Maximizing the Power of Maximizing the Power of Centricity PACS Audit DataCentricity PACS Audit Data

Bill Gregg, MS, CIIP, CPSABill Gregg, MS, CIIP, CPSAPACS Administrator/IIPPACS Administrator/IIP

LSU Health Sciences CenterLSU Health Sciences CenterShreveport, LAShreveport, LA

The materials, presentations and content The materials, presentations and content herein are the opinions and experiences, herein are the opinions and experiences, and represent the views, of the specific and represent the views, of the specific authors and presenters and are not authors and presenters and are not statements of advice, opinion or statements of advice, opinion or information of GE Healthcare. Neither information of GE Healthcare. Neither the materials, presentations nor content the materials, presentations nor content therein have been prepared, screened, therein have been prepared, screened, approved, reviewed or endorsed by GE approved, reviewed or endorsed by GE Healthcare.Healthcare.

OverviewOverview

Start SimpleStart Simple Historical perspectiveHistorical perspective Basic concepts regarding events and dataBasic concepts regarding events and data Look at basic data with the PACS AuditorLook at basic data with the PACS Auditor Finish up with workflow analysisFinish up with workflow analysis Goal is to give everyone something to take Goal is to give everyone something to take

home todayhome today

Getting StartedGetting Started

HIPAA (2004) – audit access to PHIHIPAA (2004) – audit access to PHI With Centricity 2.0 GE started providing With Centricity 2.0 GE started providing

XML audit log filesXML audit log files Direct conversion of XML to Excel wasn’t Direct conversion of XML to Excel wasn’t

working for meworking for me Wanted to work in the .NET environmentWanted to work in the .NET environment Used Visual Basic .NET to read audit Used Visual Basic .NET to read audit

files and load into MS Accessfiles and load into MS Access

Getting StartedGetting Started

First version of the PACS Auditor First version of the PACS Auditor application Nov 2004application Nov 2004

IHE value growing, looked at ATNAIHE value growing, looked at ATNA Used this platform for a poster Used this platform for a poster

presentation at SCAR/SIIM 2005 that presentation at SCAR/SIIM 2005 that was later published in the JDI was later published in the JDI

Found data useful for QC as wellFound data useful for QC as well What else can we do with this?What else can we do with this?

Time LineTime Line

11/04 11/04 Created first iteration of Audit Log appCreated first iteration of Audit Log app 4/054/05 SCAR/SIIM GE/Eric Feingold talk SCAR/SIIM GE/Eric Feingold talk 7/067/06 Offered PACS Audit Log app as open Offered PACS Audit Log app as open

source to GE User Community source to GE User Community (SupportCentral)(SupportCentral)

11/0711/07 Added workflow analysis Added workflow analysis

Talk ObjectivesTalk Objectives

Objective 1: Understand how to get Objective 1: Understand how to get Centricity audit log files and what is in Centricity audit log files and what is in them   them  

Objective 2: Understand ways to access Objective 2: Understand ways to access and manipulate the data   and manipulate the data  

Objective 3: Understand how to utilize Objective 3: Understand how to utilize this data to support HIPAA requirements this data to support HIPAA requirements and QC effortand QC effortss  

Term DefinitionsTerm Definitions

DatabaseDatabase Audit LogAudit Log XML fileXML file Elements/AttributesElements/Attributes EventsEvents ENM TableENM Table

MS Visual Basic .NETMS Visual Basic .NET MS Visual StudioMS Visual Studio MS AccessMS Access MS SQL Server/SSEMS SQL Server/SSE Oracle, SybaseOracle, Sybase

Why Care About Audit Data?Why Care About Audit Data?– To satisfy HIPAA requirementsTo satisfy HIPAA requirements

Who looked at whatWho looked at what

– To support QC projectsTo support QC projects Who verified/dictated that exam?!Who verified/dictated that exam?! Who rejected those images?Who rejected those images? How long does it take to verify an exam?!How long does it take to verify an exam?!

– To Monitor DICOM events (not implemented)To Monitor DICOM events (not implemented) Who created/changed KIN, ED, PGIWho created/changed KIN, ED, PGI

– To support ILM (Information LifeCycle To support ILM (Information LifeCycle Management) (not yet implemented)Management) (not yet implemented) Who created/implemented/changed rulesWho created/implemented/changed rules What exams were deleted/movedWhat exams were deleted/moved

Hugged Your Audit Data Today?Hugged Your Audit Data Today?

