1. BROOKLYN 3 PACS USER GROUP Kevin WHITE Sun 1 st Sep 2013 Session 1 / Talk 1 09:00 – 10:00 Instigating the PACS USER GROUP PACSUG Presentation on Regionalization

2. Regionalisation Midland Style By Kevin White

3. Regionalisation Definition: The process of dividing an area into smaller segments called regions. One of the more obvious examples of regionalization is the division of a nation into states or provinces. Businesses also use regionalization as a management tool and a way to make certain that needs unique to particular areas are met. Definition: The process of dividing an area into smaller segments called regions. One of the more obvious examples of regionalization is the division of a nation into states or provinces. Businesses also use regionalization as a management tool and a way to make certain that needs unique to particular areas are met.processsegmentscalledregionsexamples divisionnationstates Businesses managementtool needsprocesssegmentscalledregionsexamples divisionnationstates Businesses managementtool needs Read more: http://www.businessdictionary.com/definit ion/regionalization.html#ixzz2dIT8ahUo http://www.businessdictionary.com/definit ion/regionalization.html#ixzz2dIT8ahUo http://www.businessdictionary.com/definit ion/regionalization.html#ixzz2dIT8ahUo

4. Midland DHBs Midland DHBs is made up of 5 District Health Boards Midland DHBs is made up of 5 District Health Boards TaranakiTaranaki TairawhitiTairawhiti LakesLakes WaikatoWaikato Bay Of PlentyBay Of Plenty

5. Midland PACS/RIS Midland PACS/RIS is made of only 3 of the 5 Midland DHBs. Midland PACS/RIS is made of only 3 of the 5 Midland DHBs. TairawhitiTairawhiti Bay Of PlentyBay Of Plenty WaikatoWaikato

6. Other 2 DHBs? Why are there only 3 of the 5 DHBs involved in the regional PACS/RIS? Why are there only 3 of the 5 DHBs involved in the regional PACS/RIS? Politics!

7. Vendors Main Vendor Main Vendor Philips (iSite PACS)Philips (iSite PACS) Subvendor Subvendor Kestral (Karisma RIS)Kestral (Karisma RIS) Other Companies Other Companies Gen-I, Datacom, IBM, OrthoView, Sound Business Systems (Dragon Naturally Speaking)Gen-I, Datacom, IBM, OrthoView, Sound Business Systems (Dragon Naturally Speaking)

8. How does it fit together? Philips won the tender to provide a 10 year regional PACS/RIS solution. Philips won the tender to provide a 10 year regional PACS/RIS solution. Philips contracted Kestral to provide the RIS. Philips contracted Kestral to provide the RIS. Philips supplied OrthoView for the Orthopaedic Templating Philips supplied OrthoView for the Orthopaedic Templating Philips has contacted Sound Business Systems to supply the voice recognistion software. Philips has contacted Sound Business Systems to supply the voice recognistion software.

9. How does it fit together? continued PACS Servers (50+) PACS Servers (50+) Main Location server farm is in Hamilton.Main Location server farm is in Hamilton. Mirror server farm is in Tauranga.Mirror server farm is in Tauranga. Local cache servers located at Gisborne, Whakatane, Tauranga, Taumarunui, Te Kuiti, Tokoroa, ThamesLocal cache servers located at Gisborne, Whakatane, Tauranga, Taumarunui, Te Kuiti, Tokoroa, Thames Waikato Hospital is close to main location so currently doesn’t have local cache servers.Waikato Hospital is close to main location so currently doesn’t have local cache servers.

10. How does it fit together? continued RIS Servers RIS Servers All located in HamiltonAll located in Hamilton OrthoView OrthoView Managed by each DHBManaged by each DHB Dragon Natuarally Speaking Dragon Natuarally Speaking Managed by each DHBManaged by each DHB

11. How does it fit together? continued HL7 Integration HL7 Integration Regional HL7 Interface Engine (HL7Connect)Regional HL7 Interface Engine (HL7Connect) Through to each DHBs own Enterprise Interface Engines. E.G Rhapsody and HL7Connect.Through to each DHBs own Enterprise Interface Engines. E.G Rhapsody and HL7Connect. 3 Clinical Results Viewers3 Clinical Results Viewers 3 Patient Management Systems3 Patient Management Systems National Breast Screening Programme – SectraNational Breast Screening Programme – Sectra HealthLink – outbound reportsHealthLink – outbound reports 3 rd Party Reports from Comrad – inbound reports via HealthLink3 rd Party Reports from Comrad – inbound reports via HealthLink

