We have been digital, using Vivid 7 and Echo Pac, for almost 2 years. We
have a big Heart Failure clinic

I ROUTINELY browse the old images in patients with LV dysfunction, and
ROUTINELY report changes that I have confirmed by direct comparison of
serial studies. It takes very little extra time, because the old
studies are on line (I think we have a Terabyte of storage). It has
improved our ability to make ands confirm diagnoses a lot, and to
recognize changes. I would never go back to having to pull studies out
of an archive. If it's there, you'll use it. If it is not there and
takes effort to get it, you won't.



Jack M. Colman MD, FRCPC
<mailto: j.colman@...>
Division of Cardiology, University of Toronto, at Mount Sinai Hospital,
and
Toronto Congenital Cardiac Centre for Adults at Toronto General
Hospital/UHN
600 University Avenue, Suite 1603
Toronto, ON M5G 1X5
416-586-5288 Fax 416-586-5968



-----Original Message-----
From: Andrew Horning [mailto:ahorning@...]
Sent: June 3, 2004 10:30 AM
To: 'echocardiography@yahoogroups.com'
Subject: RE: [echocardiography] Re: Re: Excelera digital system


I agree that human correction of human mistakes is sometimes required!
But I have a question for y'all: How much do you need to keep online?
I've been in this business with several different manufacturers for a
while now, and have seen that serial analysis is relatively rare across
a broad range of users (hospital, private practice...).
Any offline files feature allows you to (theoretically) keep only unread
studies online, and still offer fairly quick serial analysis if
required. In practice, we've found that people using our Biopacs system
keep a little more than a week's worth of studies online as a
contingency buffer. On the rare occasion that they do need to look up a
prior study's images for side-by-side comparison, it's a simple matter
to click on a prior study icon, see the location of the study, and pop
in a disk or whatever. Is there a magic number of
months/studies/whatever that you think needs to be online? Are online
archival requirements dependent upon practice type or something I might
be missing?

Andrew Horning, RDCS
Clinical Product Engineer
Biosound Esaote
8000 Castleway Drive
Indianapolis, IN 46250

Toll Free: 800.428.4374, ext. 6048
Direct: 317.813.6048

ahorning@...


-----Original Message-----
From: Stam Kapetanakis [mailto:stam66@...]
Sent: Thursday, June 03, 2004 1:57 AM
To: echocardiography@yahoogroups.com
Subject: [echocardiography] Re: Re: Excelera digital system

In theory, this may be correct. In practice, particularly if echoes are
performed by busy clinicians, you may find that patient data entered
onto the machine is not always correct (e.g. a single digit error in
the medical records number), or even absent. And what happens if the
patient has changed name or MRN between serial studies?

Creating a "folder" does not influence the integrity of the study or
series. It's essentially an entry in the "patient" table of the
database, i.e. a unique patient identifier. While there are no perfect
solutions for the scenarios above, I have found this approach practical
- creating a "folder" is simply a matter of confirming patient identity
or choosing/creating a new one.

The "human intervention" is necessary - you may create a patient
unique ID on the echo machine or on the database system, the potential
for error is there. I would argue that this is less significant in such
systems, as the user has to confirm the patient identity.

As for grouping study files into folders... well, suffice to say that
we perform over 10,000 echoes per year, each with 30-80 digital loops.
Our current storage exceeds 2 terabytes. Is it really feasible to have
a database solution that stores this enormous amount of files under the
same directory?

This is not to say that systems such as EnConcert or Xcelera do not
have their problems, but creating is a patient folder is not really an
issue.

Regards,
Stam

On 3 Jun 2004, at 0:29, Christopher Bohl <christopher_bohl -at-
yahoo.com> wrote:

> The fact that you must create folders for patients is quite risky. A
> DICOM solution with conformant database, i.e. structured reporting,
> really should not require the creation of a folder.
>
> The DICOM standard is constructed with a heirearchy of patient, study,
> and series. Every study and the series within the study must be
> attached to the patient. A separate database creates a significant
> potential for lost study and series information. Not to mention the
> analysis data.
>
> A DICOM solution should automatically save and manage the patient,
> study and series data without any operator intervention assuring the
> integrity of the patient information without any risk of loss.
>
> Each DICOM image or loop contains all of the information regarding the
> patient. This information includes vital data such as name,
> birthdate, medical record numbers and other information. This was
> quite deliberate in the DICOM standard development because it helps
> assure patient image data management and integrity.
>
> Any product which does not automatically and seamless file patient,
> study and series information and requires human intervention for study

> management is deficient. Care should be taken when evaluating such
> solutions and selection of product should really be within the DICOM
> standard.
>
> Regards
> cmb




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