Biomedical subjects

J Romlein

Publications and source records attributed to J Romlein.

10 recordsLinked to original sources

PubMed2000

New facility picture archiving and communication system implementation strategy.

Strategies for deployment of picture archiving and communications systems (PACS) in new hospitals often involve the establishment of initial PACS operations. Such a strategy is flawed in the sense that the clinical and radiological users must adapt to PACS operations, while being faced with several other new facility learning curves. This increases the complexity and risk of the radiological services. A strategy of implementing PACS operations in the old facility and performing a zero-downtime transition into the new facility offers several advantages to this method. The successful undertaking of such a project will support not only the physical movement of the existing PACS, but the accomplishment of other re-engineering goals associated with the new hospital. This report will describe the strategy used in two successful transitions of PACS into newly constructed hospitals.

Hospital Design and Construction↗

PubMed2000

Security model for picture archiving and communication systems.

The modern information revolution has facilitated a metamorphosis of health care delivery wrought with the challenges of securing patient sensitive data. To accommodate this reality, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). While final guidance has not fully been resolved at this time, it is up to the health care community to develop and implement comprehensive security strategies founded on procedural, hardware and software solutions in preparation for future controls. The Virtual Radiology Environment (VRE) Project, a landmark US Army picture archiving and communications system (PACS) implemented across 10 geographically dispersed medical facilities, has addressed that challenge by planning for the secure transmission of medical images and reports over their local (LAN) and wide area network (WAN) infrastructure. Their model, which is transferable to general PACS implementations, encompasses a strategy of application risk and dataflow identification, data auditing, security policy definition, and procedural controls. When combined with hardware and software solutions that are both non-performance limiting and scalable, the comprehensive approach will not only sufficiently address the current security requirements, but also accommodate the natural evolution of the enterprise security model.

Computer Communication Networks↗

PubMed2000

Picture archiving and communication systems project management using web-based tools.

As the technology of picture archiving and communications systems (PACS) improves and implementation becomes more widespread, the project management of deploying substantially large, multiple-facility systems becomes an integral part of success. A successful deployment requires project support from the initial planning and surveying to the final acceptance, even encompassing support during active use of the PACS. The sharing of information between project stakeholders of a PACS implementation can be daunting at times, but with the flexibility of the worldwide web, this aspect can be eased. This report speaks to the tools and usability of the worldwide web to disseminate project management information for planning, implementation, and support of any PACS implementation--anywhere. This sharing of knowledge prepares the end user for what will be available for them when the complete systems is in place, allowing for a smoother migration to PACS.

Humans↗

PubMed2000

Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.

Cost-Benefit Analysis↗

PubMed1999

Clinical services assessment and reengineering: lessons learned.

Healthcare enterprises often "acquire and install" picture archiving and communications systems (PACS) without examining many of the care delivery processes and information flows that will be affected. Many times these unexamined factors can delay or be the cause of failure of the PACS project. This article presents issues that were worked through as part of a PACS clinical services assessment and reengineering analysis for several US military medical treatment facilities.

Alaska↗

PubMed1999

The philosophy of benchmark testing a standards-based picture archiving and communications system.

The Department of Defense issued its requirements for a Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS) in a Request for Proposals (RFP) to industry in January 1997, with subsequent contracts being awarded in November 1997 to the Agfa Division of Bayer and IBM Global Government Industry. The Government's technical evaluation process consisted of evaluating a written technical proposal as well as conducting a benchmark test of each proposed system at the vendor's test facility. The purpose of benchmark testing was to evaluate the performance of the fully integrated system in a simulated operational environment. The benchmark test procedures and test equipment were developed through a joint effort between the Government, academic institutions, and private consultants. Herein the authors discuss the resources required and the methods used to benchmark test a standards-based PACS.

Benchmarking↗

PubMed1999

Benchmark testing the Digital Imaging Network-Picture Archiving and Communications System proposal of the Department of Defense.

