ECR 2013.indd - Agfa HealthCare

Healthcare transformation, we’ll take you...8cEnTRo22dE EspEciAlidAdEs mÉdicAsAmbulAToRiAs (cEmA), mAR dEl plATA, ARgEnTinANew diagnostic center strengthens healthcare networkand enables more effective care across municipalitycAnisius-wilHElminA ziEkEnHuis,nijmEgEn, THE nETHERlAndsCWZ Nijmegen goes beyond PACS vendorlock-in with new Vendor Neutral Archive1424March 2013Edition 14uc iRvinE HEAlTH, oRAngE counTy, cAlifoRniA, usAUnique technology in ICIS ‘connects the dots’between EHR and patient imagesAllEgiAncE HEAlTH, jAckson, micHigAn, usAOn-the-go bedside imaging brings better care topatients in ER and beyondinTERviEw insidE wiTH:» charles morris, chris magyar & genady knizhnik,icis Experts at Agfa Healthcare

Some thingsare meantto transcendbordersAnywhere in the world, themovements and rhythms of thetango are unmistakable: thesteps, the precision and, aboveall, the perfect timing. It’s apassionate dance, requiringdiscipline and a search forperfection.ICIS, our Imaging ClinicalInformation System, translatesthose same demandingcharacteristics into the worldof healthcare. It makes imagesreadily available to the physiciananywhere: across the department,enterprise, region, country, etc.By freeing medical images fromthe hospital’s “information silos”,by offering a way to capture,store, exchange and access theseimages directly through the EHR,ICIS gives them new meaningand perspective. And providescaregivers with seamless accessto the patient’s imaging history,with as much precision andsmoothness as a meticulouslyexecuted tango.With solutions like ICIS, AgfaHealthCare continues to play animportant role in the changinghealthcare world, which isalways reaching farther, beyondAgfa healthcare Editorial Team Marc De Fré, Editor-in-Chief • GeertruiDe Smet, Managing Editor • Content & distribution Agfa HealthCare NV• Septestraat 27 • 2640 Mortsel • Belgium Concept, content & designwww.livingstone.eu • Printing Artoos • Oudestraat 19 • 1910 Kampenhout •BelgiumThe Agfa HealthCare editorial team would like to thank its customers, staff membersand interview partners for their contribution to this publication.Agfa and the Agfa rhombus are trademarks of Agfa-Gevaert N.V., Belgium, or its affiliates. DX, ICIS, IMPAX,IPLAN, MUSICA and XERO are trademarks of Agfa HealthCare NV, Belgium. All other trademarks are heldby their respective owners and are used in an editorial fashion with no intention of infringement. Thedata in this publication are for illustration purposes only and do not necessarily represent standards orspecifications, which must be met by Agfa HealthCare. All information contained herein is intended forguidance purposes only, and characteristics of the products and services described in this publication canbe changed at any time without notice. Products and services may not be available for your local area.Please contact your local sales representative for availability information. Agfa HealthCare diligentlystrives to provide as accurate information as possible, but shall not be responsible for any typographicalerror.2 THEREyesterday’s limits and limitations.This evolution is like a danceitself, using passion to take a new,expanded perspective on eachstep and movement, creating newmeaning.Inside this edition of THERE,you will find examples of howour own meaningful passion ishelping transform healthcare, inreal-life stories and interviewsfrom healthcare enterprises.In radiology as well as at theenterprise level, our solutionssupport physicians and hospitalsto make better-informeddecisions.Under the umbrella themeof Insight. Delivered. we willdemonstrate at ECR 2013 howall our solutions help improvethe delivery of patient careand collaboration across thedepartment, hospital and region,underlining our promise: “Leaveno image behind.”Enjoy!Marc De FréDirector MarketingCommunications4 MÁXIMA MEDISCH CENTRUM, EINDHOVEN,THE NETHERLANDSMáxima Medisch Centrum buys peace of mind forthe next decade6 PIUS HOSPITAL OLDENBURG, GERMANYWireless detector helps hospital addressefficiency goals8 CENTRO DE ESPECIALIDADES MÉDICASAMBULATORIAS (CEMA), MAR DEL PLATA,ARGENTINANew diagnostic center strengthens healthcarenetwork and enables more effective care acrossmunicipality12 AMC HOSPITAL, AMSTERDAM,THE NETHERLANDSGlobal Remote Incident Prevention services bringpeace of mind to radiology department14 UC IRVINE HEALTH, ORANGE COUNTY,CALIFORNIA, USAUnique technology in ICIS ‘connects the dots’between EHR and patient images16 ENVISION YOUR EHR WITH IMAGING USINGICIS19 NORWEGIAN RADIUM HOSPITAL, OSLO,NORWAYHelping multi-disciplinary teams work togethermore efficiently22 CANISIUS-WILHELMINA ZIEKENHUIS,NIJMEGEN, THE NETHERLANDSCWZ Nijmegen goes beyond PACS vendor lock-inwith new Vendor Neutral Archive24 ALLEGIANCE HEALTH, JACKSON, MICHIGAN,USAOn-the-go bedside imaging brings better care topatients in ER and beyond27 AZ SINT-REMBERT, BELGIUM“IMPAX Agility is my office and I take itanywhere I want to work”30 TECHNOLOGY CORNERAgfa HealthCare introduces the benefits oftask-based workflow engines to medical imagingOn the cover of this edition of THERE magazine:Interpreted the world over, the tango has built a culturalheritage all its own. Blending precision with poetry, thedance is here performed in the old city of Split, Croatia –the perfect setting for one of the world's most imaginativedances.

© Katerina BodrunovaDefying expectationsRussian artist Katerina Bodrunova exploresthe nature of physics in UnderwaterTango, a spectacular series of photographsdepicting an underwater danceperformance. Transcending space, timeand gravity, these dreamlike images offera compelling visual interpretation.THERE 3

Máxima Medisch Centrum, Eindhoven, The NetherlandsMáxima Medisch Centrum buyspeace of mind for the next decadeRigorous tender involving all stakeholders translates global vision into smart long-termrelationshipInterviewees Jac Verbruggen, Purchase Manager · Jef Pluijmen, Radiology Manager · Robert Waterschoot, Functional Application Managerwe wanted to move into the purchasingprocess.”Stringent requirements leadproject team to Agfa HealthCareThe team eventually ended up with ashortlist of five and a very long list ofrequirements. Says Jac Verbruggen: “Wewere quite thorough in our demandsas we wanted to safeguard the existingfunctionalities and add all the attractivefeatures from the different vendors. Ourresearch taught us that all vendors had theirown approach to PACS and their growthpath for it.”When Máxima Medisch Centrum, TheNetherlands, decided to replace its RIS/PACS, it wanted the best of all worlds: toacquire the most current, appealing featuresfrom as many of the shortlisted vendorsas possible. After a thorough review, theysigned a contract for Agfa HealthCare’sIMPAX 6 solution covering radiology,cardiology, nuclear medicine; IMPAX DataCenter; and IMPAX Business Intelligenceincluding long-term Managed Services withGlobal Remote Incident Prevention. It ispeace of mind for at least ten years, theysay.Máxima Medisch Centrum has two sites inthe south of The Netherlands (Veldhovenand Eindhoven) totaling 595 beds. Its 3,300staff members, including 210 specialists,care for about 25,000 inpatients eachyear. The medical center is committed toimplementing a hospital-wide imagingsolution with high-end connectivity toother hospitals.4 THEREAfter thorough preparation for severalyears, a project team consisting of radiologyand purchase departments launcheda tender to upgrade the facility’s RIS/PACS, and cover cardiology and nuclearmedicine as well. Purchase Manager JacVerbruggen: “The project group consistedof the functional application manager ofradiology, the manager of clinical physics,the purchase manager and the radiologymanager. In the course of the process, thissteering group was advised by clinicalspecialists, ICT and radiologic technologists.We wanted a future-proof solution, so weinvolved all stakeholders in the hospital.”The need to replace the existing PACSinfrastructure had been clear for severalyears. “We visited numerous importantexhibitions in Europe to fine-tune the tenderand establish our short list of vendors,” saysJef Pluijmen, Radiology Manager. “Thiswas a ‘field reconnaissance’ phase, whichallowed us to define the vendors with whomEventually, the team’s choice was AgfaHealthCare including its IMPAX 6,IMPAX for Cardiology, IMPAX for NuclearMedicine, IMPAX Data Center and IMPAXBusiness Intelligence. IMPAX 6 is the latestversion of Agfa HealthCare's proven imageand information management solution.IMPAX for Nuclear Medicine delivers thebenefits of integrated care to the nuclearmedicine department and supports thepatient's entire exam flow, while IMPAXfor Cardiology enables patient-centriccardiac management with all the relevantdata promptly available. The decision“We wanted a future-proofsolution, so we involved allstakeholders in the hospital.”Jac Verbruggen, Purchase Manager

