making radiology work flow

www.siemens.com/medical

Making Radiology Work FlowLinda DiMeo

The Next Frontier: An Integrated Medical Information Technology PlatformLaura Newman

Reprints from Medical Solutions, RSNA 2006

COVER STORYWORKFLOW

RADIOLOGIST JAMES BUSCH, MD, Director of Informatics for Diagnostic

Radiology Consultants, now also heads the private practice group’s IT arm called

Specialty Networks.

Making RadiologyWork Flow

Having the right information available at the right time and place, linking resources togetherand using them more effi-ciently, accomplishing moretasks in a shorter period oftime – in short, optimizingworkflow to improve qualityand reduce costs – is at thecenter of implementing infor-mation technology in health-care. A group of radiologistsin Chattanooga, TN, USA, notonly recognized this trend,but decided to go for it.By Linda DiMeo

COVER STORYWORKFLOW

During the past ten years, medicine has been

experiencing a trend toward decentralization,

with outpatient care becoming more the

norm. While this has resulted in the desired

cost efficiency, it has unfortunately also

resulted in a loss of communication between

healthcare providers, slower turnaround times

and greater opportunities for medical errors

caused by lost, outdated, or mistranscribed

data. With the aid of Siemens Medical

Solutions technology, Diagnostic Radiology

Consultants (DRC) has managed to integrate

a complex, multistate and multisite radiology

practice into an unified environment, which

has resulted in increased speed, simplicity,

flexibility, profitability, and, most importantly,

improved patient care and safety.

Founded more than 50 years ago, DRC is a

private practice group of eleven radiologists

who read and interpret approximately

200,000 cases per year, generated from

multiple sites across the greater Chattanooga

and northern Georgia region. As they would

travel from site to site to interpret images,

DRC radiologists found themselves changing

IT platforms with virtually every facility they

visited. The variety of radiology information

systems (RIS), picture archiving and commu-

nication systems (PACS), and postprocessing

systems they were using was causing con-

fusion, inefficiency, and delays. To complete

a case, a radiologist could deal with as many

as four different platforms, one for RIS, one

for PACS, one for voice interpretation, and

yet another for postprocessing functions. In

many cases, this involved moving back and

forth among several workstations, each with

a separate log on and password.

Adding to the inefficiency was the fact that

the radiologists were often unable to view

images that were taken at a facility with a

different PACS. And since the transcription

systems were not integrated with the RIS,

the radiologists had to redictate patient

information before even beginning the body

of their reports.

The DRC radiologists began discussing the

benefits of an enterprise-wide integrated

solution at all the facilities they service. They

decided to try to find a vendor that offered a

solution in which RIS, PACS, postprocessing,

and transcription came together in a compre-

hensive package. If such a product existed,

they talked about incorporating it into all of

the facilities at which they interpreted. From

that idea, Specialty Networks was born –

a corporation that would become the infor-

mation technology (IT) arm of Diagnostic

Radiology Consultants.

4 www.siemens.com/medical-magazine MEDICAL SOLUTIONS RSNA 2006

COVER STORYWORKFLOW

“We immediately began to assess the tech-

nology that was available to serve our goals,”

says James Busch, MD, Director of Specialty

Networks, and Radiologist and Director of

Informatics for DRC. “Not only did we want to

find a vendor that would be a good partner

and offer an enterprise-wide solution, but

also one that was looking down the path of

integration for the future.” From fall 2004 to

summer 2005, Specialty Networks conducted

vendor evaluations, and in the end, chose

Siemens Medical Solutions.

“Siemens was the only vendor that offered

exactly what we were looking for and was

also interested in continuing to refine the

integration of the various software platforms

that radiologists use to do their jobs,” says

Busch. Specialty Networks chose syngo® Suite,

a comprehensive IT solution from Siemens

that provides integration at the RIS, PACS,

postprocessing, and transcription levels. On

the RIS end, syngo Workflow manages the

processes for the exchange and distribution

of patient data and images from end to end.

The PACS applications for diagnostic prepara-

tion, quality assurance, and diagnostic inter-

pretation are bundled into syngo Imaging.

syngo Voice* is the component of syngo Work-

flow offering voice recognition and transcrip-

tion solutions within syngo Suite. Specialty

Networks chose Siemens strategic partner

NextGen Healthcare Information Systems,

Inc., a leading provider of electronic medical

record and practice management solutions,

to provide its electronic practice management

(EPM) solution. Siemens had been working

closely with NextGen to streamline the patient

experience from patient access through

diagnosis to treatment. The NextGen® EPM

solution has been completely integrated with

syngo Suite, extending the comprehensive IT

solution to include scheduling as well.

