MILLENSYS

1. MILLENSYS Tele-Radiology Solution

2. Main Topics • Introduction • Workflow/ Components • Communication / Optimization • Millensys Teleradiology Features • Failure and restore scenario • Similar Project (Eastern Cape, South Africa) • Q&A

3. Tele-Radiology, Definition What is Tele-Radiology Teleradiology of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of interpretation and/or consultation Why is Tele-Radiology Needed • Radiologists are increasingly a scarce resource, given that imaging procedures are growing by ~15% annually against an increase of only ~2% in the Radiologist population • Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient. • Teleradiology improves patient care by allowing Hospitals to outsource subspecialty expertise needed but not found except in big cities. • The virtual radiology network (VRN) is a modern service for radiology groups that collects digital imaging studies from multiple, geographically-dispersed locations and delivers them securely, reliably and efficiently to physicians over the Web.

4. Teleradiology Workflow / Components

5. Tele-Radiology, Workflow Hospital 1 Hospital N Hospital 2 Hospital 3 Verified reports to be sent BACK to Acquisition server Verified reports to be sent BACK to Acquisition server Images sent to main server using priority queuing Images to be sent to Millensys MINI PACS at other branches Image are be sent to service provider PACS Service Provider 1 Service Provider N Image are available ON Web Verified reports to be sent to datacenter server Verified reports are sent to datacenter server Statical Info. are sent to management

6. Tele-Radiology, Proposed Solution

7. Tele-Radiology, One Solution One Solution , MILLENSYS Web-based Teleradiology Internet And Intranet Search Worklist Process and Diagnose Report with Dictation High Availability Archive Work Online/ Offline Web-based Administrator Use Multiple Compression

8. Tele-Radiology, Solution Components Reporting Workstations Web Viewing Data Center Web-PACS Radiology Scheduling Mobile Viewing Data Center Hospital Service Provider Store/forward MiniPACS Service Provider PACS (Optional) Billing and Monitoring Administration

9. Tele-Radiology, Data Center Billing and Monitoring Administration

10. Tele-Radiology, Emergency Cases Dealing with Emergency Cases: The Technician identifies the case as an Emergency The Case is sent to the PACS Server with High Priority Emergency case is sent to the Data Center before any Normal Case Emergency case is sent to the Service Provider to be reported The case is reported and sent back to the data center Study Identification N : Normal Study (No report needed) R : To be Reported E : Emergency etc. The report is sent back to the Hospital

11. Teleradiology Communication / Optimization

12. Tele-Radiology, Communications SDSL 24 Mbps (1:1) ADSL 24 Mbps (1:4) 54 Mbps 2Mbps - 14.4 Mbps Stationary 348 kbps Moving 56 kbps

13. Tele-Radiology, CT and CR Transmission *The previous examinations depend on the size of each case and the type of connectivity available for each site. Load balancing Should be an issue for multi-site/multi-modality transmission

14. Tele-Radiology, Mammography Transmission *The previous examinations depend on the size of each case and the type of connectivity available for each site. • Load balancing Should be an issue for multi-site/multi-modality transmission • Using Digital Mammography, the image sizes will be much higher (x6) and we need either to increase the link speed to able to reach the same studies.

15. Tele-Radiology, Optimization and Compression Hardware Compression Compression of WAN traffic using WAN Routers with Layer 2 payload compression or Layer 3 TCP/IP header compression using Cisco Internetwork Operating System (Cisco IOS) Software Compression • Compression Methods • Lossless JPEG (1:2) • Lossless JPEG 2000 (1:4) • Lossy JPEG (1:9 ~ 1:70) Streamed Communication • Using traffic dispersion to increase the download speed and the utilization of the link bandwidth • Using rule-based auto-routing techniques to insure the delivery of studies between servers.

16. Teleradiology Millensys Features

17. Tele-Radiology, Technology • Pure Web-Based Technology • Same GUI for all users • Depending on Active Server Pages “ASP” Model. • Streaming with Dispersion over low band width lines. • Multiple compression methods for studies • Simple-Fast Search Results. • Resume downloading of studies when connection failure. • No need for special communication ports. • Embedded reporting tool with dictation and speech option. • Fast client Setup. • Automatic client update. • Supports of multi-branch hospitals • Built for the enterprise

18. Tele-Radiology, Archive Millensys PACS “MiPACS” • Priority queuing for emergency studies • Secure over the Internet and HIPAA compliant • Auto-routing between acquisition and reporting facilities • Multiple compression methods (JPEG, JPEG2000) • Handles transmission of studies and reports. • Short term archive in hospitals • Long Term archive in Data Center • Clustered Solution to get 99.9% uptime • Monitors the Round-trip time for studies • Assure the delivery of studies when link failure • Resume transmission automatically when link is up

19. Tele-Radiology, Web Distribution Vision Tools WebView Viewing • Run on any Web Browser • Streaming technology In viewing and download. • User defined image compression for rapid download • Customized worklist with user profile • Visual Hanging Protocols • Rapid operations for large studies • Display static and dynamic studies • Oblique, Bi-Oblique and Curved MPR/MIP • Slice Locator / Pilot Image for CT/MRI • Printing on DICOM and A4 Printers • Multiple Measurements • Image Processing and Annotations • 3D Reconstruction and Fly-Through Option

20. Tele-Radiology, Web Reporting Dictation Transcription Vision Tools WebView Reporting • Web Reporting • Template Reporting • Compatible with Microsoft Word • Voice Dictation and Transcription • Speech Recognition (Option) • Send Reports back to Hospitals

21. Tele-Radiology, Web Administration MiAdminweb based administrator • Web administration • Single administration for PACS/RIS • Manage user profiles • Manage user rights • View Audit logs • Manage Multi-Branches

22. Tele-Radiology, Administration Study Status Report • Report on the type of studies transmitted • Report is user selectable • Report is generated from the web

23. Tele-Radiology, Administration Round Trip Report • Monitor the round-trip time for studies from the time the study is acquired till the final report is sent back to the hospital

24. Tele-Radiology, Administration Billing Report • Generate multiple bills on the reported studies.

25. Tele-Radiology, Major Features Compression Compression on the web JPEG Lossy/Lossless, JPEG 2000 User Selectable compression before download Transmission CR study (Lossless) delivered in less than a minute over a 1Mbps ADSLUpload Priority queuing , Emergency Studies have highest priority in transmission Reports are sent back in Text and dictated voice formats Facilities View Images and Report on Multi-Monitor Configuration Roaming Profile for radiologists Works with Any PACS solution, MILLENSYS or Third Party Multi-Level Security

26. Tele-Radiology, Security Administration & Management: • HIPAA Compliance • Web Based Administration at Data Center • Log Files to monitor system operations and users • Clustered Solution in Data Center to guarantee 99.9% uptime operation • SAN Storage is a non single point of failure device with RAID 5 storage • Store and forward for images from Hospitals to Data Center enable continuous operation in case of link failure. • Cases resume transmission when link is up automatically.

27. Any Questions ?