1. society
2. welfare
3. healthcare

SPECIAL REPORT
March 2015
HEALTH
MANAGEMENT
SPECIAL REPORT
Taking control of
health management
In all parts of the world, new communication
technologies – whether the internet,
smartphone or cloud, to name only a
few – are letting us take greater control
in our lives and our work. And healthcare
is no exception. With value-based care
replacing volume-based care, integration
is key. Convenient, comprehensive and
unified access to information from every
source is increasingly necessary, to allow
healthcare to evolve into a true collaboration
between all stakeholders, including doctors,
hospitals and regions, with the engaged and
empowered patient in the center.
But this will only succeed if tools are put in place that remove barriers
between stakeholders and that allow them to focus on cost, quality and
patient care.
Agfa HealthCare has proven and innovative solutions that answer the
needs of enterprises and users, built upon our long-term experience in
healthcare and our in-depth understanding of the clinical environment.
We have developed systems leveraging the cloud, mobile usage,
interoperability, big data and advanced analytics. Known for offering both
tightly integrated and vendor-neutral solutions, we use standard-based
designs to provide the interoperability that health management needs.
So you can make the most of your Agfa HealthCare investments.
In this Special Report, you can explore the issues faced by healthcare
organizations around the world and discover how Agfa HealthCare
is supporting them to succeed – and to take control of their
health management.
Katarina van der Hoeven
Marketing Communications Manager
March 2015
3
IN PROFILE: LUC THIJS
Health Management: bold vision, step-by-step
implementation, in collaboration
6
ZERO-PAPER SAFETY NET FOR
INFORMATION ACCESS
Hospitals CH de Saint-Lô and CH de Coutances,
France, speed up and secure access to information
10 IN PROFILE: PROF. WINFRIED A. WILLINEK
Not even a Ferrari will get you to your
destination without a driver
14 AGFA HEALTHCARE AND M’BOI MIRIM
STRENGTHEN COLLABORATION TO ADVANCE
TOWARDS A FULLY DIGITIZED FUTURE
Implementation of HIS/CIS allows
São Paulo hospital to enhance patient care,
staff efficiency and management control
18 IN PROFILE: JOOST FELIX AND JÖRG SCHWARZ
EHR Portal: The gateway to integrated care
22 NEW APPROACHES TO COMMUNICATION
WITH REFERRING PHYSICIANS AND
COOPERATION PARTNERS
At the Hufeland Klinikum Bad Langensalza,
Germany, information is shared quickly and
securely, thanks to the ORBIS portal solution
26 MARKET INTELLIGENCE FOR ENTERPRISE
IMAGE MANAGEMENT SOLUTIONS
Key findings of a study on Enterprise Image
Management performed by HIMSS Europe
27 IMAGES – THE MISSING ELEMENT
IN TODAY’S EHR
Dr. Cheryl Petersilge of MyPractice Imaging at
the Cleveland Clinic, Ohio, talks about why adding
images into its EHR solution was so important
30 A LONGTERM IT STRATEGY SUPPORTS QUALITY
INFORMATION AND QUALITY CARE
IT solutions come together to help the
Jacques Lacarin hospital in Vichy, France,
meet its development program and
regulatory requirements
34 IN PROFILE: BRAD GENEREAUX
XERO Viewer – Bridging the imaging gap for
the electronic health record
36 ORBIS PLATFORM OFFERS LONG-TERM BENEFITS
The Agfa HealthCare editorial team would like to thank all those who contributed to this publication.
Agfa, the Agfa rhombus, HYDMEDIA, IMPAX, ORBIS and XERO are trademarks of Agfa-Gevaert N.V.,
Belgium, or its affiliates. All other trademarks are held by their respective owners and are used for
editorial purposes with no intention of infringement. All information contained herein is intended
for guidance purposes only. Characteristics of the products and services can be changed at any
time without notice. Agfa HealthCare strives to ensure all information is accurate but shall not be
responsible for typographical errors.
2 SPECIAL REPORT HEALTH MANAGEMENT
ORBIS upgrade brings new functionalities for
meeting ambitious goals of H. Hartziekenhuis Mol, Belgium
40 STEP-BY-STEP DIGITIZATION LEADS TOWARDS
THE ULTIMATE GOAL: THE EMR
Evangelisches Krankenhaus Mettmann
adopts an integrated comprehensive solution
from Agfa HealthCare
Health management:
bold vision, step-by-step
implementation, in collaboration
Few companies can survive 100 years, and yet Agfa HealthCare today is thriving, offering
dynamic and top-of-the-line medical imaging and IT solutions that continue to evolve.
How has it done this? Because it is not the same company it was a century ago.
It has kept itself relevant by deeply understanding the context and needs of its customers,
then using its experience and knowledge to guide them on their own steps to the future.
100 years ago, ‘health management’ could not have meant what it means today.
Luc Thijs, President of Agfa HealthCare, explains to us how the company’s vision has
progressed in sync with the evolving reality of healthcare, while always staying true
to its mission: making its customers successful.
In profile
LUC THIJS
President of Agfa HealthCare
SPECIAL REPORT HEALTH MANAGEMENT 3
Without a paradigm shift
in the way care is provided,
the cost of our healthcare
delivery systems will soon
be unsustainable.
LUC THIJS
President of Agfa HealthCare
Why is health management moving
in a new direction?
In the last decades, healthcare
expenditures have risen consistently
and sharply in all OECD countries,
outperforming the rate of inflation
and absorbing a growing part of GDP.
At the same time, a generation of baby
boomers is about to retire and chronic
disease is projected to further grow
as a consequence of aging.
Without a paradigm shift in the
way care is provided, the cost of our
healthcare delivery systems will soon
be unsustainable.
What role will outcome-based
reimbursement and integrated
care play?
There is a growing consensus that
current volume-based payment models,
as well as the lack of co-ordination of
care, are two important root causes
to be addressed.
Volume-based reimbursement
(fee‑for-service) is being blamed
for incentivizing over-consumption
and for encouraging the build-up of
over‑capacity. New outcome-based
4 SPECIAL REPORT HEALTH MANAGEMENT
payment models focus on obtaining
efficiency within a fixed payment (or
envelope). Moreover, preventable
adverse events, such as hospital-acquired
infections and medication-related
errors, as well as excessive readmissions,
are being penalized, contributing to
patient safety.
Fee-for-service payment models did not
intrinsically motivate care providers
to collaborate. In fact, no single care
provider was reimbursed to align primary
care, acute care, subsequent recovery
and community care.
For the new outcome-based models to
be really successful, providers need to
actively co-ordinate care with other
stakeholders in the process. Medical
information needs to be transparently
shared and patients need to be seriously
engaged in managing their own health.
The dominant focus on acute care inside
the premises of the hospital diminishes,
prevention becomes important and
the social and behavorial reality of the
patient comes into play.
‘Connected’ or ‘integrated’ care becomes
essential.
How does Agfa HealthCare contribute?
20 years ago, service departments and
clinical specialties were focusing on
their part of the patient care equation:
each independent, each with their own
investments and processes. Yes, there
was quite a bit of inefficiency, due,
among other causes, to the paper-based
workflows, but there weren’t really any
other options.
While digitalization started out
departmentally and dramatically
improved productivity in radiology, in the
laboratory and in administration, hospitals
gradually moved away from investing in
departmental systems towards investing
in enterprise systems. EMRs today provide
an overarching view of clinical and
administrative processes in the hospital.
While Agfa HealthCare continues to
enrich its own ORBIS* EMR with the
most advanced clinical functionality, we
decided to also invest in three other areas:
Although imaging is prolific and more
imaging data is being created today across
the care continuum than ever before,
EMR systems generally have not been
very good at capturing all types of images
that are relevant to the care process.
For every radiology or cardiology image
that finds its way to the patient record,
an equal number of images from other
disciplines (GI, OB/GYN, pneumology,
dermatology, ophthalmology, etc.) do
not. Together with key customers, we
have developed an Enterprise Imaging
platform that truly image-enables
the EMR. At the level of the different
departments generating images, we have
built efficient workflows that allow for
swift integration of the relevant images
with the proper patient record in the EMR.
We have completed the patient’s visual
info graphic and made it available to all
physicians and care providers.
For the new outcome-based
models to be really successful,
providers need to actively co‑ordinate
care with other stakeholders in
the process.
LUC THIJS
President of Agfa HealthCare
Responding to the needs of hospitals to
better engage with their patients, their
referring physicians and other stakeholders
in the care process (GPs, visiting nurses,
physiotherapists, social care workers,
etc.), we have recently been developing
an EHR portal. Based on its underlying
information exchange architecture,
it extracts relevant information from
different sub-systems (EMR, LIS, PACS,
ECM and more) and aggregates it at
a higher level for presentation in a
user‑friendly way. While it now focuses
on sharing patient-centric information,
the EHR portal is also meant to support
activity-driven workflows in an integrated
care concept.
Last but not least, we are investing in
Clinical, Operational and Financial
analytics, so as to be able to provide
our customers with actionable
insights. Whether at the level of a
clinical department, a hospital or an
integrated care network, contextaware information, often extracted
from different subsystems and residing
in different formats, will always be of
critical value for decision making.
So what’s next?
While potentially disruptive, true
integrated care opens the door for new
models that manage health for large-scale
populations in a radically different way.
We are determined to collaborate
with our customers in addressing that
challenge, gaining experience from
common initiatives, creating new IT
solutions on that basis and solving the
problems our customers have today and
foresee tomorrow.
That’s how we can ultimately contribute
to their success. W
* ORBIS is not available in Canada or the U.S.
SPECIAL REPORT HEALTH MANAGEMENT 5
Centre Hospitalier Mémorial France États-Unis (CH de Saint-Lô) – Centre Hospitalier de Coutances – France
Zero-paper safety net
for information access
Hospitals CH de Saint-Lô and CH de Coutances speed up and secure access to
information by dematerializing all patient files and “fossilizing” paper archives.
INTERVIEW WITH F. BREUILLE, Director of Information Systems for CH de Saint-Lô and CH de Coutances – M. VOISIN, Deputy Director of
CH de Coutances – DR. P. BALOUET, Doctor – S. ALLAIN, Archive manager – R. BERNASCONI, Computer engineer – N. BISSON, Health executive
As part of the TACTILIS project to implement a single global and shared electronic medical record, begun in 2011 and built around the
ORBIS solution, the hospitals CH de Saint-Lô and CH de Coutances have carried out an innovative digitization program of their paper
archives, successfully achieving their goal of making access to information smooth and fluid.
From left to right:
Dr. Pierre Balouet,
Francis Breuille
and Marc Voisin
HYDMEDIA is to ORBIS what Google is to the
internet, providing fast access to a high-performance
search tool.
DR. PIERRE BALOUET MD
Doctor, Director of the TACTILIS project
6 SPECIAL REPORT HEALTH MANAGEMENT
Located close to one another, in the
French department of la Manche,
since the end of 2011 the two hospitals
Centre Hospitalier Mémorial France
États-Unis de Saint-Lô (CH de Saint-Lô)
and Centre Hospitalier de Coutances
(CH de Coutances) have together
formed a Regional Hospital Network,
with a shared strategy based on pooled
resources and a common medical
project. Their ambitious and innovative
project to enhance the performance and
quality of patient care was introduced by
director Thierry Lugbull. As part of this
strategy, the information in the patient
files, sourced from the hospitals’ ORBIS*
solution, has contributed to the TACTILIS
project, which aims not only to bring the
information close to the patients using
touchscreen terminals attached to their
bed trays, but also to carry out a vast
digitization of the paper archives. With
the HYDMEDIA** archive solution, the
hospital network launched, in parallel to
the TACTILIS project, a massive operation
that will support it in evolving towards
becoming a zero-paper organization,
within the context of a global move
towards optimization and security along
the course of care.
“Modernizing the regional network
of Saint-Lô and Coutances required
modernizing its information system,”
explains Francis Breuille, Director of
Information Systems for CH de Saint-Lô
and CH de Coutances. “Led by our
director Thierry Lugbull, who took up
his functions in 2008, this program was
launched soon after his arrival, with the
priority of computerizing the patient
record.” After an audit in 2009 the
blueprint was created in 2010, and the
project began in 2011 with the global
implementation of ORBIS, which was
selected thanks to its unique ‘agility’.