Thus, with one keyboard, one mouse, and a

single password-protected log on, syngo Suite

would cover the entire imaging process for

Specialty Networks, from patient registration

and diagnosis to image distribution. With

syngo Suite, the radiologists of DRC would

finally be able to communicate with each

other, and with technologists, clerks, and

referring physicians, in a uniform, consistent

manner, at all times.

Implementing syngo SuiteOnce Specialty Networks chose Siemens as

a partner, it began arranging to incorporate

syngo Suite in the facilities where it inter-

preted studies. Specialty Networks selected

Galen Imaging, which is the outpatient imag-

ing center for Galen Medical Group, as the

first site to implement syngo Suite. With a

total of eight locations spread throughout the

greater Chattanooga and northern Georgia

area, Galen was a perfect candidate in which

to conduct volume testing, averaging 22,000

exams per year. In October 2005, Galen

became the first successful go-live of Siemens

»Siemens wasthe only

vendor thatoffered exactly

what we were looking

for.«James Busch, MD, radiologist,

Director, Specialty Networks,

Director of Informatics, DRC,

Chattanooga, TN, USA * Currently available with the U.S. version of syngo Workflow only.

MEDICAL SOLUTIONS RSNA 2006 5

COVER STORYWORKFLOW

University Hospital Erlangen: The Art of Individualizing Standards

Discussing workflow topics with Professor Stephan Achen-

bach, MD, is no easy task. Instead of answering my ques-

tion regarding his department’s workflow in cases of acute

chest pain, the Assistant Medical Director for Cardiology

and Angiology at the Hospital of the Friedrich-Alexander-

University Erlangen-Nuremberg, Germany, asks in return:

“What is workflow?” Considering his following explanation,

“Every patient presenting to the emergency unit with

acute chest pain is different – you can’t just squeeze

them into standardized flowcharts,” he sure is right. Just

think of how differently people experience chest pain in

the first place. “It would be a true piece of art to develop

a workflow that leaves enough space for the individuality

of each patient,“ he says.

Nevertheless, he and his colleagues send patients with

clear acute chest pain, electrocardiograms (ECG) with-

out elevated ST-levels, and inconclusive blood tests to

a computed tomography (CT) scan to exclude acute

myocardial infarction (MI) as the cause of the pain.

Achenbach expects both medical benefits – due to faster

treatment initiation for patients with acute MI – and

economic advantages – due to shorter stays in the emer-

gency room for other patients – from this procedure.

“We have to work economically without practicing sub-

par medicine,” he says, “and I think CT can be very useful

in doing so,” even if standardizations are difficult. With

an early CT diagnosis, the President of the Society for

Cardiovascular CT sees the chance to intervene early on

and put the patient on the right track for treatment. One

major problem he perceives in establishing this new

workflow as a rule once its medical and economic merits

are scientifically proven, however, is staffing: “You need

to have a physician and a technologist available at all

times, who can run a cardiac CT. There are not many

around yet.”

Exploring Data FlowTo Achenbach, like most other physicians, more important

than a standardized, step-by-step patient workflow is data

flow. Having ECG, laboratory, image, and any other patient

data available is key when it comes to determining a

final diagnosis and treatment decision – wherever that

decision may be taken. The Imaging Science Institute (ISI),

a cooperation of the Global Solutions Division of Siemens

Medical Solutions and the University Hospital Erlangen,

provides a platform to investigate possibilities to solve this

issue of seamless data availability, among other projects.

As an interdisciplinary research institution housed within

the university hospital, ISI is dedicated to analyzing treat-

ment processes. It is supported by excellent medical

expertise, a powerful information technology (IT) infra-

structure and the latest generation of diagnostic systems.

The aim is to improve the overall workflow, from patient

admission to discharge, and to define optimized treat-

ment paths for specific diseases. Holistic treatment paths

are developed, tested, and optimized using Siemens work-

flow-oriented software systems syngo and Soarian®.

Implemented within a modern hospital, these treatment

paths enable extensive automation of administrative

processes, so that scheduling, data exchange, and billing

can be done at the push of a button. The result is a

streamlined workflow that allows doctors and hospital

staff to concentrate on what is important – the patients

and their treatment. dpi

THE IMAGING SCIENCEINSTITUTE is dedicated

to looking beyond current

workflow concepts.


COVER STORYWORKFLOW

RIS/PACS integrated with the NextGen EPM

system.

The implementation was conducted as a

phased installation to minimize the risk of

downtime, and the eleven radiologists of DRC

rotated their time at Galen so they could each

train on the new system. Since then, the

technology is currently being implemented

in the remaining seven other DRC customer

sites, including the largest multi-specialty

medical group in the Chattanooga region, a

300-bed community medical center, and one

of the largest orthopedic groups in the area.

They are in negotiations to add at least two

more clients to their roster.

