Yuanyuan Yang

Web-based electronic patient records for collaborative medical applications

Abstract We developed a web-based system to interactively display electronic patient records (EPR), such as DICOM images, graphics, and structure reports and therapy records, for intranet and internet collaborative medical applications. This system has three major components, a C/S (client/server) architecture for EPR data acquisition and authoring, and a Web B/S architecture for data delivering. The Web viewer of this system integrates multi-media display modules and remote control module together to provide interactive EPR display and manipulation functions for collaborative applications. We have successfully used this system two times to provide teleconsultation for severe acute respiratory syndrome (SARS) patients in Shanghai Infection Hospital and Xinhua Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could use this system interactively to manipulate and navigate the EPR objects of the SARS patients to facilitate a more precise diagnosis. This paper gives a new approach to create and manage image-based EPR from actual patient records, and also presents a novel method to use Web technology and DICOM standard to build an open architecture for collaborative medical applications. The system can be used for both intranet and internet medical applications such as tele-diagnosis, teleconsultation, and distant learning.

Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai

PurposeDue to the rapid growth of Shanghai city to 20 million residents, the balance between healthcare supply and demand has become an important issue. The local government hopes to ameliorate this problem by developing an image-enabled electronic healthcare record (EHR) sharing mechanism between certain hospitals. This system is designed to enable healthcare collaboration and reduce healthcare costs by allowing review of prior examination data obtained at other hospitals. Here, we present a design method and implementation solution of image-enabled EHRs (i-EHRs) and describe the implementation of i-EHRs in four hospitals and one regional healthcare information center, as well as their preliminary operating results.MethodsWe designed the i-EHRs with service-oriented architecture (SOA) and combined the grid-based image management and distribution capability, which are compliant with IHE XDS-I integration profile. There are seven major components and common services included in the i-EHRs. In order to achieve quick response for image retrieving in low-bandwidth network environments, we use a JPEG2000 interactive protocol and progressive display technique to transmit images from a Grid Agent as Imaging Source Actor to the PACS workstation as Imaging Consumer Actor.ResultsThe first phase of pilot testing of our image-enabled EHR was implemented in the Zhabei district of Shanghai for imaging document sharing and collaborative diagnostic purposes. The pilot testing began in October 2009; there have been more than 50 examinations daily transferred between the City North Hospital and the three community hospitals for collaborative diagnosis. The feedback from users at all hospitals is very positive, with respondents stating the system to be easy to use and reporting no interference with their normal radiology diagnostic operation.ConclusionsThe i-EHR system can provide event-driven automatic image delivery for collaborative imaging diagnosis across multiple hospitals based on work flow requirements. This project demonstrated that the grid-based implementation of IHE XDS-I for image-enabled EHR could scale effectively to serve a regional healthcare solution with collaborative imaging services. The feedback from users of community hospitals and large hospital is very positive.

DICOM Image Secure Communications With Internet Protocols IPv6 and IPv4

Image-data transmission from one site to another through public network is usually characterized in term of privacy, authenticity, and integrity. In this paper, we first describe a general scenario about how image is delivered from one site to another through a wide-area network (WAN) with security features of data privacy, integrity, and authenticity. Second, we give the common implementation method of the digital imaging and communication in medicine (DICOM) image communication software library with IPv6/IPv4 for high-speed broadband Internet by using open-source software. Third, we discuss two major security-transmission methods, the IP security (IPSec) and the secure-socket layer (SSL) or transport-layer security (TLS), being used currently in medical-image-data communication with privacy support. Fourth, we describe a test schema of multiple-modality DICOM-image communications through TCP/IPv4 and TCP/IPv6 with different security methods, different security algorithms, and operating systems, and evaluate the test results. We found that there are tradeoff factors between choosing the IPsec and the SSL/TLS-based security implementation of IPv6/IPv4 protocols. If the WAN networks only use IPv6 such as in high-speed broadband Internet, the choice is IPsec-based security. If the networks are IPv4 or the combination of IPv6 and IPv4, it is better to use SSL/TLS security. The Linux platform has more security algorithms implemented than the Windows (XP) platform, and can achieve better performance in most experiments of IPv6 and IPv4-based DICOM-image communications. In teleradiology or enterprise-PACS applications, the Linux operating system may be the better choice as peer security gateways for both the IPsec and the SSL/TLS-based secure DICOM communications cross public networks

Image-Based Electronic Patient Records for Secured Collaborative Medical Applications

We developed a Web-based system to interactively display image-based electronic patient records (EPR) for secured intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), image-based EPR repository server (EPR-Server), Web server and EPR DICOM viewer (EPR-Viewer). In the EPR-GW and EPR-Viewer, the security modules of digital signature and authentication are integrated to perform the security processing on the EPR data with integrity and authenticity. The privacy of EPR in data communication and exchanging is provided by SSL/TLS-based secure communication. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications

Implementation methods of medical image sharing for collaborative health care based on IHE XDS-I profile