This was a fundamental criterion, as the
objective of the project was to achieve
a single, global and shared patient
record for the two hospitals and all of
the specialties. The project was both
ambitious – as it was to be implemented
in only 4 years – and innovative.
“Two options we selected stand out:
touchscreens, which enhance the users’
acceptance and adoption, and ‘zero
paper’, which avoids the continuation
of a paper file in parallel to the EMR,”
continues Francis Breuille. “With the
extension of the ORBIS project, the
patients’ terminals, installed at their
bedsides, serve a triple purpose: firstly,
entertainment, with Video on Demand,
internet and even audio books.
With the mass digitization
workshop, the volume of files returned
to the archives every day has dropped
from 250 before the implementation
of HYDMEDIA to 150.
SANDRA ALLAIN
Archive manager for CH de Saint-Lô and CH de Coutances
Secondly, informative, with both
contextualized and medical information,
because the medical staff can check
or enter data in the patient record via
the terminal. Thirdly, as ‘front-line’
communication between the medical
team and the patient.”
Integrating archiving from the
beginning of the EMR project
When the ORBIS EMR was selected in
2011, the HYDMEDIA archiving solution
was also chosen. The digitization of the
patient file is a global, multi-facetted
project, and evolving towards zero
paper is a key success factor. “Since
the beginning, we asked ourselves how
best to handle the digitization of the
paper archives, because all of the files –
whether old or new – must be in the same
format. We can’t have a ‘double-archive’
of both paper and digital documents,”
highlights Dr. Pierre Balouet, Director
of the TACTILIS project. “What’s more,
inputting information twice creates
double work and increases the risk of
error, which can cause serious problems
of divergence in information. With
well-structured files, information only
needs to be entered once.” At the same
time, reducing the physical access to
the paper archives that remain stocked
in the basement of Saint-Lô provides
a considerable time saving. This
“fossilization” of the physical archives
is the key principle of the project:
SPECIAL REPORT HEALTH MANAGEMENT 7
HYDMEDIA
150 files
are sent back down
to the archives every day now,
versus 250 before 2012.
4 seconds
are needed to access
information.
90%
of the hospital practitioners
acknowledge a time savings and an
ergonomic access to information.
3 minutes
are needed to fill in
the documents for
a newborn baby,
versus 25 in the past.
WBrings together the patient information in
the form of multimedia content.
WAccelerates the availability of information
via the search tool.
WEnhances the security of information.
WProvides data recovery in case of disaster.
WReduces the cost of consumables.
ORBIS
WSharing of data from patient records
and administrative data.
WEnhanced cooperation between
care professionals.
WReduced risk of error due to control
and validation features.
WMigration towards paperless hospital.
Archiving is a fundamental axis, the red thread and a
key condition for the successful deployment of an EMR.
With HYDMEDIA, we will achieve zero paper.
FRANCIS BREUILLE
Director of Information Systems for CH de Saint-Lô and CH de Coutances
the clearly identified goal is that paper
archives no longer go upstairs, even if the
physical archive is preserved. New files
are digitized from the start. This way
of working lightens the workload of
the administrative staff, but also of
the doctors who can immediately
find the information they need with
only a few clicks, wherever it may be.
Moreover, the patient records must
remain accessible and HYDMEDIA
provides the necessary backup
capability. “This is why the archive,
an integral part of the EMR project,
is a fundamental axis, the red thread.
And why we have carried out this project
in parallel with the implementation
of the EMR project,” summarizes
Francis Breuille.
Meticulous preparation
Marc Voisin, Deputy Director of CH
de Coutances, and responsible for the
ORBIS digitization project, carried out
the dematerialization for the hospital
network. “As I had experience working
on an archive digitization project for
the AP-HP hospitals in Paris, I was
given this responsibility. It was quickly
obvious that it would not be possible to
8 SPECIAL REPORT HEALTH MANAGEMENT
digitize everything, i.e. all 4 linear km
of archives (300 meters per year): too
much information kills the information!
With the internal project team, the OPER
group, which includes operational staff,
a set of specifications was established
with the preferences.”
The start of operations began with
a ‘housecleaning’ phase, carried out
by the archive unit, during which 33
tons of documents were destroyed,
which made it possible to gain a clear
overview of the situation and avoid
duplication. The items that needed to
be digitized for the 300,000 active files
were identified and indexed using a
barcode system. A strict naming system
was put in place. “Two processes were
defined,” explains Marc Voisin. “Mass
digitization for the archives and ongoing
documentation, which is entered by the
administrative staff into the EMR when a
patient arrives with documents.” A mass
digitization workshop was set up in the
archives of each hospital. The technical
equipment (6 scanners at Saint-Lô and
4 at Coutances), tested and validated
by the staff, was used by dedicated
teams of 13 archive assistants at CH de
Saint-Lô and 7 at Coutances. On each
site, the work was carried out under the
supervision of an archivist (1.5 FTE at
Saint-Lô and 0.5 FTE at Coutances) who
verified the digitization and indexed each
file in HYDMEDIA. “It was a painstaking
work with heavy responsibilities for these
teams which have a real medical record
culture,” adds Francis Breuille.
HYDMEDIA: a safety net for
information access
Before 2012, 250 files were sent back
down to the archives every day at
Saint-Lô; that number has now dropped
to 150. Buildup has been progressive,
with the digitizing of about 200 files per
day on average, with the objective of
reducing the digitization workload to the
bare minimum in 2015.
“We had some initial difficulties in terms
of access time in consultation mode, but
this was resolved when we moved the
module to full web. Today, accessing
information takes four seconds,”
comments Romain Bernasconi, computer
* ORBIS is not available in Canada or the U.S.
** HYDMEDIA is not available in the U.S.
Agfa HealthCare’s
contribution
Agfa HealthCare worked in close collaboration
with the CH de Saint-Lô and CH de Coutances
to develop ways to adapt its solutions to the
hospitals’ specifications. Agfa HealthCare
also trained the hospital’s project team in the
applications implemented and transferred the
knowledge so that the project team could
conduct future trainings on-site and create a
help cell for the users.
engineer in charge of processes and IT
tools. “It also required compromises
in the number of documents included
in a file, because too many files
complicated access.”
HYDMEDIA can also be used in the
event of degraded operation of the
main application: fed by ORBIS in daily
production, it contains a copy of the
documents and becomes the principle
source in case of technical problems
or a planned shutdown of ORBIS.
“The weakness of paper as a storage
medium is not always recognized,” adds
Francis Breuille. “While the loss of a paper
file is accepted, the level of demand rises
with an IT solution and the inability to
access information is less tolerated. With
HYDMEDIA, we have a safety net to ensure
access to the patient’s information.”
Time savings and reduced risk
of errors
The EMR created around ORBIS/
HYDMEDIA has been a clear success for
the hospital network and its staff: 90% of
the hospital practitioners acknowledge
“a time savings and a truly ergonomic
access to information.” Dr. Pierre Balouet
adds, “Before, in the maternity unit, a
midwife would have to write the name of
a newborn baby 16 times in 16 different
documents, and spend 25 minutes filling
in the documents. Today, 3 minutes is
enough: that’s time saved and the risk of
errors reduced.” In terms of the archiving
and mass digitization with HYDMEDIA,
the processes are mature and efficient.
The return on investment is clear: time
savings for nurses, limitation of exam
duplication, improvement of productivity
for the administrative staff, control of
paper consumption and rationalization
of the printing systems are a few of the
examples which lead to a better resource
management for the two hospitals.
The fossilization is ongoing, and the
solution is both playing its primary role
and fulfilling its complementary backup
mission. “HYDMEDIA is to ORBIS what
Google is to the internet,” concludes
Dr. Balouet. W
SPECIAL REPORT HEALTH MANAGEMENT 9
I think we will
see treatments with
biologicals becoming
more established within
the next five years –
in combination with new
developments in devicebased medicine.
PROF. WINFRIED A. WILLINEK
In profile
PROF. WINFRIED A. WILLINEK
Managing Senior Physician and Deputy Director of the Department of Radiology, University Hospital Bonn, Germany,
currently working as Chairman, Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Trier, Germany
10 SPECIAL REPORT HEALTH MANAGEMENT
University Hospital Bonn, Germany
Not even a Ferrari will get you to your
destination without a driver
Radiology is an interdisciplinary field influenced by virtually all medical innovations.
This naturally applies to imaging and image-guided interventions just as much as to
diagnostics and data management. We spoke to Prof. Winfried A. Willinek and asked
him about present and future challenges.
Prof. Willinek, where do you
see current developments in
radiological imaging?
The trend is moving away from static
individual images toward collated image
data sets, for example data gained from
multiparametric imaging with the option
of quantifying the pathological processes,
or from moving images (“4D”) that allow
dynamic visualization of the kinetics of
pathological changes. Today, in oncology,
not only are statements about tumor size
required, but also information gathered
non-invasively, including that concerning
a tumor’s metabolic activity or
malignancy. For instance, surgeons would
like to see in front of them in 3D not
only the liver they are going to operate
on – to help in planning the operation,
including colored display of the liver
segments, vessels and metastases – but
also data about the size and volume of
the remaining parenchyma, and about
the function. This means evidence of
liver damage or fat content/fibrosis.
When treatment is being monitored,
increasingly we need functional
information about the residual tumor and
its vitality. Based on these radiological
data, it is possible to plan the best courses
of treatment or treatment options. In this
process, I see my colleagues and myself
more and more in a pioneering position.
Radiology should play a crucial role not
only in reaching a diagnosis, but also in
treatment management and the selection
of patients. Ultimately this is based on
standardized, structured findings that
allow comparisons and can document the
success of the treatment.
One major example of the growing
requirements placed on radiology is the
rising importance of genetic analysis of
cancers with a view to immunological
approaches to treatment. Previously
the role of radiology was to provide
image-guided histological diagnosis
of a lesion. Today it is important
to document the changes in tumor
genetics during treatment.
This requires numerous sequential
biopsies over time. And here we find
the foundation for the paradigm shift
with individualized therapies – for
example, moving away from classical
chemotherapy to a combination of
chemotherapy and immunotherapy,
possibly also alternating with
locoregional and local ablative
radiological treatments.
In what period of time will this
paradigm shift take place?
I think we will see treatments with
biologicals becoming more established
within the next five years – in combination
with new developments in device-based
medicine.
Can you give us an example?
With high intensity focused ultrasound,
HIFU for short, we do not yet know the
areas where it will become a routine
clinical procedure in the future. In our
Radiology Department in Bonn we have
the first device in the German-speaking
region that can offer treatment based
purely on ultrasound. Initial results are
encouraging, especially in the treatment
of acute cancers with a poor prognosis,
such as pancreatic cancer. The possibility
of using HIFU in local and focal therapy
opens up many more fields of application.
Fibroids already constitute one established
indication. In the future I can see
additional applications, for example the
prostate, but also soft tissue sarcomas
or brain tumors.
Therefore, in tumor boards, radiology
should promote all innovative treatment
options for consideration alongside the
others. Here functional information
about the tumor is important for
correctly categorizing the course of the
disease under treatment. Radiology has
the task of ensuring that findings are
classified correctly and that decisions
made on this basis serve the wellbeing of the patient (and especially
to avoid overtreatment). It is not only
the quality and standardization of the
diagnostic process, but also the marking
of crucial lesions over time, which make
it possible to demonstrate the images
and findings to an interdisciplinary
conference.
Have these developments any impacts
on the organization of radiological
departments and institutes?
Sure. To improve our handling of the
constantly increasing amount of data
and complexity of the imaging, more
than anything else we have to have
the appropriate personnel, but we also
have to work in networks. This may
require bringing in several departments
together in some cases. Furthermore,
the number of interdisciplinary meetings
in certification processes is rising all
the time.
Radiology is an interdisciplinary field
and is, therefore, in contact with other
departments through its staff. For
instance, in Bonn we have more than
60 meetings a week. This demands
that radiology has very good time
management and convincing research
and image demonstration, so that
clinically relevant findings from many
patients can be presented within a short
space of time.
SPECIAL REPORT HEALTH MANAGEMENT 11
Radiology must and
will always find new
ways to maintain its
key role in diagnostics
and treatment.
PROF. WINFRIED A. WILLINEK
Are these types of work and services
already reflected in billing?