“Agfa HealthCare came with asmart deal for both of us.”Jef Pluijmen, Radiology Manageralso involves a 'smart' Managed Servicescontract and GRIP (Global Remote IncidentPrevention), Agfa HealthCare's remotemonitoring and event management solutionfor PACS and IT infrastructure.Scalable solution will expandPACS into wide range of specialtydepartments“We proved that Agfa HealthCare was themost suitable vendor to stabilize and extendour existing functionality and workflow.But they can also guide our growth towardsa wider PACS solution, which includes“We found Agfa HealthCare tobe the best in supporting ourambition. They make it possiblefor us to grow towards theimplementation of ahospital-wide PACS solutionusing a single viewer.”Robert Waterschoot,Functional Application Managernuclear medicine, cardiology, oral surgeryand medical photography,” explains RobertWaterschoot, Functional ApplicationManager. “We also considered expandingtowards a hospital-wide PACS solution,but we first needed to quickly offer onesingle viewer, integrated into the ElectronicHealth Record, so medical specialists couldaccess all images made and stored in thetwo different PACS within Máxima MedischCentrum. Another goal is the efficientsharing of images with outside thirdparties.”The key to the solution is IMPAX DataCenter, Agfa HealthCare's scalableenterprise imaging management solution,which can store imaging data from multipledepartmental imaging systems anddisparate hospital PACS solutions. IMPAXData Center will allow doctors at MáximaMedisch Centrum to view images fromradiology, cardiology and nuclear medicinefrom a single viewer, thereby increasingproductivity.Service and budget in line withhospital's vision“Functionality, workflow and AgfaHealthCare’s technical dimensions wereexcellent,” Jef Pluijmen continues. “Theysupported our vision on making workflowsefficient, as well as how to expand thesolution to the complete organization.They also offered an outstanding serviceorganization that’s close to us, with a budgetthat met our needs.”During the pre-tender discussions, AgfaHealthCare introduced its ManagedServices concept, with its Global RemoteIncident Prevention functionality. Thesteering team decided to include ManagedServices as part of the list of requirements.Says Jef Pluijmen: “Agfa HealthCare camewith a smart deal for both of us: we wouldinvest in our infrastructure, but we wouldhave a contract that includes permanenttechnology updates to keep our solutionsstate-of-the-art for as long as we continuethe relationship. We realized this ManagedServices concept would provide us withpeace of mind for at least a decade. Evenwith the equipment completely on-premise,we are assured of minimum downtime,and we don’t have to continually invest intechnology upgrades to prevent our systemfrom becoming obsolete.” •Agfa HealthCare’s contribution» Solutions that meet the needs of today, whilelaying the foundation for expansion» Comprehensive Managed Services conceptthat keeps solutions current» In-depth knowledge of workflows andhospital information management needsSolutions» IMPAX 6 RIS/PACS, IMPAX for Cardiology,IMPAX for Nuclear Medicine, IMPAX DataCenter and IMPAX Business Intelligence» Managed Services contract including GlobalRemote Incident Prevention (GRIP)DID YOU KNOW…» Máxima Medisch Centrum’s very existence isclosely related to the multinational concernPhilips. Philips’ early 20 th century growth ledto the 1933 creation of a hospital site closeto the company, thanks to an initiative by Dr.Anton Philips. This is still the location of thehospital’s facility at Eindhoven.THERE 5

PIUS HOSPITAL OLDENBURG, GERMANYWireless detector helps hospital addressefficiency goalsSmall device delivers big benefits including cost savings, seamless integration intoworkflow and sharing options for flexible useInterviewees Priv.-Doz. Dr. Alexander Kluge, Director of the Institute for Diagnostic and Interventional Radiology · Jutta Juilfs, Head Technologistimaging and pathology exams thanother hospitals of this size, which meansproductivity is paramount. Advancedimaging technology and PACS play akey role here in creating an efficientworkflow for physicians’ reports andstudy comparisons, and enablinga smooth interchange with clinicaldepartments and referring physicians.Previously, a cassette-based imagingsystem was in place, used formammography and in the emergencydepartment. “We decided to upgradefrom imaging cassettes to a wirelessdetector, which would make workflowsmore convenient and faster, andalso save on cassette costs,” saysDr. Alexander Kluge, Director ofthe Institute for Diagnostic andInterventional Radiology.Pius Hospital, located in the northeastregion of Germany, serves a widegeographical area, providing both generalmedical services and highly specializedexpertise. Over the last 10 years, PiusHospital has gone through a process ofcomplete refurbishment, including thehospital building as well as its medicaltechnology. The introduction of a DX-D6 THERE“Our staff is very satisfied withthis detector, they appreciatethe quality of the images aswell as the significant workflowimprovements.”Priv.-Doz. Dr. Alexander Kluge, Directorof the Institute for Diagnostic and InterventionalRadiologyRetrofit solution fits into the hospital'sgoal of streamlining processes across thefacility, especially in the ER.The 400-bed hospital’s major focus is ononcology, and it offers centers dedicatedto breast, lung, colon and pancreaticcarcinomas. Because of these specialtycenters, the hospital performs moreThe DX-D Retrofit solution allowshealthcare facilities to upgrade tothe benefits of Direct Radiography,without having to replace their existingequipment. The solution consists of a flatpanel detector, a retrofit box and an NXworkstation with Agfa HealthCare’s goldstandard MUSICA 2 image processingsoftware, which provides excellentcontrast detail and exam-independent,consistent image quality.Familiarity with Agfa HealthCaresolutions, interfaces and imagequalityHospital staff were already familiar withimaging solutions and user interfacesfrom Agfa HealthCare, having workedwith them for many years. Afteranalyzing DR detectors in the marketwith regard to image quality, workflowand cost, Pius Hospital decided in favourof the WLAN-enabled DX-D Retrofit.“This solution has the added benefit ofnot requiring any significant training forour staff,” explains Dr. Alexander Kluge.“Software and interfaces are from asingle source, which is a great plus.”

“Since September 2012, we’ve usedthe DX-D Retrofit to perform examson approximately 30 patients dailyon weekdays, and approximately10-15 patients during weekends,” saysHead Technologist Jutta Juilfs. Thesepatients had to be examined in a veryshort amount of time. Therefore, quickturnaround was a requirement. “Thedetector has significantly reduced staffworkload for each patient.”Because it is wireless, the DX-D Retrofitoffers enhanced flexibility. Demographicdata is automatically fed to the detectorfrom the PACS, and acquired images aretransmitted directly onto the detector,streamlining workflow and speedof exams. Within seconds after theacquisition, technologists can pre-checkthe image, approve the technical quality,and transmit it wirelessly to the PACS.The detector fits into any standard buckytray, and can be used in multiple X-raymodalities, meaning it can be sharedamong several rooms or modalitiesas needed, maximizing efficiency andkeeping costs low.As part of the re-organization, the CRsystem from Agfa HealthCare thatwas already in place was moved fromthe ER to the radiology departmentto be used for mammography, and toprovide backup to the department.Featuring a team of 25 radiologistsand technologists, the departmentcarries out approximately 40,000 examsannually, including X-ray, 64-slice CT,MRI, high-end ultrasound, as well asmammography exams. Radiologistsalso work with PET/CT in the nuclearmedicine department, and provideservices for the ER, ICU, and theintermediate care department.Technology investment key tohospital’s positioning in market“Investing in an infrastructure ofadvanced medical technology is astrategy fostered by our CEO, whoclearly sees the necessity for this in thecontext of our positioning in the market.Our staff and our technology stand fordiagnostic and therapeutic competencein complex cases,” says Dr. Kluge.In working with the DX-D Retrofit,radiologists at Pius Hospital typicallyaim to reduce dose by approximately 20to 30 percent. “Our staff is very satisfiedwith this detector, they appreciate thequality of the images as well as thesignificant workflow improvements,”states Dr. Kluge. Agfa HealthCarehas been very responsive in regard toquestions and with support, he says.“Patients profit from the investment byreduced queuing and more time spentwith them by technologists,” adds JuttaJuilfs.investments that provideimage quality and workflowimprovements NOW AND INTO THEFUTUREBoth the CR solution and the wirelessdetector technologies are economicallyforward-thinking investments, concludesDr. Kluge. “DR detectors require acertain minimum number of examsto make sense financially, based onresource economies and productivity.In Oldenburg, a city with three hospitalsproviding in-patient care, Pius Hospitalis well-positioned with its generalscope, plus its focused expertise ononcology,” he says. “Innovative, and stillaffordable, medical technology supportsus in managing this mix of patients,which includes many complex cases, byproviding advanced image quality andenabling swift turnaround times. TheDX-D Retrofit is an excellent illustrationof a solution which supports our goals.” •“Patients profit from theinvestment by reduced queuingand more time spent with themby technologists.”Jutta Juilfs, Head TechnologistSolutionDX-D Retrofit» Offers the workflow and image quality benefitsof DR» Easy and quick to set up» Wireless for enhanced flexibility» Seamlessly connects to HIS, RIS, and PACS» Single detector can be shared across differentrooms, different modalities, maximizingefficiency and reducing equipment costsAgfa HealthCare’s contribution» Enables cost savings and efficiencyimprovements» Makes workflows more convenient andproductive with technology that fits inseamlessly at all steps in the workflow process» Develops technology that improves staff andpatient satisfactionDID YOU KNOW…» Founded in 1871 as a charitable refuge for thepoor, Pius Hospital has grown into anacute-care hospital with more than 400beds, 1,000 employees, and 13 specialtydepartments.» The European Medical School, newlyestablished by Oldenburg University, integratesPius Hospital as well as the two other hospitalsin Oldenburg and local care providers into itsresearch and teaching activities.THERE 7

CENTRO DE ESPECIALIDADES MÉDICAS AMBULATORIAS (CEMA), MAR DEL PLATA, ARGENTINANew diagnostic center strengthenshealthcare network and enables moreeffective care across municipalityCompletely digital approach aligns with government’s aim to evolve towards preventivehealthcareInterviewees Dr. Alejandro Cristaldi, General Manager · Germán Giles, Medical Technology DirectorUnlike other health service models inArgentina, the Centro de EspecialidadesMédicas Ambulatorias (CEMA, Centerof Specialized Ambulatory Medicine)was designed to be completely digital,right from the start. The objective forCEMA was to support the 32 Centersof Primary Healthcare of the GeneralPueyrredón Municipality, along withtwo provincial hospitals. Through itsspecialized diagnostic technology andhealthcare professionals, CEMA servesas a key link between the first andthird levels of the healthcare system,optimizing healthcare in the publicsector.The city of Mar del Plata, Argentina’smost important tourist center, islocated on the Atlantic coast, about400 kilometers south of the capital,Buenos Aires. CEMA, the area's newestand most technologically-advanceddiagnostic center, opened its doorsthere in late 2012. Designed toprovide medium- and high-complexitydiagnostics to inhabitants of the region,CEMA will serve up to 1,500 patientsper day.8 THERE“Our completely digital site isperceived as a benchmark forhealthcare in Latin America.”Dr. Alejandro Cristaldi, General ManagerThis state-of-the-art facility featuresthe latest ecologically-sustainablebuilding materials and systems, andwas funded by Argentina's national andprovincial governments. Dr. AlejandroCristaldi is General Manager of CEMA,and also Undersecretary of MunicipalHealth. "This project, included in themunicipal healthcare system, wasdesigned by mayor Gustavo Pulti,and Dr. Alejandro Ferro, Secretary ofMunicipal Health. We are very pleasedwith the building’s design," he says, ofthe 6,200 square meter, three-storeypurpose-built center. "But I alwayssay that CEMA’s main asset is itsinformatics profile."Shaping the project profileOnce Agfa HealthCare was awardedthe contract, it helped to shape thatproject profile from the earliest stagesof implementation. Local governmentadministrators turned to AgfaHealthCare experts to help define thetechnology and workflow requirements."The local team from Agfa HealthCarewas of inestimable value during theprocess of the project, as they offereddifferent types of specialized knowledgeto help identify the specific needs," saysGermán Giles, Medical TechnologyDirector at CEMA.Most of the examinations performed atCEMA are in the areas of CT, MRI, X-ray,ultrasound, echocardiography, andmammography. Patients are referredby physicians at any of the 32 primaryhealthcare centers in the municipality,which could be up to 30 kilometersaway. Before CEMA, there were onlyfour centers in this system providing