According to Busch, customers have been

very enthusiastic about implementing the

new technology at their facilities. “Installation

week is always a bit difficult, because staffs

have to learn to use the new technology and

make adjustments to their workflow pro-

cesses,” says Busch. “But they are eager to

roll with it because they know that in the

long run their jobs will be much easier and

they will be more self-sufficient. They like the

idea of having this cutting-edge technology

at their fingertips.”

Janice Cooke, the RIS/PACS Manager for

Specialty Networks, is amazed at how well

the implementation has gone. “I expected

that it would take at least a year to bring the

first five sites online,” she states. “The fact

that this was accomplished in five months is

incredible.”

Cooke attributes the success of the implemen-

tation to the team Siemens provided to over-

see the project. “Of course, there have been

small hardware and software issues along

the way, but the whole adventure has been

overwhelmingly smooth. I’ve been in radiol-

ogy since 1978, and this is by far one of the

best systems I’ve ever used. It’s easy to use,

easy to fix problems, and easy to train staff

on. It’s just an excellent system.”

Busch also credits the Siemens team for the

success of the implementation. “Siemens was

extremely accommodating and supportive.”

Reaping the Benefits of syngo SuiteAccording to Busch, DRC has already saved

more than one full-time radiologist, and

expects to save even more in the future. “I

don’t think we’ve even remotely reached our

peak efficiency with syngo Suite,” he says.

DRC has also drastically reduced turnaround

time, from an average of 24 hours to one

hour, and in some cases, just minutes. “Now,

when we call doctors to give them reports,

they often already have them in their hands,”

explains Busch. “syngo has really helped us

to differentiate ourselves in the marketplace.”

Busch adds that making their practice more

efficient has also made it more profitable.

“The most expensive part of a radiology prac-

tice is the radiologist, so it is extremely cost-

effective to do more exams with less staff,”

he states.

syngo Suite has also contributed to improving

the overall quality of patient care. “With inte-

grated RIS and PACS, patient demographics

are already in the system and don’t have to

»It’s easy to

use, easy to

fix problems,and easy to

train staff. It’s just

an excellent system.«

Janice Cooke,

RIS/PACS Manager,

Specialty Networks,

Chattanooga, TN, USA

JANICE COOKE (RIGHT) and James Busch, MD, look back at the successful

implementation of syngo Suite at DRC and its customers’ sites.


COVER STORYWORKFLOW

Continuous Improvements: Thinking Beyond Imaging Systems

Siemens Medical Solutions constantly develops new and

improved workflow solutions. Among the most recent

developments are:

■ syngo Chorus MR*, which, for the first time ever, opti-

mizes magnetic resonance imaging (MRI) workflow

beyond the scanner, enabling a perfect synergy between

the modality and the radiology information system (RIS)

and the picture archiving and communication system

(PACS) environment. From the moment the patient is

scheduled in the RIS, syngo Chorus MR goes to work: The

application cross-checks patient data and validates order

entry based upon diagnosis. With the Protocol Planning

functionality of syngo Chorus MR, the radiologists can

plan the MRI exams right out of the RIS –

providing the MR technologist with the exact protocol

that he or she wants to be run – without unnecessary

phone calls or clarifications. Beyond that, if the patient is

scheduled for a follow-up study, using the PhoenixZIP

functionality of syngo Chorus MR, the protocols previously

used can be sent to the MRI scanner, so that exactly the

same parameters are reproduced, and comparative diag-

nosis can easily be made. This saves time and enables

diagnostic accuracy.

Using the Protocol Distribution functionality of syngo

Chorus MR, the RIS can also distribute MRI protocols

from one MRI scanner over the network to all other

Siemens scanners running on the latest MRI software.

This helps ensure standardization of protocols through-

out the different MR suites and optimizes quality.

The new Inline Billing (MPPS) follows the patients’ process

progress. At the end of the procedure, the system bills

automatically. Inline Billing even supplies the associated

codes necessary to report back to the RIS with no manual

entry.

■ syngo WebSpace is a real pace setter. It offers instant,

web-based access to imaging data plus state-of-the-art

2D, 3D and 4D postprocessing tools – enterprise-wide

and beyond. Real-time streaming of reconstructed imaging

data to the server allows up to 20 concurrent users

instant access to data via the PACS or any personal com-

puter (PC)** client throughout the institution, in their home

office or while traveling, by simply connecting to the net-

work.

“For a large institution such as Johns Hopkins, this client-

server solution means that we can offer all our staff

access to computed tomography (CT) data, 24/7. Now

our physicians can have access where*** and when they

need it and not just at the workstations in our 3D lab or

at the scanner. The client server solution expands our

capabilities to deliver outstanding patient care and

improve workflow,” explains Professor Elliot Fishman, MD,

of Johns Hopkins Medical Center in Baltimore, MD, USA.

