VA/DoD and VA to VA Image Sharing Class 755 Julian Werfel and Roger Coney.

VA/DoD and VA to VA Image Sharing

Class 755Julian Werfel and Roger Coney

Cumulative Images Captured 2003-2010

Image Sharing

• Provides more patient information to use in diagnosis and treatment

• Reduces number of procedures for patient by making remote data available

• Saves money by reducing procedures• Saves patient and staff time

“A picture is worth a thousand words”

VA Remote Image Views

• Clinical Display communicates across the VA WAN to retrieve images from the VistA Imaging systems at remote VA facilities

VA/DoD Image Sharing

• NDAA (National Defense Authorization Act) El Paso pilot to share radiology images and reports with DoD

• Full access to patient record• DoD provides images to VA,

viewed in Clinical Display

VA/DoD Image Sharing

• Provide VA images to DoD users• Particularly important for Polytrauma

patients• Transfer images in DICOM with JPEG

2000 compression• Thumbnail, Lossy, and Lossless

quality• Realized as the VIX service – Imaging

Patch 83

VIX for VA/DoD Image Sharing

• VistA Imaging Exchange (VIX) Service• VIX implemented as part of VISA

(VistA Imaging Service Architecture)– Encapsulates VistA Imaging behind well

defined interfaces - SOA– Standards based: JPEG2000, DICOM, XCA

• Clinical Display requests DoD images from site VIX

• DoD images available to clinicians since Patch 72 Display client

VA/DoD Sharing Field Testing

• All sites with Imaging Patch 83 can see DoD images

View DoD Radiology Images

• View DICOM Radiology images for shared patients from the 7 original DoD NDAA sites

• BHIE Image Adapter (BIA) requests DoD images from site PACSi (analogous to VIX)

• Compression and caching to boost performance

View VA Radiology Images in DoD

• Provide DICOM radiology images for shared patients• Access images from all VA sites with a VIX Server• Available to DoD facilities with a PACSi server• Images viewable from the web based Advanced

Medical Image Viewer (AMIV)

Imaging Patch 72

• DoD images integrated with VA images

Enhanced Remote Image Views

• Access remote VA images through VIX• Remote VA and DoD images now available

to VistARad in Imaging Patch 90

Enhanced RIV Benefits

• Take advantage of VIX Caching and Compression– Image is compressed at source before

transfer over WAN– Image cached at local and remote VIX

• VIX handles remote connection rather than client– Fewer connections over WAN

• Enhanced RIV seamless to user

Enhanced RIV Image Quality

Imaging Patch 93

• Updated user interface

Viewing Remote Images

• DoD accessible same as VA data

Viewing DoD Images

• Accessing images from DoD same as VA

Viewing DoD Images

Viewing DoD Images

• No special tools for DoD, same as VA

Comparing VA and DoD imagesBHIE PATIENT

Area of Clinical Interest

DoD Image

WBAMC 03/2007

VA Image

El Paso 10/2001

VistARad and the VIX

• View images and reports from DoD• View images, reports and requisition

reports from remote VA sites• Monitor exam lists from remote sites

without requiring user to login• Exams from remote sites integrated

with exams from local site

VistARad Manager

• VistARad Manager shows exams from multiple sites including the DoD

VistARad Displaying DoD Images

Monitor Remote Sites

• Monitor remote sites without logging in

Support New DoD Architecture

• HAIMS, the Healthcare Artifact and Image Management Solution, will replace the NDAA El Paso solution in the DoD enterprise

• NDAA El Paso pilot will be sustained through the transition

• No changes will be required to the VA architecture

Providing VA Images to DoD with HAIMS

• No changes will be required to the VA architecture

VA/DoD Artifact Sharing

• Share Artifacts– Non radiology images• NCAT (Neurocognitive Assessment Test)

reports from DoD• Bidirectional• Implemented with IHE profile Cross

Community Access (XCA)• Development in progress

Expanding the VIX – the CVIX

• Centralized VistA Imaging Exchange (CVIX) Service

• Enterprise gateway for image sharing• Currently deployed in AITC (Austin

Information Technology Center)• Highly Available, Load Balanced,

Clustered Deployment• Based on the VIX design

CVIX Provides

• Artifacts available to VA Users– Artifacts from HAIMS– NCAT (Neurocognitive Assessment Test)

reports

• Artifacts from VA to DoD• Radiology sharing through CVIX• Support Future Interfaces