conventional radiology. Now, there areseven centers in the network providingdigital radiology, around the clock, andthe images from these health centers areread in real-time by the radiologists atCEMA.Digital patient recordsimprove security and minimizeduplicationThe changes in the way healthcare ismanaged in the municipality go waybeyond this improved use of radiologyresources. Before CEMA startedoperations, all patient information forthe municipality was handled on paper,including medical records, radiologyfilms, etc. Now, this information ismanaged digitally. Once the patient ischecked in, the system receives theirdemographics and personal details,so there is no need to transcribe thepatient's personal information orre-perform imaging studies, improvingpatient security and minimizing examduplication."The digital solutions from AgfaHealthCare play a central role at thecenter, helping us to meet our goalsfor high-quality diagnostics and forconnectivity," says Germán Giles. Thecenter uses a range of CR solutions fromAgfa HealthCare, including theCR 30-X, CR 35-X and CR 85-X. It startedwith CR to be able to use the analogradiology equipment in place in theprimary healthcare centers, and alsobecause CEMA received some analogmammography equipment as a donationfrom the Buenos Aires province. Radiologyworkflow is managed with an IMPAX RIS/PACS solution, and the center also usesiPlan, Agfa HealthCare's internet-basedenterprise scheduling and planningsolution.Technology to enable preventivehealthcareIn addition to all of the efficiencyimprovements that the technologyenables, there are also important gainsbeing made in the area of preventivehealthcare. The network makes thesolutions more widely available, and italso grants access to a wider professionaloffer. Day by day, as the project“The digital solutions from AgfaHealthCare play a central roleat the center, helping us tomeet our goals for high-qualitydiagnostics and for connectivity.”Germán Giles, Medical Technology Directorgrows, physicians, technologists, andadministrative staff are being added to thenetwork.This is making a significant impact onthe health of the population. Becausethey have access to more equipment andprofessional expertise, diseases may bediagnosed faster. Healthcare providersare working with health protocols thatdetermine what studies are needed, andhow to make the best use of the facilitiesand all the solutions both in the CEMA andthe health centers. "This is generating amajor cultural change, not only from thetechnology point of view, but also on themedical side by standardizing processes ofpatient care," says Dr. Alejandro Cristaldi.THERE 9

“The local team from AgfaHealthCare was of inestimablevalue during the process of theproject, as they offered differenttypes of specialized knowledgeto help identify the specificneeds.”Germán Giles, Medical Technology DirectorThe project tender required that theIT solutions proposed for CEMA bebased on the Project ManagementInstitute (PMI) and its high projectstandards, to specify baselines for theimplementation schedules, the staffneeded and the hardware necessaryto start this project. According to Dr.Cristaldi, Agfa HealthCare’s solutionsnot only complied with the standardsrequired by the municipality; they alsooffered a very attractive economicproposal, which facilitated the decisionwhen assigning the tender.The implementation was verystructured, and broken into steps,including progressive training steps.This was helpful because the staffmembers were starting from a varietyof perspectives, e.g. the staff at CEMAwere more easily trained because theywere all new; meanwhile at the healthcenters the staff were used to workingwith conventional radiology solutionsand protocols.Benchmark for care in LatinAmericaAs the first site of its kind in thecountry to be developed as completelydigital, CEMA is a model of efficiencyand cost-effectiveness. This pilotproject is being analyzed so it can beduplicated not only in the provinceof Buenos Aires, but in othermunicipalities in Argentina as well."It is perceived as a benchmark forhealthcare in Latin America," concludesDr. Cristaldi.•Agfa HealthCare’s contribution» Recognized across Latin America forhealthcare technology and expertise» Strong local team provides support andknowledge at all stages in the process» Focus on integration for more efficientprovision of healthcareSolutionsCR 30-X» Compact, tabletop digitizer for ComputedRadiography where space is limited or inmobile environmentsCR 35-X» Supports a broad range of applications andprovides significant results to facilitiesexperiencing a high volume of spinalexaminations among other commonorthopaedic examsCR 85-X» Multi-user, multi-application digitizer withcompact footprint, for centralized ComputedRadiography environmentsIMPAX PACS» Next-generation PACS, streamlines enterpriseworkflow and delivers increased efficiency andproductivityIMPAX RIS» Electronically manages radiology operations,from patient registration through worklistgeneration and transcription, to medicalreporting and business intelligenceiPlan» Internet-based enterprise scheduling andplanning solutionDID YOU KNOW…» Mar del Plata is the seventh largest city inArgentina.» In the early 20 th century inhabitants of BuenosAires began to come to Mar del Plata as aholiday resort, and it is the biggest seasidebeach resort in the country today.» It is the most popular destination forconventions in Argentina, after Buenos Aires.10 THERE

Communicating without wordsIt’s the electricity between partners thatgives the tango its magic. You can’t quitesee it, but when it’s there the dancebecomes transcendent. The tango firstsaw its start in African-Argentine dancevenues, frequented by ‘compadritos’ –young men with a certain style.THERE 11

AMC Hospital, Amsterdam, The NetherlandsGlobal Remote Incident Preventionservices bring peace of mind toradiology departmentGRIP increases uptime levels and reduces patient care delaysInterviewees Dr. Annette Bak, Manager of Radiology and Nuclear Medicine · Jan Wolters, Functional Application Specialistshowed the best overall score, andwhen they suggested that we supportour version of the IMPAX radiologysolution with Global Remote IncidentPrevention (GRIP), we were quiteconfident we would also benefit fromthis new service.”GRIP provides state-of-the-artelectronic monitoring of IMPAXRIS/PACS to help prevent serviceinterruptions or downtime surprisesin the healthcare IT environment. Apermanently open VPN connection linksGRIP to the Agfa HealthCare centralmonitoring center in Rijswijk, TheNetherlands.With its new GRIP remote monitoring andevent management and reporting solution,the Academic Medical Center (AMC) inAmsterdam, The Netherlands, expectsto reduce the incidence of technicalincidents. “With GRIP we can providehigher uptime levels to our users in theradiology department,” says FunctionalApplication Specialist Jan Wolters.12 THERE“It brings a peace of mind thatincidents will not affect our endusers.”Dr. Annette Bak,Manager of Radiology and Nuclear MedicineBefore AMC Hospital in Amsterdamdecided to install an IMPAX RIS/PACS solution from Agfa HealthCare,it went through a lengthy Europeantender process. “The upside of this wasthat we gained an in-depth view ofour IT-supported workflow,” says Dr.Annette Bak, Manager of Radiology andNuclear Medicine. “Agfa HealthCarePreventing delays in patientcareGRIP services consist of a real-time,centralized global monitoring centerand technical team, watching fordisruptive incidents at all connectedcustomer sites. “You can havecommunication problems between RISand PACS, where patients may not beincluded in the PACS queue, but theymay already be in the examinationroom,” says Jan Wolters. “Currently wehave some 80 open incidents. We lookinto each incident first ourselves, andif we cannot handle it, we refer to AgfaHealthCare’s helpdesk.”At AMC Hospital, the GRIP solution isset up to act when certain thresholdsof event incidence are surpassed. Thethreshold determines when GRIP notifiesthe hospital, explains Jan Wolters.“At the moment we are fine-tuningthese thresholds together with AgfaHealthCare and also implementing newmonitoring points in the system. A lowthreshold results in a high reportinglevel of incidents, many of which maynot be important. A high threshold maylead to a reduced preventive reliability.The balance is where we have the lowest