Unfortunately they are not yet included to
a sufficient extent in the billing systems,
that’s true. But that absolutely has to
change, because radiology requires high
staffing levels and a lot of time if it is to
provide high quality diagnostic work-up –
including when services are provided by
clinics outside the institute – and to hold
meetings with properly qualified staff
members. The preparation frequently
includes examination and archiving of
the patient’s prior images from medical
practices or other hospitals. In the case of
cancer patients, for example, during the
tumor board’s preparation for the Center
for Integrated Oncology (CIO) Köln
Bonn. I often make a detailed study of
the progression over two or three years.
Without this preparation and knowledge,
I can’t take part in the discussions to
identify suitable treatment options.
We focus on the patient, and any piece
of information can be decisive for him
or her.
What do the new challenges in
radiology now mean for providers
of IT solutions?
We are increasingly moving away
from purely modality-guided solutions
where we examine, assess and process
images, towards comprehensive,
12 SPECIAL REPORT HEALTH MANAGEMENT
network-based solutions from a
single supplier. IT providers have to
integrate assessment, analysis (like the
quantification mechanisms I mentioned)
and archiving. In addition, demonstration
must be simple and we must be able to
find index lesions that are then archived
and are at the focus for periods of years
when the patients come for check-ups.
An archive of this kind is not least a
prerequisite for complex clinical studies
that our radiology department here at
the Study Center Bonn has a hand in
designing. IT companies can be incredibly
helpful in this if they allow simplification
of the assessment and archiving processes
and of data handling, but at the same
time make it possible to integrate complex
pathways in image analysis by means of
standardized reporting templates.
What can you do to support the
IT professional?
Also act professionally when it comes to
IT. My experience is that the supporting
systems and data management always
work in departments that have specialists
looking after the systems. Otherwise, our
five-year success story since introducing
PACS would not have been possible.
Several years ago my boss, Professor
Schild, brought in Dr. Wolfgang Block
to fill the new post of Head of
Radiology IT in our department.
He takes care of all IT issues and is
an important contact person both
for the whole hospital and for the
employees in radiology. On the one
hand, he translates the special needs
of radiology and ensures the smooth
implementation of internal processes,
while on the other he is responsible
for integrating and networking the
radiological systems, such as PACS,
with those of the University Hospital.
As a specialist he leads a whole team of
employees: at this point the “clinically
active” members of staff wish to express
their heartfelt thanks to Dr Block and
his team!
How will image data management
systems have to change?
PACS must adjust very rapidly to the
changing demands. I have already
mentioned the continually growing
amounts of data. First, that brings
challenges in archiving, and second,
challenges in diagnostics. You only have
to think of a patient from the emergency
center after a car accident who is given a
full-body 3D CT scan in multiple trauma
diagnostic workup. Here an intelligent
and powerful program is needed to
quickly reach a reliable diagnosis and
valid findings.
What requirements does a PACS have
to satisfy in particular, to support you
in your work?
Alongside quality for compiling the
findings, I attach special importance to
demonstration of images. This reflects
radiology’s selfconfidence as a provider of
information on the one hand, and on the
other the interdisciplinary cooperation
that will become even more important in
the future; for instance working together
with pathology, radiotherapy, oncology
and surgery to arrive at the best possible
treatment decisions.
The IT solutions are important here:
to save time and emphasize relevant
findings, we need simple tools for
presenting complex data. When
preparing to demonstrate findings, but
especially for recommending a treatment
and assessing the success of treatment,
it is important to have direct access to all
the patient’s clinical data. The faster and
more effectively the image management
systems provide the information, the
more able radiologists will be to meet
the constantly increasing requirements.
Radiologists influence patient care
during examination, diagnostic
work-up and imageguided
interventions. Aren’t they turning
more and more into treatment
managers?
That is true, but I would not call them
that. Actually they actively intervene
far too often in the workflows to be
considered “treatment managers”
– whether it’s with locoregional or
local-ablative imageguided therapies.
Even if they adopt a central position
in the treatment process, they always
seek interaction with other specialist
departments – and the better this
works, the better it is for the patient.
For radiology it is essential to continue
to follow the developments occurring in
technology so that new roles will always
emerge for the therapeutic pathways.
I see one of our most pressing tasks in
defining – alongside the clinical pathways
– relevant imaging pathways that ensure
we undertake rapid, effective imaging
procedures, but only those that are
necessary or expedient. At the end of
the process it must be possible to get the
patients onto the best lines of treatment
for them. That necessitates high quality in
diagnostic imaging and image processing.
What conditions are needed for this
to happen?
Best of all would be to realize this in a
central radiology department. It would
be advantageous to have the imaging
– meaning all modalities – in a single
department. In my opinion this structure
is the only way to implement the imaging
pathways. At the end of the day this can
be more cost-effective for the hospital
and better for the individual patients,
because it enables even more immediate
and targeted diagnostic work-up and
treatment.
Moving away from technology, how
important is the personnel in this?
The staff are the most important factor.
If you own a Ferrari but have no one to
drive it, you’re not going to reach your
destination. It is therefore essential
to invest in personnel. Staff members
must be continuously given support
and training, first in relation to the
technology, and second in relation to the
human and clinical challenges.
In this process, the chief radiologist has
an important role as a person who thinks
ahead and acts as an intermediary. But as
far as I understand, that only works when
they keep their eyes firmly on everyday
practice. Of course they have to perform
their management duties, but the
clinical pathways harbor potential and
knowledge that they need for optimizing
the organizational structure.
Prof. Willinek, to finish off, let’s take a
look into a crystal ball. Where do you
see radiology in 2020?
Oh, even famous people have been
mightily mistaken when looking into a
crystal ball. But I’ll have a go. Radiology
must and will always find new ways
to maintain its key role in diagnostics
and treatment. Examples of this would
be standardization, networking, image
fusion, multiparametric imaging and
the quantification of pathways in the
body. Furthermore, hybrid procedures
will become more significant, just
like minimally invasive therapies
(including HIFU).
I think that personalized diagnostics and
treatment will be part of the standard
in 2020. I also think that what I have
now formulated as a wish for image
management systems (for instance
integration of analytical software) will
already be reality by that time. Radiology
IT will require software solutions to
be even more mobile, connected and
integrative, so that they form the solid
basis for further technical developments
in innovative diagnostic and treatment
procedures. W
At the time of interview, Prof. Winfried
A. Willinek, was Managing Senior Physician
and Deputy Director of the Department of
Radiology at the University Hospital Bonn,
Germany. He has since taken up a new
position in Trier, Germany.
Prof. Dr. med. Winfried A. Willinek,
MD Chairman Department of Radiology,
Neuroradiology, Sonography and Nuclear
Medicine (Imaging Center) Krankenhaus
der Barmherzigen Brüder Trier, Nordallee 1,
54292 Trier, Germany.
“Our Imaging Center is a place of
interdisciplinary cooperation between
radiologists, internists, nuclear physicians,
surgeons, EDP specialists, physicists and
economists – which means people from
many fields work together. Medical technical
assistants, medical assistants and secretarial
staff are responsible for the organization
and medical technical services.”
PROF. WILLINEK
SPECIAL REPORT HEALTH MANAGEMENT 13
Hospital Municipal Dr. Moysés Deutsch, M’boi Mirim, São Paulo, Brazil
Agfa HealthCare and M’boi Mirim
strengthen collaboration to advance
towards a fully digitized future
Implementation of HIS/CIS allows São Paulo hospital to enhance patient care,
staff efficiency and management control, as it moves towards adopting Agfa HealthCare
technology for all hospital tasks.
INTERVIEW WITH DR. FABIANA ROLLA, Coordinator General Medicine and ELDER JUREN, IT Coordinator,
Hospital Municipal Dr. Moysés Deutsch
14 SPECIAL REPORT HEALTH MANAGEMENT
When the Hospital Municipal Dr. Moysés
Deutsch was being built in the low-income
São Paulo neighborhood of M’boi Mirim,
management already wanted a hospital
information system (HIS) and clinical
information system (CIS) that would
deliver the same dynamism and reliability
this new public facility sought to provide
for its patients. The hospital turned to
Agfa HealthCare because the company
could commit to implementing the desired
solution within the required timeframes.
The results since then have been
transformative. As staff members have
become more familiar with the new
technology, they have reported time
savings from having the entire patient
histories, exam results and protocols at
their fingertips. Patient care is increasingly
standardized, and the HIS has allowed
greater efficiency in managing not only
patient waiting lists but also stocks.
The hospital is now strengthening its
collaboration with Agfa HealthCare to
replicate the success in the adoption of
the initial HIS/CIS solution, now as a pilot
for more advanced CIS modules, reaching
towards its goal to use information
technology in all its procedures, and
prepare itself to become totally paperless.
In roll-out, patient safety
is paramount
Even before the April 2008 inauguration
of the hospital, management was
preparing the HIS/CIS. As a new-built
facility, the hospital’s infrastructure could
be made to order, allowing the HIS to be
implemented before the hospital opened
its doors customizing the performance and
availability of the system to the hospital’s
requirements. The CIS modules were then
gradually rolled out starting September
2008. During this roll-out, patient safety
remained paramount and internal hospital
procedures were revised to work with
the new technology. Agfa HealthCare
provided technical consulting and on-site
training during the roll-out.
The hospital’s IT team provided
24-hour support for users’ questions,
and answered requests with action
plans. As implementation was gradual,
workflows had to be redesigned
and problems resolved in order to
reduce disruptions while supporting
procedures related to patient care.
Certain units within the hospital were
identified as most suitable for the
initial implementation of modules,
Agfa HealthCare’s
HIS/CIS
 Optimization
of procedures, through
easy access to patient medical records
and exam results.
 Improved delivery of patient care,
adopting tools for risk assessment and
creating uniformity in patient care,
thanks to the availability of tools that
allow the adoption of uniform standards.
 More efficient management of patient
waiting lists and stocks.
Agfa HealthCare’s CIS solution allows easy access to
the patient’s history from every visit to the hospital: it is
easier for caregivers to follow clinical cases, errors in
medical prescriptions are reduced thanks to the legible
text, and all exam results are available.
DR. FABIANA ROLLA
Coordinator General Medicine
SPECIAL REPORT HEALTH MANAGEMENT 15
allowing a quick build-up in acceptance
of the new system among the hospital
professionals and minimizing the
impact from an operational perspective.
The implementation team included
management, medical and IT staff,
backed by a directive from senior
management.
Reaping the benefits of the
digitized hospital
Immediately following the
implementation, there was a slight
increase in the time required by each
process. But this was rapidly reversed
as users became familiar with the new
technology, and today staff members
use all the modules available.
“Electronic processes have contributed
to time savings, enhanced access to
data and historical records, and provided
the strategic indicators management
requires,” says Dr. Fabiana Rolla, the
hospital’s Coordinator of General
Medicine.
The benefits are many: “Agfa HealthCare’s
solutions have allowed us to digitize all
our patient care and hospital operations.
The system helps us implement clinical
protocols, manage patient waiting lists
Agfa HealthCare’s
Contribution
 Digitized
all patient care, supporting the
hospital to become the first in São Paulo
to win an excellence ranking from Brazil’s
non-governmental medical National
Accreditation Organization.
 Agfa HealthCare’s team worked with
the hospital’s IT unit to create customdesigned solutions that maximize the
potential of the solution in conjunction
with the institution’s procedures.
 Agfa HealthCare is now helping to set up
new pilot projects that will provide future
process improvements, with the eventual
goal of eliminating paper.
The closeness between Agfa HealthCare and our IT unit
was fundamental in allowing us to explore all the potential
of the system. Today the collaboration allows us to create
pilot projects, guaranteeing improvements in processes.
ELDER JUREN
IT Coordinator
and control stocks, among other things,”
says Elder Juren, IT Coordinator for
the hospital.
Nurses can now access a patient’s
entire medical record at the hospital,
while the emergency room has tools
that make it easier to carry out triage
protocols. Exam results are ordered and
available electronically. There has also
been a reduction in errors from using
handwritten prescriptions, as prescriptions
are now done electronically via the CIS.
“The multi-functionality of a patient’s
electronic record allows us to improve
16 SPECIAL REPORT HEALTH MANAGEMENT
that patient’s care,” says Dr. Rolla.
The system also allows for far greater
control over stock management,
supporting workflows for tracking of
supplies such as medicines. Brazil’s
public health system has long faced stock
control challenges due to weak stock
management systems.
