va/dod and va to va image sharing class 755 julian werfel and roger coney
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VA/DoD and VA to VA Image Sharing
Class 755Julian Werfel and Roger Coney
Cumulative Images Captured 2003-2010
Image Sharing
• Provides more patient information to use in diagnosis and treatment
• Reduces number of procedures for patient by making remote data available
• Saves money by reducing procedures• Saves patient and staff time
“A picture is worth a thousand words”
VA Remote Image Views
• Clinical Display communicates across the VA WAN to retrieve images from the VistA Imaging systems at remote VA facilities
VA/DoD Image Sharing
• NDAA (National Defense Authorization Act) El Paso pilot to share radiology images and reports with DoD
• Full access to patient record• DoD provides images to VA,
viewed in Clinical Display
VA/DoD Image Sharing
• Provide VA images to DoD users• Particularly important for Polytrauma
patients• Transfer images in DICOM with JPEG
2000 compression• Thumbnail, Lossy, and Lossless
quality• Realized as the VIX service – Imaging
Patch 83
VIX for VA/DoD Image Sharing
• VistA Imaging Exchange (VIX) Service• VIX implemented as part of VISA
(VistA Imaging Service Architecture)– Encapsulates VistA Imaging behind well
defined interfaces - SOA– Standards based: JPEG2000, DICOM, XCA
• Clinical Display requests DoD images from site VIX
• DoD images available to clinicians since Patch 72 Display client
VA/DoD Sharing Field Testing
• All sites with Imaging Patch 83 can see DoD images
View DoD Radiology Images
• View DICOM Radiology images for shared patients from the 7 original DoD NDAA sites
• BHIE Image Adapter (BIA) requests DoD images from site PACSi (analogous to VIX)
• Compression and caching to boost performance
View VA Radiology Images in DoD
• Provide DICOM radiology images for shared patients• Access images from all VA sites with a VIX Server• Available to DoD facilities with a PACSi server• Images viewable from the web based Advanced
Medical Image Viewer (AMIV)
Imaging Patch 72
• DoD images integrated with VA images
Enhanced Remote Image Views
• Access remote VA images through VIX• Remote VA and DoD images now available
to VistARad in Imaging Patch 90
Enhanced RIV Benefits
• Take advantage of VIX Caching and Compression– Image is compressed at source before
transfer over WAN– Image cached at local and remote VIX
• VIX handles remote connection rather than client– Fewer connections over WAN
• Enhanced RIV seamless to user
Enhanced RIV Image Quality
Imaging Patch 93
• Updated user interface
Viewing Remote Images
• DoD accessible same as VA data
Viewing DoD Images
• Accessing images from DoD same as VA
Viewing DoD Images
Viewing DoD Images
• No special tools for DoD, same as VA
Comparing VA and DoD imagesBHIE PATIENT
Area of Clinical Interest
DoD Image
WBAMC 03/2007
VA Image
El Paso 10/2001
VistARad and the VIX
• View images and reports from DoD• View images, reports and requisition
reports from remote VA sites• Monitor exam lists from remote sites
without requiring user to login• Exams from remote sites integrated
with exams from local site
VistARad Manager
• VistARad Manager shows exams from multiple sites including the DoD
VistARad Displaying DoD Images
Monitor Remote Sites
• Monitor remote sites without logging in
Support New DoD Architecture
• HAIMS, the Healthcare Artifact and Image Management Solution, will replace the NDAA El Paso solution in the DoD enterprise
• NDAA El Paso pilot will be sustained through the transition
• No changes will be required to the VA architecture
Providing VA Images to DoD with HAIMS
• No changes will be required to the VA architecture
VA/DoD Artifact Sharing
• Share Artifacts– Non radiology images• NCAT (Neurocognitive Assessment Test)
reports from DoD• Bidirectional• Implemented with IHE profile Cross