Abstract. IHE XDS-I profile proposes an architecture model for cross-enterprise medical image sharing, but there are only a few clinical implementations reported. Here, we investigate three pilot studies based on the IHE XDS-I profile to see whether we can use this architecture as a foundation for image sharing solutions in a variety of health-care settings. The first pilot study was image sharing for cross-enterprise health care with federated integration, which was implemented in Huadong Hospital and Shanghai Sixth People’s Hospital within the Shanghai Shen-Kang Hospital Management Center; the second pilot study was XDS-I–based patient-controlled image sharing solution, which was implemented by the Radiological Society of North America (RSNA) team in the USA; and the third pilot study was collaborative imaging diagnosis with electronic health-care record integration in regional health care, which was implemented in two districts in Shanghai. In order to support these pilot studies, we designed and developed new image access methods, components, and data models such as RAD-69/WADO hybrid image retrieval, RSNA clearinghouse, and extension of metadata definitions in both the submission set and the cross-enterprise document sharing (XDS) registry. We identified several key issues that impact the implementation of XDS-I in practical applications, and conclude that the IHE XDS-I profile is a theoretically good architecture and a useful foundation for medical image sharing solutions across multiple regional health-care providers.

Using deep learning for content-based medical image retrieval

Content-Based medical image retrieval (CBMIR) is been highly active research area from past few years. The retrieval performance of a CBMIR system crucially depends on the feature representation, which have been extensively studied by researchers for decades. Although a variety of techniques have been proposed, it remains one of the most challenging problems in current CBMIR research, which is mainly due to the well-known “semantic gap” issue that exists between low-level image pixels captured by machines and high-level semantic concepts perceived by human[1]. Recent years have witnessed some important advances of new techniques in machine learning. One important breakthrough technique is known as “deep learning”. Unlike conventional machine learning methods that are often using “shallow” architectures, deep learning mimics the human brain that is organized in a deep architecture and processes information through multiple stages of transformation and representation. This means that we do not need to spend enormous energy to extract features manually. In this presentation, we propose a novel framework which uses deep learning to retrieval the medical image to improve the accuracy and speed of a CBIR in integrated RIS/PACS.

Medical imaging document sharing solutions for various kinds of healthcare services based on IHE XDS/XDS-I profiles

One key problem for continuity of patient care is identification of a proper method to share and exchange patient medical records among multiple hospitals and healthcare providers. This paper focuses in the imaging document component of medical record. The XDS-I (Cross- Enterprise Document Sharing – Image) Profile based on the IHE IT-Infrastructure extends and specializes XDS to support imaging “document” sharing in an affinity domain. We present three studies about image sharing solutions based on IHE XDS-I Profile. The first one is to adopt the IHE XDS-I profile as a technical guide to design image and report sharing mechanisms between hospitals for regional healthcare service in Shanghai. The second study is for collaborating image diagnosis in regional healthcare services. The latter study is to investigate the XDS-I based clearinghouse for patient controlled image sharing in the RSNA Image Sharing Network Project. We conclude that the IHE XDS/XDS-I profiles can be used as the foundation to design medical image document sharing for Various Healthcare Services.

Design of e-Science platform for biomedical imaging research cross multiple academic institutions and hospitals

More and more image informatics researchers and engineers are considering to re-construct imaging and informatics infrastructure or to build new framework to enable multiple disciplines of medical researchers, clinical physicians and biomedical engineers working together in a secured, efficient, and transparent cooperative environment. In this presentation, we show an outline and our preliminary design work of building an e-Science platform for biomedical imaging and informatics research and application in Shanghai. We will present our consideration and strategy on designing this platform, and preliminary results. We also will discuss some challenges and solutions in building this platform.

Design of image sharing and exchanging for cross-enterprise and cross-domain collaborative healthcare in Shanghai

We designed the image-enabled EHR sharing solution (i-EHR) for cross-enterprise and cross-domain with SOA architecture and combined the grid-based image management and distribution capability, which are compliant with IHE XDS-I/XCA integration profiles. We selected one districts with four hospitals and two hospital groups as image sharing pilot testing bed. Our approach presented in this presentation uses peer-to-peer mode to share and exchange image data cross enterprise PACSs and domains, which provides single point of services to local systems so it is easy to integrate with different vendors PACS and easy to deploy to different hospitals to implement the i-EHR.

Design and implementation of GRID-based PACS in a hospital with multiple imaging departments

Usually, there were multiple clinical departments providing imaging-enabled healthcare services in enterprise healthcare environment, such as radiology, oncology, pathology, and cardiology, the picture archiving and communication system (PACS) is now required to support not only radiology-based image display, workflow and data flow management, but also to have more specific expertise imaging processing and management tools for other departments providing imaging-guided diagnosis and therapy, and there were urgent demand to integrate the multiple PACSs together to provide patient-oriented imaging services for enterprise collaborative healthcare. In this paper, we give the design method and implementation strategy of developing grid-based PACS (Grid-PACS) for a hospital with multiple imaging departments or centers. The Grid-PACS functions as a middleware between the traditional PACS archiving servers and workstations or image viewing clients and provide DICOM image communication and WADO services to the end users. The images can be stored in distributed multiple archiving servers, but can be managed with central mode. The grid-based PACS has auto image backup and disaster recovery services and can provide best image retrieval path to the image requesters based on the optimal algorithms. The designed grid-based PACS has been implemented in Shanghai Huadong Hospital and been running for two years smoothly.