possible level of incident reportingby the users in radiology and nuclearmedicine, which means that GRIP takescare of the incidents before they actuallyoccur. Ideally, Agfa HealthCare would bemonitoring and handling the problemsfaster than our users can experiencethem.”Knowledge of a problem beforeit occursGRIP allows AMC Hospital to knowabout a problem before it occurs, andthis knowledge can enable staff toprevent the incident from taking placeat all. Says Dr. Annette Bak: “We clearlyexpect to benefit from GRIP from auser perspective. Upfront awareness ofpotential disruptions, 24/7, allows IT tointervene before outages or incidentsoccur and even help make sure theydo not occur in the future. It brings apeace of mind that incidents will notaffect us.”Jan Wolters provides an example. “Werecently were pre-notified of a memoryspace problem that would occur in oneof our servers. Because of this report,we were able to anticipate and avoidproblems. This allows us to increase ouruptime levels to our end users in thehospital.”Clinicians work efficiently andreliably, thanks to enhanceduptimeAMC Hospital has an SLA agreementoutlining uptime expectations, and AgfaHealthCare is keen on keeping uptimeas high as possible and preventing anyunsettling downtime surprises. Thisis the win-win between both parties,says Jan Wolters. “Our clinicians needto be able to do their job reliably.This requires uptime of the servicesoffered by Agfa HealthCare. With ourparticular Agfa HealthCare systemconfiguration, our SLA is end-to-end99.84% guaranteed. The uptime ismeasured each quarter and needs tobe end-to-end all the way to the enduser. We use a stopwatch model whenincidents occur, allowing us to label anincident from P1, a major problem, toP4, a low relevance incident. GRIP canprevent incidents evolving from P4 toP1.”“The Agfa HealthCare GRIP solutionis a watchdog for AMC Hospital,delivering this service in a reliableway,” concludes Jan Wolters. “Constantmonitoring by the Agfa HealthCaretechnical team allows them to quickly“The Agfa HealthCare GRIPsolution is a watchdog for AMCHospital.”Jan Wolters, Functional Application Specialistdetect potential issues and take action,ranging from calling a local technicianto intervening remotely to correct thesituation. We are still fine-tuning, butthe potential is huge.”•SolutionGlobal Remote Incident Prevention (GRIP)services with:» Remote monitoring of the complete AgfaHealthCare system infrastructure» Event management for fast action remotelywhen issues arise» Event reporting of all warnings with instantgraphical displays and historical records ofpast events» 24/7 SLAAgfa HealthCare’s contribution» Support IMPAX radiology solution with GlobalRemote Incident Prevention (GRIP) services» Define an SLA agreement focused on keepinghigh uptime and preventing downtime» Team up with AMC’s IT department andend users to find the right level of incidentreporting“With GRIP we can provide higheruptime levels to our end users.”Jan Wolters, Functional Application SpecialistDID YOU KNOW…» The Academic Medical Center was founded in1983, when two hospitals from the Amsterdamcity center, the Wilhelmina Gasthuis and theBinnengasthuis, merged with the medicalfaculty of the University of Amsterdam.» In collaboration with the city of Amsterdam,AMC Hospital is stimulating the developmentof a Medical Business Park: a whole range ofinnovative businesses and research institutesin the field of healthcare, biosciences and lifesciences.» AMC Hospital has 1,010 beds, and about 7,000employees.THERE 13

UC IRVINE HEALTH, ORANGE COUNTY, CALIFORNIA, USAUnique technology in ICIS ‘connects thedots’ between EHR and patient imagesBuilt-in acquisition and workflow reference tools create the links between data and usersInterviewee Jim Murry, Chief Information Officer, UC Irvine Health and Associate Dean of IT & Informatics, School of Medicine“By giving people accessto images from anywhere,connected to reports, we'reimproving patient care.”Jim Murry, Chief Information Officerto have the workflow technology builtright into it.”Like many healthcare enterprises, UCIrvine Health needed a way to managethe explosion in patient images and data.From ultrasounds to OR videos, from X-raysto angiograms, the facility had to find asolution to manage these millions of patientimages, securely and cost-effectively, andalso link them seamlessly to the ElectronicHealth Record (EHR). With ICIS, an enterpriseclinical IT platform from Agfa HealthCare,UC Irvine found a comprehensive solutionthat provides data storage and much more.UC Irvine Medical Center is OrangeCounty’s only university medical center,not far from Los Angeles. Opened in1976, the 422-bed medical facility offersa full scope of acute and general care14 THEREservices, including a regional burn center,Level I trauma center, neuropsychiatriccenter, Level III neonatal care unit and aNational Cancer Institute (NCI) designatedcomprehensive cancer center. It has about35,000 ER visits per year, and 18,000admissions.There were several key criteria that theUC Irvine image storage solution had toaddress. “It had to be able to hold any typeof digital image, it had to be scalable, ableto scale up and out, it needed to have asingle viewer, and it needed to be very fast– users just won’t tolerate a slow system,”says Jim Murry, Chief Information Officer.“It needed to be compatible with ourdisaster recovery approach, and it neededWorkflow technology in ICIS setsit above standard VNAsFor Jim Murry and his team, the workflowtechnology in the Imaging ClinicalInformation System (ICIS) is what elevatesthis solution above standard vendorneutral archives. “A vendor neutral archiveon its own does not typically have thisconnecting piece – a workflow tool thatallows you to ‘connect the dots’, to connectan image to a report,” describes Jim Murry.“In the Agfa HealthCare solution there areworkflows and technologies that let youget into the archive, and build a referencethat allows you to feed it back into theEHR through interfaces, and connect upwith the report. This allows a physician toread a report, then click on an icon to seean image, and the system will retrieve thatprecise image from this massive collectionof images and present them with exactlythe one they want to see.”In its search for a partner for its imagerepository, UC Irvine reviewed themarketplace, compared other vendors, andalso turned to its radiology department.Since the radiologists were accustomedto working with the image managementcapabilities of IMPAX, they were able toshare their knowledge and experience.“That helped quite a bit,” says Jim Murry.Reduced costs to manage andstore dataThere are numerous advantages to movingto an enterprise approach. First, there

Agfa HealthCare’s contribution» Global leaders in managing healthcare imagesand reports» Professional, expert teams contribute toprojects of all sizes and scope» Understanding of hospital IT requirements andprocessesDID YOU KNOW…» The ICIS repository at UC Irvine will containabout 17 terabytes of data by the end of 2013;the IT department anticipates about 1 terabytewill be added each month.» More than 60 UC Irvine Health physiciansare listed as Physicians of Excellence in theJanuary 2013 issue of Orange Coast magazine,selected by the Orange County MedicalAssociation.» The UC Irvine School of Medicine offerssummer enrichment programs to about 150high school students interested in pursuingcareers in healthcare and research.are all the costs associated with runningseparate image storage ‘silos’ across thehospital enterprise. “Now, instead ofbuying and managing storage for all theseone-off departments, I’m supportingone enterprise-scale storage system,”explains Jim Murry, “greatly reducing theinvestment needed in these one-off storagesolutions.”The approach also brings more focusaround the role of the CIO, andstrengthens the connection betweentechnology and the hospital’s strategicgoals. For UC Irvine, this improved accessto information will help towards theenterprise’s goal to become one of the top20 academic health systems in the UnitedStates, within five years. This rankinglooks at clinical, research and educationoutcomes – all areas that will see benefitswith the implementation of ICIS.Enabling better clinical outcomesand research work“By giving people access to images fromanywhere, connected to reports, we’reimproving patient care,” says Jim. “Whenyou look at what we will be able to dowith the data and the metadata, we’reenabling better clinical outcomes andresearch work. For the first time ever,through this technology, and the rightprotocols, researchers will be able to accessthe metadata to understand and identifycohorts, and access images that theycouldn’t access before.”Another focus as a medical school is datasecurity. Students, and professors, needaccess to images, but access must be strictlycontrolled. With all images in a singlearchive, it is easier to control and monitoraccess. “You can get access to the imagesfrom anywhere in the world, if you havethe right security, but you can’t downloadanything, without IT oversight andencryption,” Jim comments.So far, the ophthalmology departmenthas gone live; cardiology is next, to befollowed by ultrasound. At the same time,Jim is working with Agfa HealthCare’sManaged and Cloud Services to movethe solution to the cloud. “Right now, thestorage is sitting in my data center. Whenwe move it to the cloud, it becomes evenmore scalable, we can look at genomics,research, we can move the entire PACS intothis environment. Agfa HealthCare willlook after backups, disaster recovery, all ofthat,” he says. “Agfa HealthCare broughtgood, experienced resources to the table,they’ve got a great team, they made thishappen.” •“Agfa HealthCare brought good,experienced resources to thetable, they've got a great team,they made this happen.”Jim Murry, Chief Information OfficerSolutionsImaging Clinical Information System (ICIS)» Provides a comprehensive view of multimediapatient imaging records, across regions,facilities and departments, creating a truelongitudinal patient imaging record byintegrating and linking multi-facility,multi-departmental and multi-specialtyimaging dataXERO Technology Viewer» Enables anywhere, anytime access to images» Provides secure access to standard healthcaredata from existing workstations anywhere onthe network» Uses any popular internet browser and simplenetwork connection» No software download or installation requiredIMPAX PACS» Integrated reporting solution provides easyand convenient access to reports, workflowoptimized for the different users in anenterprise, web-deployable for access to datafrom any locationTHERE 15