– NHIN (National Health Information Network)

– VLER (Virtual Lifetime Electronic Record)

View DoD Artifacts and Radiology Images

• CVIX retrieves HAIMS artifact and radiology lists from the BHIE Framework for viewing by VistA Imaging client applications

• CVIX retrieves HAIMS artifact lists from the BHIE Framework for viewing by VA applications

• CVIX retrieves HAIMS and NCAT artifacts for viewing by VistA Imaging client applications – Imaging Patch 104 (June 2010 – Pending Approval)

Providing VA Artifacts and Radiology Images to DoD with CVIX

• CVIX provides VA study and artifacts lists to the BHIE Framework for consumption by HAIMS

• CVIX provides radiology images to the BHIE framework for consumption by HAIMS

• CVIX provides artifacts directly to the HAIMS gateway

Image Enabling VistaWeb

• VistA Imaging providing Advanced Web Image Viewer (AWIV) to VistaWeb for image viewing

• View images associated with Progress Notes and Radiology Reports

• VistaWeb users can view VA images within VistaWeb

• Similar to CPRS/Clinical Display interface

• VistaWeb version 12

AWIV

• Uses components from Clinical Display

• Easy access from VistaWeb• Does not show all images stored in

VistA Imaging• Will view DoD Radiology and artifacts

in future• AWIV uses Centralized VistA Imaging

Exchange (CVIX) server• Currently in field testing (June 2010)

– Imaging Patch 105

VistaWeb Viewing VA Images

• AWIV retrieves all images from CVIX• CVIX communicates with VA sites

with and without a VIX

VistaWeb Progress Notes

• New icon indicates images are associated with note

AWIV Viewing VA Note

AWIV Viewing VA Note

VistaWeb Radiology Reports

• New icon indicates images are associated with report

AWIV Viewing VA Radiology Image

VistaWeb Viewing DoD Artifacts

• Prototype of Artifact Sharing• Future Development

AWIV Viewing NCAT Report

AWIV Viewing DoD Artifacts

VA/DoD Radiology Sharing Today

• DoD radiology images available in Clinical Display and VistARad

AWIV Viewing VA Images

• AWIV can view VA images through VistaWeb – Field Testing June 2010

VA Viewing DoD Artifacts

• DoD Artifacts available in Clinical Display• HAIMS providing artifacts and radiology• Field Testing December 2010

Server Deployment Changes - 2011

• CVIX clustered and moved to Philadelphia• NDAA fully replaced by HAIMS

AWIV Viewing DoD Artifacts - 2011

• Artifacts available in VistaWeb and AWIV

Image Sharing Big Picture

• Sharing of images improves patient care

• VA users can now view Radiology Images from VA and DoD in Clinical Display and VistARad

• DoD can view VA images• VistaWeb users can view VA images

with AWIV• Artifact sharing with DoD coming

soon

VIX Makes Image Sharing Work

• VIX provides access to images for VA and DoD

• Improves performance within VA• VIX is reliable• Optimized for delivery of images as

quickly and safely as possible• VIX encapsulates functionality with

standards using VISA

Questions?

Julian WerfelJulian.werfel@va.gov(240) 638-2634

Roger ConeyRoger.coney@va.gov(240) 638-2604

VIX Development Team

• Julian Werfel (julian.werfel@va.gov)• Keith Buck (donald.buck@va.gov) • Chris Beckey (

christopher.beckey@va.gov)• Csaba Titton (csaba.titton@va.gov)• Roger Coney (roger.coney@va.gov)

Shared Modalities

• CT – Computed Tomography• CR – Computed Radiography• MR – Magnetic Resonance• US - Ultrasound• DX – Digital Radiography• RF – Radio Fluoroscopy• NM – Nuclear Medicine• XA – X-Ray Angiography• PT – Positron Emission Tomography• DS – Digital Subtraction Angiography