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

It has been hard to watch TV recently without seeing an ad from a leading technology company describing how a top health institution used its video conferencing software for patient care during the COVID-19 pandemic. A featured doctor mentions being able to share a screen with a patient to show X-ray images, and then the camera cuts to the patient looking at a computer screen nodding their head and smiling. There is no doubt that the frequency and value of telehealth visits has increased substantially during the pandemic, but the TeraMedica Division of Fujifilm has been exalting the benefits of virtual collaboration through Synapse® Mobility for years. Given the renewed interest, I thought it would be valuable to describe some of the differences between standard video conferencing and Mobility’s collaboration feature.

Synapse Mobility is an enterprise viewer that any authorized clinician can access directly or from a link in the EHR to view patient images. Mobility displays standard radiology and cardiology images, along with most specialty department images such as dermatology, physical therapy, GI endoscopes, dental images, etc. One of Mobility’s more innovative features allows a clinician to set up a real-time collaboration session with other specialists, physicians, or family members. Examples include:

• An internist conferring with a radiologist, oncologist, and/or neurologist about a patient’s recent exam
• That same internist adding the patient into the discussion or collaborating directly with the patient
• A physical therapist conferring with the school board to demonstrate that a child is able to return to their regular Phys Ed class
• A gastroenterologist reviewing colonoscopy images with a radiologist to identify the source of abnormal anatomy from a recent abdomen CT

An example I frequently share from personal experience comes from my daughter, who has ongoing problems with her knee. A few years ago, my wife took her to the orthopedic surgeon to review her MRI, but I was working, so they conferenced me in by phone, and I wasn’t able to see the MRI. If they were using Synapse Mobility, they could have sent me a link in real time, and I could have been more engaged in my daughter’s care plan by not only hearing the discussion, but also participating in the review of the MRI.

A few weeks ago, we had a follow-up visit with the same orthopedic surgeon, who ordered another MRI for my daughter and said we could have the follow-up by video visit. He mentioned doing it on his iPad so that he could aim the camera at the screen so we could see the images. (When I asked, he said he could also do it from his computer, but found the iPad more convenient).

While standard video conferencing software is now ubiquitous in healthcare, Synapse Mobility offers a few key differentiators for reviewing images:

1. 1. Automatic anonymization: As soon as the clinician initiates collaboration mode, Synapse Mobility removes all PHI from the screen. If a remote user takes a screenshot, they have no way to identify the patient. And because Synapse Mobility runs on the server, there’s no concern about information being left on the remote system.
2. 2. True collaboration: The host can grant each guest the ability to point to the images and/or use the tools. Each guest has a different-color pointer, so it’s clear what each person is pointing to, and they can each scroll through the images while sharing the same view. Measurement and annotation tools are also available to anyone, and markups can be saved as a secondary capture so there’s a record of what was found. Only the host has access to the archive, which is needed to bring other images into the collaboration space and prevents access to images by the guests.
3. 3. Diagnostic-quality images from any device: Synapse Mobility is the leading mobile-viewing platform for unrestricted access to diagnostic-quality content. It’s globally accredited to support diagnosis via desktop, laptop, tablet, and mobile devices, as well as specifically on Windows, Mac, iOS/iPadOS, and Android devices.
4. 4. Full audiovisual collaboration: Synapse Mobility uses the device’s webcam and superimposes the video on top of the images, so users can see each other while viewing the images. Additionally, users can grant access to the device microphones to enable real-time verbal communication during the session.
5. 5. Inherent tool: Synapse Mobility’s collaboration features can be accessed from all platforms, including the HTML 5 browser or through the tools within the iOS app.

Collaborating can cover so many clinical use cases. Many of our customers have had a variety of experiences and are always finding different ways to leverage the tool. Scenarios can include things such as tumor boards and teaching opportunities where multiple guests can collaborate at the same time, family members who are remote or may not be in the same location due to pandemic-inspired isolation, or in the pediatric setting where only one parent can be present during the consultation. All communication is encrypted, and since the source files never leave the server, security risks are mitigated. We’re glad to see telehealth enable continuity of care during the pandemic and look forward to helping providers deliver the best possible care to patients with the Synapse family of products.

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 Sara Osberger, Senior Director of Marketing, Fujifilm Medical Systems, U.S.A., Inc.

Radiology and cardiology departments have dominated the enterprise imaging arena for more than 40 years. About one billion radiological imaging exams are performed worldwide every year, making radiology the clear leader in medical imaging volume. Add to that the global surge in echocardiography, cardiac MR, cardiac CT, and cardiac catheterization studies and there you have the lion’s share of all enterprise imaging.

