The How and Why of DICOMWeb and RESTful API

Part 1: The RESTful API Revolution

With Apple’s recent entry into the EHR market, interoperability in healthcare is attracting more attention.

When it comes to medical imaging integration, interoperability has always had a high bar to entry.

Historically, developers had to rely on the DICOM protocol, which was defined by the American College of Radiology and National Electronic Manufacturing Association. Since hitting the scene in 1983, it is the de-facto protocol built into CT scanners, ultrasound machines, and other digital radiology equipment. Using DICOM requires a very detailed understanding of how it works from the network level to the data structure. The entire standard, if printed, would require a decent size suitcase to carry. If a developer was tasked to use this standard, it required hiring a DICOM consultant to work and acquire a DICOM toolkit program; both very costly and time-consuming propositions.

Fortunately, the DICOM committee started to solve this, first with XML access, then in February 2013, nearly thirty years after the first DICOM standard, RESTful access was formalized. This is now commonly called “DICOMWeb.”

RESTful API has taken the world by storm. Accessing services running on Facebook, Google, Amazon, Azure, Watson or IoT devices means all we need to know is their RESTful API specifications, and use JSON as the language of communication. With these changes, developers no longer require the expense of a DICOM toolkit program or the need to hire specialists.

RESTful API, A Breakthrough in Communication

While fully utilizing, for example, a CT image, would require additional knowledge of the CT itself, for the most part, exchanging and especially retrieving patient and visit information, plus getting images as JPEG or video as MP4 has become very as simple as downloading a photo. DICOM servers can do the conversion work for developers.

 

An example of a DICOM RESTful API Study Query by date range

An example of a DICOM RESTful API Study Query by date range

In the world of medical imaging, DICOMWeb is still relatively new, but products like DICOM System’s Unifier can promote the interoperability of be added into the existing hospital’s imaging network and instantly activate DICOMWeb capabilities over the secure encrypted HTTPS access. As a bonus, the Unifier’s smart routing and proxying allows developers to access many different imaging systems in a hospital network from a single access point.

Now, there is no excuse for not being able to integrate your mobile or cloud app to imaging systems. WinguMD has also switched to DICOMweb to integrate mobile medical photography. We  have switched to DICOMweb primarily for the speed and simplicity of implementing interoperability. Quick implementation means users can start improving productivity in just a few days.

In Part 2, I will dive a bit deeper into the API and services available. 

Test drive Body Map Snap today by contacting us for a free demo

Attending HIMSS18 in Las Vegas? Receive an in-person demo at the Dicom Systems Booth 11649, Hall Gwhere WinguMD founders will be available.

About WinguMD

WinguMD designs, develops and markets Visual Mobile Medical Collaboration and Integration Solutions to enhance care delivery workflow for physicians, suppliers, payers and patients. As a Dicom Systems partner, WinguMD is able to integrate with PACS, EMR, RIS and other vendor platforms as part of your Enterprise Imaging solution.

BodyMapSnap 3.6.8 Is Here

We will be switching over our server with our next major release BodyMapSnap 3.6.8 (we had 8 internal beta iterations) on Friday, 2 February 2018 in the evening. 

There will be a short server downtime surrounding this event.

After the server is up, we will release the 3.6.8 app on the AppStore.

We have made some significant updates and improvements along with the usual "performance and stability" improvements.

Your current 3.5.x version will not support all of the latest API changes we made so the update is mandatory.

We came a long way from 1.0, and you will notice the continued evolution in BodyMapSnap. Rather than providing a lengthy list, I invite you to watch a short 2.5 minute video to see the changes.

 

Encounters and Orders World Mismatch, Our Experience

Encounters and Orders World Mismatch, Our Experience

Our product BodyMapSnap had a humble start, with a vascular surgeon wanting to coordinate his pre-and-post care and developing compliant mobile photo collaboration tool such as Slack to fix the HIPAA issues inherent in social media photo and video apps.

Efficient and accurate care coordination requires a lot of visual elements, including tracking the wound healing process, or checking case planning worksheets to make appropriate pre-operative decisions as a team

As those images accumulate, other clinical users have started to ask why not share some of these images and videos in their PACS/VNAs or EHRs. We’ve found that similar workflows were largely shared by Pediatrics, Orthopedics, Sports Medicine, Dermatology, Wound Care, Podiatry and even Dentistry.