Building a long-term relationship
with Agfa HealthCare
The relationship between the hospital and
Agfa HealthCare has not ended with the
successful initial HIS/CIS implementation.
The IT staff is constantly looking for ways
to improve internal processes with the
The HIS/CIS solutions have allowed us to digitize all
our patient care and hospital operations. They help us
implement clinical protocols, manage patient waiting
lists and control stocks, among other things.
ELDER JUREN
new systems. “The closeness between
Agfa HealthCare and our IT unit was
fundamental in allowing us to explore
all the potential of the system. Today
the collaboration allows us to jointly
embrace new pilot projects, guaranteeing
continued improvements,” says Mr. Juren.
The target now is to introduce
information technology in all hospital
procedures in order to become a 100%
paperless institution. Other future
goals are to implement a mobile system
in critical areas such as the hospital’s
emergency ward. With this dedication to
constantly seeking new improvements, it
is no surprise that the Hospital Municipal
Dr. Moysés Deutsch has become an Agfa
HealthCare show-site in Brazil. W
Did you know...
 Although
it is part of Brazil’s public
health service, Hospital Municipal
Dr. Moysés Deutsch is managed
in partnership with the Hospital
Israelita Albert Einstein, a private
institution that is a reference across
Brazil for healthcare excellence.
 Each month, the hospital delivers some
450 babies and carries out 15,000
urgent and emergency consultations,
with 1,450 hospital admissions in the
areas of clinical medicine, general
surgery, orthopedics, obstetrics, general
pediatrics and neonatal.
 Jardim Angela (where the hospital of
M’boi Mirim as it is informally known
is located) is a poor area on the edge
of São Paulo, with high levels of urban
violence. The hospital therefore treats
a high number of patients with trauma
injuries; it has 20 intensive-care unit
beds for adults and 10 for children.
SPECIAL REPORT HEALTH MANAGEMENT 17
In profile
JÖRG SCHWARZ, Global Business Development Director, Agfa HealthCare
JOOST FELIX, Lead Product Manager, Agfa HealthCare
18 SPECIAL REPORT HEALTH MANAGEMENT
EHR Portal:
the gateway to integrated care
With the launch of its new electronic health record (EHR) Portal, Agfa HealthCare is
taking customers on a journey towards an integrated care solution. Easy to implement,
yet providing a comprehensive road map, the EHR Portal integrates the experience
and knowledge Agfa HealthCare has acquired in its long history, to drive towards
the future of healthcare delivery with an architecture that can be extended into the
entire care continuum. Co-project leaders Joost Felix and Jörg Schwarz explain…
Can you explain what the EHR Portal is?
JOOST: With the Portal, all care providers
– physicians, nurses, physiotherapists,
etc. – as well as the patients themselves
can access health information, using an
interface that is easy and clear to read
and is focused on the patient. It provides
an overview of information coming from
different healthcare sources: hospitals,
laboratories, imaging centers, etc. That
is what it currently does. But there is an
underlying Health Information Exchange
(HIE) architecture that also allows
the information to be aggregated on a
higher level.
JÖRG: It can pull and extract the
information needed from different
individual records and present it together
in a very user-friendly way. So if you
want the history of the patient’s lipid
panel, you don’t have to sift through
pages and pages of lab records: you
get the most recent results of whatever
you are looking for. And the patient
or caregiver can see all of the patient’s
information in one place.
The EHR Portal is a web‑enabled
software platform that can be
installed either at the customer’s
premises, or we can host it for
the customer, with a service
level agreement.
JÖRG SCHWARZ
Global Business Development Director, Agfa HealthCare
But that is just the start. This is actually
the first product in a new range called
‘Agfa HealthCare 360’. This means that,
while the EHR Portal provides excellent
and important value now to healthcare
providers, we have a planned evolutionary
path that will in the future integrate all
clinical players, including social services,
pharmacies, etc. plus all imaging providers
such as mammography and pathology.
JOOST: That’s why we call the EHR Portal
the ‘Gateway to Integrated Care’.
What is the technology behind the
EHR Portal?
JÖRG: The EHR Portal is a web-enabled
software platform that can be installed
SPECIAL REPORT HEALTH MANAGEMENT 19
either at the customer’s premises, or
we can host it for the customer, with a
service level agreement.
JOOST: It can be integrated with both
information systems like ORBIS* and
HYDMEDIA** and with Enterprise
Imaging. Combined with the XERO
Viewer***, it provides high quality
images. Radiologists want to see not
only images but all kinds of information,
such as lab results and patient diagnoses,
which provides a greater context for
the medical images. But it is up to the
customer how and with what systems
they want it to be integrated. That means
it is scalable, too. It can be used with their
current systems, and then be integrated
with new products and solutions as they
add them.
The EHR Portal provides both a Patient View
and a Clinical View
PATIENT VIEW:
CLINICAL VIEW:
The patients can:
Provides the clinician:
W Look at their own images, results and
other reports;
W All of the Patient View functions;
W Share results securely with another
doctor to get a second opinion;
W Give access to their results on the
EHR Portal to a caregiver;
W Upload information from e.g.
wearable activity trackers or CDs
provided by another doctor.
20 SPECIAL REPORT HEALTH MANAGEMENT
W A work list with an easy overview
of all patients;
W Certain key performance indicators
(KPIs) based on embedded analytics;
W Peer-to-peer communication with
other providers;
W A role-based framework that allows
the care providers to operate within the
local legislative framework and their
internal processes.
How is the EHR Portal answering
the specific needs of hospitals and
hospital groups?
JOOST: Hospitals and hospital networks
are asking us “How can we integrate
with our referring physicians, how can
we get results to them? How can we
establish and strengthen our relationship
with our patients? How can we keep
onboard new patients more easily,
for them and for us?” Hospitals don’t
want departmental systems, they want
enterprise-wide solutions.
JÖRG: Agfa HealthCare has a lot of great
IT and Imaging products and solutions.
With the EHR Portal, we are providing an
umbrella that brings them all together,
whatever solutions the customer has
or needs. But it isn’t a product that is
intended to do just one thing: it has been
designed to grow and evolve in order to
continue the healthcare story.
JOOST: And it’s not just for Agfa
HealthCare products! We are known
as a company that makes products
supporting standards, such as DICOM,
IHE, etc. that allow other vendors to
integrate their products with ours.
That is true for the EHR Portal, too.
A non‑Agfa HealthCare picture archiving
and communication system (PACS) can
share images, a non-Agfa electronic
medical record (EMR) can send results…
So it fits into any hospital, regardless of
what solutions they have.
JÖRG: The EHR Portal also lets hospitals
realize significant cost reductions,
by making all information, including
imaging, available where and when
it is needed, and helping to eliminate
redundant procedures. To take one
example: if surgeons are preparing an
intervention and cannot find an image
that was taken three weeks ago, they
might have to order another. We have
studies that show that with the EHR
Portal functionality, a hospital can
reduce redundant images by up to 2%
of the entire imaging volume. For a
high‑volume imaging environment, that
is an enormous savings; in some cases
enough to pay for the portal itself!
Why is Agfa HealthCare the
right company to accompany
the healthcare provider into an
integrated care future?
JÖRG: With the EHR Portal, we are taking
proven Agfa HealthCare expertise and
experience, and turning them in a new
direction for our company: a direction
that our customers, the healthcare
providers, both want and need. Our
IT solutions are already about sharing
information in multiple hospitals, in a
clinical, relevant way. In imaging, we have
multiple regional projects that are also
about sharing. Our clinical expertise is
demonstrated by the over 1000 hospitals
that use our EMR and over 2500 that work
with our PACS systems. With our proven
experience, we have a broader outlook,
vision and capability – which is what you
need for integrated care.
JOOST: So on the one hand it is a new
product, but it is really built on all the
different and proven elements and
experiences Agfa HealthCare already has.
Can it be used on mobile devices,
smartphones, etc.?
JOOST: Absolutely! All functionalities of
the EHR Portal are available on mobile
devices, thanks to the native mobile
interfaces for Google Android and Apple
iPhone mobile digital devices. The user
experience is adapted to the mobile
device, but the functionality is the same.
So the screen is sized differently, but the
pertinent information, such as lab results,
is adapted to fit.
JÖRG: Some smartphones have amazing
image resolution these days, great for
looking at high quality images. There is
also an instant messaging system that
is even better than email for a mobile
environment, for sending short messages
and collaborating with peers.
How will the EHR Portal help lead the
way to integrated care?
JOOST: The first step is the total overview
of the patient care, not just of what comes
from the care provider’s own hospital or
clinic, but all along the care continuum.
This is what the EHR Portal will provide.
The second step, still to come, will
then be to include the activity-driven
workflows.
JÖRG: Then there is a third aspect:
adding social care. Integrated care
incorporates not only acute care,
e.g., within the hospital, but also
preventative and elective care.
The caregiver’s goal is to improve
outcomes and prevent the patient from
coming back to the hospital for the
same problem, and to prevent severe
escalations, like emergency room visits.
So the patient’s information needs to be
available not just within the hospital but
also to whoever will be involved in the
patient’s ongoing wellbeing. This could
be a home nurse, a physiotherapist,
even a relative who will be making
sure the patient takes the prescribed
medicine, makes it to the scheduled
appointments, everything.
That’s our vision of the way forward,
and with the EHR Portal we and the
care providers have a road map to
achieve it. W
All functionalities of the EHR
Portal are available on mobile
devices, thanks to the native
mobile interfaces for Google
Android and Apple iPhone
mobile digital devices.
JOOST FELIX
Lead Product Manager, Agfa Healthcare
* ORBIS is not available in Canada or the U.S.
** HYDMEDIA is not available in the U.S.
***XERO Viewer is pending 510(k) clearance in the U.S.
and not currently available in Canada.
SPECIAL REPORT HEALTH MANAGEMENT 21
Case study Hufeland Klinikum, Bad Langensalza, Germany
New approaches to communication
with referring physicians and
cooperation partners
At the Hufeland Klinikum Bad Langensalza information is shared quickly
and securely, thanks to the ORBIS portal solution.
INTERVIEW WITH DR. UTA KÄSTNER, internist and nephrologist at the Dialysis Clinic,
and IVONNE TIPPMANN, Director of the Central Secretariat for Department Heads
One of Dr. Uta Kästner’s patients has been admitted to the Hufeland Klinikum (Hufeland Medical Center) in Bad Langensalza. Kästner,
an internist and nephrologist working in the dialysis clinic attached to the medical center, is worried: this patient comes to the clinic
three times a week for dialysis. At admission a bleeding ulcer is diagnosed. Before the next treatment is administered – by necessity
in hospital – several questions have to be answered: How severe is the bleeding? Does it have any effect on the administration of
medication during dialysis? How is the patient’s general condition? To obtain an overall impression fast, Dr. Kästner logs into the online
portal of the Hufeland Klinikum, where she can see all the data and pictures for her patient. Fortunately, the situation is not as bad
as it first appeared and dialysis can be performed the next day as scheduled.
Previously my
colleagues were always
on the phone or using
the fax to get records
for me. The fact that
I can now call up these
records online is an
enormous advantage
for my work.
DR. UTA KÄSTNER
Internist and nephrologist at the Dialysis Clinic
22 SPECIAL REPORT HEALTH MANAGEMENT
General practitioners
and specialists can
review the examination
results even before
the patients arrive in
their practices.
IVONNE TIPPMANN
Director of the Central Secretariat for Department Heads
At its two locations, in Bad Langensalza
and Mühlhausen, the Hufeland Klinikum
offers any physician requesting it the
option of downloading all records
stored for the 22,500 inpatients and
53,000 outpatients treated at the hospital
each year.
The technical side has been solved in a
very secure manner. A special computer
(application server) retrieves only
those data for which the physician is
authorized from the hospital information
system (HIS) and transfers them to an
additional communications computer
(proxy server) located in a network sector
specially protected by several firewalls
and referred to as the ‘demilitarized zone’
(DMZ). From here the information is
transmitted to the referring physicians
over a secure connection. “This can
happen only if patients have previously
given their consent to the data transfer,”
explains Ivonne Tippmann, Director of
the Central Secretariat for Department
Heads at Hufeland Klinikum. Tippmann
is responsible for looking after the portal
solution and the associated workflow.