12. How does it fit together? continued PACS Integration PACS Integration Obviously modalities to the PACSObviously modalities to the PACS Transferring of studies outside of the 3 DHBs using a DICOM router managed by Bay Of Plenty DHB.Transferring of studies outside of the 3 DHBs using a DICOM router managed by Bay Of Plenty DHB. PACS to image printersPACS to image printers PACS to DVD robotsPACS to DVD robots

13. How does it fit together? continued Desktop Integration Desktop Integration iSite Radiology – KarismaiSite Radiology – Karisma Karisma – Clinical Results ViewerKarisma – Clinical Results Viewer Karisma – Dragon Naturally SpeakingKarisma – Dragon Naturally Speaking iSite Enterprise – OrthoViewiSite Enterprise – OrthoView iSite Radiology/Enterprise – Advanced Visualisation ToolsiSite Radiology/Enterprise – Advanced Visualisation Tools Karisma - SectraKarisma - Sectra

14. What Works? More and more doctors are working in multiple DHBs, this enables them to see images of one DHBs patient while being at another DHB. More and more doctors are working in multiple DHBs, this enables them to see images of one DHBs patient while being at another DHB. Dramatic decrease in repeat studies due to patient being imaged else where and images not being available. Dramatic decrease in repeat studies due to patient being imaged else where and images not being available.

15. What Works? Story Hawkes Bay had a very sick patient. No one in the lower North Island could help the patient. Images were transferred to the Midland PACS via the DICOM router. Within an hour an Interventionalist was viewing the images from home. A couple of hours later the patient was in a helicopter heading for Waikato Hospital. A few more hours later the patient is in the Interventional Suite having a life saving procedure. Patient went back to Hawkes Bay in a much better state. Hawkes Bay had a very sick patient. No one in the lower North Island could help the patient. Images were transferred to the Midland PACS via the DICOM router. Within an hour an Interventionalist was viewing the images from home. A couple of hours later the patient was in a helicopter heading for Waikato Hospital. A few more hours later the patient is in the Interventional Suite having a life saving procedure. Patient went back to Hawkes Bay in a much better state.

16. What Works? Continued No matter what politics exist (Some will be mentioned shortly) the patient is who needs to benefit from the system. We have seen many examples each week of this system effecting patients in a positive way. No matter what politics exist (Some will be mentioned shortly) the patient is who needs to benefit from the system. We have seen many examples each week of this system effecting patients in a positive way.

17. What Works? Continued Multiple PACS/RIS Administrators spread across a large area. Multiple PACS/RIS Administrators spread across a large area. 6x PACS/RIS Administrators across 3 DHB share call.6x PACS/RIS Administrators across 3 DHB share call. Lessens work impact on personal life. Lessens work impact on personal life. If all PACS/RIS administrators of 1 DHB are away from work 1 day, life still continues. If all PACS/RIS administrators of 1 DHB are away from work 1 day, life still continues. 2x RIS Administrators2x RIS Administrators Dedicated administrators to understand RIS processes etc. Dedicated administrators to understand RIS processes etc.

18. What Doesn’t Works? 3x Information Services (IS) Departments 3x Information Services (IS) Departments If one IS department can not provide resource with assisting an upgrade, it means no one gets the upgrade or the upgrade is delayed.If one IS department can not provide resource with assisting an upgrade, it means no one gets the upgrade or the upgrade is delayed. Another words 2 DHBs are at the mercy of the weaker DHB. (Weaker doesn’t mean smallest DHB)Another words 2 DHBs are at the mercy of the weaker DHB. (Weaker doesn’t mean smallest DHB) IS Departments generally have great trouble helping each other. - Regional IS is being created to assist with resolving this.IS Departments generally have great trouble helping each other. - Regional IS is being created to assist with resolving this.

19. What Doesn’t Works? Continued Senior management not turning up to regional meetings. Senior management not turning up to regional meetings. The business in one DHB making a business decision that impacts all 3 DHBs. The business in one DHB making a business decision that impacts all 3 DHBs.

20. Future Have the 2 other DHBs onboard. Have the 2 other DHBs onboard. Second DICOM Router to be located at Waikato. Second DICOM Router to be located at Waikato. More blurring of lines between the Radiology and Information Services Departments More blurring of lines between the Radiology and Information Services Departments

21. Thank you! kevin.white@waikatodhb.health.nz pacs@waikatodhb.health.nz pacsinfo@bopdhb.govt.nz pacssupport@tdh.org.nz 07 579 8111