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Re: [echocardiography] Re: Excelera digital system

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  • joyce smith
    I work in a small hospital that has Enconcerte digitlal system and the Excelera . I love it because there is no more dealing with VHS tapes. I can Tranmitt
    Message 1 of 9 , May 30 8:20 AM
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      I work in a small hospital that has Enconcerte digitlal system and the Excelera . I love it because there is no more dealing with VHS tapes. I can Tranmitt sudies from the floors and then put them in folders later when I have time. My paper work time has definitly decreased. I am really happy with it.
       

      Jenny Campbell <jcampbell@...> wrote:


      We now have the Enconcerte digital system in our echo lab and are
      considering updating to the Excelera. I would be interested in knowing
      others who have this system and if they are happy with it.
      Thanks



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    • Christopher Bohl
      The fact that you must create folders for patients is quite risky. A DICOM solution with conformant database, i.e. structured reporting, really should not
      Message 2 of 9 , Jun 1, 2004
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        The fact that you must create folders for patients is quite risky.  A DICOM solution with conformant database, i.e. structured reporting, really should not require the creation of a folder.
         
        The DICOM standard is constructed with a heirearchy of patient, study, and series.  Every study and the series within the study must be attached to the patient.  A separate database creates a significant potential for lost study and series information.  Not to mention the analysis data.
         
        A DICOM solution should automatically save and manage the patient, study and series data without any operator intervention assuring the integrity of the patient information without any risk of loss.
         
        Each DICOM image or loop contains all of the information regarding the patient.  This information includes vital data such as name, birthdate, medical record numbers and other information.  This was quite deliberate in the DICOM standard development because it helps assure patient image data management and integrity.
         
        Any product which does not automatically and seamless file patient, study and series information and requires human intervention for study management is deficient.  Care should be taken when evaluating such solutions and selection of product should really be within the DICOM standard.
         
        Regards
        cmb

        joyce smith <joycesmith47203@...> wrote:
        I work in a small hospital that has Enconcerte digitlal system and the Excelera . I love it because there is no more dealing with VHS tapes. I can Tranmitt sudies from the floors and then put them in folders later when I have time. My paper work time has definitly decreased. I am really happy with it.
         

        Jenny Campbell <jcampbell@...> wrote:


        We now have the Enconcerte digital system in our echo lab and are
        considering updating to the Excelera. I would be interested in knowing
        others who have this system and if they are happy with it.
        Thanks



        Yahoo! Groups Links

        <*> To visit your group on the web, go to:
        http://groups.yahoo.com/group/echocardiography/

        <*> To unsubscribe from this group, send an email to:
        echocardiography-unsubscribe@yahoogroups.com

        <*> Your use of Yahoo! Groups is subject to:
        http://docs.yahoo.com/info/terms/


        Do you Yahoo!?
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      • Stam Kapetanakis
        In theory, this may be correct. In practice, particularly if echoes are performed by busy clinicians, you may find that patient data entered onto the machine
        Message 3 of 9 , Jun 2, 2004
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          In theory, this may be correct. In practice, particularly if echoes are
          performed by busy clinicians, you may find that patient data entered
          onto the machine is not always correct (e.g. a single digit error in
          the medical records number), or even absent. And what happens if the
          patient has changed name or MRN between serial studies?

          Creating a "folder" does not influence the integrity of the study or
          series. It's essentially an entry in the "patient" table of the
          database, i.e. a unique patient identifier. While there are no perfect
          solutions for the scenarios above, I have found this approach practical
          - creating a "folder" is simply a matter of confirming patient identity
          or choosing/creating a new one.

          The "human intervention" is necessary - you may create a patient
          unique ID on the echo machine or on the database system, the potential
          for error is there. I would argue that this is less significant in such
          systems, as the user has to confirm the patient identity.

          As for grouping study files into folders... well, suffice to say that
          we perform over 10,000 echoes per year, each with 30-80 digital loops.
          Our current storage exceeds 2 terabytes. Is it really feasible to have
          a database solution that stores this enormous amount of files under the
          same directory?

          This is not to say that systems such as EnConcert or Xcelera do not
          have their problems, but creating is a patient folder is not really an
          issue.