The patients’ consent is requested at
admission. The records of patients who
refuse consent to this transfer are sent by
normal post, as before.
better support to the referring physicians
responsible for the follow-up care of
these patients.” It soon became clear that
a portal solution was the only feasible
route to this goal. “With this solution the
physicians obtain the discharge summary
in the fastest and most direct way and
also have access to additional records,”
she explains.
Portal solution for rapid
transfer of findings
Installing the technical solution was not
enough, however: at Hufeland Klinikum
the current workflows also had to be
adapted. Today the doctors dictate a
short discharge summary into a device
with digital voice recognition before the
patient is discharged; this summary is
then processed by the secretarial service.
It can be accessed by the clinician in
ORBIS* HIS, printed out, and issued
to the patient. In parallel, the referring
physician can already have a look in
the portal: X-ray images, lab reports,
A survey conducted among referring
physicians in 2009 revealed, among other
things, that they are unhappy about
the disparities in how medical reports
are treated by different individuals and
institutions. The time of dispatch ranges
from ‘immediately’ to ‘two months
later’, reports Tippmann. “We wanted
to standardize this and at the same time
find a solution that allowed us to avoid
superfluous waiting times and to provide
SPECIAL REPORT HEALTH MANAGEMENT 23
histology reports and other records are
added afterwards, and a signed version
of the complete discharge summary is
available after two days at the latest.
Referring physicians were
initially reluctant and had
to be persuaded
In June 2011, the Hufeland Klinikum
launched the “Referring Physicians’ Portal”
project with a first large information event
for the referring physicians.
“Initially traffic on the site was slow to get
started,” recalls Tippmann. “To remedy
this, the medical center assigned an extra
staffer to our office; we then phoned
every referring physician and explained
the possibilities and advantages offered
by the new solution. We even visited
many of these physicians and presented
the portal to them on their premises.”
This enormous effort was repeated in
September 2011, when the solution was
activated for the outpatient and inpatient
nursing care facilities in order to facilitate
patient transfer management.
For Tippmann the modest participation
figures are a generational issue. “We
succeeded in convincing the younger
doctors, in particular, very quickly.
24 SPECIAL REPORT HEALTH MANAGEMENT
This group is generally open to
technological innovations. Often, they
have already heard of our portal and
are eager to use it to save time and
expenditures. However, there are also
doctors’ practices that are completely
analog and work with paper files, X-ray
films in paper envelopes, etc. It is simply
harder for us to gain a foothold there,”
she says about one of the most difficult
parts of her job.
By September 2014, 109 – i.e. nearly
one-third – of the referring physicians
were using the portal solution. The
participation rate is higher at the inpatient
and outpatient nursing care facilities.
This group does include 43 referring
physicians who, as of January 2012, have
only been able to obtain records via the
portal. Two other institutions completely
integrated into the portal solution are
the Hainich Ecumenical Medical Center
(a specialized hospital for neurology,
psychiatry and psychotherapy) and
St. Elisabeth Hospital in Lengenfeld
unterm Stein. “St. Elisabeth Hospital
works with ORBIS HIS; this naturally
made the introduction and operation
of the portal much easier,” reports
Ivonne Tippmann happily.
Nevertheless, Tippmann and her
colleague personally visited all the new
participants, set up access to the portal
on their premises, and trained office
staffers. Tippmann adds: “This service is
important: we don’t want acceptance of
the project to be sabotaged by incorrect
operation of the portal.”
Peace and quiet plus
higher efficiency
The dialysis centers at the Bad
Langensalza and Mühlhausen sites of
the Hufeland Klinikum have now been
using the ORBIS portal solution for a
full year. It is estimated that the four
staff doctors call up the records of about
60 percent of their patients on the
portal. The objective was to give them
faster access to the medical findings of
their patients who have been admitted
to hospital. Dr. Kästner elaborated:
“The patients spend about five hours
at one of the dialysis centers for each
treatment. During this time I have to
collect all the important findings and
make therapeutic decisions on the spot.”
She comments that, “This is distinctly
easier now than it was in the past.”
Previously, the nephrologist had to make
multiple phone calls, read a lot of faxes,
and drive many kilometers to pick up
records at the Medical Center. “Those
days are over. I can now obtain all the
information I need with a mouse click,
and can begin or modify treatment much
faster,” says Dr. Kästner.
This fast and secure access to all the
information in the patient’s record
is precisely what Hufeland Klinikum
wanted to offer referring physicians
and cooperating partners with the
ORBIS portal solution. “The general
practitioners and specialists can already
review the examination results before
the patients appear in their offices,”
says Ivonne Tippmann.
Dr. Kästner especially enjoys the peace
and quiet that descended on her unit
about a year ago. “Previously my
colleagues were always on the phone or
using the fax to get records for me. The
fact that I can now call up these records
online is an enormous advantage for my
work. And the patients benefit not just
from the shorter waiting times but also
from the peace and quiet which speeds
their recovery!” she adds. Dr. Kästner
has only praise for the portal solution.
“The system runs smoothly and without
problems. It is accepted by everyone
working at our dialysis centers and
lightens their workload noticeably.”
* ORBIS is not available in Canada or the U.S.
This service is important:
we don’t want acceptance of the
project to be sabotaged by incorrect
operation of the portal.
IVONNE TIPPMANN
For other users – and in particular for
patients – it has an additional advantage:
it helps prevent duplicate examinations,
since all images are available – or can be
made available – whenever needed.
Communication in
both directions
The ORBIS portal solution is also not
a one-way street: referring physicians
can upload their patients’ records onto
the server at the medical center. These
records – on previous lab studies, allergies
to medication, and previous illnesses –
provide more information to aid caregivers
in determining the treatment administered
in the hospital. “It also means that the
hospital now has a complete patient
record,” comments Ivonne Tippmann.
And the portal is continually being
expanded and optimized. “After one
of our annual physician surveys, for
example, we added the health insurance
number to the details provided,” says
Tippmann. “Requests and suggestions
are always welcome; we are happy to
implement them!” she adds. “This also
contributes to further acceptance and
widespread use of the solution.” W
SPECIAL REPORT HEALTH MANAGEMENT 25
Market intelligence for Enterprise
Image Management Solutions
HIMSS Europe recently undertook a qualitative study on Enterprise Image Management.
Carried out between August 2014 and October 2014 in Europe and the Middle East, the
survey’s objective was to gain a comprehensive understanding of the perceptions of CIOs
and clinicians in terms of expected and generated return on investment using Enterprise
Imaging Solutions and higher EMR integration deployment in hospitals.
Based on qualitative phone interviews with persons involved in the decision making process to purchase an Enterprise Image
Management Solution (EIMS) for public, private and university hospitals, the survey also invited users of EIMS to complete a short
Excel questionnaire quantifying realized benefits. All respondents were asked to provide insights into their pain points and expectations,
their perceptions regarding concrete improvements they are experiencing by having an EIMS solution, and future trends they foresee.
KEY FINDINGS
The key findings of the research
were as follows:
CURRENT PAIN POINTS AND EXPECTED
BENEFITS REGARDING EIMS
Key pain points in image
management today:
W Integration of Image Management
Solution (IMS) with EMR (Electronic
Medical Record) / HIS (Hospital
Information System).
W Integration of IMS with imagegenerating modalities.
W System performance, especially
when using mobile devices (long
waiting times to retrieve/access
images, especially for CT/MRI).
Expectations regarding EIMS:
W Across all countries IT staff and
clinicians expect that deploying an
EIMS will help to improve quality of
care and patient safety (better access
to (more) images, reduce unnecessary
(duplicated) exams and radiation
exposure, faster turn-around time of
results), save costs (less analog film,
printing, CDs, reduce staff in archives,
efficiency savings) and enhance
workflows (enable continuity of care
and interdisciplinary co-operation,
secure access to data, faster access
to images).
W IT staff in hospitals also expect
general improvements in terms of
system interoperability and software
management.
W Most other expected benefits,
e.g. improved staff and patient
satisfaction, better research capabilities,
compliance with legal requirements
26 SPECIAL REPORT HEALTH MANAGEMENT
Market Intelligence for
Enterprise Image Management
Solutions (EIMS)
etc. are a result of the above
mentioned benefits.
REALIZED BENEFITS FROM EIMS USAGE
W Workflows and information
exchange improvements are the
most visible benefits realized by the
introduction of EIMS.
W Financial savings were highly expected,
and have also been realized. However,
straightforward figures are difficult
to obtain since hardly any monitoring
exists and some savings are made in
one department, but therefore add
costs in another one.
Hospitals typically save costs
due to:
W Less time needed to find and
access images.
W Increase in billable services.
W Increased speed of diagnosis and
results/turnaround.
W Patient safety and quality of care
have often been improved after the
introduction of enterprise-wide
imaging. Typically this comes as
a result of improved workflows.
W Patient and staff satisfaction
also have often improved after
implementing an EIMS. W
MyPractice Imaging, Cleveland Clinic, Ohio, USA
Images – the missing element
in today’s EHR
Cheryl Petersilge, Medical Director of MyPractice Imaging at the Cleveland Clinic, Ohio,
USA, talks about why adding images into its EHR solution was so important.
INTERVIEW WITH DR. CHERYL PETERSILGE, Medical Director of MyPractice Imaging at the Cleveland Clinic, Ohio, USA
DICOM images such as X-ray, CT and MRI scans are often essential to discovering and communicating clinical intelligence that helps both
the ordering physician and subsequent care providers understand what’s at issue with a patient. Yet for all the progress in implementing
the means for a patient-centric approach to finding, viewing, and being able to act on the sum of information gathered throughout a
continuum of care, something important is currently missing: pictures.
What we needed was a
‘thinking VNA,’ which could do
several things. It had to manage,
in one place, the context of all
the images, their indexing, where
they came from, and where they
should appear in the EHR.
DR. CHERYL PETERSILGE
Medical Director of MyPractice Imaging
SPECIAL REPORT HEALTH MANAGEMENT 27
Recognized as one of the US’s most
forward-thinking hospitals, Cleveland
Clinic is a fully integrated health system
comprising 1,440 beds at its main
campus and more than 4,450 total beds
throughout its system of family health
centers, community hospitals and
regional and international hospitals.
Its MyPractice Imaging program recently
initiated an EHR optimization project
that provides physicians access to medical
images generated by any participating
Cleveland Clinic imaging service line.
This innovative service redefines the
electronic health record by making
virtually all medical data, including
most images, regardless of capture
modality, available to the clinician,
inside the EHR, at the point-of-care.
Because, as Cheryl Petersilge, M.D.,
medical director of MyPractice Imaging
Solutions at Cleveland Clinic explains,
“Images are data about the patient. If
we don’t have all of that information in
the chart, we haven’t really created a
comprehensive medical record. Without
images, the EHR is missing clinically
important information.”
As Dr. Petersilge recalls, “For Cleveland
Clinic and MyPractice Imaging, the
‘enterprise imaging opportunity’ was
recognized when we had to replace
our PACS. At that time the opportunity
to have, and the value of having, an
enterprise archive was recognized.”
The team at Cleveland Clinic began
to evaluate vendor neutral archive
(VNA) technologies because of their
ability to store images from a variety of
imaging formats, including DICOM and
non‑DICOM, as well as digital photos
to serve the images up to softwarebased or web-enabled viewers accessible
from workstations throughout the
hospital.
As the team closely weighed available
VNA options, it became clear that
providing ‘enterprise storage’ was only
one piece of the enterprise imaging
puzzle. To truly deliver the power and
value of an enterprise-wide image
platform, the MyPractice Imaging team
realized that workflow and indexing
standards had to be established across
all departments and clinicians who
utilize the system.
“What we needed was a ‘thinking VNA’,
which could do several things,” says
Dr. Petersilge. “It had to manage, in one
place, the context of all the images, their
indexing, where they came from, and
where they should appear in the EHR.”
The ‘thinking VNA’ Cleveland Clinic
selected was the Enterprise Imaging
Suite developed by Agfa HealthCare.
Agfa HealthCare’s Enterprise Imaging
portfolio automatically pulls medical
images into the patient’s EHR, from
virtually any device, in virtually any file
format, and tags it with clinically relevant
metadata so that information is securely
accessible throughout the enterprise. From
digital camera photos to MRIs, from videos
of CT scans to colonoscopies, medical
images, along with the accompanying
metadata information, are made viewable
in a centralized, patient-centric context
that enables quick searches and fast
consolidations of desired values.
