JiveX Integrated Imaging

The professional presentation, processing and archiving of image data in the PACS, as well as their integration into leading hospital IT systems is still frequently only undertaken for radiology data. Image data from other clinical areas, for example, cardiology, endoscopy or surgery, remain in workstation-bound subsystems. The same is true of biosignal data such as EKG or vital signs from the monitoring. Many hospitals draw the bottom line for saving the data on the basis of the file format: DICOM data is entered into the PACS, non-DICOM data is entered into the specialized systems. 

This type of approach is not only counterproductive in the sense of a consistent process organization but it also contradicts the idea of centralized data provision. As well, this strict segregation based on the file format is no longer appropriate and, from a technical point of view, is also no longer necessary. With JiveX Integrated Imaging (PACS-II), VISUS has succeeded in bridging the gap from radiology to all clinical areas within a facility. JiveX Integrated Imaging enables the integration of all imaging and, to an extent, biosignal data, into the PACS, regardless of the format. The software also converts non-DICOM data into DICOM data in the process and, as a result, facilitates a consistent, vendor-neutral management and archiving system, hospital-wide. 

Decreasing expenditure – ­increasing benefits
So, for example, video images from endoscopy, EKG data from cardiology or .jpg images from wound therapy can be integrated into the PACS. Above all, from the IT point of view, transferring all image data as well as a part of the diagnostic and biosignal data into a system has advantages: both the administration, maintenance and training expenditure as well as the number of interfaces are drastically reduced. As well, with JiveX Integrated Imaging, the information, which has been administered independently to date, can be integrated into the patient context because, just as for a purely radiology PACS, JiveX Integrated Imaging can also be integrated soundly into the HIS. As a result, all data contained in the system can be centralized and downloaded from the HIS into the patient context using a single, (German) Medical Devices Act-compliant viewer, from any workstation and at any time. JiveX Integrated Imaging also acts as a central archive for all imaging and diagnostic data arising in a hospital. The system can be implemented independently of the radiology PACS and, because of its high degree of interoperability, can be very easily incorporated into the existing IT infrastructures.

Workflow optimization by ­process standardization
By centralizing all image data into just one system, clinical processes can be simultaneously optimized in multiple ways: required information is no longer distributed across the entire hospital, laboriously having to be collected, but is available at every workstation at the touch of a button. As well, thanks to the completeness of the data, the risk of data loss or of performing unnecessary duplicate examinations is reduced, which, by implication, results in an improvement in the quality of care. The reduction to a uniform viewer for the most varied data formats also saves time. Ultimately, the user no longer has to take in the functionality and the mode of operation of different subsystems, but can process all the information in the same view, using the same shortcuts and identical functions. By means of so-called hanging protocols, that is, customized workflow profiles, each diagnostician can configure his display and processing options individually and can adapt the processes to his own requirements.

One further advantage to using a consolidated image arcade is that, during the diagnosis, the user has direct access to all the required image data, regardless of the origin or the format. When writing a medical report, for example, the relevant images can simply be transferred directly from the viewer into the report. As well, external exposures, which a patient supplies on CD or DVD, for example, or which are transferred online via DICOM communication, can be easily incorporated into the PACS. In order to avoid inconsistencies in the data transfer, JiveX matches various patient characteristics (e.g. the name or date of birth) with the data in the HIS and transfers automatically, as far as possible, the corresponding patient ID. Using the error list display, the user can also allocate patients manually, where there is a difference in spelling, for example.

Hospital-wide increase in functionality
The PACS functions for processing, archiving and viewing information in the radiology area are extremely sound and professionalized. With JiveX Integrated Imaging, these can now be transferred to all clinical areas. Thanks to the integration of , for example , ultrasound images, video images from endoscopy or surgery, .jpgs from the wound documentation or EKG traces into the PACS, entirely new options are opening up for the users of all disciplines. These include, for example, the use of the 3-D volume view from the PACS, which is also highly relevant in orthopedics and surgery, as well as the measurement tools available in the system, which are employed in wound healing. In fact, this kind of tool is also to be found in specialized systems, although there is no connection here with the overall patient context.

