Many of us happened in situation when in policlinic do X-ray or fluorography, and then it is necessary to bear independently to the doctor these big and inconvenient pictures. And how many kilograms of nerves we spend, standing in queues in registry to receive the medical records which often do not appear on site or in general are lost. How many the person — days we spend, retelling doctors of history of the diseases and illnesses, forgetting important parts and exaggerating the little significant?
It is possible to give such true-life story of one of our employees: in youth he has had pneumonia therefore all next years on photofluorograms shading in lung was registered. The district doctor perfectly knew about it. But once the hero of this history had to do fluorography in other policlinic. And there, having seen spot, it was nearly hospitalized violently, having suspected tuberculosis. No stories about pneumonia have helped, it was necessary to go to the policlinic, to ask the old pictures and to carry them as the proof. But even after that looked sideways at it and tried to force to do control pictures weekly. And after all all these inconveniences and hassles could be avoided, at us in the country be well developed system of storages of medical data of regional and city levels. The doctor could come there and open all history of diseases of the patient since birth. The set of questions would be removed and time a great lot is saved.
Lack of the storage systems aggregating medical information is characteristic not only for the cities and regions. Many networks of policlinics, and also the large hospitals, clinics and the medical centers having on some body too still have no own single systems of storage. And the doctor, accepting the patient in one body, it is forced to request physical records from doctors from other body if that is demanded by procedure of diagnostics and treatment.
There is also one more problem resulting from lack of single systems of storage. It is not so obvious. Various pictures and results of researches "settle" in local storages of devices and devices in which they have been received. And in connection with limitation of available memory the oldest records periodically are removed. Therefore if you were investigated a few years ago and you needed to receive these results, that is risk that they are already deleted.
Vendoronezavisimy archives of medical images
The modern medicine operates with the various data obtained during researches of patients by radiodiagnosis method: radiographic pictures, results of ultrasonography, MRT and computer tomography, echocardiograms and many other. Most often results of research are presented in the graphic form. And traditional way of exchange of these data is printing on the printer with the subsequent sending. With everything the inconveniences following from this.
The majority (if not all) from these devices support the industry DICOM medical standard (Digital Imaging and Communications in Medicine). It is the industry standard of creation, storage, transfer and visualization of medical images and documents of the inspected patients. For information transfer from the medical equipment in PACS — system (Picture Archiving and Communication System) and for communication between PACS — systems use TCP/IP.
Most of vendors of the medical equipment deliver together with the products also PACS and workstations for processing of researches by doctors — diagnosticians. But possibilities of similar solutions are limited as hardware manufacturers, as a rule, do not set the task of creation of global storage systems of researches. And besides, wish to protect the interests on delivery of workstations (enough expensive). For example, vendors of the medical equipment "tie" consumers to the workstations, using when saving of the processed research the so-called "proprietary" DICOM tags which do not allow to work normally with these researches from workstations of other vendors. The problem becomes sharper if clinic (or network of clinics, or even the region) decide to change the supplier of PACS/workstations. Projects on migration can take months, and in certain cases fail.
As you understand, such problem could not remain without solution. Today for creation of the centralized archives of medical images so-called vendoronezavisimy archives (VNA – Vendor Neutral Archive) from the companies which are not suppliers of the medical equipment are used. These archives also work under the DICOM protocol, and in DICOM — network, naturally, are present as PACS. The Vendoronezavisimost is provided with converting of proprietary tags in public at the time of signing up of research in archive. Naturally, each supplier of VNA declares full vendoronezavisimost. But as vendors of the medical equipment do not publish, for obvious reasons, information on use of proprietary tags, real degree of vendoronezavisimost depends only on experience of the specific supplier of VNA. The more projects are implemented, than they are more large-scale, the more different PACS from different suppliers was integrated into archive, the it is more at the supplier of experience and information on use of proprietary tags. And the quicker its reaction in case of change by any vendor of the medical equipment of methods of use of these most proprietary tags.
Besides, at creation of global archives of level of the region or even country experiment of the supplier of VNA on management of very big arrays of information, including in the infrastructure distributed on several TsOD is also important. After all the size of one DICOM — research, for example, of MRT, can reach 4,5 Gb. Risks are obvious — the supplier of VNA can declare its solutions to work with any information volumes determination, and upon it can appear that already about the first several terabyte response time at archive grows. Happens even that there are losses of information.
For solution of the problem of dependence on terminal (expensive) workstations suppliers of VNA offer as a part of means solutions for viewing of medical researches. At some suppliers it is simply facilitated browser, at some — full (often, web — based) workplace of the doctor — the diagnostician.
In our country such archives of level of the region have started being under construction during mass implementation MIS (Medical Information System) within the program of upgrade of health care. Some regions have successfully constructed such archives and operate though, as a rule, not all clinics of the region are connected to archive, and not all researches of the even connected clinics get to the central archive. Now Ministry of Health of the Russian Federation has inhaled new life in these projects, having included creation of regional archives in road map till 2018.
Solution from EMC
The standard architecture of the vendoronezavisimy archive of medical images offered EMC looks as follows:
- LPU — lechebno — preventive establishment: hospital, policlinic, medical center, etc.
- Modality — the device for medical researches: radiographic installation, computer tomograph, device ultrasonography, etc.
- The browser of researches — is the main tool of doctors for work with data. It represents web — the application written on HTML5 that allows it to work even at weak "thin clients". Thus the browser possesses all opportunities of the workstation. In Europe it is licensed as means of diagnostics and can fully be used when setting the diagnosis.
Medical devices — modalities — generate data of researches which get on the local caching server (DICOM — the gateway). It is necessary for ensuring uninterrupted operation of work on case of lack of communication with the central storage. If communication stable, data automatically go from the gateway to storage if communication is unstable, data go according to the schedule or in process of emergence of communication. On caching the server data are stored for some time which depends on server SHD capacity. And all requests from "thin clients" are processed at first by the caching server and if the necessary information on it is not present, it is requested in TsOD.
Providing vendoronezavisimost and confirmation of possibility of creation of global archives is based on huge experience of EMC. Specifics of our products — management of huge information volumes both on hardware, and at the programming layer. In our portfolio large number of the implemented solutions, including projects of level of the country (for example, Finland).
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