Says Dr. Petersilge, “You can display all
these different modalities together and
compare the findings from one modality
to the next – not just an Ultrasound and
a CT but a photograph and the CT or…
an arthroscopy image of a meniscal
tear right up against the MRI,” says
Dr. Petersilge. Having a highly efficient
image capture system ensures that
accurate, protected patient information
is available where and when it is needed.
Instead of taping USB drives or CDs
to patients as they are moved about
(often a standard procedure within and
between networks), images are available
via the EHR and can be easily accessed
by practitioners at every hospital within
an enterprise. The result is that at
Cleveland Clinic all patient information
is accessible at any of their more than
35,000 workstations.
Cleveland clinic &
Agfa HealthCare
– innovating together
In implementing its enterprise imaging
strategy, the MyPractice Imaging
team prioritized the order in which
departments would be integrated into
the system. Radiology was the first to
go on line, given its importance as an
imaging leader within the hospital.
Following radiology, the MyPractice
Imaging team deliberately chose to get
other departments involved rapidly as
it did not want the new system to be
perceived incorrectly as ‘radiology-only’.
The rationale was clear to Dr. Petersilge
and the MyPractice Imaging team.
“An enterprise imaging system, much
like a system-wide EHR, is intended to
be used across multiple departments
and medical disciplines. If there are
significant disconnects or disagreements
in how the system will function, then
it will never operate as intended. As
a result, cross-departmental support
is a must for an enterprise imaging
strategy to succeed.”
28 SPECIAL REPORT HEALTH MANAGEMENT
they are likely to find work-arounds
which can lead to failure to properly
store images or failure to properly
index images.”
The enterprise imaging
difference
Since its implementation, Cleveland
Clinic’s enterprise imaging solution
has benefited the hospital in number
of areas. Most strikingly, it has enabled
significantly greater efficiencies in turnaround time – how quickly information
gets back into the hands of the physician
who ordered the tests. The results have
been dramatic. A process that used
to take hours is now accomplished
in minutes.
Image acquisition – the process by which
an image is initially acquired – has also
witnessed marked improvement, with
the primary ‘rate-limiting factor’ now the
time it takes for the patient to physically
travel to and from the department where
the images are taken.
Cross-departmental support is
a must for an enterprise imaging
strategy to succeed.
DR. CHERYL PETERSILGE
Second to come on line was Cleveland
Clinic’s gastroenterology service, due
to its position as one of the largest
and most highly rated departments
in this field in the United States.
Additionally, with endoscopy,
colonoscopy, and other image-rich
procedures, the gastroenterology service
line would particularly benefit from
increased collaboration between their
clinicians and referring physicians.
Gastorenterology was then followed
by women’s health, pulmonary
function and ophthalmology and
then dermatology, as it necessitated
the implementation of workflows
for relatively simple, but prolific,
digital cameras.
As more departments were integrated,
the value of Agfa HealthCare’s workflow
and indexing capabilities became even
more profound. Dr. Petersilge noted,
“Developing a foundation for indexing
was a big challenge. New types of
orders and new types of reports would
be coming in to the EHR, and this
incorporation needed to be done in
a thoughtful and systematic fashion.
Workflows needed to be developed for
each new department that was brought
on board. We did not want to use a
one‑size-fits-all approach.”
Less easy to measure, but no less
significant, is the time gained by the
physicians who would otherwise have
to engage in ‘hunt and search’ activities
to locate images as every user knows
exactly where the images are located.
Additionally, Cleveland Clinic has
virtually eliminated the physical delivery
of paper-based medical records, films or
CDs, creating both cost and efficiency
benefits.
Agfa HealthCare’s enterprise workflow
engine is designed to accommodate
these variables by coordinating the
individual department workflows (where
images are generated) with enterprise
and regional workflows (where images
are accessed and collaboration occurs),
while its Enterprise Imaging Suite is able
to ‘connect the dots’ from an image to a
report, building a reference that feeds
back into the EHR and is ‘understandable’
across the entire enterprise.
Another notable benefit has been to backoffice concerns such as risk mitigation.
The Platform allows the hospital
enterprise to take control of protecting
medical imaging information in a secure,
vendor neutral environment, enabling
business continuity and disaster recovery
services. In executing its enterprise
imaging strategy, Cleveland Clinic is
now able to increase value of its medical
images by removing the shackles that
once rendered the images prisoners of the
department that created them.
Says Dr. Petersilge, “Workflow
encompasses everything from creating
a work list on a modality, to order
generation, to notification to the EHR
that a study exists. It is critical that
the workflow fits into the operational
foundation established at the enterprise
level. It is also important that the
workflow enhances and does not
encumber the work of the person
generating the image, otherwise
As to what the future holds, Dr. Petersilge
says, “I believe there will be new ways to
display all of the images that enhance a
clinician’s ability to organize and consume
the information. Additional tools will be
incorporated into the universal viewers
to support needs of a wider spectrum of
imaging modalities. Greater interaction
beyond simple co-display of images
and text information will take an image
enabled EHR to the next level.” W
SPECIAL REPORT HEALTH MANAGEMENT 29
Centre Hospitalier Jacques Lacarin de Vichy, France
At the Jacques Lacarin hospital in Vichy,
a long-term IT strategy supports quality
information and quality care
Agfa HealthCare’s IT solutions come together to help the hospital meet its development
program and regulatory requirements.
INTERVIEW WITH PATRICE JAMES, Director of Information Systems, Centre Hospitalier Jacques Lacarin de Vichy, France
Our relationship with Agfa HealthCare allows us
to take advantage of the opportunities from technical
evolutions, to anticipate things, and ultimately to
expand our vision of the future of healthcare IT.
PATRICE JAMES
Director of Information Systems, Centre Hospitalier Jacques Lacarin de Vichy, France
30 SPECIAL REPORT HEALTH MANAGEMENT
For many years, the Centre Hospitalier
Jacques Lacarin de Vichy (CH Vichy) and
Agfa HealthCare have collaborated in
creating an IT infrastructure that will
support the hospital’s development
program. Agfa HealthCare IT solutions –
from the HEXAGONE* hospital information
system (HIS), to the ORBIS* clinical
information system (CIS), through the
IMPAX radiology information system/
picture archiving and communication
system (RIS/PACS) and now the upcoming
adoption of the HYDMEDIA** enterprise
content management solution – are
helping it to achieve its long-term goals
for patient care and management.
HYDMEDIA integrates with
both ORBIS and HEXAGONE. Plus,
the flexibility of the parameterization
and the powerful search engine were
critical decision factors.
PATRICE JAMES
Director of Information Systems
“My vision for our hospital IT
infrastructure is to have a solution that
covers almost all the major, computerized
functions at the enterprise level – from
administration (especially everything
regarding the patient), to managing
our financial and economic resources,
through to human resources,” says
Patrice James, Director of Information
Systems for CH Vichy. “And of course we
need a strong medical IT part – including
all medical AND nursing information.”
Partnering to solve the real
needs of real hospitals
For fifteen years, CH Vichy has been
a pilot site for the HEXAGONE HIS,
working in close partnership with Agfa
HealthCare and its development team.
With the HIS up and running, the
hospital turned towards eliminating the
information silos that existed throughout
the enterprise. “We were already
implementing our clinical information in
the 1990s,” explains Patrice James. “But
computerizing the patient files was done
individually by department or service.
That’s the problem ORBIS has been
solving for us, decompartmentalizing
each activity within our hospital, and
bringing everything together to create a
true medicalized information system.”
CH Vichy now has a number of ORBIS
functionalities and modules, including
the patient record (diagnoses and
procedures), medical information, PMSI
(the French medicalized information
system program), prescriptions,
medication workflow and supply
management, canteen management,
office/administration and business
intelligence.
Rolling out ORBIS, step by step
The first ORBIS modules to be
implemented were the patient record
(diagnoses and procedures) and the
office/administration module. During
these initial installations, the Agfa
HealthCare team supported the CH
Vichy implementation team. But for
the rest of the modules the Vichy team
was able to act autonomously, explains
Patrice James. “We set up an internal
ORBIS implementation team consisting
of three IT professionals and a nursing
manager, who knows the functioning
of the services much better than the IT
staff! Including a ‘field expert’ in the
implementation team has been a big
factor in our success. For example, when
we implemented the administration/
office functionalities, we brought in a
secretary to provide that insight. We
continue to do this for each new module,
such as the operating theater and
emergency department.”
Patrice James highlights that one of the
most important success factors has been
bringing together into a single activity
pole the IT services and the department
of medical information, finance and
patient management. “This collaboration
allows us to optimize the interface with
the healthcare professionals and to focus
the discussions on the real optimization
issues for our HIS.”
The roll-out process for each ORBIS
functionality or module is essentially the
same. First, the team selects a ‘pilot site’
within the hospital. “We have found that
SPECIAL REPORT HEALTH MANAGEMENT 31
HEXAGONE hospital
information system
 Patient
administration management.
management.
 Human resources management.
 Financial
ORBIS clinical
information system
 Provides
access to shared patient
record and administrative data
anywhere, anytime.
 Allows better patient management
and security.
 Improves collaboration between
healthcare professionals.
 Reduces the risk of administrative
errors, and increases administrative
productivity.
HYDMEDIA enterprise
content management
solution
 Facilitates
information sharing through
integration with ORBIS and the HIS.
 Negates the need for paper and
film‑based documentation.
 Reduces physical archiving space.
 Speeds information retrieval times.
 Reduces costs and increases
productivity.
 Improves disaster recovery capabilities.
a unit with around 15 beds is generally a
good size for the pilot,” comments Patrice
James. Once the pilot site is going well,
the module is launched department by
department.
However, the length of time it takes
to implement a module can vary a lot,
explains Patrice James. “The functionality
for inputting diagnoses and procedures
was implemented across the hospital
in 15 days. The administration/office
module was completed in two months.
On the other hand, the medication circuit
is very complex: we are talking about
the prescription by the doctor, then the
verification by the pharmacist and finally
the administration of the medication by
the nurse. So that module took over a
year to fully implement. You have to be
a bit flexible with the timing: ensuring
a good quality of implementation is the
most important thing.”
32 SPECIAL REPORT HEALTH MANAGEMENT
Solutions that help improve
patient care
CH Vichy has now been using ORBIS
for five years, and the biggest changes
for Patrice James are in the traceability
and the quality of information. “It’s not
just about productivity, although we do
see gains in terms of administration and
secretarial work. For example, structured
documents, such as release letters that
automatically include the patient’s
history, obviously save time and effort,
and reduce the risk of error.”
“But the big benefits are more qualitative:
better patient management and security,
which lead to better care. Take the
medication circuit, which completely
secures the management of the patient’s
medication. That’s key! Having access
to all the relevant information about the
patient in real time also improves patient
care. Finally, being able to see the entire
history when a patient comes to the
hospital, for example to the emergency
department, allows the physicians to
make informed decisions about e.g.
which exams need to be performed,
potentially allowing us to eliminate
repeated exams.”
Agfa HealthCare’s
contribution
Agfa HealthCare and CH Vichy have a
long-term and very close relationship.
Agfa HealthCare works as a partner
with CH Vichy in helping the hospital
to achieve its healthcare and IT goals
and vision.
CH Vichy will be putting the ‘final ORBIS
brick’ in place later this year, comments
Patrice James: the module for the nursing
record will be piloted in September, with
the full implementation expected in
October/November.
Towards the paperless future
Now, CH Vichy is taking its next step in
digitization, with its project to eliminate
paper documentation. “The challenges
we faced had to do with how to manage
the ever-growing archive, how to access
files once they were archived and how
long it would take to access them. We
did an evaluation, based on archiving
and accessing documents from external
consultations only, and found it would
require six medical administration staff
Drug
prescription
via global
formulary
Pharmaceutical
validation
1
2
ORBIS
MEDICATION
4
3
Resupply
at pharmacy
and ward
level
Medication
administration
Medical information was not
circulating between departments.
ORBIS has been solving that for us,
step by step: decompartmentalizing
each activity within our hospital,
and bringing everything
together to create a medicalized
information system.
