Welcome to the OSEHRA Imaging Group

Welcome to the OSEHRA Imaging Group everyone!

Let's start by opening a conversation about the groups' goals and activities.

Luis Ibanez said: "One of the targets that we have for the immediate future is to extend EWD and VistACom to display medical images that have been extracted from a PACS system."

 

So I would like to propose some structure for the goals (by priority) regarding medical images in EHRa:

1) Display

2) Tools (basic and advanced)

Let's focus in "Display". It could be fuerther broken down into:

a) Format (DICOM, other formats, compression, headers, etc)

b) Architecture (storage, transmission, protocolos, ports, security, integrity, back-up, redundancy, etc)

c) Integration (code, links, actions, data, etc)

 

Regarding the activities, we should give this brainstorming and subsecuent guidelines, code, etc some structure. What should go into "Discussions" (and how to organise it) and what into "Wiki"?

 

Looking forward to your feedback!

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Comments

VistA Imaging

dezso csipo's picture

Jorge,

 

VistA already has an integrated imaging package :), and it adresses all the subjects you have mentioned, and some.

 

dee

;-D

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Welcome to the OSEHRA Imaging Group

Fred Prior's picture

Dee,

Thanks for joining the group. I have been encouraging Peter Kuzmak to join as well. It would be a great help to review for everyone what currently is included in the VistA imaging packages.

Fred
-------------------------------------------------------------
Fred Prior, Ph.D.
Director, Electronic Radiology Laboratory
Director, Center for High Performance Computing
Mallinckrodt Institute of Radiology
Washington University School of Medicine
Campus Box # 8131
4525 Scott Avenue - East Building, Rm 3355
St. Louis, MO 63110
priorf@mir.wustl.edu<mailto:priorf@mir.wustl.edu>
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mobile: (314) 303-2485
http://erl.wustl.edu/

From: dcsipo <dcsipo@isigp.com<mailto:dcsipo@isigp.com>>
Date: Wed, 7 Mar 2012 10:18:35 -0500
To: Imaging <imaging@groups.osehra.org<mailto:imaging@groups.osehra.org>>
Subject: Re: [imaging] Welcome to the OSEHRA Imaging Group

Jorge,

VistA already has an integrated imaging package :), and it adresses all the subjects you have mentioned, and some.

dee

;-D

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VistA Imaging

dezso csipo's picture

Hi Fred,

The issue is not whether one needs imaging, the real issue is workflow management..   VistA Imaging has done an admirable job of manaiging radiology and consults based workflows.  I think the charter of this workgroup should be, not whether there is a need to deal with images, but where the clinical information workflow for imaging has to be a few years out from now.   Given that vision one could come up with a gap analysis and direct the groups attention to areas that are not resolved, and thus avoid duplicatiuon of effort.

You may not know, even though there is no sanctioned reengineering effort in the VA for VistA Imagign, we have been slowly re-shaping the arhitecture and moving form a site centric model to a federated patient centric model that covers both VA and DoD.   Given the limited resources the VA so unvisely spends on VistA Imaging there are still some significant advances that have been made.   If the group is interested we can provide all the backgroud, arrange demonstrations, etc.  

 

dee

;-D

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Discussion versus Wiki pages

Luis Ibanez's picture

Jorge,

Regarding the management of the pages, my suggestion will be to use:

a) Discussion pages for open conversations where we explore the many side of the issues at hand (more or less brainstorming)

b) Wiki pages as the place where we organized the factual data gathering resulting from the conversations, and also organize conclusions and plans. (that is, organized material that can be used for future reference)

c) Blog posts for sharing opinions and raising awareness about specific topics.

 

Regarding content and actual activities:

It will be great to follow Fred Prior's suggestion of starting with an overview of what is currently available in the FOIA version of VistA, and then look at the gaps that the community could focus on.

My understanding is that certain portions of the Imaging package are redacted from VistA during the preparation of the FOIA release, while other portions have made it to be part of the Open Source version in the OSEHRA repository. It would be interesting to see what functionalites are missing from the Open Source version.

Integrating image display with VistACom seems to be one of those clear targets, but it is quite likely that we will find may other potential targets as we start looking closer.

 

 

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VistA Imaging

dezso csipo's picture

Luis,

Enlighten me, what portions of Imaging are included in the FOIA version of VistA?  The VA had a long standing policy to release imaging FOIA packages upon request, thus keeping records of who requested the FOIA version of imaging.  