In traditional clinical imaging scenarios, an image acquisition device is considered as a modality (like CTs and Ultrasound). So, to use those devices, an order is made, and radiologists read the images and create reports.

In our development, a few things became very clear:

1.      All those images are centered around an encounter and episode of care.

2.      Not every image is relevant in being associated with medical records, but “exporting” selectimages to PACS/VNA and EHR provides great benefits.

3.      For PACS/VNA imaging orders are typically needed.

This has been the typical clinical integration “impedance mismatch” and has been the subject of many concerns in our own customer discussions.

In this article, we would like to share how we are approaching our solution today to address this impedance mismatch.

Every Study by Default Starts with an Anonymous Encounter

When a clinician launches (or resumes) the BodyMapSnap app, the user is asked whether it is a New Encounter or a continuation of the on-going encounter. In both cases, it does not require a patient name, MRN or order to proceed. The user can proceed to take photos and chat with other users to discuss cases immediately.

Traditional Modality Worklist Starting Point is also Possible

A user is also given a choice to go to open the “Patient List” and select the appropriate patient from the Modality Worklist.

Unified Patient List Mode

If a unified patient/order search* strategy is used in combination with BodyMapSnap, it is also possible to present the unified patient list from the amalgamation of MWL, Prior Studies, and admission events from the EHR feeds.

If appending of a new series to an existing imaging order is permitted, we can “push” selected images into an existing imaging accession.

Automated Order/Accession Generation

Auto order generation and routing strategy* is an option if a patient has already been established and accession generation scheme can be implemented with the customer.

In addition, it is possible to push images to EHRs as an unsolicited order/report and store the image in their “media tab” without an order.

After-The-Fact Push

Any anonymous encounter will “park” on our the BodyMapSnap’s secure server. A user will be able to associate anonymous encounters when a patient or order is established.

Image uploaded from iOS.jpg

OCR to the Rescue

We have an OCR engine** plus a bit of AI and so the encounter has a photo of wrist band, bar-code, QR code, association of anonymous studies and “after the fact” push will be automated. This does not have to be the very first image.

In Conclusion

We have found that a surprising number of clinical users rely on photos to orchestrate efficient and accurate care coordination. We’ve explored many ways to match the encounter based and order based visual imaging workflow and clinical users can have effective choices in realizing both worlds to interoperate. We are hoping better recognition of the encounter based scenarios in medical informatics industries will provide even better support in the coming months.

*WinguMD has tested with DICOM System’s Unifier to realize these functionalities.

** We have integrated with medical grade OCR from EDCO

6 Reasons Why BodyMapSnap is Made for Home Care Providers

If you are a home nursing care provider professional, WinguMD BodyMapSnap’s patient centric visual collaboration features can make significant improvements in the efficiency and accuracy of your care-giving activities while providing medical grade security in all your communications. And you are just one download away to start trying our technology, free.

1. Gain Efficiency and Accuracy: You already use your iPhone to coordinate your daily life to run more efficiently with your family and friends. BodyMapSnap's patient centric approach, unlike other secure medical messaging apps, gives you the care contexts to speed up your work on your iPhones; instantly.

2 .. Mobile & Secure: Record images in patient homes anywhere and anytime, without the worry of HIPAA regulation concerns. Everything is secured from the moment you press the shutter button or type in a message.
 

3. Record Everything: Do not limit the picture taking to patient conditions. For example, instead of jotting down all the medications the patient is taking you can just take the photos of the bottles and bags. Capture insurance card images and consent forms too. BodyMapSnap can recognize those into text so you can always search for them later.

4. Geo Location: BodyMapSnap can keep track of where you took the images. Then use  your iPhone's map and driving directions for revisits and to locate staff closest to the patient.

5. Instantly Chat with Your Team: You can message and instantly alert everyone in your care coordination team to review cases and ask for assistance from your medical staff.

6. Includes Free and Simple Visit Management System: Don't have an Electronic Medical Record (EMR) or Scheduling System? We have a free and simple schedule management system built into BodyMapSnap. You can also search by patient name, medical record numbers and reasons for visits. We can of course integrate with most of your system today or as you grow your own practice.

BodyMapSnap has the free-forever trial tier where you can take as many days as needed to try it. We never delete your photos, and your “view-only” collaborators can use it free any time. Download it from the Apple iTunes Store (from your iPhone) and start gaining the efficiency and security today.