PATRICE JAMES
(full-time equivalents) doing only that
all day long. So we looked around at
available solutions. HYDMEDIA could
best integrate with our IT infrastructure:
it integrates with both ORBIS and
HEXAGONE. Plus, the flexibility of the
parameterization and the powerful
search engine were critical decision
factors. We began the project mid-2013,
and had our first implementation meeting
in the first quarter of 2014.”
In any case, it is clear that this won’t
be the last technological evolution
for CH Vichy. Already, the hospital is
collaborating with Agfa HealthCare to
develop further improvements to its
solutions. “We’re working on a pilot
for a touchscreen tablet for ORBIS
canteen management which will put
all patient information at the fingertips
of the dieticians, during consultations.
It’s a very interesting way to use new
technology, and it highlights to me how
our relationship with Agfa HealthCare
allows us to take advantage of the
opportunities from technical evolutions,
to anticipate things, and ultimately
to expand our vision of the future of
healthcare IT in our hospital.” W
Did you know...
W The Jacques Lacarin hospital in
Vichy, in the Auvergne region of
France, serves a population of around
140,000 inhabitants, and has a capacity
of 826 beds. In 2012, it counted
over 33,500 emergency room visits
and consultations, almost 20,000
hospitalizations, and over 92,000
outpatient consultations.
W ‘Vichy’ became synonymous with
health in the time of the Romans,
who recognized the therapeutic benefits
of the natural springs in the area.
W The mayor of Vichy, Claude Malhuret,
is a past President of Médecins sans
Frontières/Doctors without Borders
(1977-78) and played a key role in
the current form of the association.
* HEXAGONE and ORBIS are not available in Canada and the U.S.
** HYDMEDIA is not available in the U.S.
SPECIAL REPORT HEALTH MANAGEMENT 33
In profile
BRAD GENEREAUX
Product Manager, Enterprise Imaging, Agfa HealthCare
XERO Viewer – Bridging the imaging
gap for the electronic health record
With new features and functionality, the XERO Viewer is adding even more value
to imaging across the hospital ecosystem.
“There is a wealth of images being
created all over the hospital, and we want
to make sure that this wealth is being
put to good use,” says Brad Genereaux,
Product Manager, Enterprise Imaging,
Agfa HealthCare. “If images can’t be
accessed, they don’t add value.
We want to bring all images to the forefront
of the electronic health record (EHR) so
clinicians can unlock their potential. By
getting the imaging information to where it
is needed most, we will increase diagnostic
comprehension, decrease unnecessary
repeat imaging and, ultimately, significantly
improve patient outcomes.”
And that’s what the XERO Viewer* sets
out to do, he says. By unlocking access
to all of the patient’s images – not only
from radiology or cardiology, but from
every image generating department –
caregivers can finally see the patient’s
entire imaging story. “It makes imaging a
real part of the patient-centric healthcare
model. What’s more, it brings imaging
to all the different players engaged
in patient care: people who haven’t
been able to see or use images in their
workflows will directly benefit. It has
never been more true that an image
is worth a thousand words.
The XERO Exchange Network
can even be used to visualize
imaging data together from
different hospital sites.
BRAD GENEREAUX
Product Manager, Enterprise Imaging, Agfa HealthCare
34 SPECIAL REPORT HEALTH MANAGEMENT
XERO Viewer is a game changer –
leveraging the internet revolution to
support the physicians and enable them
to improve the delivery of patient care!”
Images where you want them
The XERO Viewer is built on zero
footprint technology, and is strictly
web-based: it requires no Java, no
ActiveX, no Flash, no plug-ins, downloads
or installs whatsoever. “All of the image
processing is done on the server, so the
browser only has to display the images,”
explains Brad. While that offers plenty
of flexibility for the traditional desktop
computer, the advantages are even
clearer when using mobile devices.
“More and more, people are using their
own mobile devices for work; managing
clinical hospital software on these devices
is very challenging. Too often we hear
how protected patient data has been
compromised by the loss of a tablet,
phone or laptop. What’s more, mobile
technology evolves so fast! Zero footprint
means the user doesn’t have to keep
up with every new platform: hospital
IT departments can keep pace with
the changes, resting assured that their
viewer is future-protected in this respect.
Plus, we are able to enhance the user’s
experience using the native controls of
the mobile device, like pinch to zoom
on the touch screen.”
Zero footprint also allows the XERO
Viewer to integrate easily into the
hospital’s IT strategy. “It embraces
centralized user management: all acts
of provisioning – creation, modification,
disabling and resetting passwords
– are all done by existing hospital
systems. So CTOs can leverage their
hospital systems with the peace of
mind of knowing that their investments
in security and identity control are
fully utilized. It just snaps right into
the existing security infrastructure.”
Images how you want them
New features are extending the value
of the XERO Viewer even further.
“In the previous version of the viewer,
the images were ‘reference-only’: you
couldn’t use them for diagnosis, because
of the impact of the lossy compression
used.” Lossy compression produces a
much smaller compressed file, more
suited for quick, referential viewing.
“Now, with the upcoming release of the
next XERO Viewer, users will be able
to choose Full Fidelity View* which
uses lossless compression, resulting
in diagnostic quality when images
are displayed.”
Collaboration is enhanced, too, with
real-time sharing and chat. “A physician
reviewing a patient’s study can interact
in real time with other physicians on
the system,” Brad says. “She can chat,
ask questions – and now, share her
screen in real-time with her colleagues.
They see the same images, share the same
cursor, use the same measuring tools,
make mark-ups and more, regardless of
whether they are in the same building or
across the continent.”
“It’s their tool”
The XERO Viewer is also making good
use of harnessing technologies perfected
in other industries, Brad explains.
“One example is the new patient-centric,
interactive timeline. It looks like the
event timelines you might find on news
magazine websites, so it’s a familiar
concept to clinicians. But it is really a
big leap forward in understanding the
patient story. Instead of presenting simple
textual lists of studies, it offers a rich,
thumbnail-enabled, longitudinal view of
all of the patient’s images, study by study,
over time. The user can choose any two
studies, for example, from any point in
time and compare them. For caregivers
who aren’t intimately familiar with
the depths of a radiology PACS (image
management) system, this makes image
viewing a very natural process.”
Other enhancements include being
able to view and interact with DICOM
ECG waveforms alongside any available
reports. Import functionality, called
XERO Capture, enables the uploading
of patient-centric content right into the
EHR, captured on the desktop or from
the camera of a mobile device. Another
feature is the XERO Exchange Network.
“With the XERO Exchange Network,
users can query many imaging systems
simultaneously, such as a radiology PACS,
a cardiology PACS and a VNA, and see
all of the studies available for a patient
together, creating a true longitudinal
record. It can even be used to visualize
imaging data together from different
hospital sites.”
* Pending 510(k) clearance in the U.S. Not available in Canada.
** Google Glass™ and other wearable computing devices mentioned are for illustration purposes only.
Not validated for use with Agfa HealthCare products. Google is a registered trademark of Google Inc.
Glass is a trademark of Google Inc.
Yet with all the benefits, the XERO
Viewer is so intuitive to use, it is almost
invisible to the user. “Robust application
programming interfaces (APIs) allow us
to customize the viewer as the customer
sees fit, so it embeds right into an
application like an EHR; users won’t
even realize it is separate from their
EHR. It becomes their tool. It’s another
way XERO is helping to demystify the
image viewer and make it more ‘natural’
for non-radiologists. And that’s critical
for Enterprise Imaging.”
Part of the EHR experience
“When we look at the direction of
healthcare, towards a patient-centric
model, towards collaborative care,
the XERO Viewer fulfills a major role.
It brings all the players in the patient
care continuum closer together, by
allowing them to access and collaborate
on all of the patient’s imaging studies,
no matter where they are. When you have
connected hospitals, with one investment
in XERO Viewer, clinicians can view,
upload and share images, with a natural
user experience. XERO Viewer becomes
a natural part of the EHR experience, and
it puts images where they belong – at the
heart of healthcare.” W
Making a case
for wearables
With all the hype about wearable
technology**, it isn’t yet clear what impact
it will have or how it can best be used
in any domain. Brad, however, sees real
potential for wearables in healthcare
and predicts that, for this technology,
healthcare might lead the way.
“We have been looking at how to
integrate the XERO Viewer with armbands
that let you control the viewer without
touching the screen. In operating rooms,
for example, that would be a huge benefit.
Combining a Google** Glass™ wearable
computing device with the XERO Viewer
could add another brick to building
patient safety by backing up the patient
ID process. Take a photo of the patient
when they check in. Then before any sort
of procedure, the caregiver scans the
patient barcode and the patient’s image
pops up so the caregiver can physically
see if it is the correct patient.
It’s a question of finding the right fit
with the wearable technology; but
once unlocked, healthcare is poised to
become the primary benefactor in the
wearables revolution!”
SPECIAL REPORT HEALTH MANAGEMENT 35
H. Hartziekenhuis Mol, Belgium
For H. Hartziekenhuis Mol,
the flexibility of the ORBIS platform
offers long-term benefits
ORBIS upgrade brings new functionalities for meeting hospital’s ambitious goals.
INTERVIEW WITH BENNY PEETERS, CIO and DR. IVO JACOBS, Chief Physician and abdominal surgeon, H. Hartziekenhuis Mol, Belgium
Integration: that
summarizes it all.
We have one central
record in which all of
the patient’s information
is collected. The data
is secure, in a single
repository, but accessible
to authorized users.
BENNY PEETERS
CIO, H. Hartziekenhuis Mol, Belgium
36 SPECIAL REPORT HEALTH MANAGEMENT
Since 2008, the H. Hartziekenhuis Mol
has relied on information systems such
as ORBIS* to help it address the evolution
of the Belgian healthcare environment.
Economies of scale, increasing complexity,
higher expectations – from the
government and the patients – have all
combined with the hospital’s own growth
to create new needs. Needs for which
information technology (IT) can play an
increasingly important role.
This 193-bed hospital, with 70 physicians
and 600 staff, has a detailed IT strategy
laid out to address the requirements
of patients, hospital management,
physicians and staff. “Our IT has to
support us in the evolutions and trends
that affect the hospital,” explains Benny
Peeters, CIO. “For example, increased
specialization and professionalization,
information overload, digitization,
the tight labor market, limited budget
maneuverability, strict government
oversight, empowered patients…
The list goes on.”
EPR is a priority in evolving
healthcare environment
In 2008, the ICT Steering Committee and
clinical advisory board jointly decided
to introduce an electronic patient record
(EPR). “This was one of the priorities
of our IT action plan,” comments Benny
Peeters. “So the solution had to meet
strict criteria: firstly, it had to serve
the needs of the medical, nursing and
paramedic staff. Secondly, it had to be
fully integrated into one central patient
record, in which all patient data would
converge.”
The hospital chose to implement ORBIS.
“ORBIS met the extensive specifications
and requirements drawn up by the
steering committee,” Benny Peeters
recalls. “In addition, Agfa HealthCare’s
strength as an international player, plus
our own very positive experience with the
company’s IMPAX RIS/PACS solution in
our hospital, supported this decision.”
Careful project management
for a smooth process
The hospital and Agfa HealthCare
worked out an implementation plan.
“We created three projects/work groups:
for the medical record, the nursing
record and the technical infrastructure
and interfaces. Every department had
representatives or key users in each
working group.” Key users were trained
directly by Agfa HealthCare on how to use
ORBIS. They then taught the other users,
using the ‘train the trainer’ concept.
“Our experience has been very positive,”
explains Benny Peeters. “Our strict policy
for managing the implementation of
new versions of the solution plus the
thorough testing have helped to ensure
that we can limit any disturbances to
end users.”
Thanks to ORBIS, I can work in an almost paperless
way… And wherever I am in the hospital, I always have
‘my record’ at my disposal: I can search for data, print or
forward letters, check results or the complete medical
history and medication list.
DR. IVO JACOBS
Chief Physician and abdominal surgeon
SPECIAL REPORT HEALTH MANAGEMENT 37
ORBIS clinical
information system
WProvides access to shared patient record
and administrative data anywhere,
anytime.
WAllows better patient management and
security.
WImproves collaboration between
healthcare professionals.
WReduces the risk of administrative
errors, and increases administrative
productivity.
way, the EPR has led to an enormous
gain of time, as well as to quality
improvements.”
Creating new possibilities
Now, the hospital is implementing the
latest ORBIS version, which will create
additional opportunities. “This new
version is based on an international
software code. So functions developed in
other countries will be available to all the
ORBIS users, including us.”