Audit data has a lot of value todayAudit data has a lot of value today As more information is added to it, more As more information is added to it, more

value will be derived tomorrowvalue will be derived tomorrow

Level I: The BasicsLevel I: The Basics

– GE documents on audit data, GE documents on audit data, events and fields (documentation events and fields (documentation folder)folder)

– What does this show usWhat does this show us

– How can we utilize the data (xml, How can we utilize the data (xml, spreadsheets, db)spreadsheets, db)

Centricity 2.0Centricity 2.0

Centricity RA1000, some Exam Manager Centricity RA1000, some Exam Manager events loggedevents logged

Start with initial set of audit dataStart with initial set of audit data Order event is not includedOrder event is not included Must set 4 of the events in CA ToolMust set 4 of the events in CA Tool

– LogIn/Out, Exam Print, Exam ViewLogIn/Out, Exam Print, Exam View

Centricity 2.1.xCentricity 2.1.x

Started capturing events from Centricity Web Started capturing events from Centricity Web connections alsoconnections also

Added additional events in 2.1.3 that must be set Added additional events in 2.1.3 that must be set in the CA Tool in the CA Tool – User\ Created, LoginFailure, RoleChanged, User\ Created, LoginFailure, RoleChanged,

StatusChanged, PasswordChanged, StatusChanged, PasswordChanged, ExamPresentationSaved, ReportViewedExamPresentationSaved, ReportViewed

Some quirks where didn’t complete the XML file Some quirks where didn’t complete the XML file Order event not includedOrder event not included

Centricity 3.0Centricity 3.0

Added additional data events/elements that Added additional data events/elements that must be set in CA Toolmust be set in CA Tool

Order event now included giving the Order event now included giving the complete picturecomplete picture

Important shift in architecture to a DICOM Important shift in architecture to a DICOM view in v3.xview in v3.x

This allows us to start capturing data This allows us to start capturing data regarding DICOM eventsregarding DICOM events

Take a look at the eventsTake a look at the events

BasicsBasics

Note that in Exam Manager, EM and Note that in Exam Manager, EM and PM events are logged, as well as PM events are logged, as well as status changes (such as verify, status changes (such as verify, unverify etc.), but no event if change unverify etc.), but no event if change patient name or MR directly.patient name or MR directly.

Also note that my app now includes Also note that my app now includes the 2.x/3.x events and data fields.the 2.x/3.x events and data fields.

Audit FilesAudit Files

XML filesXML files File structureFile structure How do you get them? (your FE)How do you get them? (your FE) Be aware that the ENM table only holds a Be aware that the ENM table only holds a

set number of days of data, it is NOT a set number of days of data, it is NOT a permanent repositorypermanent repository

That is why they give it to youThat is why they give it to you Also be aware that the event data is Also be aware that the event data is 2 days2 days

behindbehind

Level I SummaryLevel I Summary

Basic termsBasic terms PACS Audit Events/data from ENMPACS Audit Events/data from ENM Getting the audit log files from GEGetting the audit log files from GE Discussed version differences Discussed version differences Looked at XML fileLooked at XML file

Level II: ToolsLevel II: Tools

Have basic understanding of the audit dataHave basic understanding of the audit data Multiple ways to access the dataMultiple ways to access the data Multiple tools to access the dataMultiple tools to access the data PACS Auditor tool on SupportCentral sitePACS Auditor tool on SupportCentral site

Installing the Audit LoggerInstalling the Audit Logger

Documentation (go ahead, read it…)Documentation (go ahead, read it…) Need to have .NET 2.0 installed Need to have .NET 2.0 installed File location structureFile location structure Issue with fixed db locationsIssue with fixed db locations Fix using UDL filesFix using UDL files Need to change driver for Access 2007Need to change driver for Access 2007 Just need to re-link tables in Access feJust need to re-link tables in Access fe

Auditor Trivia Game!Auditor Trivia Game!

