McKesson Radiology 12.0 Web Push

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1 McKesson Radiology 12.0 Web Push The scenario Your institution has radiologists who interpret studies using various personal computers (PCs) around and outside your enterprise. The PC might be in one of your satellite offices Thursday; it might be at the radiologist s home on Friday; it might be at the cottage by the lake on the weekend. It is not possible to predict where a radiologist will be when he or she needs to read. The only thing in common is that wherever the radiologist is located, there never seems to be enough bandwidth to stream the images on demand upon opening. The images often don t arrive fast enough for the radiologist to interpret without delay. The solution Use the Web Push feature of McKesson Radiology to help ensure delivery of the images to the radiologists, no matter where they log in, before they even know they are going to read the study. This can be configured as an automated, a manual process or even a combination of both. How it works First, the user logs into the McKesson Radiology PACS server from a PC running McKesson Radiology Station. Immediately after login, McKesson Radiology Station will check if there are any studies waiting to be pushed to the radiologist. If there are such studies and the radiologist is allowing receipt of pushed studies, the images for these studies (and any relevant priors defined by the radiologist s own preferred display protocols) begin streaming from McKesson Radiology to McKesson Radiology Station on the PC, without the radiologist having to take any action. If additional studies are pushed to the radiologist while he or she is logged in, these will be received in order of study priority, in the background and readied for display on screen when the radiologist wants to view them. The McKesson Radiology route manager administration tool can be used to manage web push activities corresponding to a seven-day duty schedule. For example: It is possible to set Dr. Andrew Baker to receive all neuro studies performed between 7:00 a.m. and 4:30 a.m. on Mondays through Thursdays and Dr. Candice Davis to be pushed both neuro and MSK studies between 4:30 p.m. and 10:00 p.m. Tuesday to Friday. The same person at your institution who manages the radiologists schedules can update the web push image routing schedule using the route manager tool each week. Additionally, at any time, a study can be pushed from any McKesson Radiology Station to any radiologist who is authorized to receive pushed studies. Thus Web Push can be used in such situations as ad hoc after-hours consultation and temporary coverage exceptions. It is important to note that in either case, nobody including the radiologist needs to know which PC the radiologist uses on a given day. Once the radiologist authenticates to the McKesson Radiology PACS, it knows where he or she is located and Web Push begins. There is no need to track and route to host names, IP addresses, etc. Reduction in Bandwidth Needs The main reason to employ the Web Push feature is to help reduce the amount of bandwidth that is required to keep a radiologist productive. Since the system gets a head start loading the images for the next patient before the radiologist begins reading that patient, McKesson Radiology Station can stay ahead. Using Web Push, McKesson Radiology Station helps optimize its use of available network bandwidth available. The degree to which bandwidth needs can be reduced through web push will vary drastically depending on a number of factors, including: RAM and hard-drive capacity of the receiving computer Number of images in each study 1

2 Number of relevant prior studies Average rate at which a radiologist reads each study Degree of lossy compression that can be utilized Bandwidth load of other software (VPN, 3D, reporting, encryption) used at the same time The table below shows how these different factors can interact to give results with very different bare minimum network connection types even for studies of the same modality. Frequently asked questions Are relevant prior studies also pushed? Yes, if desired. By default, relevant prior studies will be pushed, based on the reading radiologists display protocol preferences for the anchor study. However, this behavior can be turned off if it is uncommon to review prior studies. What target compression ratios are used for pushed images? The receiving radiologist s preferred compression ratios are used by default. As well, higher fidelity versions of the images (e.g. with less use of lossy compression) can be requested by the radiologist for any study. Does the radiologist have to view the studies in the order pushed? No. The radiologist can view the studies in any order. The system will use adaptive image loading to reprioritize image transfer based on which patient is currently being viewed. Can the radiologist open other studies which haven t been pushed? Yes. The radiologist can open any study as they normally would. Pushed images will continue in the background while the currently viewed study images and those of the relevant prior studies now being viewed are given priority over studies being pushed in the background. 2

3 Is protected health information cached persistently to the PC hard drive, putting patient privacy at risk? No. Although McKesson Radiology Station will cache image data it receives to the receiving PC hard drive, it omits the DICOM header information containing personal details about the patient. This also means the images in the cache are formatted to be non-intelligible to other off-the-shelf image viewing software, since the information needed to understand a particular image s storage location and mode of encoding is never written to disk. Furthermore, McKesson Radiology Station clears the cache whenever it is done with the patient and whenever the user exits the application. So even if there were patient details embedded directly into the pixels of an image by the acquisition modality, the image data itself is removed from the hard drive as soon as possible. Can a radiologist control when studies are pushed to him or her? Yes. The radiologist can suspend and resume receiving pushed studies at any time. Can the radiologist choose to view prior studies that are not considered relevant by the default display protocol? Yes. The images of the newly opened study will be streamed as per the rules of adaptive image loading feature. Any background transfer of studies being pushed will operate at a lower priority than the specific images and series of interest in the newly identified prior study. Which ports does Web Push use to communicate? The same ones that McKesson Radiology Station uses for all its communication. This would be the standard HTTP or HTTPS ports used by web browsers, unless your institution wishes to use alternate ports. If you can use McKesson Radiology Station, you can use Web Push. No additional set up is required. My institution requires me to use a VPN that terminates the connection if there is no activity. Can I still use Web Push to receive studies in the background if there are long gaps between when one is pushed to me, as might happen when I am on call at night? Yes. As long as the Web Push feature is operating, it will send regular keep alive traffic between the PC and the McKesson Radiology server inside the institution. This traffic should keep the VPN link active. These regular messages include updates to the status of the currently displayed study list and thus the frequency can be controlled through the same means as controlling the rate of automatic study list refresh. What happens if my VPN or Internet connection is lost? Do I lose all the pushed studies? No. As long as McKesson Radiology Station is running, it will retain what has been previously sent. You won t be able to make any persistent changes to the study until the connection is restored, but you will be able to navigate through the images already received, even those you haven t looked at yet. My web traffic is encrypted (either by VPN or by using HTTPS). Will this interfere with Web Push? No. Other than the encryption and decryption overhead reducing your effective bandwidth, the encryption is invisible to cases pushed or opened manually. Will Stat studies be pushed at a higher priority than regular studies? Yes. Unless the radiologist manually selects to view studies out of order, studies will be received in order of priority with studies of the same priority received in the order pushed. 3