“Plus it’s syngo-based, which means we don’t have to

invest time and resources in retraining staff.”

syngo WebSpace is also ideally suited for short-term

storage of thin-slice CT data, giving users instant access

while avoiding the need to send all thin-slice data sets

directly to the PACS, freeing up the CT scanner database

at the same time. It can be fully integrated into an existing

PACS and IT environment. The simple client-server archi-

tecture is highly cost effective not only because of its

multi-user capability, but also because it makes use of

existing computer resources. dpi

syngo WEBSPACE enables 3D reading anytime, anywhere.

* 510(k) pending.** PC must meet minimum requirements.*** Internet connection required.


COVER STORYWORKFLOW

Battlefield Auxiliary Breast Center: Workflow, Technology, and Tender-loving Care Make a Difference

For many women, the experience of getting even a routine

mammography screening can be a bit unnerving. And for

those who have suspicious breast lumps, it can be downright

nerve-wracking. But for women in northwestern Georgia, the

process is not quite as daunting, thanks to Battlefield Auxiliary

Breast Center.

The first digital imaging center in the northern Georgia

region, Battlefield Imaging of Ringgold, GA, USA, was formed

in 2004 as a joint venture between Hutcheson Medical Center

and Diagnostic Radiology Consultants (DRC). A world-class

imaging center offering a full range of services, Battlefield

Imaging opened its Battlefield Auxiliary Breast Center just 18

months later.

The Comforts of HomeBattlefield Auxiliary Breast Center was designed with the com-

fort of patients as top priority. “Our goal was to create a safe

haven for women,” says John Nelson, MD, Medical Director of

Battlefield Imaging and DRC radiologist. “I think that providing

women with this kind of atmosphere makes a difference for

them in terms of their comfort and privacy.”

Battlefield Auxiliary Breast Center provides a full range of breast

imaging services, such as screening and diagnostic digital

mammography, ultrasound, magnetic resonance imaging, and

positron emission tomography/computed tomography (PET·CT),

to help diagnose breast cancer in its earliest and most treat-

able stages. The geographic layout of the center lends itself to

fluid movement throughout a patient’s visit. The diagnostic

and screening rooms are contiguous to the mammography

suite, which is directly across the hall from the ultrasound

suite. “Once a woman comes into the dressing room, she liter-

ally never has to walk more than five feet to get where she

needs to go for her exams,” says Nelson.

The Battlefield Breast Center’s scheduling procedures have

also been instrumental in making breast imaging a less daunting

experience for women. “It’s very frightening for a woman who

has a symptom such as a lump in her breast,” says Nelson.

“For that reason, we make every effort to accommodate these

patients by getting them into the schedule right away, usually

on the same day that they call to request an appointment.

Once they come in, our staff performs the necessary non-

invasive tests all in that same visit, until we are completely

satisfied that we’ve done everything we can to obtain a

thorough diagnosis. If we determine that an invasive proce-

dure, such as a biopsy, is necessary, then we will schedule that

as soon as possible.”

State-of-the-Art Digital TechnologyBattlefield Auxiliary Breast Center was one of the first to unveil

the latest all-digital mammography technology, the heart of

which is Siemens MAMMOMAT® NovationDR. The MAMMOMAT

NovationDR offers digital mammography, digital spot imaging,

and digital, imaging-based stereotactic biopsy. Its large plate

facilitates more precise imaging of large breasts, and a specially

designed compression plate enables central isocentric breast

positioning. It also helps make calcifications easier to see in

women who have dense breasts. Another benefit of the

MAMMOMAT NovationDR is its significantly accelerated work-

flow. The Center averages about one complete case every

eight minutes, and performs 45 to 50 mammogram screen-

ings and eight to 12 diagnostic mammograms per day.

Once images are acquired with the MAMMOMAT NovationDR,

they are sent to the syngo MammoReport breast care work-

place, which offers two five-megapixel monitors specially suited

for reading and reporting mammograms. The radiology infor-

mation system (RIS) drives the mammograms one at a time, or

up to ten studies can be loaded at a time. Once they are selected,

they can be loaded into syngo MammoReport almost instanta-

neously and then can be filed with the click of a button.

Patients’ old film studies can also be digitized and viewed with

the syngo MammoReport. Nelson says that because of the

magnification power of the technology, Battlefield’s callback

rate has dropped to about 20 percent of what is used to be.

“We rarely have to call patients back in to retake views,” he

BATTLEFIELD IMAGING offers full-field digital mammography

(FFDM), as well as other exams.


COVER STORYWORKFLOW

be dictated again, which drastically reduces

the risk of associating an image with the

wrong patient,” says Busch. “We simply click

on the patient’s name and go. This allows us

to focus on the image interpretation, rather

than being distracted by redundant docu-

mentation requirements. And the sooner

we can make a diagnosis and deliver a report,

the sooner the patient can begin getting

treatment.”

