Increased patient security and major time gains—result of automated multimedia flows in Swedish university hospital

Journey towards an enterprise IT for all multimedia

Regions and healthcare providers all over the world are increasingly implementing enterprise imaging solutions to facilitate collaboration between different disciplines and to streamline medical imaging and multimedia management. Patients are often transferred between different departments that produce images, videos, sound files, and documents so that specialists can make the correct diagnosis and provide the right treatment. To provide patient-centered care, all of this information needs to follow the patient and be made available to the relevant parties quickly, regardless of where the patient is in the healthcare process. This is one of the challenges that an enterprise imaging system is intended to solve, and something that Region Östergötland has its sights set on.

Niklas Lagerström, administrative IT manager within medical imaging at Region Östergötland

Niklas Lagerström, administrative IT manager within medical imaging at Region Östergötland, begins by explaining that they were among the first with a vision of processing and storing images, multimedia, and patient information on a central, region-wide platform.

“We decided to implement an enterprise multimedia system in 2014 or 2015 and quickly opted to expand our existing radiology PACS from Sectra to also include Sectra VNA,” he says. “Wherever possible, Sectra VNA is to be used as a shared archive for all image data as well as other multimedia. We’re aiming for centralized storage and have gradually wound down our use of other imaging and storage systems and started using Sectra VNA instead—as recently as spring 2023, we stopped using a multimedia system in favor of our VNA. This means that from an IT perspective, we have less management complexity and better cost transparency, as well as increased storage security, since it performs regular backups and we have data mirrored in two different server halls. Moreover, everything is logged, and we can see who has been looking at particular patient data in the system.”

The region introduced a multimedia module, Cambio COSMIC, into its journal system in 2015, which, according to Lagerström, promotes harmonized enterprise-wide multimedia. In turn, this has made it possible to centralize storage. During the last few years, they have applied the strategy to a large number of operations within the region, and today, over 120 operations have introduced multimedia flows with storage in Sectra VNA, including the dermatology clinic.

“In 2018, we carried out a project we called Hudprocessen (Eng: The Skin Process). All health centers—public as well as private—began taking skin images using mobile devices and manually importing them to Sectra VNA,” he continues. “The goal was to increase and accelerate the availability of skin images and to more quickly detect changes and potential cancer cases. Centralized storage in Sectra VNA allowed images taken at health centers to be easily shared with doctors at the dermatology clinic, who could review them in Sectra PACS to determine whether or not the patient needed to come to the clinic.”

Several of the health centers did not have a storage strategy before and therefore did not store any images or other media. Other units are now required to log everything in journals, as Lagerström goes on to explain. “As a result, the number of units in Sectra VNA, and therefore the number of imports—especially manual ones—increases every year. Each manual import takes, at best, two to three minutes, based on the requirements set by the region. We cannot import directly from mobile devices—instead, we need intermediate storage before we can import. In 2022, we had over 53,000 manual imports, and that figure will be even higher in 2023. That’s a lot of time spent on manual imports.”

Minimizing manual imports—neurology first on the list

Manual imports to Sectra VNA have increased as more departments start storing their image data in the solution. Since these departments are fairly time- and resource-intensive, the region realized there was a need to automate and streamline. There was also a need to improve patient security since manual processing includes a higher risk of error. “Here in the IT department, we’ve had two to four cases a week that include images for the wrong patient, and we’ve had to help manually transfer the images. And that’s very likely a low estimate,” says Lagerström.

With the objective of automating as many manual imports as possible, Region Östergötland therefore chose to look for other solutions, preferably with a mobile app. Lagerström explains that they quickly learned that Sectra was planning on developing a proprietary app for that exact purpose and that the region had been asked if they would like to participate in developing the product and providing valuable input.

“It was an offer we couldn’t refuse, it was obviously something we wanted. It also felt like a natural step to choose the app from Sectra, a long-time supplier that we’ve worked closely with since the 1990s. I knew from previous experience that the response and support would be incredibly fast.”

Lagerström goes on to explain that when the Sectra Upload & Store App was launched, the neurology department requested an improved flow for video recordings—to be able to save, view, and share video files easily. The department records films, such as patients’ movement patterns, and compares them during the course of treatment to monitor progress. In March 2022, they became the first unit in the region to use the app from Sectra.

“We used to film with video cameras, which were then sent to the department’s administrators so they could physically remove the memory card and transfer the files to a computer. The files were stored on a local file share within the department, but the files could not be named in a way that connected them to a patient. That made it difficult to not only find the right file for the right patient but also to share videos with other units. It was an unnecessary and overly complicated waste of time,” explains Lagerström.

According to him, the department noted that availability improved and that imports took up less resources and time after introducing the Sectra Upload & Store App. “The processing time from recording the video until it’s ready to be reviewed has been reduced drastically. In addition to time gains, we now need to look through fewer resources for the same examination—another advantage.”

Broad introduction of mobile app and increased patient security

After the successful introduction within neurology, the region has continued to introduce the app in several units, and today it is used at the region’s dermatology clinic, the hand and plastic surgery clinic (including the burn ward, BRIVA), the respiratory medicine clinic, the pain management department, and some ten primary healthcare centers. Lagerström explains that these units primarily focus on still images, unlike neurology.

“BRIVA takes pictures with another mobile app, where they also analyze the images,” continues Lagerström. “The Sectra app’s option to import images from the device’s camera roll allows them to import these images to Sectra VNA directly from the mobile device and to avoid having to manually transfer the images to a computer before they can be imported, which they needed to do before.”

Lagerström and his team are independently introducing the app within a new unit—everything from taking requests from the unit to surveying, configuring, and training the department in the use of the app. “It’s a fairly quick and easy introduction. When you look at how the entire multimedia flow is introduced, from the journal system all the way to the PACS, there’s very little we need to do to get the app flow started for a unit,” he explains.