4 Are there hardware changes I can make to optimize my PC performance when receiving pushed studies? Yes. To help maximize image display performance, McKesson Radiology Station will bias to loading images into Random Access Memory (RAM) first and only cache to the hard drive on the PC when most of the available RAM is full. Therefore, the best way to improve performance is to maximize the amount of RAM in the PC. For best results, install the 64-bit version of Windows 7 so that your operating system can manage more than 3 GB of RAM. Note that the amount of Video RAM (VRAM) on the graphics card(s) in your PC does not improve McKesson Radiology Station performance, and in the case of 32-bit operating systems, can mask higher RAM addresses and thus could degrade performance by artificially reducing available memory). How does someone else know that a study is slated to be pushed to a radiologist? The destination radiologist name will be placed into the Assigned Radiologist field of the study. In addition to being visible in the study list, the Assigned to Another warning will be shown to other radiologists who attempt to open the study while it is still in an unreported state. Does this mean that only the radiologist to whom a study is slated to be pushed can report it? No. A radiologist may choose to bypass warning messages and take over the reporting of a study. Will a study still be pushed to someone if it was read by someone else? No. The system will realize that the study no longer needs to be pushed and will drop it from the list. How does someone tell the difference between an unreported study that will be pushed to a radiologist and one that has images already received (and thus might be in the process of reporting)? Any studies that have been pushed to a radiologist, either completely or partially, are provisionally marked the status of Being Reported and will be displayed with a lock icon. If a radiologist has a large number of studies waiting for them, will they all transfer immediately at once when the radiologist logs on? No. The system throttles down the number of studies that are pushed to the radiologist to prevent their PC from becoming overwhelmed and to best match the normal rate of reading. In typical practice, McKesson Radiology will pause after the highest priority five cases (unread studies and relevant priors) which have been in the pushed-study queue the longest and then will resume sending as the radiologist finishes with one of those. Thus, the user always has a buffer of studies to read, but their PC is not slowed by excessive background activities beyond the radiologist s ability to read. Can any user have studies pushed to them? No. The site policies define which users can have studies pushed to them. Among other benefits, this keeps pick lists in the user interface to a reasonable size. The user must be authorized to receive pushed images, be able to report studies (so they can be assigned as the reader) and have at least one definition of studies of interest defined (even if it is just All Studies ). 4

5 Can a radiologist run McKesson Radiology Station in the background to receive pushed studies while I use other applications on my PC? Yes. The radiologist can minimize McKesson Radiology Station like any other application. Note, however, that the images being received will consume a lot of memory and, to a lesser extent, CPU cycles. Thus the other application performance will not be as responsive. If a radiologist has to be authenticated (i.e. logged in) to McKesson Radiology Station to receive the pushed studies, are there HIPAA concerns about someone else viewing the studies when he or she is away from the PC? No. McKesson Radiology Station will lock down and blank out its windows with a security access message that can only be cleared by the radiologist s password (or by someone by forcing a log out of McKesson Radiology Station). This works the same whether push is being used or not. Pushed studies will still be received even when the windows are locked down. How are new automated routing rules created? New routing rules can be defined by working with your McKesson support representative. Once set up, the routing rules are available for activation and deactivation via the route manager graphical user interface. What if I have two radiologists with the same specialties wanting to use Web Push at the same time, will all of the same studies be pushed to each of them? No. While the same studies will be queued up to be pushed to both radiologists, the system will minimize redundant pushing of studies based on the actual transmission and reading patterns that occur. That is, if one radiologist has three studies pushed to them and are expected to read those shortly then McKesson Radiology Station would skip pushing those three studies to the second radiologist. Instead, McKesson Radiology finds other studies in the queue to push to him or her. How specific can the push routing rules be made? Very specific. While simple rules utilizing a single parameter (e.g. modality) can be created, more complex rules involving combinations of multiple parameters such as work group, body region, patient class and other information known to McKesson Radiology can be defined. It is possible to model almost any radiologist s specialty or workload division agreements using the routing rules. Copyright 2013 McKesson Corporation and/or one of its subsidiaries. All rights reserved. McKesson Radiology and McKesson Radiology Station are trademarks of McKesson Corporation and/or one of its subsidiaries. All other product or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies. IMG175-07/13 5