Password stealing is easy to do over WiFI, it is also easy to prevent if you understand how it is done.
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.
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.
Attending HIMSS18 in Las Vegas? Receive an in-person demo at the Dicom Systems Booth 11649, Hall G. where WinguMD founders will be available.
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.
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
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.
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.
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.
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