So when it comes to a vendor-neutral archive (VNA), can healthcare professionals use a VNA to collect, store, manage, and share imaging data outside of these two service lines? What about imaging from specialty departments, such as ophthalmology, wound care, or dermatology? Can a VNA manage those images as well?

In order to bring the complete patient picture to the healthcare enterprise, a true VNA can and should be used outside of radiology and cardiology departments. Keep reading to learn more about the many ways your enterprise can benefit from expanding the use of its VNA.

Strengthen Radiology and Cardiology Departments

Although VNAs have applications beyond radiology and cardiology, the bulk of their imaging storage comes from these two service lines. In both radiology and cardiology, the digital imaging and communications in medicine (DICOM) format is king. This file format is produced by CT scans, MRIs, and other prominent types of medical imaging procedures.

Even with the bulk of DICOM images coming from radiology and cardiology, those two departments are often independent of each other and unable to share images. By implementing a single PACS solution or a robust VNA for both departments, healthcare professionals can cross-reference patient imaging.

Improve Image Management across Specialties

DICOM may be the most common medical image format, but many specialties collect images and media in non-DICOM formats as well. This data has undeniable clinical value, particularly as more specialty departments begin to capture patient images. For example, video clips taken during surgery and endoscopy procedures can assist with treatment planning and follow-up care. Although you could attempt to integrate these videos with a traditional PACS, the large file size and need for editing can make integration unrealistic. Additionally, non-DICOM still images have been proven to be difficult to integrate with PACS due to departmental workflows. To overcome this challenge, a VNA helps to make image management across specialties significantly easier.

At the TeraMedica Division of Fujifilm, our Synapse® VNA can handle multiple types of non- DICOM media to seamlessly connect imaging content from more than 30 specialty departments, including:

Enable Essential EHR Interoperability

Most electronic health record (EHR) systems can’t access departmental images through various departmental viewers. This forces physicians to find and reference images, which can be a tedious and frustrating task, not to mention a major roadblock to their workflow. One application for a VNA beyond radiology and cardiology is creating an image-enabled EHR that allows users to view any image type directly within the EHR workflow through the VNA’s enterprise viewer.

Synapse VNA provides full EHR interoperability, so physicians can reference all of a patient’s images directly from the EHR, regardless of the image’s original source or file format. As a HIPAA-compliant VNA, Synapse VNA can also implement rules to limit access to images on a need-to-know basis in an effort to keep sensitive information secure.

Capture Images at the Point of Care

As more enterprises adopt bring-your-own-device (BYOD) policies, physicians have the ability to capture images at any point during the patient encounter. Emergency care, dermatology, and wound care are already using mobile devices to capture images at the point of care. If your enterprise uses a mobile capture strategy, a VNA can help to minimize PHI risks and securely manage these real-time image captures for your care team.

With Synapse VNA Connext Mobile, for example, physicians can capture images and automatically archive them within the VNA. The VNA then communicates to the EHR that images are available for that patient encounter. Features such as secure sign-on, encrypted transmission, and intelligent data-lifecycle management help keep this tool secure and compliant, while also respecting patient privacy.

Fujifilm TeraMedica Division’s VNA Solution

The right VNA can benefit all departments across the enterprise, not just radiology and cardiology. Synapse VNA from the TeraMedica Division of Fujifilm is designed to provide true interoperability across departments. With Synapse VNA, you can view DICOM and non-DICOM images and share them with other physicians, departments, and facilities, and even with patients.

Whether you’re working in cardiology, radiology, or another specialty department, Synapse VNA can benefit you by:

• Reducing data-storage costs: By simplifying data storage and eliminating the need for expensive data migrations, Synapse VNA can significantly reduce data-storage costs over time.
• Streamlining workflows: Synapse VNA makes it easier to provide image access to physicians, care teams, and the clinical departments that need them, saving time and allowing staff to be more efficient.
• Helping improve patient care: Synapse VNA gives physicians access to all of a patient’s images in one central location. With the full picture of the patient, physicians can make more-informed diagnosis and treatment decisions, helping to improve the overall quality of care.

Applications for Synapse VNA

Synapse VNA connects imaging content across the care continuum, so it has many potential applications. Enterprises that could benefit from Synapse VNA include:

• Large hospitals and healthcare enterprises
• Integrated delivery networks (IDNs)
• Multispecialty healthcare networks
• Pediatric hospitals
• Outpatient imaging centers
• Pharmaceutical companies
• Biotech companies
• Enterprises conducting clinical trials

Contact Fujifilm TeraMedica Division to Learn More

VNAs help to bring the full patient picture to the entire healthcare enterprise. For more information about applications for VNA technology beyond radiology and cardiology, or to schedule a demo of the Best-in-KLAS Synapse VNA, reach out to us today.

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.