To provide the highest quality of care possible,

DRC has radiology specialists who are experts

at interpreting images of specific systems of

the body. For example, their neuroradiologist

interprets special images of the brain and

neck. In the past, these images would have

to be saved until the neuroradiologist rotated

through that particular imaging facility. But

now with syngo Suite, radiologist specialists

can access patient images immediately, using

their individual worklists, no matter which

facility they happen to be working at on a

particular day. This is an added benefit for

both the patient and the referring physician.

Since the implementation of syngo, Specialty

Networks has also added syngo Portal Radi-

ologist* to its syngo Workflow RIS technology.

A ’cockpit’ of sorts, syngo Portal Radiologist

lays out on a computer screen all the tasks

that a radiologist needs for his specific work

processes. Every element on the screen is

expandable and collapsible, so the radiolo-

gist can manipulate how much or how little

he wants to see of each item.

syngo Portal Radiologist offers several

advantages over the previous technology

that DRC was using. “Probably the biggest

benefit is that everything is concisely organ-

ized on one screen,” says Busch. “There’s no

need to toggle back and forth between

different views or between old and new

reports. Everything you need is right there

on your desktop.”

states. “Concerning the examination itself, up to 70 percent of

our patients have reported that MAMMOMAT NovationDR is

more comfortable than other systems. Another big advantage

is that we are able to immediately sit down with the patient at

the syngo MammoReport and go over her study. This leaves

patients with a sense that their mammograms have been

thoroughly evaluated.”

All Under One RoofThe fact that Battlefield Auxiliary Breast Center is on the same

campus as a comprehensive cancer center, ambulatory surgical

center, and a physicians’ office complex, also makes quick,

convenient care for the patients possible. “Once a woman is

diagnosed with a malignancy, she will probably require a host

of services involving appointments with various healthcare

providers,” says Nelson. “It’s very unusual for a patient to be

able to obtain all this care in one place, yet that’s what we

offer here on this campus. She can see an oncologist right

here in our physicians’ complex, she can have any surgeries

she needs in our surgical center, she can have radiation therapy

here at the Breast Center, in addition to any follow-up imaging

that needs to be done. It’s hard enough to deal with breast

cancer without having to run all over the place for different

appointments at different locations. Having all this care avail-

able virtually under one roof has been invaluable to our

patients.” ldm

JOHN NELSON, MD, considers patient comfort a top priority in

mammography screening situations.

* Currently available for U.S. market only – under development forother markets.


COVER STORYWORKFLOW

New York University Medical Center:When Time is of the Essence

There is little doubt that stroke patients are best treated

in dedicated stroke centers. However, at many medical

institutions a stroke center cannot be established, either

due to limited space, or limited financial or personnel

resources. New York University (NYU) Medical Center is

in the ideal situation of not only having a stroke unit, but

also being able to identify the patients that need to be

treated there directly in the emergency room (ER).

“Patients with acute symptoms indicating a possible

stroke go straight to the ER’s 16-slice Siemens computed

tomography (CT) scanner,” states Robert I. Grossman,

MD, Louis Marx Professor of Radiology, Chairman of the

Department of Radiology, and Professor of Neurosurgery,

Neurology and Physiology, and Neuroscience.

The perfunctory CT exam reveals immediately whether

the symptoms are caused by an ischemic or hemorrhagic

stroke, or if the ER physicians need to look for other

causes, such as low blood sugar. A radiologist is present

in the ER 24/7 to provide fast turnaround when time is

of the essence. He or she interprets the images right

on-site.

Reports are usually dictated into a voice recognition

system, but since the radiologist and ER physician work

in close proximity to one another, the radiologist can give

a preliminary oral report before he or she starts dictat-

ing, thereby expediting treatment.

Once the diagnosis is clear, the patient is referred to the

NYU’s stroke center, where further treatment decisions

are made depending, among other factors, on the

patient’s age and condition, and on the type, location, and

expanse of the stroke. Treatment, including, if possible,

intravenous or intracranial thrombolysis, commences.

Treatment results are monitored either by CT or magnetic

resonance imaging (MRI). Both imaging modalities, as

well as ultrasound, also play an important role when it

comes to finding the actual cause of the stroke once the

acute situation is resolved. Examinations also include a

cardiac work-up and a complete blood analysis. dpi

“syngo Portal Radiologist also lets you create

ad hoc workflows, which we weren’t able to

do in the past. If I am sitting at my computer

reading an exam, and a referring physician

calls in for a consultation, I can go into an ad

hoc workflow and call his exam up on the

screen without interrupting the images I’m

already working on or losing the dictation

that I’ve already done. That’s a tremendous

advantage in terms of productivity and time

savings.”

Another functionality accessible in syngo

Portal Radiologist is also contributing to

quicker turnaround and more efficient service.