          Regards,
          Stam

          On 3 Jun 2004, at 0:29, Christopher Bohl <christopher_bohl -at-
          yahoo.com> wrote:

          > The fact that you must create folders for patients is quite risky. A
          > DICOM solution with conformant database, i.e. structured reporting,
          > really should not require the creation of a folder.
          >
          > The DICOM standard is constructed with a heirearchy of patient, study,
          > and series. Every study and the series within the study must be
          > attached to the patient. A separate database creates a significant
          > potential for lost study and series information. Not to mention the
          > analysis data.
          >
          > A DICOM solution should automatically save and manage the patient,
          > study and series data without any operator intervention assuring the
          > integrity of the patient information without any risk of loss.
          >
          > Each DICOM image or loop contains all of the information regarding the
          > patient. This information includes vital data such as name,
          > birthdate, medical record numbers and other information. This was
          > quite deliberate in the DICOM standard development because it helps
          > assure patient image data management and integrity.
          >
          > Any product which does not automatically and seamless file patient,
          > study and series information and requires human intervention for study
          > management is deficient. Care should be taken when evaluating such
          > solutions and selection of product should really be within the DICOM
          > standard.
          >
          > Regards
          > cmb
        • Andrew Horning
          I agree that human correction of human mistakes is sometimes required! But I have a question for y all: How much do you need to keep online? I ve been in this
          Message 4 of 9 , Jun 3, 2004
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            I agree that human correction of human mistakes is sometimes required!
            But I have a question for y'all:
            How much do you need to keep online? I've been in this business with
            several different manufacturers for a while now, and have seen that serial
            analysis is relatively rare across a broad range of users (hospital, private
            practice...).
            Any offline files feature allows you to (theoretically) keep only unread
            studies online, and still offer fairly quick serial analysis if required.
            In practice, we've found that people using our Biopacs system keep a little
            more than a week's worth of studies online as a contingency buffer. On the
            rare occasion that they do need to look up a prior study's images for
            side-by-side comparison, it's a simple matter to click on a prior study
            icon, see the location of the study, and pop in a disk or whatever.
            Is there a magic number of months/studies/whatever that you think needs to
            be online? Are online archival requirements dependent upon practice type or
            something I might be missing?

            Andrew Horning, RDCS
            Clinical Product Engineer
            Biosound Esaote
            8000 Castleway Drive
            Indianapolis, IN 46250

            Toll Free: 800.428.4374, ext. 6048
            Direct: 317.813.6048

            ahorning@...


            -----Original Message-----
            From: Stam Kapetanakis [mailto:stam66@...]
            Sent: Thursday, June 03, 2004 1:57 AM
            To: echocardiography@yahoogroups.com
            Subject: [echocardiography] Re: Re: Excelera digital system

            In theory, this may be correct. In practice, particularly if echoes are
            performed by busy clinicians, you may find that patient data entered
            onto the machine is not always correct (e.g. a single digit error in
            the medical records number), or even absent. And what happens if the
            patient has changed name or MRN between serial studies?

            Creating a "folder" does not influence the integrity of the study or
            series. It's essentially an entry in the "patient" table of the
            database, i.e. a unique patient identifier. While there are no perfect
            solutions for the scenarios above, I have found this approach practical
            - creating a "folder" is simply a matter of confirming patient identity
            or choosing/creating a new one.

            The "human intervention" is necessary - you may create a patient
            unique ID on the echo machine or on the database system, the potential
            for error is there. I would argue that this is less significant in such
            systems, as the user has to confirm the patient identity.

            As for grouping study files into folders... well, suffice to say that
            we perform over 10,000 echoes per year, each with 30-80 digital loops.
            Our current storage exceeds 2 terabytes. Is it really feasible to have
            a database solution that stores this enormous amount of files under the
            same directory?

            This is not to say that systems such as EnConcert or Xcelera do not
            have their problems, but creating is a patient folder is not really an
            issue.

