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VA/DoD and VA to VA Image Sharing by 4o2Oob8


									VA/DoD and VA to VA Image
           Class 755
 Julian Werfel and Roger Coney
Cumulative Images Captured 2003-2010
            Image Sharing
• Provides more patient information to
  use in diagnosis and treatment
• Reduces number of procedures for
  patient by making remote data
• Saves money by reducing procedures
• Saves patient and staff time

“A picture is worth a thousand words”
      VA Remote Image Views

• Clinical Display communicates across
  the VA WAN to retrieve images from
  the VistA Imaging systems at remote
  VA facilities
       VA/DoD Image Sharing
• NDAA (National Defense
  Authorization Act) El Paso pilot to
  share radiology images and
  reports with DoD
• Full access to patient record
• DoD provides images to VA,
  viewed in Clinical Display
       VA/DoD Image Sharing
• Provide VA images to DoD users
• Particularly important for Polytrauma
• Transfer images in DICOM with JPEG
  2000 compression
• Thumbnail, Lossy, and Lossless quality
• Realized as the VIX service – Imaging
  Patch 83
   VIX for VA/DoD Image Sharing
• VistA Imaging Exchange (VIX) Service
• VIX implemented as part of VISA
  (VistA Imaging Service Architecture)
  – Encapsulates VistA Imaging behind well
    defined interfaces - SOA
  – Standards based: JPEG2000, DICOM, XCA
• Clinical Display requests DoD images
  from site VIX
• DoD images available to clinicians
  since Patch 72 Display client
    VA/DoD Sharing Field Testing

• All sites with Imaging Patch 83 can see DoD
     View DoD Radiology Images

• View DICOM Radiology images for shared
  patients from the 7 original DoD NDAA sites
• BHIE Image Adapter (BIA) requests DoD
  images from site PACSi (analogous to VIX)
• Compression and caching to boost
 View VA Radiology Images in DoD

• Provide DICOM radiology images for shared
• Access images from all VA sites with a VIX
• Available to DoD facilities with a PACSi server
• Images viewable from the web based Advanced
  Medical Image Viewer (AMIV)
          Imaging Patch 72
• DoD images integrated with VA images
  Enhanced Remote Image Views

• Access remote VA images through VIX
• Remote VA and DoD images now
  available to VistARad in Imaging Patch
       Enhanced RIV Benefits
• Take advantage of VIX Caching and
  – Image is compressed at source before
    transfer over WAN
  – Image cached at local and remote VIX
• VIX handles remote connection rather
  than client
  – Fewer connections over WAN
• Enhanced RIV seamless to user
Enhanced RIV Image Quality
          Imaging Patch 93

• Updated user interface
      Viewing Remote Images

• DoD accessible same as VA data
        Viewing DoD Images

• Accessing images from DoD same as
Viewing DoD Images
        Viewing DoD Images

• No special tools for DoD, same as VA
            Comparing VA and DoD images
                BHIE PATIENT

DoD Image                                                  VA Image
WBAMC 03/2007                                              El Paso 10/2001

                               Area of Clinical Interest
        VistARad and the VIX
• View images and reports from DoD
• View images, reports and requisition
  reports from remote VA sites
• Monitor exam lists from remote sites
  without requiring user to login
• Exams from remote sites integrated
  with exams from local site
        VistARad Manager

• VistARad Manager shows exams from
  multiple sites including the DoD
VistARad Displaying DoD Images
        Monitor Remote Sites

• Monitor remote sites without logging in
   Support New DoD Architecture

• HAIMS, the Healthcare Artifact and Image
  Management Solution, will replace the NDAA
  El Paso solution in the DoD enterprise
• NDAA El Paso pilot will be sustained through
  the transition
• No changes will be required to the VA
   Providing VA Images to DoD with