Community Access (XCA)• Development in progress
Expanding the VIX – the CVIX
• Centralized VistA Imaging Exchange (CVIX) Service
• Enterprise gateway for image sharing• Currently deployed in AITC (Austin
Information Technology Center)• Highly Available, Load Balanced,
Clustered Deployment• Based on the VIX design
CVIX Provides
• Artifacts available to VA Users– Artifacts from HAIMS– NCAT (Neurocognitive Assessment Test)
reports
• Artifacts from VA to DoD• Radiology sharing through CVIX• Support Future Interfaces
– NHIN (National Health Information Network)
– VLER (Virtual Lifetime Electronic Record)
View DoD Artifacts and Radiology Images
• CVIX retrieves HAIMS artifact and radiology lists from the BHIE Framework for viewing by VistA Imaging client applications
• CVIX retrieves HAIMS artifact lists from the BHIE Framework for viewing by VA applications
• CVIX retrieves HAIMS and NCAT artifacts for viewing by VistA Imaging client applications – Imaging Patch 104 (June 2010 – Pending Approval)
Providing VA Artifacts and Radiology Images to DoD with CVIX
• CVIX provides VA study and artifacts lists to the BHIE Framework for consumption by HAIMS
• CVIX provides radiology images to the BHIE framework for consumption by HAIMS
• CVIX provides artifacts directly to the HAIMS gateway
Image Enabling VistaWeb
• VistA Imaging providing Advanced Web Image Viewer (AWIV) to VistaWeb for image viewing
• View images associated with Progress Notes and Radiology Reports
• VistaWeb users can view VA images within VistaWeb
• Similar to CPRS/Clinical Display interface
• VistaWeb version 12
AWIV
• Uses components from Clinical Display
• Easy access from VistaWeb• Does not show all images stored in
VistA Imaging• Will view DoD Radiology and artifacts
in future• AWIV uses Centralized VistA Imaging
Exchange (CVIX) server• Currently in field testing (June 2010)
– Imaging Patch 105
VistaWeb Viewing VA Images
• AWIV retrieves all images from CVIX• CVIX communicates with VA sites
with and without a VIX
VistaWeb Progress Notes
• New icon indicates images are associated with note
AWIV Viewing VA Note
AWIV Viewing VA Note
VistaWeb Radiology Reports
• New icon indicates images are associated with report
AWIV Viewing VA Radiology Image
VistaWeb Viewing DoD Artifacts
• Prototype of Artifact Sharing• Future Development
AWIV Viewing NCAT Report
AWIV Viewing DoD Artifacts
VA/DoD Radiology Sharing Today
• DoD radiology images available in Clinical Display and VistARad
AWIV Viewing VA Images
• AWIV can view VA images through VistaWeb – Field Testing June 2010
VA Viewing DoD Artifacts
• DoD Artifacts available in Clinical Display• HAIMS providing artifacts and radiology• Field Testing December 2010
Server Deployment Changes - 2011
• CVIX clustered and moved to Philadelphia• NDAA fully replaced by HAIMS
AWIV Viewing DoD Artifacts - 2011
• Artifacts available in VistaWeb and AWIV
Image Sharing Big Picture
• Sharing of images improves patient care
• VA users can now view Radiology Images from VA and DoD in Clinical Display and VistARad
• DoD can view VA images• VistaWeb users can view VA images
with AWIV• Artifact sharing with DoD coming
soon
VIX Makes Image Sharing Work
• VIX provides access to images for VA and DoD
• Improves performance within VA• VIX is reliable• Optimized for delivery of images as
quickly and safely as possible• VIX encapsulates functionality with
standards using VISA
VIX Development Team
• Julian Werfel ([email protected])• Keith Buck ([email protected]) • Chris Beckey (
[email protected])• Csaba Titton ([email protected])• Roger Coney ([email protected])
Shared Modalities
• CT – Computed Tomography• CR – Computed Radiography• MR – Magnetic Resonance• US - Ultrasound• DX – Digital Radiography• RF – Radio Fluoroscopy• NM – Nuclear Medicine• XA – X-Ray Angiography• PT – Positron Emission Tomography• DS – Digital Subtraction Angiography