The Dynamic Loading function allows images

to appear as soon as they are selected from

the worklist, so radiologists can begin their

interpretation before the entire series loads.

This is especially beneficial with large exams.

And sophisticated postprocessing tools, which

previously would have required moving to

another workstation, are now available in the

same integrated system.

Additional advantages of syngo Portal Radi-

ologist that Busch points out include the

ability to create shortcuts and templates on

the fly, and to obtain real-time feedback on

productivity, improved search functionality,

and better communication between radiolo-

gists and technicians.

With its familiar look and feel for all modalities

and workplaces, syngo Portal Radiologist is

easy to learn, use, and share. “The learning

curve is very short, especially for those who

are already familiar with the syngo environ-

ment,” says Busch.

“I learned it in one day, but even for someone

who had never used syngo before, I’d say the

average learning time would be one to two

days.”

“I like to compare syngo Suite to a stetho-

scope,” explains Busch. “It’s a tool that can

come with me, as a radiologist, wherever I

go, similar to family doctors and their stetho-

scopes. It has also allowed us to provide

a single imaging software solution where

radiologists and other doctors can go to get

everything ‘imaging’ that they need. This has

brought back a sense of community among

physicians that had been lost in recent years


COVER STORYWORKFLOW

due to the decentralization of imaging asso-

ciated with the increase in outpatient care.”

Securing Patient PrivacyAlthough syngo Suite transfers all images

into a centralized PACS architecture, these

images are segregated by location, with each

facility driven by a different master index.

This means that radiologists at DRC can view

images from all the medical practices that

they serve, but each medical practice only

has access to the images of its own patients.

To illustrate, this is akin to someone looking

at the windows of a high-rise building and

being able to see what is going on simulta-

neously on each floor, while the people on

the individual floors can only see what is

happening on their own floors, even though

they are all in the same building.

“This segregation and regulation based on

user privileges is extremely important for

patient privacy, and is not available with any

other imaging technology on the market,”

says Busch.

Integrating Imaging Technology – Now and in the FutureDr. Busch hopes to expand the role-based

workflow allowed with syngo Portal Radiolo-

gist by implementing the syngo Portal Refer-

ring Physician as soon as it becomes available.

A web-based portal, syngo Referring Physician

allows medical practices to link into a hospi-

tal or other imaging provider’s diagnostic and

therapeutic workflow.

“syngo Portal Referring Physician would be a

huge marketing advantage to us because it

would allow us to provide referring doctors

with even greater convenience in terms of

scheduling and obtaining reports,” Busch is

convinced. “These two factors play a great

role in deciding where doctors will refer their

patients for imaging.”

“There is much being said about the need

for greater IT adoption in healthcare and the

integration of imaging and IT, but Siemens

is the vendor that is making it happen and

meeting our business model needs today,”

says Dr. Busch. “From a standalone imaging

center perspective, having RIS/PACS inter-

operating with an EPM system provides a

complete solution for managing our imaging

workflow – from scheduling and registration

to interpretation – and that is what we’ve

achieved through our partnership with

Siemens.”

Author: Linda DiMeo is a freelancer writer, editor, and

proofreader based in Philadelphia, PA, USA. She has

18 years of experience in the communications field, and

holds a BA in English from St. Joseph’s University in

Philadelphia.

»syngo PortalReferringPhysicianwould be ahuge market-ing advantageto us.«James Busch, MD, radiologist,

Director, Specialty Networks,

Director of Informatics, DRC,

Chattanooga, TN, USA

BUSINESSIMAGE MANAGEMENT


The Next Frontier: An Integrated MedicalInformation TechnologyPlatformBreaking new ground, a partnership betweenSiemens and New York University is driving thedevelopment of new imaging software proto-types that will achieve efficiencies well beyondcurrent industry expectations by focusing on integration over interfacing.By Laura Newman

At last, the barriers to optimized workflow

throughout radiology, cardiology, and oncol-

ogy are coming down. Siemens Image and

Knowledge Management Division is contribut-

ing to this exciting development by focusing

on image and workflow management appli-

cations and computer-aided diagnosis under

the roof of its syngo® software platform.

Ajit Singh, PhD, who is heading the division,

met with Bernard A. Birnbaum, MD, Professor

of Radiology and Vice Chairman of Clinical

Affairs and Operations at New York University’s

(NYU) Department of Radiology, to talk about

NYU’s needs and the innovative products

Siemens has in the pipeline to revolutionize

how work is organized in imaging depart-

ments and medical networks around the

globe.

MEDICAL SOLUTIONS: Until now, workflow

in radiology has been somewhat fragmented.

What strategies do you see as paving the way

to the radiology department of the future?