envision your eHr withimaging using iciSDespite the promise of the ElectronicHealth Record (EHR) to provide a view ofpatient health generated from encountersacross all healthcare settings, imaginghas been a critical missing component.Until now. In keeping with its “Leave noimage behind” promise, Agfa HealthCarehas developed the Imaging ClinicalInformation System, or ICIS, to provideclinical images within the EHR. In thisarticle, Charles Morris, Chris Magyarand Genady Knizhnik of Agfa HealthCarereveal how ICIS empowers physicians tomake more informed care decisions byembedding medical image accessibilitywithin the EHR user interface to provide amore accurate view of the patient.ICISEXCHANGEICISACCESSICISCONNECTICISWORKFLOWICISVIEWICISCAPTUREICISVNAgiven these realities, image-enabling theEHR is a logical way to help physiciansdeliver higher quality care, faster. To putit in context, imagine an orthopaedicor plastic surgeon is preparing to repaira patient’s severely injured hand. Ifthe surgeon was able to access imageswithin the EHR to visualize the hand,using clinical photography side by sidewith CT and perhaps even MRI imaging,it would add so much value to theprocess and the patient. Furthermore,if the primary care physician also hadeasy access to pre- and post-surgeryimages and reports through the EHR,that patient’s experience would becomericher still.Healthcare organizations around theglobe are under pressure to delivercare more cost-effectively and withhigher quality. One way to achievethis is to empower physicians witheasy, direct access to all of a patient’srelevant medical information. While thisunderstanding is driving a meteoric risein Electronic Health Record installations,there is still one significant roadblock toultimate clinical productivity: most ofthe EHRs available on the market todaydo not complement the textual data withrelevant clinical images.“Physicians can deliver better, moreexpedient care when they haveimmediate access to a patient’s entiremedical history regardless of the caresetting the information was createdwithin,” explains Charles Morris,ICIS US Market Segment Manager.“If they are limited to only looking atthe textual data that comes out of theEHR, then they aren’t getting the wholepicture. The addition of pre-diagnostic,diagnostic, treatment, and descriptiveimaging data gives a truly integratedview of the continuity of care.”imAging silos ARE widEspREAdgiving physicians access to all theimages associated with a particularpatient isn’t easy. “Most departmentshave their own solutions for capturingimages, but their strategies for storingand distributing those images varygreatly,” says genady Knizhnik, Business16 THEREDevelopment Director, Regional HealthEMEA. “Radiology has the systems inplace to manage all of their images, dataand workflow – and even to collaboratethrough regional PACS – but otherdepartments do not have the same levelof sophistication. Solutions can rangefrom sophisticated and automated imagecapture and workflow to simple digitalsnapshots, for example, in dermatology.”While each department’s clinical imagestorage solution is based on proceduresthat work fine within their own walls,things get more complicated when theytry to share those images with colleaguesin other facilities or departments, orwith referring physicians.“Images are going into privatedepartmental silos in every possibleway that you can imagine,” explainsChris Magyar, Head of the ICIS BusinessUnit for the US Region. “Some imagesare printed out and filed in a paperrecord. Some are stored on hard drives,CD or USB sticks. Some are enteredas a line item in a spreadsheet. Nowimagine you’re a physician from anotherdepartment and you’re making a caredecision. How much time do you haveto hunt that image down? Even if you dohave the time, there is no guarantee thatyou will find what you are looking forin the end. You have to choose betweendoing without that piece of the puzzleor, if you can’t, reordering an imagingstudy that has already been performed.”TAking THE EHR To A wHolE nEwlEvEl“Our Imaging Clinical InformationSystem addresses a whole class ofmissing information from the EHR,”explains Morris. “It seamlessly capturesimaging data in a clinical contextand then links it to the EHR. Sincethe images are embedded inside theprimary textual interface, it is muchmore streamlined and efficient for thepeople using it. Images are presented inthe context of the patient’s entire healthrecord. Doctors do not know that ICISis managing the imaging health record,they simply know that images show upwithin the EHR when they need them.”According to Morris, creating ICISinvolved looking at existing AgfaHealthCare solutions and expertiseand imagining what was possible.“iciS has workflow componentsfor capturing image sourcesthat do not adhere to DicoMstandards, creating metadataaround them and deliveringthem to the same vendorneutral archive as the moretraditional imaging generated bydepartments like radiology.”gENADY KNIZHNIK, Business DevelopmentDirector, Regional Health EMEA

“The addition of pre-diagnostic,diagnostic, treatment, anddescriptive imaging data givesa truly integrated view of thecontinuity of care.”Charles Morris,ICIS US Market Segment Manager“We wanted to create a platformsolution composed of Agfa HealthCaretechnologies that were pre-integratedtogether in a particular way so thatwhen we encounter a department thathas gaps along the chain of acquiring,viewing, interpreting, storing andsharing images, we can offer them acomplete workflow. And that workflowleverages technology that is in placeor provides supplemental technologyto produce a high-quality, intelligentimaging study that is ready for EHRintegration.”“ICIS has workflow components forcapturing image sources that do notadhere to DICOM standards, creatingmetadata around them and deliveringthem to the same Vendor NeutralArchive as the more traditionalimaging generated by departments likeradiology,” explains Knizhnik. “So if wego back to our surgery example, wherethe emergency department is recordingimages with their digital camera,ICIS can store those images alongsidetraditional DICOM images and makeboth accessible to everyone through theEHR.”ICIS also includes Agfa HealthCare’swidely adopted regional health portfoliothat enables the creation of imagesharing networks across administrativeor geographical boundaries. Thisprovides radiologists and clinicians withaccess to the patient’s entire radiologyhistory irrespective of the originatingradiology department. Moreover, itenables health authorities to optimizethe utilization of both radiologistand radiology equipment by allowingan “acquire anywhere – report fromanywhere” workflow.ICIS has the clinical breadth to crossthe 3 primary care settings: inpatient,ambulatory/outpatient and physician’soffices. Since each environment deliverscare differently (encounter-basedmedicine vs. schedule-based medicinevs. office appointments), ICIS supportstheir unique workflow in order tosuccessfully acquire images.ICIS is for everyone“In a way, ICIS is really the secondfrontier of the EHR,” says Morris. “Theprimary health record is the singlemost important thing we can do forpatients. And then right behind it is theimaging record. All hospitals need thistechnology.”ICIS offers a vendor neutral architectureand support for multiple patient IDdomains. What this enables is the abilityto provide a comprehensive patienthealth record across departments withina single facility or between multiplefacilities. Hospital groups, IntegratedDelivery Networks (IDN), or public andprivate health information exchangescan develop and effectively share unifiedpatient records containing both imagesand textual information.“ICIS enables healthcare organizationsto share imaging information acrossregional, facility, departmental andtechnical boundaries,” says Magyar.“This allows them to focus on theirprimary mission of care delivery.”In this era of increasing regulatorypressures and efficiency focus, gettingimages out of departmental silos and infront of the physicians who need themjust makes sense. Adding an imaginglayer to the EHR with ICIS can deliverfar-reaching benefits that go above andbeyond expedited delivery of care andimproved clinical confidence. Surgeonscan use it to enhance their preparationprocess. Primary care physicians canleverage it to deliver more detailed,image-rich patient consultations.Physicians can access it to streamlinetheir collaborations, even in emergencymedical situations. Plus having theimages in the EHR where authorizedstakeholders can access them helpseliminate the cost- and labor-intensiveprocess of ordering duplicate imagingprocedures.“You don’t need to wait until your EHRis up and running to think about imageenablement,” advises Knizhnik. “Ifyou’re in the process of implementingyour EHR, or even if you’re just in theplanning stages, it is a good time tohave a conversation about ICIS. GettingAgfa HealthCare involved earlier in theprocess is beneficial because we can helpmake important decisions regardingthe acquisition, discovery and access ofimaging and non-imaging data.”Industry-first image enablementICIS is a unique solution in the industrytoday. “The healthcare market is nowfully appreciating the value of managingimages in the EHR,” says Knizhnik.“Agfa HealthCare is in a great positionto leverage the experience we havegained over the past 15 years improvingimage and information managementfor the radiology world. We have theexperience, expertise and products tomake it happen.”“We don’t just think about imagemanagement from the perspective ofthe radiologist,” says Magyar. “We havebeen stretching beyond that perspectivefor some time and considering howimaging affects the overall quality, costand effectiveness of care. Any number ofvendors will sell you a place to store yourimages. That’s not good enough. Thetrue value comes in having a solutionthat gives physicians access to storedimages from all sources in the contextof the EHR. That’s what makes ICISdifferent and so powerful.”“Someone might ask why physiciansneed images in the EHR now when theircurrent methods have served them forso long. Diagnoses still happen, peoplereceive the care that they need,” saysMorris. “It is one of those you-don’tknow-what-you’ve-been-missing-untilyou-have-itscenarios. Once physicianshave access to the image-enabled EHR,just try taking it away. They won’t letyou.” Agfa HealthCare has alreadyenabled sharing of imaging data forcustomers in Europe, Brazil, Canada,and the United States. ICIS is globallyavailable to healthcare organizationseverywhere.“ICIS enables healthcareorganizations to share imaginginformation across regional,facility, departmental andtechnical boundaries. Thisallows them to focus ontheir primary mission of caredelivery.”Chris Magyar,Head of the ICIS Business Unit for the US RegionTHERE 17

© SandroAn artist’s perspectiveInternationally-renowned photographerSandro’s love of dance shines through inhis images of dancers from the River NorthChicago Dance Company and the JoffreyBallet. With over twenty years’ experiencephotographing dancers, Sandro’sphotographs capture perfectly the beautifulmovements of the tango.18 THERE

NORWEGIAN RADIUM HOSPITAL, OSLO, NORWAYHelping multi-disciplinary teams worktogether more efficiently‘Easier image interpretation’ and streamlined management of high image volumesdeliver more informed treatment plans at leading cancer centerInterviewee Dr. Cathrine Saxhaug, Specialist in Oncologic Radiology“We use Volume Viewing ‘live’ when we demonstrate pathology for theclinicians, because we can choose to display IMPAX Volume Viewing onthe projector screens.”Dr. Cathrine Saxhaug, Specialist in Oncologic RadiologyAs the largest cancer center in NorthernEurope, combining a hospital and aresearch arm (the Institute for CancerResearch), the Norwegian RadiumHospital is leading the way with newcancer treatments and ground-breakingscientific advancements. With theimplementation of IMPAX VolumeViewing, one of the latest clinicalapplications available for IMPAX, thehospital has applied that same approachto the technology and processes thatsupport the work of its professionalteams.As a cancer center, the hospital'simaging requirements are complex.Many diverse groups within the hospitalwork with patient images; and there isalso a high volume of images to manage– both those that come from outside,from referring physicians across Norway,and those from exams performed withinthe hospital itself. "We have more examscoming in from referring doctors thanthose we do ourselves," says Dr. CathrineSaxhaug, Specialist in OncologicRadiology, whose primary focus is onbrain tumors and head and neck cancer.Diagnostic imaging is used to diagnosecancer, and also to assess responses totreatment. In addition, many researchprotocols are more image-intensivethan clinical imaging, and they can alsorequire more types of imaging.Another difference as a cancer centeris the close cooperation betweenthe radiologists and the oncologists,physicists and technicians who performradiation therapy. "We really worktogether as a team," says Dr. Saxhaug.Faster, easier imageinterpretation and detection ofpathologiesThe heaviest imaging demands comefrom the large volumes generatedby MR. "We do a lot of 3D volumeimaging, so we need to have a systemthat displays the volumes effectively,"explains Dr. Saxhaug. The hospital usesIMPAX Volume Viewing mainly for MR,but also CT and PET CT. "In MR weTHERE 19

