Authored By John Hansen, Director of Product Management, Synapse VNA

The mobile workforce has arrived in healthcare. Smartphones and tablets have become ubiquitous in the workplace and are increasingly being used at the point of care. Meanwhile, healthcare organizations are increasingly investing in vendor neutral archive (VNA) technology to embark on their enterprise imaging journey and have recognized mobile solutions for point-of-care imaging is an essential aspect of their strategy. 

These enterprise imaging strategies must account for  mobile solutions capturing images at the point-of-care. Thinking about the convergence of mobile and enterprise imaging, here are three areas of importance, and what to look for in a well-designed solution to capture images at the point-of-care.

1. Improve Productivity. Health care professionals are some of the most patient and compassionate people on earth, but not when it comes to dealing with poorly designed software applications that slow them down, add steps and are frustrating to use.

Software solutions intended for use by health care professionals must be intuitive,  elegantly simple to use, require minimal training and enhance productivity. The software should be harmonized to the workflow at the point-of-care, rather than requiring the care provider to conform to a poorly designed workflow built into the applications.

Speed to the ‘capture flow’ with the fewest clicks and steps possible are essential. The time between when a care provider decides to capture point-of-care images to the time when they are capturing images should be as instantaneous as possible. For example, this may start  with facial recognition or touch ID for authentication. Manual entry of username & password is a productivity killer at the point-of-care.

Manual patient lookup is another productivity killer. An intelligent, department-specific, easily navigable patient list is preferred. The patient list should be encounters-based and not require orders to be placed ahead of time. Alternatively, a barcode scan is also preferred over manual patient lookups.

Once in the capture flow, applications need to enable the user to do everything quickly and seamlessly in a single experience to improve productivity. For example, a form should be provided to capture supporting documentation such as body site, clinical notes and observations at the point-of-care. We shouldn’t force the care provider to capture images in one place and document those images in another.

2. Improve Care. The ultimate objective of any point-of-care solution should be to improve patient care. If implemented properly, mobile solutions to capture patient photos, videos and audio clips at the point-of-care can positively impact care. 

Care providers require access to imaging from across the enterprise to see the full patient picture so they can make better informed decisions on behalf of their patients. This includes images taken at the point-of-care. For maximum benefit, this content must be available in the context of the patient record in the EHR, be easily accessible to the care team, and include body site labeling for those close up photos where it may be difficult to discern the body site and laterality.

3. Risk Reduction. Simply enter ‘HIPAA data breach’ into your favorite search engine and you’ll get the idea. HIPAA data breaches (and corresponding lawsuits and fines) can be costly to healthcare providers and tarnish their reputation in their markets.

Increased security and risk reduction are a major aspect of the overall VNA value proposition and securing the mobile workforce is a win-win for the organization.

In absence of a secure mobile application, care providers may be tempted to use the native features of their own device resulting in PHI on their device which exposes the organization to risk. A well designed mobile capture solution should ensure no PHI is stored on the mobile device thereby eliminating the risk of PHI leaving the premises inadvertently. 

Healthcare organizations have seen for some time the introduction of mobile image capture during patient procedures. What has been missing are the workflows and solutions to support these images being accounted for in the patient record. With a valued partner and an overall enterprise imaging strategy, the VNA can provide seamless solutions to the end user to capture, store and manage these images, all in a secure location- which in the end are accessible throughout your organization in the EHR. 

By Laurence Yudkovitch, Product Manager – Synapse VNA, TeraMedica Division of Fujifilm

The COVID-19 pandemic has upended most office environments across the globe, and healthcare is no exception. Much of the world is under social distancing and stay-at-home guidelines. To limit the spread of disease and conserve scarce personal protective equipment (PPE), many hospitals have closed outpatient departments and cancelled elective procedures and visits. Many providers have transitioned to telehealth, with doctors treating patients in the comfort and safety of their home. Along with EHRs and telemedicine portals, enterprise viewers make it easier to treat patients outside the walls of traditional healthcare environments.