SINGH: If I think ahead, our end goal is to

have all the relevant information and knowl-

edge – which is context and role sensitive –

in the right place at the right time. By that, I

mean at the point of decision making and the

point of care.

That is our fundamental goal. To make this

happen, you need to optimize end-to-end

workflow – from the time patients come

into the system to the time they leave the

system. Imagine any end-to-end patient flow

– all the necessary information and knowledge

would be available right at the fingertips of

each clinical stakeholder, such as radiologist,

technologist, or referring physician.

MEDICAL SOLUTIONS: Could you take a

step back and reflect on the problems that

need to be overcome in order to optimize


workflow for each clinical stakeholder and

across the network?

SINGH: Right now, diagnostic and therapeutic

information are poorly integrated. You have

information from imaging and pathology –

vast amounts of data. All the data is in the

system, but it is not organized or immediately

accessible. Also, you cannot convert laboratory

and radiology data into high-level constructs

at the patient and disease level. Multiple

users cannot access it. To overcome these

challenges, we’ve made knowledge-driven

solutions a top priority in our agenda.

Role-based ApproachBIRNBAUM: If I look at our department at

NYU, we still have multiple IT systems. We are

currently using IDX® version 9.92 as our radi-

ology information system (RIS). We use

Siemens for our enterprise picture archiving

and communication system (PACS), but have

3D post-processing systems from both

Siemens and non-Siemens vendors. We also

use different vendors for our document scan-

ning and speech recognition systems. We

cannot cleanly integrate these systems as is.

As such, we are currently working to replace

the IDX RIS with syngo Workflow. Subse-

quently, we plan to drive maximum integration

between all of these systems by incorporating

syngo postprocessing into our integrated

syngo PACS imaging suite. Integration wins

over interfacing every time. Also, what we

want to achieve – and I am confident we will

achieve through Siemens syngo products –

is the ability to log onto the system at any

place and time. When I log on, I immediately

want to see a radar map of my own work-

flow.

This may include cases that need to be proto-

colled, preliminary reports that need to be

finalized, and all outstanding examinations

that need to be read. Moreover, I would

like my clinical section chiefs and those with

executive responsibility to be able to view

the workflow of individual sections or the

entire department, respectively. By seeing

who is in the ’green, yellow or red zones’, we

will be able to redistribute the clinical work to

optimize our workflow.

MEDICAL SOLUTIONS: Siemens innovative

syngo Suite is a pacesetting product that is

setting the bar for the industry. Can you offer

a snapshot of the system and how Siemens

customers will benefit from using it?

SINGH: The syngo Suite offers all the diag-

nostic and therapeutic information collated on

the same IT platform to integrate all steps:

patient registration, scanning, interpretation,

archiving and billing. All tasks that a radiologist,

technologist, or referring physician performs

are organized into portals. The syngo-based

platform makes sure that all the tasks

share a common environment and intuitive

user interface. Self-explanatory icons make it

easy to use. We are also eliminating the time

these people spend moving from one work-

station to another. With syngo-based products,

doctors will be able to access the system

from any personal computer (PC) in the net-

work. This allows them to perform the full

array of reporting, reading and dictating tasks

from one workstation. Our product develop-

ment group is also gearing up to include

oncologists and cardiologists into the net-

work, enabling them to configure the system

based on their clinical focus. Ultimately, we

are aiming to streamline workflow not only

across disciplines throughout the institution,

but also between a hub and satellite facilities.

With this unique bundling of competencies,

we are helping our customers maintain their

competitive advantage.

MEDICAL SOLUTIONS: Can you describe

how medical device data will be integrated

into RIS, PACS and postprocessing systems?

SINGH: Medical devices are data sources.

We need to collate all their information into

an integrated platform. Like any other data

source, medical devices are enablers. This

idea marks a very important paradigm shift.

These very disparate data sources integrate

into one IT platform. If you think of it in terms

of functionality, the scanner could be sitting

three miles across town, but I could be view-

ing it on my PC or on any workstation in the

network.

MEDICAL SOLUTIONS: Siemens 64-slice

computed tomography (CT) and SOMATOM®

Definition scanners are among the most



Siemens/NYU Laboratory: Building the Next Generation of RIS and PACS Products

Radiologist Bernard A. Birnbaum, MD, Vice Chairman of

Radiology at New York University (NYU) Medical Center,

says that the partnership between his team and Siemens

has been fruitful. By the end of the year, a laboratory

housed at NYU will open with the goal of jointly developing

and testing Siemens next generation radiology informa-

tion systems (RIS) and picture archiving and communica-

tion systems (PACS) products.