use it all the time," says Dr. Saxhaug."It gives us a better visualization ofthe image volumes, and it is easierto interpret the images and to findpathologies. Another major use forIMPAX Volume Viewing is to comparetwo sets of images effectively byusing the registration tool: either acomparison of two different sequencesfrom the same exam or a comparison ofthe same sequence from two differentexams. This is an efficient way ofmonitoring tumor development andtreatment response over time."IMPAX Volume Viewing offers advancedvisualization tools including MIP/MPR,volume rendering and segmentation,and allows users to save reconstructedseries, static screenshots and videocaptures. With IMPAX Volume ViewingPLUS (an optional extension for IMPAXVolume Viewing), users at the NorwegianRadium Hospital can also view series infusion mode or subtraction mode, andit offers automatic registration of bothvolumes. "The advanced functionalityof automatic registration and fusion isextremely helpful and useful for us," saysDr. Saxhaug.A tight integration with IMPAX PACSmakes IMPAX Volume Viewing highlyefficient. "It improves the workflow, andyou don't waste time loading all theimages," comments Dr. Saxhaug. "It isseamless, easy to use, fast, offers a highlevel of automation and it has a familiaruser interface."Radiology-led MEETINGS benefitwith better view of patientinformationThe radiologists at the hospitalhold daily and weekly meetings inthe radiology department, wherethey demonstrate pathology for thehospital's clinicians. "In Norway,these meetings are a central wayfor the radiologists to provideinformation to clinicians," says Dr.Saxhaug.The daily meetings focus on cancerpatients who will be operated on, orreceive radiation treatment, that day.Clinicians attend in groups, accordingto their specialty area. For examplethe oncologists who are working withbrain tumors come as a group, or thesurgeons who are working with breastcancer. "We use Volume Viewing 'live'when we demonstrate pathology forthe clinicians, because we can chooseto display IMPAX Volume Viewing onthe projector screens. It gives thema better picture of the pathology. Forthe surgeons, for example, it makesit easier to visualize the tumors inreference to neighboring structures."The radiologists also host weeklymulti-disciplinary team meetings,which are attended by surgeons,oncologists, pathologists and nurses.These meetings include discussionson cancer treatment options and nextsteps, and here also the participantsrefer extensively to patient images.“The advanced functionality ofautomatic registration and fusionis extremely helpful and usefulfor us.”Dr. Cathrine Saxhaug,Specialist in Oncologic Radiology20 THERE

“It gives us a better visualizationof the image volumes, and it iseasier to interpret the imagesand to find pathologies.”Dr. Cathrine Saxhaug,Specialist in Oncologic RadiologyIn addition to providing a better viewof the images, the implementation ofIMPAX Volume Viewing has also helpedto streamline the daily and weeklymeeting process. "Because the VolumeViewing is so tightly integrated withIMPAX, we can start volume viewingright when we are in a specific study,"describes Dr. Saxhaug. "We use theIMPAX PACS as the 'mother' system, andwe have two image screens plus a thirdscreen where we have Volume Viewing.We are looking to add a fourth screen,which will add an area for text as well."New applications to helpmanage images and aid indiagnoses coming in futureA challenge for the Norwegian RadiumHospital, and for hospitals aroundthe world, is how best to manage theexponential increase and complexity inimages and data. Agfa HealthCare hasintroduced IMPAX Volume Viewing anda range of other clinical applicationsin answer to this need, and is workingon others that will further address themanagement of large image and datavolumes.For Dr. Saxhaug, advances intechnology in this area will becomeincreasingly important. "We use acombination of different imagingtypes and different modalities in themajority of patients, which meansa lot of information for radiologiststo sort. We need more help fromcomputers, in sorting differenttypes of signal intensities from allthe different types of sequences.This is what I think technology willdo in the future. If you 'teach' it, acomputer can sort this huge amountof information rapidly and presentit to us, much more easily than if welook through every single image ofan exam that has 7,000 images. Weare moving more and more in thisdirection," she concludes. •DID YOU KNOW…» The Institute for Cancer Research hasinternationally strong research groups withinbiochemistry, cell and tumor biology, genetics,radiation biology, immunology and cancerprevention.» The Norwegian Radium Hospital is part of theOslo University Hospital, one of the largesthospitals in Scandinavia, with more than 40different locations, and more than 20,000employees.» Oslo University Hospital treats more than 1.2million patients each year.SolutionsIMPAX Volume Viewing» Provides radiologists with advancedvisualization tools to diagnose large CT andMR volumes» Covers MIP/MPR, volume rendering andsegmentation» Allows users to save reconstructed series,static screenshots and video capturesIMPAX Volume Viewing PLUS» Optional extension, allows users to view twoseries from the same or from different studiessimultaneously and view series in fusionor subtraction mode, and offers automaticregistration of both volumes as well asstereoscopic 3D viewIMPAX PACS» World leader in enterprise-wide image andinformation management» Offers seamless integration with IMPAXClinical ApplicationsAgfa HealthCare’s contribution» Builds solutions that integrate seamlessly,across modalities and enterprise IT» In-depth knowledge of image and informationmanagement, founded on decades ofexperience with PACS» Can scale solutions and expertise accordingto modality and connectivity requirementsTHERE 21

Canisius-Wilhelmina Ziekenhuis, Nijmegen, The NetherlandsCWZ Nijmegen goes beyondPACS vendor lock-in with newVendor Neutral Archive‘Leave no image behind’ approach extends PACS-independent view of EHR across allclinical departmentsInterviewee Pascal van Nispen, Information Advisor“With Agfa HealthCare’s VendorNeutral Archive solution we riseabove the PACS vendor lock-inconstraints and can start sharingdata with other hospitals tocoordinate care.”Pascal van Nispen, Information AdvisorA VNA concept to stop build-upof imaging silosWith a strong board of directors atits helm, CWZ has taken its futurefirmly in hand. The hospital has beenrecognized by the Dutch governmentas a top-clinical hospital in the fieldsof neurosurgery, PCI (PercutaneousCoronary Intervention) and ICD(Implantable Cardioverter Defibrillator)surgery, and it also has a strongreputation as a pioneer in severalmedical fields, such as childhooddiabetes, large vein surgery andlaparoscopy interventions. The fourthmedical training institute of the country,CWZ has a continuous influx of youngand ambitious clinicians and careprofessionals that share this dedication.Moving beyond the limits of PACSvendor lock-in and taking the lead inthe development of a regional ElectronicHealth Record (EHR) were the driversfor the Dutch Canisius-WilhelminaHospital in its implementation ofAgfa HealthCare’s Vendor NeutralArchive IMPAX Data Center (IDC).As an enterprise or regional imagingmanagement solution, IDC extends theEHR to include all medical images andrelated information to the point-of-careinside and outside of the hospital.22 THEREWith University Medical Center StRadboud nearby, Canisius-WilhelminaHospital (CWZ) is both competingand collaborating with one of TheNetherlands’ foremost healthcarecenters. Sharing patient data is part ofthis relationship and CWZ decided totake the lead in developing a regionalEHR. When Agfa HealthCare’s VendorNeutral Archive IDC becomes availableto the CWZ healthcare network,a major milestone will have beenreached.Almost 380,000 day clinic visits andover 31,000 inpatients per year acrossits six sites mean that the hospital mustorganize its workflows effectively.Pascal van Nispen, Information Advisor,conducted an inventory of the existingimage flows. “We found that ourimaging flows were diverse, to say theleast. Some departments printed theirown images and attached them in paperto a departmental paper patient file,some saved images as compressed jpegs,some stored them on offline CDs. All ofthese ‘imaging silos’ resulted in a lackof centralized management, corrupt

Solutions» IMPAX Data Center VNA with XEROTechnology Viewer» Long-term Managed Services Agreement» Serve as General Contractor withinmulti-vendor agreementAgfa HealthCare’s contribution» Meeting the aim of the customer to movebeyond vendor-based PACS and take the leadin regional EHR concept» Comprehensive Managed Services conceptthat provides peace of mind to IT and clinicalusers» Ability to take the lead in a multi-vendorenvironmentfiles, and incomplete patient records.Our findings led our board to propose acentralized approach based on a VendorNeutral Archive (VNA).”Pascal van Nispen: “We decided to askAgfa HealthCare to take the lead as ourgeneral contractor, coordinating withour local PACS vendor, and providea VNA solution to six departmentsin the first phase: gastroenterology,ophthalmology, urology, pneumology,the OR and the medical photographer,”says Pascal van Nispen. “AgfaHealthCare had already provided itsIMPAX PACS solution to radiology,cardiology and nuclear medicine, andour local hospital-wide PACS vendorjoined in, so each department haddigital access in one way or another topatient images and data. We just neededto centralize all imaging data, be able tovalidate it, and share it seamlessly withall of our care professionals.”Agfa HealthCare’s role was to providea back-end solution that would enableall images to be centrally stored, andbe HL7, DICOM, IHE and XDS/XDS-IFramework compliant. The IMPAXData Center is central to creating alongitudinal imaging-enabled medicalrecord and is designed to work withmulti-vendor solutions. “We wanted tosteer away from a vendor lock-in,” saysPascal van Nispen, “and we were lookingfor the lowest integration cost possible.Agfa HealthCare supports the hardwareinfrastructure according to the servicelevel specifications in our ManagedServices Agreement, and proactivelydetermines when to replace or upgradethe solution to improve uptime andfunctionality.A low-cost and user-friendly wayto view all images in the EHRIn line with the hospital’s aim to playa leading role in the development ofa regional Electronic Health Record,using the Agfa HealthCare XEROTechnology Viewer as the unique wayto access images coming from the VNAis a major asset. This enterprise medicalimage viewer allows clinicians to accessimaging information securely andindependent of location, on a varietyof web-enabled devices, improving thedelivery of patient care throughpoint-of-care access to patient data.“The XERO Technology Viewer is animportant asset to us, as it doesn’t requirethe installation of client software. It usesexisting infrastructure and connects onstandard browsers, such as MicrosoftInternet Explorer, Google Chrome, orMozilla Firefox,” says van Nispen. “Ourclinical users will access medical imagesfrom any location and image sourceacross the hospital, straight from thepatient record. It is a matter of timebefore we extend our VNA with the XEROTechnology Viewer to outside referringdoctors, remote sites and collaboratinghospitals, completely secure.”This will fully release the power ofthe VNA concept to the care networkand also to the patients, continues vanNispen. Instead of paper prints, CDsor even “snail mail” transfer of images,examination images and results willbe able to be accessed by referringdoctors or tertiary care clinicians almostimmediately. “This will result in fewerretakes, fewer superfluous examinationsand a more streamlined patient flowbetween care providers. With XEROintegrated in the EHR, we can completeour VNA proof-of-concept and startexpanding its use outside our campus.We will then be able to really rise abovethe PACS vendor lock-in constraints andstart sharing imaging data with otherhospitals to coordinate care.” •DID YOU KNOW…» Nijmegen is the oldest town in TheNetherlands as we know it today. It was 2,000years old in 2005.» The most famous story, known in literaturethroughout Europe and the Middle East, is thatof Mariken van Nieumeghen, an inhabitant ofNijmegen. It is a late medieval Dutch text fromthe early 16 th century, where Mariken spendsseven years with the devil, after which she ismiraculously released having confessed hersins with remorse to Saint Mary. The morale ofthe story is that no matter how sinful one is,there is always salvation through Saint Mary.THERE 23