• No changes will be required to the VA
         VA/DoD Artifact Sharing
• Share Artifacts
     – Non radiology images
•   NCAT (Neurocognitive Assessment Test)
    reports from DoD
•   Bidirectional
•   Implemented with IHE profile Cross
    Community Access (XCA)
•   Development in progress
   Expanding the VIX – the CVIX
• Centralized VistA Imaging Exchange
  (CVIX) Service
• Enterprise gateway for image sharing
• Currently deployed in AITC (Austin
  Information Technology Center)
• Highly Available, Load Balanced,
  Clustered Deployment
• Based on the VIX design
             CVIX Provides
• Artifacts available to VA Users
  – Artifacts from HAIMS
  – NCAT (Neurocognitive Assessment Test)
• Artifacts from VA to DoD
• Radiology sharing through CVIX
• Support Future Interfaces
  – NHIN (National Health Information
  – VLER (Virtual Lifetime Electronic Record)
View DoD Artifacts and Radiology

•   CVIX retrieves HAIMS artifact and radiology lists from the BHIE
    Framework for viewing by VistA Imaging client applications
•   CVIX retrieves HAIMS artifact lists from the BHIE Framework for
    viewing by VA applications
•   CVIX retrieves HAIMS and NCAT artifacts for viewing by VistA
    Imaging client applications – Imaging Patch 104 (June 2010 –
    Pending Approval)
Providing VA Artifacts and Radiology
      Images to DoD with CVIX

• CVIX provides VA study and artifacts lists to the BHIE
  Framework for consumption by HAIMS
• CVIX provides radiology images to the BHIE framework for
  consumption by HAIMS
• CVIX provides artifacts directly to the HAIMS gateway
     Image Enabling VistaWeb
• VistA Imaging providing Advanced
  Web Image Viewer (AWIV) to
  VistaWeb for image viewing
• View images associated with Progress
  Notes and Radiology Reports
• VistaWeb users can view VA images
  within VistaWeb
• Similar to CPRS/Clinical Display
• VistaWeb version 12
• Uses components from Clinical Display
• Easy access from VistaWeb
• Does not show all images stored in
  VistA Imaging
• Will view DoD Radiology and artifacts
  in future
• AWIV uses Centralized VistA Imaging
  Exchange (CVIX) server
• Currently in field testing (June 2010) –
  Imaging Patch 105
   VistaWeb Viewing VA Images

• AWIV retrieves all images from CVIX
• CVIX communicates with VA sites with
  and without a VIX
     VistaWeb Progress Notes

• New icon indicates images are
  associated with note
AWIV Viewing VA Note
AWIV Viewing VA Note
    VistaWeb Radiology Reports

• New icon indicates images are associated
  with report
AWIV Viewing VA Radiology Image
  VistaWeb Viewing DoD Artifacts

• Prototype of Artifact Sharing
• Future Development
AWIV Viewing NCAT Report
AWIV Viewing DoD Artifacts
 VA/DoD Radiology Sharing Today

• DoD radiology images available in
  Clinical Display and VistARad
     AWIV Viewing VA Images

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

• DoD Artifacts available in Clinical Display
• HAIMS providing artifacts and radiology
• Field Testing December 2010
Server Deployment Changes - 2011

• CVIX clustered and moved to
• NDAA fully replaced by HAIMS
AWIV Viewing DoD Artifacts - 2011

• Artifacts available in VistaWeb and
     Image Sharing Big Picture
• Sharing of images improves patient
• VA users can now view Radiology
  Images from VA and DoD in Clinical
  Display and VistARad
• DoD can view VA images
• VistaWeb users can view VA images
  with AWIV
• Artifact sharing with DoD coming soon
  VIX Makes Image Sharing Work
• VIX provides access to images for VA
  and DoD
• Improves performance within VA
• VIX is reliable
• Optimized for delivery of images as
  quickly and safely as possible
• VIX encapsulates functionality with
  standards using VISA
Julian Werfel
(240) 638-2634

Roger Coney
(240) 638-2604
       VIX Development Team
• Julian Werfel (
• Keith Buck (
• Chris Beckey
• Csaba Titton (
• Roger Coney (
             Shared Modalities
•   CT – Computed Tomography
•   CR – Computed Radiography
•   MR – Magnetic Resonance
•   US - Ultrasound
•   DX – Digital Radiography
•   RF – Radio Fluoroscopy
•   NM – Nuclear Medicine
•   XA – X-Ray Angiography
•   PT – Positron Emission Tomography
•   DS – Digital Subtraction Angiography

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