Way back in 2009, I was attended a 1 month-long observership within Hospital Clinic as a medical student within the Department of Orthopedics and Trauma Surgery and little did I know that I would return to Hospital Clinic as a visitor a couple of years later. The typical corridors didn't change from back then but in today's visit, got a deep insight into what is happening in the background and the heavy duty information technology work within the department of Medical Imaging.
— Stefan Buttigieg (@stefanbuttigieg) November 20, 2016
Integrations and Storage Challenges
We started off the tour with an introduction on the integration and workflow of a large number of investigations within Hospital Clinic. One would think, that would only include radiological investigations, but lo and behold, we even found out how electrocardiograms (an electrophysiological measurement for the heart for the non-medics out there) are processed. 128TB worth of investigations are stored within the Hospital Clinic PACS, dating back to 2002 and they have calculated that approximately 950 examinations are done per day with 60GB worth of compressed data generated per day(uncompressed, that would amount to about 90GB). That's quite significant! The integrated medical images within PACS vary from CT Scans to Urodynamics investigations. Throughout this presentation they even had the wonderful opportunity to showcase their PACS/HIS/RIS integration through SAP and their backup systems for storing and archiving PACS data.
I love grapes and so I was delighted to find out that 'raim' in Catalan stands for grapes and guess what, their medical imaging viewer is called 'RAIM Viewer'. This system allows clinicians to observe the medical images in tandem with the clinical reports for a holistic review of the patient. The Application Icon is even designed in such a way to reflect this meaning. Quite nifty! On a serious note, RAIM also stands for 'Radiological Archive and Image Management' and it's supported by two software solutions, the RAIM Server and the RAIM Viewer, which started off in Hospital Clinic, a number of years back and has expanded to now include 40 Clients and 100 installations extending to Cantabria, SESCAM and Navarra i Arago. They even showed us their 3D viewer which allows clinicians to view 3D images from investigations such as CT Scans and Angiograms. Currently Hospital Clinic is in fact in discussions with the Catalan Government to collaborate for a central PACS on the cloud in Catalonia. This bodes well for a highly integrated and well-connected medical imaging network within the Catalan region.
Touring the Medical Imaging Department
The tour of the Medical Imaging department followed that insightful presentation and we had a good opportunity to view all the different parts of the department, including the waiting area which has an advanced ticketing system integrated with the Social Security Card with a focus on patient confidentiality where patients are called by their ticket number and not their full name. We even had an opportunity to view the MRI rooms, the rooms for interpretation of Radiological Investigations and many more rooms which are way too many to mention here.
I also appreciated the awareness for Breast Cancer on the doors of their Mammography Investigation Rooms dedicated to screening. On the way back to the Administrative area of the Medical Imaging Department, I had the opportunity to observe the inner workings of the hospital and I appreciated a number of different technologies, including a textile management system which provides clean hospital clothes to members of staff. I appreciated the fact, that Hospital Clinic has integrated technology on a number of levels. The little details count.
Following that little side-track, we were taken back to the Administrative Area where we were showcased the latest project that the Medical Imaging Department is working on within the region of Catalonia, and that is, a Clinical Decision Support System for ordering of radiological investigations. In this particular moment, I had the wonderful opportunity to get to know about 'ESR iGuide', which is the Clinical Decision Support System for European Imaging referral guidelines developed by the European Society of Radiology in cooperation with the American College of Radiology. The main focus, in this particular session was to understand that the patient deserves the very best and safest choice which are evidence-based and thus at the same time encourage appropriate resource usage of precious healthcare resources.
Piloting Radiology Decision Support
The pilot project is available for viewing on http://acr.critic.cat . It's in Catalan, but you will still be able to get a good gist of what it's all about and how it works. The interface is user-friendly and in the final implementation, it will be deeply integrated with the Order Communication System to facilitate ordering especially by primary care physicians.
— Stefan Buttigieg (@stefanbuttigieg) November 20, 2016
There a number of pilot projects like this throughout Europe and the main focus is that all EU Member States need to comply by the "Directive 2013/59/Euratom - protection against ionising radiation" and transpose this into their legislation by 2018, relating to Article 55 from the directive:
any medical radiological procedure on an asymptomatic individual, to be performed for the early detection of disease, is part of a health screening programme, or requires specific documented justification for that individual by the practitioner, in consultation with the referrer, following guidelines from relevant medical scientific societies and the competent authority. Special attention shall be given to the provision of information to the individual subject to medical exposure, as required by point (d) of Article 57(1).
The intertwining of the legislative and technological aspects, were showcased in the final part of this hospital tour and one could clearly observe one of the positive aspects of implementing this kind of legislation. On a concluding note, the wonderful trip to Hospital Clinic ended shortly after this interesting showcase and we all made our way to lunch with ponderings on the future of medical imaging, the challenges and an important reminder how we should not forget to put the patient at the center of care to provide value based healthcare.