The information technology (IT) and the installation of

latest whole-body MRI, dual-source, and 64-slice CT enable

NYU and Siemens to investigate strategies to optimize

high-volume reading, workflow, and data mining. They will

give top priority to building new medical IT solutions with

an extremely intuitive user interface. There are benefits

to both partners. Siemens views the laboratory as critical

in helping them provide new prototypes for medical IT

products that will eventually become available across

the globe. NYU wants to contribute to that vision and

believes that Siemens has the outstanding capabilities

and foresight to help NYU devise a medical IT solution

across its enterprise-wide network, extending it from its

hub in the radiology department to all satellite facilities.

sophisticated in the industry. syngo Suite

collects data from the CT-imaging studies

and optimizes workflow. Can you tell us about

your experiences with these modalities and

your expectations regarding syngo Suite?

BIRNBAUM: Let us use an example. A physi-

cian orders a coronary CT angiography study

for a patient with atypical chest pain and

inconclusive prior tests. The patient would be

interviewed by our staff and prepped. He or

she would lie down in the machine and

would not require a beta blocker.

While the actual data acquisition on the

SOMATOM Definition scanner takes only

a few minutes, interpretation of this high

volume data set remains a cumbersome

process. Multiple dedicated workstations are

typically used to analyze the data set, post-

process the study and archive the appropriate

3D views. However, the integrated syngo-

based platform will enable users to open

several task-oriented software applications

simultaneously. With a minimum number of

mouse clicks, the study could be interpreted,

dictated, and archived at a single workstation.

MEDICAL SOLUTIONS: How does NYU

handle the high-volume data generated by

these powerful scanners?

BIRNBAUM: Because these scanners may

generate thousands of images per study, we

need to modify our workflow accordingly. We

typically archive thicker – at least four milli-

meter – slices and send the thinner slices

to our 3D workstations. Doing so enables us

“ALL TASKS that a radiologist, technologist, or referring physician performs are organized into

portals,“ explains Ajit Singh.

»When you improve

workflow, you also

improve quality

while reducing costs

– that’s a fact!«Ajit Singh, PhD,

Image and Knowledge

Management Division,

Siemens Medical Solutions



to interrogate an optimized data set to create

high-resolution postprocessed images that

we then archive without sacrificing band-

width and archive space.

One Intuitive PlatformMEDICAL SOLUTIONS: In previous conver-

sations with NYU, you mentioned that the

ideal system would integrate RIS, PACS, and

postprocessing into one intuitive platform. Is

there anything more you would like to add to

that concept?

BIRNBAUM: We really know exactly what

we want. What we are going to do here is

ensure that Siemens builds just that product,

because it will achieve these goals and more.

At this point in time, ideally, we would like to

add on speech recognition and document

scanning, and probably additional software

that would allow us to immediately access

information via the Internet that would pro-

vide decision support.

MEDICAL SOLUTIONS: To what extent will

syngo be an out-of-the-box solution? How

close to ’one click’ will it be?

SINGH: For 80 percent of the users, the

system will be out of the box. However,

recognizing that some users will want to con-

figure the system differently, we will build in

flexibility for customizing the system. We are

striving for a one-click system because the

closer to one-click you are, the less invasive

you need to be. With our portals for the radi-

ologist, the referring physician, and more

planned, we have already come a long way

toward achieving this.

MEDICAL SOLUTIONS: Do you expect there

will be resistance to moving towards an inte-

grated IT platform that optimizes workflow?

SINGH: Yes. Doctors have been trained to

use paper and film for the last 100-plus years.

It is so embedded in the curriculum. Only now

the curriculum is changing to incorporate

structured reporting and image handling

into a computerized system. What will make

it hard is this: If you make a computerized

system too complicated, it will impede the

thought process. You want a computer to

think with you and not for you. You have to

make it as transparent as possible so doctors

can think about their patients and not the

technology. There is also a mindset in health-

care that you cannot improve quality while

reducing costs. That is simply inaccurate. If you

look at every other industry, you see that these

goals are co-optimized. It does cost less. When

you improve workflow, you also improve

quality while reducing costs – that’s a fact!

“INTEGRATION wins over interfacing every time,” says Bernard A. Birnbaum.

»We will ensure

that Siemens builds

the very product we

envision, because

it will achieve our

goals and more.«Bernard A. Birnbaum, MD,

Professor of Radiology,

Vice Chairman of Clinical Affairs

and Operations, Department of

Radiology, New York University

Medical Center, USA

Author: Laura Newman is a freelance medical journalist

based in New York City. She has contributed articles to

the Journal of the National Cancer Institute, The Lancet

and the Institute of Medicine (part of the National

Academy of Sciences), among others. She is also author

of Developing Technologies for Early Detection of Breast

Cancer (National Research Council and the National

Cancer Policy Board).

Siemens AGWittelsbacherplatz 2D-80333 MunichGermany

HeadquartersSiemens AG, Medical SolutionsHenkestr. 127, D-91052 ErlangenGermanyTelephone: +49 9131 84-0www.siemens.com/medical

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