ORBIS and its modules fit
very well into our IT policy,
especially in our goals of supporting
primary care processes and
generating data that supports
management decision making.
BENNY PEETERS
Flexible data accessibility and
a streamlined workflow
The big benefit of ORBIS for
H. Hartziekenhuis Mol, says Benny
Peeters, is the integration. “That one
word summarizes it all. We have one
central record in which all of the patient’s
information is collected. The data
is secure, in a single repository, but
accessible to authorized users. Each type
of user – physician, nurse, paramedic, etc.
– has access to the part of the patient’s
record they need. All data is entered only
once, and is digital – so no more errors
from illegible notes! The system offers
referring physicians advantages, too:
structured discharge letters, access to
a more complete patient record, better
communication and collaboration, etc.”
38 SPECIAL REPORT HEALTH MANAGEMENT
Dr. Ivo Jacobs, Chief Physician and
abdominal surgeon, adds: “Thanks to
ORBIS, I can work in an almost paperless
way. My desk is always neat during
patient visits. And wherever I am in the
hospital, I always have ‘my record’ at my
disposal: I can search for data, print or
forward letters, and check results or the
patient’s complete medical history and
medication list.”
He continues: “The tasks of my
administrative staff have also changed
considerably. They used to spend most
of their time archiving documents and
preparing patient visits. Now they have
more time to help the patient and to
coordinate a good preparation of the
patient’s discharge, for example. In this
The upgrade process went very smoothly,
confirms Benny Peeters. “By following
our version management procedures,
everything went according to plan.
The support by Agfa HealthCare’s team
was excellent. We started by performing
the upgrade in a test environment.
After validation, it was fine-tuned, then
implemented in a live environment.
After a few hours, it was up and running.
We had a back-up and recovery plan in
case of emergency, but we didn’t have
to use it.”
ORBIS is now installed in over
20 departments and wards throughout
the hospital, where it is used on a daily
basis. The hospital has several modules,
including Nursing, Operating Room (OP)
and Composer.
Surgery planning tool is the
connecting link
“We are the first in Belgium to use the OP
module,” comments Benny Peeters. “In
a lot of ways, this is the connecting link
for our whole story. In our hospital, we
organize surgical procedures around the
available resources, time slots, etc. The
physicians plan the procedures, and then
the wards must follow that planning, for
example reserving a bed. So a planning
module for the surgery department,
integrated in the EPR, is essential. The
tool also includes functionalities such
as a safety checklist. Since everything
is electronic, potential errors can be
avoided.”
“The module also helps us keep track
of resources used, such as time or
consumable materials used. More and
higher quality information is available,
giving us better management oversight
of the surgery unit.”
Tailoring ORBIS with the
Composer
With the ORBIS software upgrade, the
hospital has also been able to make use of
the Composer module. “This allows us to
develop custom forms, which can then be
bundled into a ‘record’,” comments Benny
Peeters. “For example, we configured our
emergency care record, including the
Manchester triage system (which sorts
patients based on the seriousness of their
condition). This took some time from the
functional analysis to installing it in the
live environment, but we are very happy
with it! ”
With the ORBIS upgrade up and
running, the hospital is looking at
additional modules that will help it
achieve its IT goals. “We’re investigating
all the new modules that are now
available to us. The integration offered
by ORBIS is a big advantage for
new functions.”
He concludes: “ORBIS and its modules
fit very well into our IT policy,
especially in our goals of supporting
primary care processes and generating
data that supports management
decision making. We’ve had a good
experience with the Agfa HealthCare
team: they are professional, experienced
and accessible.” W
Agfa HealthCare’s
contribution
Agfa HealthCare has worked closely
with H. Hartziekenhuis Mol for the new
upgrade, to develop the solution to
meet the hospital’s needs. Together
with H. Hartziekenhuis Mol, the Agfa
HealthCare team implemented ORBIS,
using Prince II project management
principles.
*ORBIS is not available in Canada or the U.S.
SPECIAL REPORT HEALTH MANAGEMENT 39
Case study Evangelisches Krankenhaus Mettmann, Germany
Step-by-step digitization leads
towards the ultimate goal:
the electronic medical record
Evangelisches Krankenhaus Mettmann adopts an integrated comprehensive
solution from Agfa HealthCare.
INTERVIEW WITH BERND HUCKELS, Managing Director, and HANS PETER KLAUS, IT Director
40 SPECIAL REPORT HEALTH MANAGEMENT
The data are
available earlier,
which leads to
faster diagnosis
and treatment
and ultimately to
faster discharge
of the patient.
BERND HUCKELS
Managing Director
Evangelisches Krankenhaus Mettmann
(Mettmann Protestant Hospital) is
taking a step-by-step approach towards
achieving an electronic medical record
(EMR). “With the EMR, we aim to put the
finishing touches on the concept of the
paperless hospital,” is how Managing
Director Bernd Huckels described this
ambitious goal.
“We repeatedly encounter obstacles,
however, either on the technical side
or the data protection side,” he says.
Nevertheless, Huckels is convinced that
the hospital is on the right path; a view
shared by IT Director Hans Peter Klaus:
“I believe that we have now overcome
most of the hurdles. There are hurdles
to integrating with referring physicians,
in particular, that we cannot simply
eliminate. However, we have covered
about 80 percent of the distance to
our goal so far.” To achieve this, the
hospital has made large investments in
recent years. The construction of the
new hospital building was an important
step, as was the annexation of a nearby
doctors’ clinic. “Most recently, we were
able to move into the new hospital
building and new hospital annex. Today
Evangelisches Krankenhaus Mettmann
has almost 300 beds.”
cannot realize all of this on the highest
level without IT support.” The fact that
the IT department employs five people
attests to the important role IT plays
in both primary and standard care.
For Huckels this is quite normal: “Our
hospital operations would come to a
standstill without an IT department
performing on a very high level. To
ensure this, we have to invest in the
smooth operation of this department.”
Integration: a central
decision‑making criterion
Since 2003 the hospital has been
using the ORBIS* hospital information
system (HIS) in the administrative
and medical units. In 2009 it adopted
Agfa HealthCare’s RIS/PACS solution.
“Ultimately, the seamless integration
with the HIS, especially of ORBIS
RIS, was the deciding factor,” recalls
IT Director Klaus. The PACS used by
the radiology practice attached to the
hospital is also integrated, so that the
images can be viewed by the doctors on
the wards. “The system is very fast and
reliable and thus enjoys a high degree
of acceptance among the doctors,”
reports Klaus. To eliminate paper as far
as possible, Evangelisches Krankenhaus
Mettmann launched the current IT
project a year ago. This project entailed
the introduction of a digital document
During this entire period, the digitization
of the hospital was one of the main
areas of activity. “We always kept our
focus on optimizing all the hospital
processes – from admission to discharge.
Profitability is important here, as are
quality and documentation,” says
Huckels. He is convinced that “We
SPECIAL REPORT HEALTH MANAGEMENT 41
management and archiving system
(DMAS). “In the medium term we
want to eliminate mixed-media usage
and make sure that the digital workflows
are being used consistently,” says
Huckels. Previously, it took a day to get
hold of the records of the hospitalized
patients; today the medical and nursing
staff can obtain a rapid and complete
overview with a few mouse clicks. To
achieve this, all data collected from 2004
onwards have been imported from the
old record management system from DVD
into HYDMEDIA**, Agfa HealthCare’s
content management system.
Any paper records collected during
a patient’s stay at the hospital – e.g.
reports from external sources, referrals,
medication instructions, etc. – are
promptly digitized. “We have set up
a dedicated workstation controlled
by the secretarial service. Once the
record is closed, it is handed over and
scanned. Our goal is to have no more
than, say, two pieces of paper in the file,”
explains Klaus.
Precise preparation for
reaching goals
The EMR was introduced according to a
precise plan. First, the various processes
were defined within a project group
consisting of doctors and members
of the nursing staff. Afterwards, the
participants explored how these
42 SPECIAL REPORT HEALTH MANAGEMENT
processes and the accompanying paper
records could be transferred to the IT
system. “To do this in a manner close
to actual hospital practice, we created
a position in the IT department for a
member of the nursing staff who was
familiar with the processes and could
design the corresponding forms,”
explains Klaus.
The aim here was not to simply
reproduce the usual workflows, but rather
to continue them in an intelligent way
into the HIS. For example, if a patient is
admitted to the emergency department
and vital data are collected, these data
are transferred automatically to all of
the related forms, preventing duplicate
recording and eliminating sources of error.
Our hospital
would come to a
standstill without
high-performance
electronic data
processing.
Therefore we have
to invest in the
smooth operation
of this system.
HANS PETER KLAUS
IT Director
The responsible personnel at
Evangelisches Krankenhaus Mettmann
have followed this procedure to look
critically at the current workflows.
The aim has always been to establish
meaningful processes with the support
of the IT department. The procedure
therefore had to be one that could
be implemented with the aid of
electronic data processing (EDP).
For example, the piece of paper at the
patient’s bedside was replaced by the
documentation trolley.
High-performance software
supports stable operation
This preparation shows clearly that
the introduction of the EMR was also
an infrastructure project. Therefore,
the hospital had to create the technical
prerequisites. Regarding the most
important investments, Klaus recalls:
“We set up a closely meshed and
secure WI-FI network throughout the
hospital and purchased two to three
documentation trolleys for each ward.”
He continues, however, that these
steps alone were not sufficient: “Our
new computing center constitutes the
foundation for the secure operation of
the IT systems. We had to make sure
that the doctors and nursing staff could
access the information on their patients
24/7. In this situation a system failure
is not acceptable.” From the point of
view of risk management as well, data
security and protection against failures
play a very decisive role.
* ORBIS is not available in Canada or the U.S.
** HYDMEDIA is not available in the U.S.
As was already the case for the selection
of the RIS/PACS, ‘integration’ was a
critical factor in the decision in favor of
HYDMEDIA. It is Huckels’ conviction that
“interfaces to external systems always
involve high expenditures and great
effort. Only a system from one source can
provide genuinely continuous workflows
with no discontinuities.”
Klaus emphasized, however, that the high
satisfaction that has characterized the
collaboration with Agfa HealthCare to
date also played an important role: “The
Agfa HealthCare solutions are founded on
consistently good programming. A doctor
who is new to our hospital rapidly learns
to work with the system. Moreover, the
quality is high and the technology used
is always state of the art. Looking back,
we can see that the decision we made
11 years ago was exactly the right one.”
This is also shown by the gains in
efficiency that Huckels increasingly
observes: “The data are available
earlier, which leads to faster diagnosis
and treatment and ultimately to faster
discharge of the patient. And when the
already short times in hospital become
even shorter, it is very important that
doctors and the nursing staff can devote
themselves intensively to the patient
during this period. To allow more time
for human interaction, administrative
activities have been minimized and
workflows automated, via the EDP; this
is something the patients appreciate.”
Klaus points to a quantifiable success:
“Today we have a good 25 percent less
paper in circulation. This results in lower
expenditures for printer paper, toner,
printer maintenance, etc.”
And that’s not the end
of the story
Evangelisches Krankenhaus Mettmann
is currently closing another gap with
digital voice recognition. At the beginning
of November, the first department heads
should be able to use the system on a trial
basis. Another project in the pipeline is
to further specify and expand the range
of services offered by the hospital. The
importance of medical collaboration, with
maximum care facilities as well as other
hospitals, is another supporting pillar.
In this way Mettmann Hospital is
always able to offer its patients the best
possible medical care. In this context
as well, IT plays a vital role – in the
area of telemedicine, for example. Not
only are images sent back and forth:
there is also a bidirectional flow of
patient data.
“With HYDMEDIA we are able to transmit
complete electronic patient records
– while observing the current data
protection regulations – to the invoicing
centers of the healthcare insurance
companies, for example. A pilot project
is currently underway,” says Huckels,
providing a glimpse into the hospital’s
present planning. W
SPECIAL REPORT HEALTH MANAGEMENT 43
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Agfa HealthCare Portal
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A gateway to integrated care
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Integrated care is becoming a reality, and hospitals need systems and
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The Portal is the first step to achieving that full integrated care model.
It provides an easy-to-integrate and -use portal for image and results
delivery. With the Portal, Agfa HealthCare has taken the knowledge
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and other data and is extending it beyond the hospital walls, to
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