With JiveX Integrated Imaging, the number of existing image archives and subsystems is greatly reduced without having to go without the features and special functions of the subsystems since preparing particular findings, for example, based on support systems, can still be performed on workstations provided for this purpose. It is critical that these data end up in one and the same format (DICOM) and system and are available for everyone. For this purpose, JiveX Integrated Imaging has the appropriate conversion tools.

JiveX File Import Gateway 
JiveX provides the File Import Gateway, in order to integrate non-DICOM files into the PACS and hence into the infrastructures and workflows of the hospital. This is capable of selecting .pdf data, .jpeg data and files and findings in the file system and making these available, hospital-wide. So, for example, the wound documentation can also be administered on a patient basis in the PACS.

In the process, the transfer files are converted into the DICOM format, sent to the JiveX Communication Server via the DICOM Storage Service or allocated to an examination as a diagnostic finding. In this way, the data are permanently integrated into the diagnostic processes and are always easily locatable. The JiveX File Import Gateway can monitor a defined directory, verify all files stored there at defined time intervals, transfer and delete or relocate these on successful import. For the import of .jpeg images or .pdf objects, the allocation data such as the name and ID of the patient, the date of the examination and the accession number can be read out from a separate description file or the file name. All incoming image data can be allocated and harmonized with job numbers via the JiveX Study Verification Manager. If findings are read out from the filing system using the JiveX File Import Gateway, these can be allocated directly to an examination in the JiveX Communication Server via an accession number.

JiveX Analog Modality Gateway
The JiveX Analog Modality Gateway (AMG), functions according to a similar principle. On the one hand, this also enables the data of older modalities, for example, non-DICOM ultrasound images, to be transferred into the complete archive. 

On the other hand, the AMG also opens up the opportunity to digitalize the entire OR environment. So, the surgical video recordings or even endoscopy videos, important for the documentation, are also included in the PACS and are archived here according to case. 

JiveX PDF Printgateway
The so-called PDF Print Gateway also allows those medical devices, whose output to date has only been available on paper, to be integrated into the PACS. Instead of generating a printout, the PDF Print Gateway converts the information into DICOM and then makes it available to the PACS. So, the user will be able to file the results of a hearing test or even lung function results, for example, in the future by initiating a print job. With the aid of the in-house DICOM Worklist Broker, the printout and the job information will then be linked, so that the findings are then verified and available in the DICOM archive and can be legally long-term archived. 

JiveX ECG Gateway
JiveX Integrated Imaging also has a corresponding interface for the integration of monitoring data, for example, for rest EKGs. The data converted in this way are available hospital-wide in the standardized DICOM format. This means the PACS also functions here as a signal data storage device and reanalysis tool for patient monitoring systems.

Transferring the worklist concept
Converting clinical information into the proven DICOM format has yet a further advantage: the DICOM worklists application. This interaction between the PACS and the HIS can be transferred to all clinical processes with JiveX Integrated Imaging, to the generation of rest EKGs, for example. For this, a job is generated in the HIS, which is passed on as an HL7 Order Entry message (ORM). By using the HL7 standard, JiveX is able to create a work list for the EKG device using a DICOM Worklist Broker. In parallel to this, the job can be scheduled in the administration management system, as well in the HIS. Subsequent to the examination, the service is automatically recorded and the EKG data are transferred to JiveX as biosignals. This conversion enables the hitherto paper-bound data to be displayed digitally on a monitor and to be made available at each workstation as part of the patient file via the JiveX Integrated Imaging Viewer. Of course, on the way, the data is also entered into the archive. In the process, the patient allocation also takes place either via the patient ID or the job number. 

The archiving solutions of the JiveX Medical Archive are flexible and can be adapted to the customer’s individual requirements. The options for saving and archiving data range from online storage in a central computer center, through network storage solutions (Storage Area Network, SAN), right up to unlocked hard disk systems in the network (Network Attached Storage, NAS) or hard disk systems directly linked to the server (RAID, DAS). Of course, off-line archiving systems on DVDs, Blu-Ray disks or computer tape are also supported. However the solution is technically implemented: thanks to the archive status messages, these are always transparent for the user. Thanks to the alignment with the order communication of the leading information system, the process quality is guaranteed on all levels of image circulation.