 

dee

 

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Imaging Package in FOIA

Luis Ibanez's picture

Dee,

 

Here is what we got in the FOIA

https://github.com/OSEHRA/VistA-FOIA/tree/master/Packages/Imaging/Routines

 

It contains 321  M files.

They all have the following introductory text:

;; +---------------------------------------------------------------+ ;; | Property of the US Government. | ;; | No permission to copy or redistribute this software is given. | ;; | Use of unreleased versions of this software requires the user | ;; | to execute a written test agreement with the VistA Imaging | ;; | Development Office of the Department of Veterans Affairs, | ;; | telephone (301) 734-0100. | ;; | | ;; | The Food and Drug Administration classifies this software as | ;; | a medical device. As such, it may not be changed in any way. | ;; | Modifications to this software may result in an adulterated | ;; | medical device under 21CFR820, the use of which is considered | ;; | to be a violation of US Federal Statutes. | ;; +---------------------------------------------------------------+

 

This should probably be one of the first topics of conversation.

 

Now, regarding the actual functionalities:

 

After a cursory glance at the code (geek term for "grep", "vim", "less"...)

About 100 of them seem to be related to DICOM communications,
and it appears to include Query/Retrieve functionalities.

About 41 of them seem to have functionalities related to PACS / HL7.

There is a bit about microscopy images and pathology.

There is a bit about document scanning...

 

I'm sure I'm missing a lot from that coarse list, and certainly a simple cursory glance doesn't do justice to the content of the package.  We definitely can use the guidance of an expert familiar with the Imaging package, as Fred Prior suggested.

Maybe we could setup a webinar to go through the big picture.

 

There is also abundant documentation in the Imaging folder of the VDL:

https://github.com/OSEHRA/VistA-Document-Library/tree/master/Clinical/VistA%20Imaging%20System/3.0

 

The documentation could be useful here to help us identify the pieces that might be missing from the FOIA version.

 

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VistA Imaging

dezso csipo's picture

 

The FDA is definitely an issue.   So how does OSEHRA deal with blood bank?  This is the same process.   Then it becomes an issue who is the "medical device manufacturer” and who holds the filing.  The VA does have all that for imaging and for blood bank, and it is not a transferable asset.  

A policy discussion for the open source community would be useful, regardless what is the software that will be used for imaging.  The open source community cannot be a registered manufacturer (at least there is no established model), and the imaging component still will be a device that fall under the QS regulation is in Part 820 of Title 21 of the Code of Federal Regulations (CFR).   As an example the Pro version of Osirix has a 510K filing and it is sold as a product by an organization that bears the burden of the QSR and is a gatekeeper of the exact functionality that gets migrated from the open source base into the pro version under documented  controls.  (Standards organizations like  MITA/NEMA has struggled with the FDA requirements esp. in the application hosting arena. Maybe there is a takeaway from that effort that is applicable here.  Fred Prior and Larry Tarbox can chime in in detail.)

The reason I am bringing all this to the forefront because there is a difference between getting a community project going to have a few people work on a display station that people can use at their own risk, and an EMR that is intended for enterprise use.  If the necessary components do not have adequate regulatory clearances the enterprise takes on the regulatory burden, and we all know how risk adverse most large enterprises are.

I need to get help on getting the group educated about existing functionality, I hope other people working with VistA Imagign can jump in and start the process.

dee

;-D

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Cross-group interest

Jorge Cortell's picture

Seems like this is the kind of multidisciplinary discussion that should involve other groups like:

Certification

Situational Awareness

Support

Software Licensing Terms

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Clinical input: is there any here?

Rafael Richards MD, MS's picture

Just want to remind folks that while it is interesting to talk about technology, if there is no practicing radiologist or clinician giving any input here, any talk about workflow, integration, display technology, etc.  will not be serving the end user...  Let's keep things clinically focused.

 

 

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Welcome to the OSEHRA Imaging Group

dezso csipo's picture

VistA imaging has been in clinical use since 1987. There had been thousands of clinicians providing input over the past 26 years. We are first getting the end result of this collaboration into the open source community. Once there is expansion of functionality we will need additional clinical input

Dee

Sent from my iPhone

On Mar 25, 2013, at 2:40 PM, rrichards <rmrich5@gmail.com> wrote:

> Just want to remind folks that while it is interesting to talk about technology, if there is no practicing radiologist or clinician giving any input here, any talk about workflow, integration, display technology, etc. will not be serving the end user... Let's keep things clinically focused.
>
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>
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> Full post: http://www.osehra.org/blog/welcome-osehra-imaging-group
> Manage my subscriptions: http://www.osehra.org/og_mailinglist/subscriptions
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