Frontend/Backend databaseFrontend/Backend database Access allows a file size of about 2 GbAccess allows a file size of about 2 Gb This holds approximately 2.9 million audit This holds approximately 2.9 million audit

records (currently on my 3records (currently on my 3rdrd)) You can create front ends that limit accessYou can create front ends that limit access You can implement some reasonable You can implement some reasonable

securitysecurity

Your ‘PAL’Your ‘PAL’

Loading filesLoading files SafeguardsSafeguards TroubleshootingTroubleshooting

The ‘PACS Auditor’ DatabaseThe ‘PACS Auditor’ Database

Basic front end (GUI) for immediate queriesBasic front end (GUI) for immediate queries Search fieldsSearch fields How the date fields workHow the date fields work Report buttonsReport buttons Exam 2020, Patients 1228, 2003Exam 2020, Patients 1228, 2003

Level III: WorkflowLevel III: Workflow

Have basic reporting capabilities that can Have basic reporting capabilities that can help address HIPAA requirementshelp address HIPAA requirements

Can answer basic questions about who did Can answer basic questions about who did what using discrete event datawhat using discrete event data

Take the data and extract more information Take the data and extract more information from it by looking at time spans between from it by looking at time spans between eventsevents

Workflow ReportsWorkflow Reports

Going past event data to look at workflowGoing past event data to look at workflow Time ReportsTime Reports Issues with dataIssues with data

– Start and end dates can caused partial spansStart and end dates can caused partial spans– Accession range more completeAccession range more complete– Skipped status levels (Arrived-Dictated etc.)Skipped status levels (Arrived-Dictated etc.)– Manual manipulations (Unverify, Verify)Manual manipulations (Unverify, Verify)– How these affect countsHow these affect counts

Update for 2.x/3.x DataUpdate for 2.x/3.x Data

Completed the update to include 2.x/3.x Completed the update to include 2.x/3.x data fieldsdata fields

Requires a database conversionRequires a database conversion Will need to load prior archived db’s into a Will need to load prior archived db’s into a

new empty databasenew empty database New db won’t hold entire old ‘full’ dbNew db won’t hold entire old ‘full’ db Created routine to help import, but Created routine to help import, but

IMPORTANT to follow the documentationIMPORTANT to follow the documentation

Future WorkFuture Work

Create new reports/views based on 2.x/3.x data Create new reports/views based on 2.x/3.x data fieldsfields– Login FailuresLogin Failures– Image rejectsImage rejects– Any other suggestions? Any other suggestions?

Move from Access to SQL Express/SQL ServerMove from Access to SQL Express/SQL Server Build in creation of summary data for use with Build in creation of summary data for use with

pivot tablespivot tables Create de-identified data sets for research useCreate de-identified data sets for research use

SummarySummary

Centricity PACS audit dataCentricity PACS audit data Satisfying HIPAA requirementsSatisfying HIPAA requirements Satisfying basic QC needsSatisfying basic QC needs Using the Time Reports to satisfy Using the Time Reports to satisfy

advanced QC needsadvanced QC needs

We Can Maximize the Power We Can Maximize the Power of Centricity PACS Audit Dataof Centricity PACS Audit Data

Where is it?Where is it?

Both the documentation and the application Both the documentation and the application can be downloaded from GE’s can be downloaded from GE’s SupportCentral site or our Radiology siteSupportCentral site or our Radiology site

Everything we talked about today is in the Everything we talked about today is in the documentationdocumentation

You get it all as an open source app, but it You get it all as an open source app, but it can be used ‘out of the box’.can be used ‘out of the box’.

No logo’s in it, you can put in your own!No logo’s in it, you can put in your own!

Protected Healthcare InformationProtected Healthcare Information

Have proper policies and procedures set up Have proper policies and procedures set up for access to this datafor access to this data

Limit user access where you can with Limit user access where you can with specific front end formsspecific front end forms

Contact InformationContact Information

Do have a day job, there is documentationDo have a day job, there is documentation bgregg@lsuhsc.edu http://www.shreveportradiology.com/depart

ment/pacs/downloads (look at end of list) (look at end of list)

Also have a forum on the GE Also have a forum on the GE SupportCentral siteSupportCentral site

Thank you for joining this presentation today.Thank you for joining this presentation today.

Any Questions?Any Questions?