            Regards,
            Stam

            On 3 Jun 2004, at 0:29, Christopher Bohl <christopher_bohl -at-
            yahoo.com> wrote:

            > The fact that you must create folders for patients is quite risky. A
            > DICOM solution with conformant database, i.e. structured reporting,
            > really should not require the creation of a folder.
            >
            > The DICOM standard is constructed with a heirearchy of patient, study,
            > and series. Every study and the series within the study must be
            > attached to the patient. A separate database creates a significant
            > potential for lost study and series information. Not to mention the
            > analysis data.
            >
            > A DICOM solution should automatically save and manage the patient,
            > study and series data without any operator intervention assuring the
            > integrity of the patient information without any risk of loss.
            >
            > Each DICOM image or loop contains all of the information regarding the
            > patient. This information includes vital data such as name,
            > birthdate, medical record numbers and other information. This was
            > quite deliberate in the DICOM standard development because it helps
            > assure patient image data management and integrity.
            >
            > Any product which does not automatically and seamless file patient,
            > study and series information and requires human intervention for study
            > management is deficient. Care should be taken when evaluating such
            > solutions and selection of product should really be within the DICOM
            > standard.
            >
            > Regards
            > cmb




            Yahoo! Groups Links





            -- CONFIDENTIALITY NOTICE --
            The materials in this electronic mail transmission (including all
            attachments) are private and confidential and are the property of Biosound
            Esaote, Inc. Unauthorized disclosure, copying, distribution or the taking
            of any action in reliance on the contents of this material is strictly
            prohibited. Please notify us at (317) 813-6000 or biosound@... if
            you have received this in error.
          • Jack Colman
            We have been digital, using Vivid 7 and Echo Pac, for almost 2 years. We have a big Heart Failure clinic I ROUTINELY browse the old images in patients with LV
            Message 5 of 9 , Jun 3, 2004
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              We have been digital, using Vivid 7 and Echo Pac, for almost 2 years. We
              have a big Heart Failure clinic

              I ROUTINELY browse the old images in patients with LV dysfunction, and
              ROUTINELY report changes that I have confirmed by direct comparison of
              serial studies. It takes very little extra time, because the old
              studies are on line (I think we have a Terabyte of storage). It has
              improved our ability to make ands confirm diagnoses a lot, and to
              recognize changes. I would never go back to having to pull studies out
              of an archive. If it's there, you'll use it. If it is not there and
              takes effort to get it, you won't.



              Jack M. Colman MD, FRCPC
              <mailto: j.colman@...>
              Division of Cardiology, University of Toronto, at Mount Sinai Hospital,
              and
              Toronto Congenital Cardiac Centre for Adults at Toronto General
              Hospital/UHN
              600 University Avenue, Suite 1603
              Toronto, ON M5G 1X5
              416-586-5288 Fax 416-586-5968



              -----Original Message-----
              From: Andrew Horning [mailto:ahorning@...]
              Sent: June 3, 2004 10:30 AM
              To: 'echocardiography@yahoogroups.com'
              Subject: RE: [echocardiography] Re: Re: Excelera digital system


              I agree that human correction of human mistakes is sometimes required!
              But I have a question for y'all: How much do you need to keep online?
              I've been in this business with several different manufacturers for a
              while now, and have seen that serial analysis is relatively rare across
              a broad range of users (hospital, private practice...).
              Any offline files feature allows you to (theoretically) keep only unread
              studies online, and still offer fairly quick serial analysis if
              required. In practice, we've found that people using our Biopacs system
              keep a little more than a week's worth of studies online as a
              contingency buffer. On the rare occasion that they do need to look up a
              prior study's images for side-by-side comparison, it's a simple matter
              to click on a prior study icon, see the location of the study, and pop
              in a disk or whatever. Is there a magic number of
              months/studies/whatever that you think needs to be online? Are online
              archival requirements dependent upon practice type or something I might
              be missing?

              Andrew Horning, RDCS
              Clinical Product Engineer
              Biosound Esaote
              8000 Castleway Drive
              Indianapolis, IN 46250

              Toll Free: 800.428.4374, ext. 6048
              Direct: 317.813.6048

              ahorning@...


              -----Original Message-----
              From: Stam Kapetanakis [mailto:stam66@...]
              Sent: Thursday, June 03, 2004 1:57 AM
              To: echocardiography@yahoogroups.com
              Subject: [echocardiography] Re: Re: Excelera digital system

              In theory, this may be correct. In practice, particularly if echoes are
              performed by busy clinicians, you may find that patient data entered
              onto the machine is not always correct (e.g. a single digit error in
              the medical records number), or even absent. And what happens if the
              patient has changed name or MRN between serial studies?

              Creating a "folder" does not influence the integrity of the study or
              series. It's essentially an entry in the "patient" table of the
              database, i.e. a unique patient identifier. While there are no perfect
              solutions for the scenarios above, I have found this approach practical
              - creating a "folder" is simply a matter of confirming patient identity
              or choosing/creating a new one.