Enterprise viewers, also known as universal viewers, provide any member of the care team access to a patient’s medical images. Typically, a clinician launches the viewer from the EHR while reviewing a patient’s chart to view images associated with the order, visit, or procedure. An enterprise viewer often can federate across multiple archives, meaning it can query a radiology PACS, CV PACS, or vendor-neutral archive (VNA).

The benefit of an enterprise viewer compared to a basic EHR viewer is the ability to provide access to the patient’s full medical imaging record. Enterprise viewers can display multiple images simultaneously, display patient photos, and stream patient-centric video or audio content. We will discuss some examples later, but the key point is that clinicians no longer need to wait for specialists to share files with them, which can be particularly challenging in these socially distant times when many offices are closed.

Modern enterprise viewers run on any HTML5 browser and can be accessed from any system without requiring special software or VPN connections. This translates into easy access both inside and outside the office. Synapse Mobility, for example, is a zero-download HTML5 application that runs on Chrome, Internet Explorer (IE), Firefox, and Safari. It supports Android and offers a dedicated iOS app that is perfect for iPhones and iPads frequently used in healthcare facilities. While the ability to diagnose an X-ray or CT while out for dinner may seem superfluous in normal times, it’s become more essential during the pandemic and will likely see continued demand as clinicians grow accustomed to the benefits of the technology.

Consider the following use cases, whether you’re still in-clinic or providing telehealth while social distancing:

• Wound care: A patient was recently admitted to the emergency department (ED) with third-degree burns on his abdomen. While at home, the physician reviews the patient’s prior images to see how the wound has changed since the initial admission.
• GI visit: A patient with irritable bowel disease (IBD), such as Crohn’s or colitis, schedules a telehealth visit due to continued abdominal pain 5 days after being discharged from the hospital with COVID-19. The specialist pulls up the patient’s most recent colonoscopy images along with the point-of-care ultrasound (POCUS) scan taken in the intensive care unit (ICU) to help determine the need for further testing.
• Transplant follow-up: A patient reports a rash on her neck 15 months post-transplant and submits photos through the EHR patient portal, sparking concern about possible GVH (graft vs. host). During the telehealth visit a week later, the transplant specialist and consulting dermatologist (who are in different offices) compare the patient-submitted photos with photos taken at discharge and observe the current state of the rash during the video consultation.
• Pediatric injury: A parent schedules an urgent visit after her child suffers an injury attempting a viral TikTok challenge. She uploads the video to the patient portal, which the pediatrician watches in the enterprise viewer before the telehealth visit.
• Orthopedic: A patient is scheduled for a 6-month follow-up after knee surgery to repair a torn meniscus. The surgeon brings up an MRI of the knee, an arthroscopic video from the surgery, and a gait study video taken by the physical therapist showing improvement and ongoing challenge areas.

One of the great benefits of Synapse Mobility is its built-in collaboration tools. From the Synapse Mobility platform, a clinician can invite others to join the session, making it great for consultations with colleagues and/or engaging family members remotely. Users can share audio/video in a HIPAA-compliant manner and obtain access to all the tools, including measurement and annotation.

Synapse Mobility is also a cacheless system in that it retrieves all content directly from the source archive (PACS, VNA, etc.) and streams it to the user. For IT, this means no extra storage is needed, and it can easily scale up by adding additional servers. For users, performance is similar to YouTube or Netflix, where the server does the heavy lifting and they can start browsing content immediately.

Social distancing has forced many of us to adopt new workflows and learn new tools. Although this disruption in routines has created some chaos, a positive aspect emerges as the technologies scale to support our new normal, and we learn better ways to care for patients. An enterprise viewer, such as Synapse Mobility, is one such tool that has demonstrated its value during the pandemic and should continue to be an integral part of a comprehensive enterprise imaging strategy going forward.

