is another point of concern in our discussion. The present situation in health care requires researches to carry out research studies in isolated fashion at different locations. The use of the EHR which is the common medical software in use varies widely across different nations worldwide and so challenges the re-use of EHR data in clinical researches and other uses. Other issues like the maintenance of patient confidentiality, requirement of time and cost effective resources are a few to requiring attention in the field of re-use of EHR data. A qualitative control on re-use of EHR data can lead to a sustainable, beneficial and commercial impact on treatment and drug development which ultimately will lead to better healthcare system in a viable economy.
With the increased focus on HIT (Health Information Technology), the situations in US and EU in re-use of EHR data is changing positively. Introduction of HITECH act in US is an initiative in the direction of Health Information Technology. The European Seventh Framework Program for research and technological development is the initiative by EU to focus on HIT. The use of proper EHR systems in place is growing fast in US. The vision of the EFPIA EHR task force is another forcing factor that will help in attaining the standards for re-use of EHR data.
And in future with such a huge amount of efforts we surely will have a proper system with proper medical software in place which will coordinate in re-use of EHR or any such data with satisfaction.
2 Imaging the medical business: DICOM
The efficiency in every sphere of life due to the technological and scientific advancements includes the health sector also. With the technological and scientific progress the people are becoming more aware of their health and nutrition. And due to this growing importance on health, the medical sector is also experiencing a huge growth. This growth in the medical sector is accompanied by the technological improvements as in the cases of other sectors. Almost all the hospitals and clinics are using technological advancements in their practices. Be it the medical software for billing or the EMR software system they are using. It is estimated that the use of an appropriate medical software product in place has the potential to increase the earnings by a considerable amount of more than or equal to 30%. So, simply you cannot neglect the importance that a right medical software product bears in medical industry.
And in this age of advancement any medical business unit without the imaging division is just incomplete. Imaging in medical business is of a great importance that nobody can ignore and even alter. The image reports like cardiographs, biomagnetic imaging, computer radiography, tomography, diaphanographs, microscopy, endoscopy, mammography, spectroscopy, radio fluoroscopy, thermographs, ultra sound, x-ray angiography are a few of the imaging services to name that comes into the scene when we talk about medical imaging reports. Today’s treatment of a patient is incomplete if no one of these images accompanies his records. And with these imaging services there is a common standard for the handling, storage, printing and transmission of imaged information in medical imaging. This common standard or the common format for the images is known as DICOM.
DICOM is the abbreviation for Digital Imaging and Communications in Medicine. The Picture Archiving and Communication System or simply PACS which is a system, uses this standard for the all the medical imaging. DICOM includes a file format definition and a network communication protocol. And this network communication protocol uses TCP/IP for communication in between the systems. DICOM enables the integration of scanners, printers, workstations, computer systems and other network hardware into PACS. DICOM supportive devices come with the capacity to support different DICOM classes separately. DICOM is developed by American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). The present DICOM is the third version of this standard. The first version was released in the year 1985. It was ACR/NEMA 300. The second version came in the year 1988 by the name ACR/NEMA V2.0.
DICOM bears some very necessary information along with the images like the patient ID, which is inseparable from this information even by mistake. While handling DICOM data different medical software products are used. Software tools for the transfer, organizing of DICOM data, for image supports etc. are very widely used. Trial Wire is a very useful medical software used in DICOM data transfer, de-identify and handling. There are other software products like GDCM, OsiriX, ImageVis3D, VRRender, ImageJ, MicroDicom, Medstrat, kPacs, UniPACS etc. which are very commonly used in DICOM interpretation.
Trial Wire is a medical software product used to transfer DICOM image from one to another web enabled computer. It is a java based tool available free of cost. The use of a medical software product like Trial Wire reduces the cost associated with the couriers used to transfer DICOM data from one location to the other. Trial Wire also provides an audit trail for any changes made to the DICOM data in order to comply with the HIPAA regulations.