ALLEGIANCE HEALTH, JACKSON, MICHIGAN, USAOn-the-go bedside imaging bringsbetter care to patients in ER and beyondMoving technology to ‘critical areas’ as needed lets doctors and technologists obtainimages and share results more quicklyInterviewees Robyn Pulliam, Director of Imaging Services · Dr. Samir Parikh, Vice Chief Radiologist · Amy Helton, Manager of ImagingPerformance and Qualityproducing about 230,000 procedureseach year.Immediate access to interpretimages from anywhereOne of the key drivers in the hospital'sdecision to add mobile DR to this rangeof services was the need to receiveand share images, especially in criticalcases, more quickly. "It's importantto have direct digital technology incritical areas, so that the image can beviewed and evaluated immediately,"says Amy Helton. For Dr. Samir Parikh,Vice Chief Radiologist, the speedyimage access that is enabled by theDX-D 100 solution is vitally important.Allegiance Health has played an integralrole in south-central Michigan for morethan 90 years, growing from a 100-bedfacility to a full-service acute carecommunity health system, now with411 beds and a broad range of specialtydepartments. In its continuous effortto improve patient care and processes,Allegiance Health recently implementedtwo DX-D 100 mobile DR solutions fromAgfa HealthCare.Allegiance Health interprets'community' broadly, extending thedefinition to include an emphasis oneducation, both on the medical side andcommunity outreach. It will become ateaching hospital in 2014, bringing 140new physicians to Jackson. The hospitalalso strives to educate its communitythrough initiatives like the SpeakersBureau, offering experts to speak to24 THEREgroups on topics such as diabetes,health and wellness, or palliative care.For imaging, this focus on educationtranslates into a collaboration withlocal colleges. Allegiance providesa clinical experience for students ofgeneral radiology, ultrasound andnuclear medicine. "Having students inthe department supports an atmosphereof professional growth for all of us,"says Amy Helton, Manager of ImagingPerformance and Quality at AllegianceHealth. "They're able to learn in avariety of settings, on both older analogand the newest digital solutions."Imaging services at Allegiance Healthinclude about 170 staff members,operating 20 departments thatinclude MRI, CT, general radiology,nuclear medicine and mammography,“The DX-D 100 solutions werethe choice for us, meeting thecriteria, providing overall valueand ensuring the best use of ourresources.”Robyn Pulliam, Director of Imaging Services

“My staff technologists like theMUSICA 2 image processingsoftware, because they canmake immediate adjustmentsimproving efficiency, and theimages are excellent.”Amy Helton,Manager of Imaging Performance and Quality"The DICOM wireless connectivity isof great benefit," he says. "We haveimmediate access to interpret imagesfrom anywhere in the hospital, or evenour offices."One DX-D 100 is used in the emergencydepartment, and the other is used onselect patient floors. With its largeservo-driven wheels, and narrowwidth, "it maneuvers easily throughoutthe building," says Amy Helton. "Inaddition, my staff technologists like theMUSICA 2 image processing software,because they can make immediateadjustments improving efficiency, andthe images are excellent."The ‘gold-standard’ MUSICA 2 imageprocessing has been specially adaptedfor the DX-D 100 and tuned to furtherenhance the excellent DR image quality.Exam-independent, it providesconsistent image quality andhigh-contrast detail.Improved image quality anddecreased radiation doseFor Dr. Parikh, the image quality ofthe DX-D 100 is important as well. "Ingeneral, the quality is much better thanconventional portable radiography,providing very sharp and detailedimages. In addition, we are able tomanipulate the contrast on PACS forbetter visualization of lines and tubes.There is also an externaldose-measuring device that helps uscontrol the dose."The DX-D 100 features an integratedNX workstation, for an optimalworkflow. When users select a specifictype of exam, the appropriate X-raysettings are automatically transferredto the X-ray generator and displayedon the touch-screen console. NX addsthe exposure parameters used to thedigital image file, and communicatesseamlessly with the hospital's PACS.DX-D 100 takes the lead instringent review processFor this first foray into mobile DR,Allegiance Health conducted astringent review, assessing threevendors' solutions against a long listof requirements, including how thesolutions provided patient care, safety,quality, as well as cost, operationaland technical factors, and efficienciesgained. “In the end, the DX-D 100solutions were the choice for us,meeting the criteria, providing overallvalue and ensuring the best use ofour resources," says Robyn Pulliam,Director of Imaging Services. "When wechoose responsibly and use resourceswisely, it allows us to make goodquality healthcare accessible to asmany members of the community aspossible."The hospital already had a level offamiliarity with Agfa HealthCare, withan IMPAX PACS and CR from AgfaHealthCare in place. "Allegiance hasenjoyed a strong business partnershipwith Agfa HealthCare for over 12“In general, the quality is muchbetter than conventional portableradiography, providing very sharpand detailed images.”Dr. Samir Parikh, Vice Chief Radiologistyears. We've been pleased with theirproducts, level of responsiveness, andcustomer service," concludes RobynPulliam. •Agfa HealthCare’s contribution» 100-years’ experience in developing imagingsolutions to meet full range of hospitalrequirements» In-depth understanding of user needs, fromtechnologists to radiologists through tohospital administrators» Specialists in ergonomics and intuitivesystems that are easy to learn and simple touseSolutionsDX-D 100 mobile DR solution» Efficient mobile bedside imaging solutionprovides improved patient comfort» Handles broad range of general radiographyX-ray studies» Offers instant high-quality image capture;immediate image validation, transfer andaccess (HIS/RIS/PACS integration)» Features specially-tuned MUSICA², forgold-standard image processing, and NXworkstation, for smoother workflowIMPAX PACS» Foremost image management solution forhealthcare providers around the worldDID YOU KNOW…» The emergency department at AllegianceHealth, which sees about 80,000 patients eachyear, was renovated in 2006, and features40 private rooms, an on-site pharmacy, valetparking, and family waiting areas.» Allegiance Health appears in many nationalrankings, including the CareChex Top 100Hospital 2012 Medical Excellence Awards;the Distinguished Hospital Award - ClinicalExcellence in 2012 for the third year in a rowfrom HealthGrades; and an “A” Patient SafetyRating from The Leapfrog Group.THERE 25

Power in precisionIt’s deceptively simple. It starts with a walk,and builds to an orchestration, legs andfeet drawing silent shapes that tell a storyunlike any other. It’s romance, crossed withathleticism and art, that draws us in to themagic of the tango.26 THERE

AZ SINT-REMBERT, BELGIUM“IMPAX Agility is my office and I takeit anywhere I want to work”Integrated solution takes radiologists closer to clinician’s therapeutic decision-makingInterviewees Dr. Geert Biebau, Medical Director and Head of Radiology · Dr. Frederique Van Robaeys, Radiologist“With IMPAX Agility at hand,we are more often considereda sounding board in supportof the clinician’s therapeuticdecision-making.”Dr. Geert Biebau, Head of RadiologyRadiologists at Belgium’s Sint-Rembertgeneral hospital were the first to testand approve the image display, workflowmanagement and personalized settingsof Agfa HealthCare’s new IMPAX Agilitysolution. It passed with honors, connectingthe hospital’s radiology department withmedical imaging of the future.The radiology team at Sint-Rembert,situated between two major regionalhospitals at Roeselare and Bruges, is youngand enthusiastic. Under the direction ofDr. Geert Biebau, Head of Radiology andMedical Director of the hospital, threeradiologists have been striving to providetop-notch care to their patients. A strongfocus on technological advancements iskey to their ability to meet the referringclinician’s expectations.Dr. Biebau knows this technology focusalso requires accepting an increasinglydigital dimension to all their activities.“We have embraced the idea thatup-to-date digital technology is essentialto providing the best patient care andmost accurate information to referringdoctors and clinicians.” Dr. Biebau’s teamperforms examinations at the hospital site,but for MRI, they use facilities at nearbyhospitals in Bruges and at the seaside.Most modalities, such as MRI, cardio-CTand mammography, require more intenseinvolvement by the radiologist and alsostretch the performance and ergonomicdemands of the underlying PACSinfrastructure. “This requires pushingthe boundaries of processing speed,user-friendliness and flexibility,” saysDr. Biebau. “So when Agfa HealthCareproposed our testing their new integratedIMPAX solution, called Agility, we did nothesitate.”IMPAX Agility is a new solution indevelopment at Agfa HealthCare. It hasbeen released in Turkey and Brazil and isTHERE 27

