Go to any veterinary trade show and you will hear talk about “open standards” in practice management software (PIMS) and digital radiography. You will hear even more talk about practice management integration. In the past, most of this talk was nonsense talk about vaporware.
The good news is that things are changing in PIMS integration. DICOM modality worklist (MWL) is the first form of integration that uses open standards that is getting traction in veterinary medicine. This year at the Digital Imaging SHOWDOWN and DICOM validation, we are testing DICOM MWL integration. There are many practice management vendors and modality vendors that currently support DICOM MWL and are participating in the SHOWDOWN. The following guide will explain DICOM MWL and what it means to your practice.
What exactly is DICOM MWL?
In the past, entering patient information into the digital radiography machine or ultrasound machine was done by hand by the technician. Despite their best efforts, this process frequently resulted in errors and inconsistent data being stored in PACS. In our clinic, we saw greater than a 20% error rate one day. REMEMBER – all you need to do wrong when entering patient information is miss a capital letter (MClovin is not the same a McLovin to a computer) or type a number differently (001 is not the same as 01 to a computer) and your digital images will be lost forever. Furthermore, future and prior studies will not be grouped together properly in PACS. The need to have correct patient and study demographics quickly became apparent and the Modality Worklist was developed.
The MWL is a server that receives radiology orders from practice management and stores all the study and patient information for that order. When a technologist begins a procedure, he or she searches the MWL server from the imaging device they are going to be using for that procedure. When the worklist on the imaging device is populated, the technologists simply select the study that is going to be performed is selected and the procedure is begun. As such, there is no need for them to type in the study information and there are no errors in the patient information in PACS.
That selection process fills in all the patient and study fields that normally were entered by the technologist. This increases the efficiency of the process. What was ordered in the system is what passes through MWL and is attached to the images(1).
Do you need DICOM modality worklist in your practice?
The easy answer is -yes. You need it. Heck it is cool and is certainly a benefit.
The more difficult answer is – it depends. Vespa’s and Ferrari’s are cool but most of us drive Buddy’s and Subaru’s. As with all things that are cool and nifty, there is a price. DICOM MWL functionality is not generally a standard feature.
At the modality level, obtaining DICOM MWL functionality in your modality may require you to move up to a system with more functionality ($5-10K), or purchase DICOM MWL as an add on feature (1-2K). In other cases, DICOM MWL is included in the purchase price.
At the PIMS level, DICOM MWL, if it is available, is usually offered as a standard feature but some PIMS vendors will charge you ($~1000+) to configure the service.
As you can see, DICOM MWL is not a free service so you need to decide if this added functionality is essential to your practice. If you are an emergency or referral hospital the decision for DICOM MWL is a no brainer. Get it and stop the nonsense of trying to save a few bucks. It will save you headache and hassle in the future.
If you are a 1-2 doctor practice, you need to weigh the pro’s and con’s. The benefit of DICOM MWL is not as clear because you probably won't have as many cases to make errors on and you can probably locate old cases manually if needed.
When buying PIMS or digital radiography it is probably best not let the tail wag the dog.
Remember – DICOM MWL uses open standards. In theory, this should mean that you should be able to use any PIMS and any digital radiography or ultrasound machine the supports MWL and they should be able to talk with one another. This is analogous to your cell phone. You don’t care if the person on the other end uses Verizon, T-mobile, or AT&T* because you will be able to talk with them.
At this year’s SHOWDOWN we are independently validating vendor claims for conformance with the DICOM MWL standard. See the list of vendors who are offering this functionality that have passed the test. Please check back as we update this list as more vendors complete their testing.
When shopping for a digital system you will see that some vendors really do not care what digital system you purchase. For example, this is a list of tested systems that one vendor can interface with ** This list is only possible because the PIMS vendor and digital vendors use open standards. There is no need for them to build proprietary interfaces for their machines to talk with one another.
In other cases your salesperson will tell you things like “we strongly recommend that you buy system “x.” or we “only integrate with” system “y.” In most cases, these are proprietary bridges or kickback schemes used to influence your purchase decisions. In these types of situations, you should be cautious because proprietary schemes lock you into relationships with two vendors. In the future you will not be able to switch either vendor and maintain your current level of functionality. Since PACS and digital software is likely a 5 year purchase, proprietary bridges can be a short sighted solution and may not be the best way to go.
It should be noted, however, that the aforementioned proprietary schemes may offer functionality that is not offered by DICOM MWL. For example, some proprietary schemes offer interesting ways to tightly integrate billing between PIMS and digital radiography. If these functions are important to your practice, the benefits of going proprietary may outweigh the risks of a proprietary bridge. Do your research and understand what you are buying.
(1) http://www.pacs-admin.com/Modality_Worklist.html
* Actually you might care if they use AT&T. If they do, they will likely drop your call and you wont be able to talk with them. The conversation will go like this. Hey Sparky. How are you doing? Great. Did I lose you. Hello. Hello. Dang it. When you call back the conversation will go like this. “Hey – sorry about that. I dropped your call. Are you there. Hello. Dang it. I hate AT&T. Please Mr. Jobs… please let me jailbreak this stupid thing”
** I have no association with this vendor. If there is any other vendor who feels slighted or thinks I am impartial for including this list. Well, it is the only list that I know of that is available to the veterinary community. If you have a list, I am happy to include it. Just send it to me. Better yet - how about helping me organize a connect-a-thon so we have a public list. The Western Veterinary Conference offered us the space. All we need is a sponsor. Hmmm...VCA/Antech/Sound/Eklin - how about it? You have a few systems that support open standards. Wouldn't it be cool if you bought a new hospital and you didnt care what PIMS they had and you could just plunk in a new digital system and not worry about lost revenue or data entry errors? Come on, you are the gorilla in the room. It is your job to pressure the market to improve and look toward the future. I am happy to play the impartial mediator, facilitatior, and all around "get it done" guy. Contact me if you are interested. Red rover, red rover, send VCA/ANTECH/SOUND/Eklin over.
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