When asked about how the app has been received by users out in the field, Lagerström responds that his experience is that it has received a positive response, not least considering the increased patient security. “They think that the automated flow is excellent—not having to import images manually and guess their way to which images belong to which patient.”

Once again, he mentions the workflow that was developed in 2018 during the Hudprocessen project, which was based on starting an image series with patient information, taking images, and closing the image series with the same patient information, so that all the images within the two files are of the same patient.

“The problem, however, is that when they are imported manually, there is a risk that the user will choose the wrong images, even with the images that begin and end the series. Sectra’s app provides the user with patient information throughout the entire flow and image capture process. The patient information is taken from the booking in the journal system, where this information has also been synced with the population register. That was also a contributing factor in our decision to introduce it. The number of cases where those of us working in IT need to manage the transfer of images that have ended up associated with the wrong patient has now decreased dramatically.”

Significant time savings at the dermatology clinic

During our visit to Linköping University Hospital, we also took the chance to visit the dermatology clinic. This department generates a significant number of images, since they carry out 350 to 400 examinations per month, with an average of six to ten images per examination. Here we have the chance to meet Elin Johansson, a healthcare administrator, and Dr. Alexander Shams, chief skin tumor specialist at the hospital’s dermatology clinic.

Elin Johansson, healthcare administrator at the dermatology clinic at Linköping University Hospital

“In 2018, we replaced the system cameras with mobile phones,” begins Johansson. “These images were stored locally on the device and loaded to the central archive by a healthcare administrator. It took up a lot of our time—we had to spend three to four hours per day transferring images from cameras to the PACS. That’s why we were interested in another solution that could free up time for us to do other things.”

“People also forgot to take the first or last image of the series, one with the personal identification number,” she continues. “Sometimes the images ended up with the wrong patient, and we couldn’t fix it ourselves, so we had to contact our IT support, who went in and transferred the images manually. That also took unnecessary time.”

Since June 2023, the dermatology clinic has been taking images with the Sectra Upload & Store App instead, and they are automatically uploaded to Sectra VNA. As previously mentioned, they also have access to patient information in the app since they create media documentation ahead of time in the journal system, which is available to the doctor through a work list in the app.

Both Johansson and Dr. Shams believe that patient security has improved significantly since the introduction. “You can confirm the whole time that you have the right patient before you take the image. We feel much more confident now in ensuring that the right images end up with the right patient and that there’s no risk of confidential information falling into the wrong hands,” says Johansson.

The new workflow has freed up the equivalent of a part-time employee for all of the healthcare administrators—time that they can spend on journals and projects that they previously did not have time for. The doctors now upload the images directly after taking them. This is an extra step for dermatologists, but Dr. Shams believes that the gains with this method outweigh the slight increase in work for them. “It’s reasonable for the extra security and total time savings that we get—nothing difficult or time-consuming,” he says.

Dr. Shams goes on to explain that the manual image imports also meant that doctors needed to wait until the day after images were taken to access them, since they were only

Dr. Alexander Shams, Chief skin tumor specialist at the dermatology clinic, Linköping University Hospital

imported every morning. Now they are imported to Sectra VNA immediately after an examination, which reduces lead times and increases availability. He also points to consultations and supervision of resident physicians as examples: they can immediately view images on a large screen instead of the cramped smaller screen on a mobile device.

This also enables remote consultations, since the images are immediately available on the region-wide platform and there is no need to communicate with each other to see the images. Since the images are quickly available in Sectra VNA, it is also possible to share them between clinics, who no longer have to e-mail them to each other.

Johansson recalls that there was some resistance and concern among the doctors when the solution was presented, but the introduction went well. “There was a little more resistance than I had expected in the beginning, when we were here to introduce the project and get it started,” she explains. “It seemed to us that the doctors were a bit worried, but I haven’t heard anything negative since we started, only that it’s worked well. Most people who have ever had to introduce a new IT system know that there’s always some hiccups in the beginning. There’s always some concern, of course, but this was a really painless process.”

“The reason that introduction went well, I think, is that the app is very well designed and adapted to our organization. It’s as simple and user-friendly as possible, which makes the transition painless,” adds Dr. Shams.

Multimedia flows—the region’s visions going forward

But just like any other solution, there is room for improvement. Sectra’s app is still relatively new, and early users within Region Östergötland are providing valuable input for Sectra’s product development to make the solution even better. Dr Shams explains that some functions are not entirely intuitive and that they would like clearer feedback in the user window; for example, the app could indicate when pictures were not uploaded to the VNA, to ensure that the transmission is made. From an IT perspective, Lagerström has also requested simpler administration and configuration, since these currently happen in different places.

In terms of plans for the future, Lagerström stresses that their goal is to replace as many manual imports as possible with the Sectra Upload & Store App. If a department takes images with a camera today, this will be replaced with mobile devices and the app. If they already have mobile devices but the images are stored locally on the device, the app will be introduced. “The plan is to expand use as much as possible, to try to introduce the app within primary care first of all. That’s where we have a high flow of patients, and staff have very little time per patient.” He explains that a few health centers and the emergency room in Linköping are next on the list.

The next step in their work with centralized storage in Sectra VNA is to try to automate multimedia flows for units that currently have a manual flow. If that is not possible, the manual flow will be simplified as much as possible, for example, by introducing Sectra Upload & Store Web, another solution within the Sectra Enterprise Capture suite that includes several different solutions for importing non-DICOM files to create a more patient-centered enterprise solution for sharing information. “I think this will do a lot to simplify and streamline the manual flow,” concludes Lagerström.