3 Medical Software in HIS sphere:
Automated health practice management systems, e-prescribing, CAT scanners, heart rate monitoring with software are a few of the names from the medical area in the 21st technology driven century. From the patient’s personal data to the cardiographs everything has got the driving force of technological advancement. Introduction of PACS or Picture Archiving and Communication System and DICOM or Digital Imaging and Communication in Medicine has changed the way of imaging in the medical practices. Similarly the introduction of EMR/EHR medical software has changed the way of medical record keeping. In most of the hospitals and clinics in EU, US or Canada you would notice the use of medical software like an EMR system in practice very well. Likewise the introduction of medical software for billing purpose is another important contribution of modern technology. Medical billing software used in billing has introduced the comfort of coordination among other medical services like lab report of patients and its coordination with proper insurance claims etc.
Medical Software is the modern technological term that has driven the medical sector to an unalterable stage of advancement. The introduction of various medical software products has changed the way of management and even the administration concerned with hospitals and clinics across EU and US. Medical software use even in health informatics like HIS is of great help. HIS or Hospital Information System is the platform covering all the medical related clinical as well as administrative sections. From the simple hospital discipline management to the management of health records, financial records, and other medical reports all are covered under this single umbrella named HIS.
Hospital Information System or simply HIS is the information system assisting all the administrative, financial and clinical aspects of a hospital or a clinic. HIS also known as CIS or Clinical Information System comprises of a comprehensive, integrated information system covering all the papered and non-papered software based clinical as well as administrative medical areas of concern. A simple HIS construction can be understood as the sphere covering the entire medical aspects from EMR systems to the software based billing services. A proper HIS is always aimed at achieving best possible support towards the health care of patients and an adequate management by deploying either medical software products or machineries along with responsible technicians/persons. Radiology information system, Laboratory Information System, PACS, etc. are the sub categories of Hospital Information System. EMR, EHR, software based billing services, insurance claims, patient care, profit drive, hospital management, administrative works all belong to the sphere of HIS.
The advantage from HIS includes well maintained decision support system in healthcare, exchange of information towards the betterment of the healthcare services, coordinating the standards of ancillary services with the primary one, enabling referring physicians and doctors to access all the studies and reports via a single user interface etc. In a nut shell a proper HIS with adequate medical software support is the demand of the time, conforming to which can rise your business in the medical sector to an incredible level.
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Functions Of A PACS RIS System
To begin, PACS RIS are two separate but related features. PACS stands for Picture Archiving and Communication System, while RIS means Radiology Information System. PACS has to do with digital medical imaging, and it is a software and hardware system that allows medical facilities to store, view, retrieve, send and receive digital medical images from a computer. RIS is a software database that enables radiology departments to archive and distribute both digital medical images as well as other types of data such as patient scheduling, tracking and reporting. When used together, they greatly improve the workflow for any radiology department in a small or large medical facility.
A pacs server allows medical personnel to obtain images from various modalities, such as mammographies, MRIs and CTs, and then take those digital images and view them on a workstation, store them in archives and transmit them via a secure network. PACS RIS also come as mini-pacs and web-based pacs. Mini-pacs are an extremely focused type of pacs system that allows you to use images taken from one type of modality, rather than multiple modalities as can be done on a full pacs system, and then manipulate them on a workstation. A web-based pacs is a system that allows you to send and receive digital medical images and other data over the Internet. They use secure transmissions over virtual private networks or secure socket layer. The web-based aspect of the pacs has changed how medical offices function, because now it is a simple matter to remotely work nearly anywhere in the world due to the use of the World Wide Web, and this also allows for improved consultations with physicians located down the hall or across the world from you.
A RIS PACS system helps keep a radiology department organized in terms of patient care. With this type of system, departments can track the registration and scheduling of their patients. It is easy to create test requests and results entries, reports and printouts automatically. The system can handle emailing clinical reports, and can be used to book patient appointments, to maintain your office workflow, and even to create customized reports. Many systems also take care of billing as well.
For the speed and ease of use brought about by this new technology, many medical offices are switching over to a pacs server.
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