By Laurence Yudkovitch, Product Manager – Synapse VNA, TeraMedica Division of Fujifilm

If you spend any time consuming media these days, you’ve likely seen an ad for Apple’s new iPhone 11 Pro. It features not one, not two, but three lenses to create a “pro camera system.” Apple is conveying the impression that this system is designed for professional photographers and gives you (a typical user) the same capabilities to take and edit professional photos and videos with the iPhone 11 Pro. Prior advertising from Apple even suggested you could shoot a feature-length movie on the iPhone. With the iPhone 11 Pro, Apple notes that even some (professional-grade) DSLR cameras “don’t do” the 11 Pro’s Smart HDR algorithms. It’s a bold claim.

At Fujifilm, we know a thing or two about cameras, lenses, and video solutions. Fujifilm developed the world’s first digital camera, the FUJIX DS-1P, back in 1988. Revolutionary for its time, it featured 2 MB of SRAM, enough memory to store 5–10 photographs. Today, our equipment is used by photo and video professionals daily for high-definition TV broadcasting, including sports broadcasting and program production.

As a company that serves both amateurs and professionals, we understand that their needs are different. Most casual camera users have no idea how to adjust the aperture setting, focal length, or white balance on their device, and that’s why Apple’s automatic adjustment and point-and-shoot capabilities appeal to them. It’s easy to use, with virtually no training required. Professional photographers may find the iPhone 11 Pro’s camera system appealing for its simplicity, but they won’t be satisfied with the results relative to what they are capable of doing on their professional units. That’s why they are professionals, or specialists, and require more-sophisticated equipment.

In the enterprise imaging world, I just saw an ad for an enterprise viewer that’s also a PACS workstation. That positioning has been a trend in the industry. From an IT administrator’s perspective, the assumption is that it’s easier, because like the original iPhone, which combined the phone, daily planner, and camera into one, a combined PACS/enterprise viewer means one application for IT to manage and deploy. However, similar to how true professional photographers still use specialized equipment, one should question if this is best solution for clinical users.

PACS systems are designed for specialists. Radiologists spend most of their day in a dark room reading images. Workflow, integrations, performance, and usability are critical to their success and satisfaction. If they can complete a task with one mouse click instead of two, or can save scrolling through menu options by using a hotkey, they are much happier and more productive. And a typical PACS offers dozens of commands and image manipulation options. Two of Jakob Nielson’s well-regarded 10 usability heuristics for user interface design include:

1. Recognition rather than recall

Minimize the user’s memory load by making objects, actions, and options visible. The user should not have to remember information from one part of the dialogue to another.

2. Flexibility and efficiency of use

Accelerators—unseen by the novice user—may often speed up the interaction for the expert user such that the system can cater to both inexperienced and experienced users. Allow users to tailor frequent actions.

This means that a good PACS UI will make all the options visible to the user and offer speed keys for quick access. This works very well for users who live in the PACS all day, need that enhanced functionality, and can remember the hotkeys to access it.

An enterprise viewer is designed for the masses. It should be easy to use and require very little training. It’s also meant to be used in any environment, more often than not an office setting or on a mobile device in a bright and sunny patient room. These users need to see a wide assortment of images but require only a basic toolset for scrolling through images and performing small manipulations and measurements. They may be viewing these images on a portable tablet or phone that doesn’t have a keyboard to activate speed keys. As such, their needs are vastly different from those of a diagnostic PACS user.

The point is, different users need different solutions. And just because radiologists can and will use an enterprise viewer for clinical review, it doesn’t mean it’s the best day-to-day tool for them. Similarly, although any user could learn to use a PACS system with training, a typical PACS has far more features than they eventually need and actually makes it more difficult for an administrator to support all these users and their varied settings. This overhead makes it harder for the average user to use a PACS system and ultimately can make them less efficient, potentially affecting patient care.

What healthcare organizations really need to consider is how to support their specialists with all the diagnostic tools they need, but also support the general clinical user with a smaller default toolset, on a unified back-end architecture. At Fujifilm, we recognize the needs of different users within the healthcare environment, and that’s why we’ve designed separate tools specifically to meet the needs of the radiologist and cardiologist as well as the enterprise user, all on one platform. For enterprise imaging, one size does not fit all.