“This is my office and I can easilytake it anywhere to continueworking with Sint-Rembert’sserver over a VPN connection.”Dr. Frederique Van Robaeys, Radiologista work in progress currently in the testingand evaluation phase in other regions ofthe world. Sint-Rembert agreed to serve asone of Agfa HealthCare’s test locations forthis new solution.IMPAX Agility appeals tomedical professionals thanksto integration with patientinformationHaving used Agfa HealthCare’s IMPAXsolutions since 2009, the radiologyteam was able to keep both solutionsoperational during the trial. Because theywere familiar with IMPAX, the team didnot need additional training prior to usingIMPAX Agility’s interface. “It was a way totest, and if necessary, adjust the interfaceto make it the most intuitive interfacepossible.” Radiologist Dr. Frederique VanImages and panels from different modalitiesare linked together and displayed accordingto preset hanging protocols, providing afamiliar way of looking at results to begindictation.Robaeys explains the intuitive interface andthe power of IMPAX Agility’s integrationwith other relevant patient information,retrieved from the RIS, HIS, medical patientrecord, nomenclature and lab result server,as well as the IMPAX archive. “I get all thisinformation from IMPAX Agility’s interface,which means I no longer need to loginanywhere else or wait for other applicationsto open.”Hanging protocols allow 3D viewof the bodyThe interface’s starting point is thepowerful concept of hanging protocols.This determines how you see images fromdifferent modalities at the same time. “Thecombination of connected axial, coronaland sagittal planes constitutes a 3D viewof the body from any perspective I want.Because all images are displayed accordingto preset hanging protocols, it provides afamiliar way of looking at results to begindictation.”Reporting macros avoid omissions,even if interrupted duringreporting“I can see the scanned original examinationrequest form and use report macros thatadapt as I complete the diagnosis. Themacros considerably speed up reporting,helping to avoid omissions, even if I’minterrupted when reporting. Duringreporting, I tag key images that will formthe basis of the image set which is providedto the referring doctor or clinician. If I needto add supportive viewpoints from externalsources, the integrated internet browser“We are convinced AgfaHealthCare will be our partneron our path to the future ofmedical imaging.”Dr. Geert Biebau, Head of Radiology28 THERE

“Macros considerably speedup reporting, helping toavoid omissions, even if I’minterrupted when reporting.”Dr. Frederique Van Robaeys, Radiologisttakes me to any source I want. I can thensimply add files or links to my report. This ismy office and I can easily take it anywhereto continue working with Sint-Rembert’sserver over a VPN connection.”Radiologists now considered asounding board for clinician’sdiagnosis and therapyThe faster reporting speed and imagesupport provided to clinicians has changedtheir working relationship with radiologists,underscores Dr. Biebau. With all imagesat hand, as well as those coming fromthe clinician’s modality, the radiologistis able to interpret images from a moreholistic clinical perspective. As a result,he is more routinely asked to explain hisview on certain studies with his knowledgeof images from other modalities. “WithIMPAX Agility at hand, we are more oftenconsidered a sounding board in support ofthe clinician’s therapeutic decision-making.”Dr. Biebau has been working with AgfaHealthCare for many years, and thisrelationship lets his department keepabreast of the fast technology evolutionin medical imaging. “It has enabled usto improve our service and increaseproductivity. With IMPAX Agility we cancope with the challenge of increasinglycomplex imaging and softwaredevelopments, such as cardio- or angio-CT,which can be easily integrated. We areconvinced Agfa HealthCare will be ourpartner on our path to the future of medicalimaging.” •“If I need to add supportiveviewpoints from externalsources, the integrated internetbrowser will take me to anysource I want. I can then simplyconnect either files or links tomy report.”Dr. Frederique Van Robaeys, RadiologistThe use of macros in reports provides anexamination-based template structure for theradiologist to complete his report. This offersmore comfort to radiologists when pickingup the report after being interrupted andascertains the completeness of the report.Agfa HealthCare’s contribution» A new intuitive image management solutionthat helps improve the delivery of care whilereducing costs.SolutionsIMPAX Agility» Unifies RIS, PACS, Reporting, 3D, Connectivityand Clinical Applications» Uses a single data model to provide aseamless system offering relevant and variedclinical data in one platform» Supports Agfa HealthCare’s vision of imagemanagement across healthcare functions» Easily adds new applications like specialvisualization or MIP/MPR/3D» Fully standards-based design (IHE, HL7 andDICOM) for integration into existing healthcaresystemsDID YOU KNOW…» With four radiologists, Sint-Rembert hospital’sradiology department reported on 60,000examinations in 2011.» Saint Rimbert, or Rembert, was archbishop ofBremen-Hamburg from 865 until his death.Rimbert is revered as the Second Apostle ofthe North but his efforts to christen Denmarkand Sweden suffered from resistance by theVikings.THERE 29

Technology Corner: Workflow EnginesAgfa HealthCare introduces the benefits of task-based workflowengines to medical imagingWorkflow engines are ideally suited for healthcare workflows, yet many Picture Archiving and Communication Systems (PACS) continue touse status-driven workflows – which are hard to organize, resistant to customization and inflexible to change. This means many healthcareenterprises are missing out on the advantages a task-based workflow offers. Agfa HealthCare considers that task-based workflow enginesoffer hospitals and caregivers the best opportunity to improve patient care and minimize operational costs.NEW PROCESSES REQUIRE NEW TOOLSContemporary digital imaging hastransformed the face of healthcare.But to experience all the benefits, asuitable workflow is also necessary.This is where workflow applicationscome in. Healthcare enterprises todayneed applications that organize,customize and measure. This meanstools that support them in organizingwork and tasks in the most efficient andcost-effective way possible; allow theworkflow to be customized to the specificneeds of the hospital, department oruser; and offer the possibility to measureprocesses, so that they can be improved.workflow engine does not consider atask complete, and remove it from thelist, until all the information is available.It can even include clinical guidelines ifneeded. When input is required from acolleague, the user can create a task forthat person, enhancing communication.And it is easier to measure how muchwork each person has to do, andto assign work to another person ifnecessary.For the hospital, the workflow enginecan enforce hospital-defined workflows,and then validate that they are beingfollowed. This allows the enterprise toensure that its best practices are beingused correctly.YOUR WORKFLOW IS UNIQUENo two healthcare enterprises will useexactly the same process and rulesfor their workflow. One may requirean extra, manual quality check beforean image is sent to the RadiologyInformation System (RIS). In another,perhaps only radiologists may createreports.WHO DRIVES THE TASKS?Status-based workflows simply don’tmeet those needs. In a status-basedworkflow, the user first searches for astudy with a certain status, and thenmust determine, prioritize, organizeand complete all the steps and tasksto be carried out. But the typicalworkday rarely runs so smoothly. Ashe goes about his tasks, a person isoften interrupted, by colleagues, byemergencies, by new tasks that may havea higher priority… Each time, he mustreturn to the interrupted workflow, andagain determine what needs to be done.For the enterprise, there is also therisk that the individual’s sense ofpriorities doesn’t match the hospital’s:who decides which tasks are mosturgent? Who decides if a task has beencompleted? Who determines the bestperson to carry out a task?A workflow engine creates a task-drivenworkflow that answers all those issues,and more. Each user can create a tasklist for himself, organized by priority.New tasks are automatically added tothe list in the correct place. So the useralways has a clear and defined overviewof everything that must be done. Afterany interruption, it is easy to return tothe exact place in the list and task. TheMammoReporting MammostartWhich reading workflow do I use?Report DistributionendOther examDefault reading workflow30 THERE

startSend EmailBPE PipelineGoogle account available?YesNoSend calendar reminderBPE PipelineFax number available?YesNoSend faxBPE PipelineCellular phone available?YesNoSend SMSBPE PipelineIs confirmation already sent?YesNoSend letterBPE Pipelineend1In a status-based workflow, there is noway to configure these specifications:usually a comment is added tostudies. But the workflow enginecan incorporate these requirementsinto a customized workflow. Eachunique requirement is turned intoan additional step, and prioritizedcorrectly. The specification of theperson to complete the task can alsobe configured, and so can the priority.In fact, tasks can be prioritizeddepending on their purpose: a task foran emergency patient can be given ahigher priority than the same task foranother patient.These customizations andspecifications are configured into theworkflow engine using normal, naturallanguage. So it is easy to configurethe system as needed at runtime. Forexample, to specify that the creatorof a report needs to approve the finalversion of the report, the following rulemight be configured: “each approvaltask is assigned to the creator of thetask.” The engine itself turns thenatural language into the technicalformat and applies the rule.CONTINUOUS IMPROVEMENT IS AMUSTHealthcare enterprises are committedto continuously improving processes, toenhance care and control operationalcosts. But status-based workflows donot support change, as they createrigid, rather than flexible, workflows.With a workflow engine, the hospitalcan easily measure the efficiency ofits processes, and then change theworkflow configuration to optimizethem. All kinds of measure points canbe used, interpreted and compiled intoreports. And the hospital can monitorthe evolution of its processes, keepingit agile and responsive to changingneeds and regulations.WORKFLOW ENGINES IN PRACTICEWith all the benefits of workflowengines, Agfa HealthCare is committedto introducing them into the medicalimaging domain. Solutions like IMPAXNext Generation and IMPAX Agilityuse powerful task-based workflowengines that help to ensure that usersfollow the appropriate steps for theprocedure, circumstances and, mostimportantly, their own workflow.This supports the hospital in meetingregulatory obligations and workflowbest practices, as well as improvingcommunication.THERE 31

CMYCMMYCYCMYKRadiologywithout boundariesAgfa HealthCare’s Regional Health portfolio provides radiologists andclinicians with seamless access to the patient’s entire radiology history,irrespective of of the originating radiology department, making medicalimages available across all clinical disciplines as part of the patient’scomprehensive medical record. Moreover, our solutions enable sharingof of longitudinal imaging records by by connecting 3rd third party party RIS/PACS systemsacross systems all across facilities all via facilities federated via federated and centralized and centralized approaches approaches utilizing utilizing stateof state-of-the-art the art industry industry standards standards techniques and techniques allowing allowing an ‘acquire an ‘acquireanywhere –report – from anywhere’ workflow.Insight. Delivered.Copyright 2013 Agfa HealthCare NVAll rights reservedPrinted in BelgiumPublished by Agfa HealthCare NVB-2640 Mortsel – Belgium5YA9W GB 00201303www.agfahealthcare.comLearn about Agfa HealthCare at atwww.agfahealthcare.com