The Department of Defense issued a Request for Proposal (RFP) for its next generation Picture Archiving and Communications System in January of 1997. The RFP was titled Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS). Benchmark testing of the proposed vendors' systems occurred during the summer of 1997. This article highlights the methods for test material and test system organization, the major areas tested, and conduct of actual testing. Department of Defense and contract personnel wrote test procedures for benchmark testing based on the important features of the DIN-PACS Request for Proposal. Identical testing was performed with each vendor's system. The Digital Imaging and Communications in Medicine (DICOM) standard images used for the Benchmark Testing included all modalities. The images were verified as being DICOM standard compliant by the Mallinckrodt Institute of Radiology, Electronic Radiology Laboratory. The Johns Hopkins University Applied Physics Laboratory prepared the Unix-based server for the DICOM images and operated it during testing. The server was loaded with the images and shipped to each vendor's facility for on-site testing. The Defense Supply Center, Philadelphia (DSCP), the Department of Defense agency managing the DIN-PACS contract, provided representatives at each vendor site to ensure all tests were performed equitably and without bias. Each vendor's system was evaluated in the following nine major areas: DICOM Compliance; System Storage and Archive of Images; Network Performance; Workstation Performance; Radiology Information System Performance; Composite Health Care System/Health Level 7 communications standard Interface Performance; Teleradiology Performance; Quality Control; and Failover Functionality. These major sections were subdivided into workable test procedures and were then scored. A combined score for each section was compiled from this data. The names of the involved vendors and the scoring for each is contract sensitive and therefore can not be discussed. All of the vendors that underwent the benchmark testing did well. There was no one vendor that was markedly superior or inferior. There was a typical bell shaped curve of abilities. Each vendor had their own strong points and weaknesses. A standardized benchmark protocol and testing system for PACS architectures would be of great value to all agencies planning to purchase a PACS. This added information would assure the purchased system meets the needed functional requirements as outlined by the purchasers PACS Request for Proposal.

Benchmarking↗

PubMed1997

Highlights of the Digital Imaging Network-Picture Archiving and Communications System Project.

The Department of Defense issued its requirements for a Digital imaging Network-Picture Archiving and Communications System (DIN-PACS) in a Request for Proposals to industry in January, 1997. The DIN-PACS shall be an open systems network of digital devices designed for the effective acquisition, transmission, display and management of diagnostic imaging studies. This network is primarily based on two international standards, Digital imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7). The DIN-PACS is required to communicate in a bidirectional manner with the Department of Defense standard hospital information system called the Composite Health Care System (CHCS) through an HL7 compliant interface. The DIN-PACS model and its published specifications stress functionality and performance rather than system architecture to allow industry to propose optimal approaches for implementation. This paper discusses the functional requirements of the DIN-PACS in terms of its internal operations as well as its communication with external systems and components. This is a US government work. There are no restrictions on its use.

Diagnostic Imaging↗

PubMed1995

Evaluation of the medical diagnostic imaging support system based on 2 years of clinical experience.

The Medical Diagnostic Imaging Support (MDIS) system at Madigan Army Medical Center (MAMC) has been operational in a phased approach since March 1992. Since then, nearly all image acquisition has been digital with progressively increasing primary softcopy diagnosis used. More than 375,000 computed radiography (CR) images as well as other modality images have been archived. Considerable experience in installation and implementation phasing has been gained. The location and ergonomic aspects of equipment placement were refined with time. The original clinical scenario was insufficiently detailed and additions were made to facilitate smoother and more complete transition toward a filmless environment. The MDIS system effectiveness and performance have been good in terms of operational workload throughout, background operations, and reliability. The important areas regarding reliability are image acquisition, output, display, database operations, storage, and the local area network. Fail-safe strategies have been continually improved to maintain continuous clinical image availability during the times when the MDIS system or components malfunction. Many invaluable lessons have been learned for effective quality assurance in a hospital-wide picture archiving and communication system. These issues include training, operational quality control, practical aspects of CR image quality, and increased timeliness in the generation and distribution of radiographic reports. Clinical acceptability has been a continuous process as each phase has been implemented. Clinical physicians quickly used the workstations soon after the start of MDIS at MAMC. The major advantage for clinicians has been the amount of time saved when retrieving multimodality images for review. On the other hand, the radiologists have been slower in their acceptance of the workstation for routine use.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗

PubMed1990

System for mechanical measurements during cardiopulmonary resuscitation in humans.

Effective study of CPR requires measurement of the mechanical properties of the human chest and the resultant vascular pressures. A computer-based mobile data acquisition system was designed and built for this purpose. During manual CPR a short cylindrical module was placed between the rescuer's hands and the patient's chest. This module, which was attached to an easily manipulated position-sensing arm, measured force and acceleration at the sternum. Three-dimensional position and orientation of the module were measured, as well as the component of the applied force which was perpendicular to the sternum. The central venous and aortic pressures were measured by high fidelity pressure transducers. All transducer signals were recorded by digital computer. Real-time feedback of sternal force and displacement, and vascular pressures was provided to the rescue team via chart recordings. An audible signal was produced as an aid in maintaining desired compression rate and duration. The system's mobility permitted rapid implementation at any hospital location. In conclusion, this system was capable of measuring, recording, and displaying multiple physical quantities during manual CPR in humans.

Biomechanical Phenomena↗