              The "human intervention" is necessary - you may create a patient
              unique ID on the echo machine or on the database system, the potential
              for error is there. I would argue that this is less significant in such
              systems, as the user has to confirm the patient identity.

              As for grouping study files into folders... well, suffice to say that
              we perform over 10,000 echoes per year, each with 30-80 digital loops.
              Our current storage exceeds 2 terabytes. Is it really feasible to have
              a database solution that stores this enormous amount of files under the
              same directory?

              This is not to say that systems such as EnConcert or Xcelera do not
              have their problems, but creating is a patient folder is not really an
              issue.

              Regards,
              Stam

              On 3 Jun 2004, at 0:29, Christopher Bohl <christopher_bohl -at-
              yahoo.com> wrote:

              > The fact that you must create folders for patients is quite risky. A
              > DICOM solution with conformant database, i.e. structured reporting,
              > really should not require the creation of a folder.
              >
              > The DICOM standard is constructed with a heirearchy of patient, study,
              > and series. Every study and the series within the study must be
              > attached to the patient. A separate database creates a significant
              > potential for lost study and series information. Not to mention the
              > analysis data.
              >
              > A DICOM solution should automatically save and manage the patient,
              > study and series data without any operator intervention assuring the
              > integrity of the patient information without any risk of loss.
              >
              > Each DICOM image or loop contains all of the information regarding the
              > patient. This information includes vital data such as name,
              > birthdate, medical record numbers and other information. This was
              > quite deliberate in the DICOM standard development because it helps
              > assure patient image data management and integrity.
              >
              > Any product which does not automatically and seamless file patient,
              > study and series information and requires human intervention for study

              > management is deficient. Care should be taken when evaluating such
              > solutions and selection of product should really be within the DICOM
              > standard.
              >
              > Regards
              > cmb




              Yahoo! Groups Links





              -- CONFIDENTIALITY NOTICE --
              The materials in this electronic mail transmission (including all
              attachments) are private and confidential and are the property of
              Biosound Esaote, Inc. Unauthorized disclosure, copying, distribution or
              the taking of any action in reliance on the contents of this material is
              strictly prohibited. Please notify us at (317) 813-6000 or
              biosound@... if you have received this in error.



              Yahoo! Groups Links
            • Stam Kapetanakis
              We have the last 4 years online, and it has proven an invaluable resource, both for patient care, teaching and research. And while it s feasible to have older
              Message 6 of 9 , Jun 3, 2004
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                We have the last 4 years online, and it has proven an invaluable
                resource, both for patient care, teaching and research. And while it's
                feasible to have older studies offline, i think that adding a level of
                complexity/interaction (i.e. searching for and loading an offline
                study) significantly reduces usage of these - it's human nature. The
                fact is that if the facility is there, it will be used more
                extensively.

                On 3 Jun 2004, at 21:43, echocardiography@yahoogroups.com wrote:
                > Is there a magic number of months/studies/whatever that you think
                > needs to
                > be online? Are online archival requirements dependent upon practice
                > type or
                > something I might be missing?
                >
                > Andrew Horning, RDCS
                > Clinical Product Engineer
                > Biosound Esaote
                > 8000 Castleway Drive
                > Indianapolis, IN 46250
              • Christopher Bohl
                Thank you for your follow up and perspective. While for the short term some of your perspectives I understand, there is and will be a huge change in patient
                Message 7 of 9 , Jun 3, 2004
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                  Thank you for your follow up and perspective.  While for the short term some of your perspectives I understand, there is and will be a huge change in patient data entry and its integrity.  I do agree that the "ability to correct duplicate UIDs and patient information" should be present in any solution.  However, the creation of "two" records increases the likelihood of data entry error.
                   
                  The scenario to which I allude is the following.  You enter patient information when beginning the examination which includes name, ID, date and other imperative information.  The data entered is parsed by the DICOM solution and included in every image/loop.  You conduct and complete the study.  You then create a folder which has certain parameters which require data entry.  Errors can be made in new patient data entry and patient folder creation.  I agree that human intervention and have human readable/correctable patient data entry is an imperative.  Redundant methods however from my perspective are wasteful and create additional points where error can occur.
                   
                  The days of redunt and error prone human data entry are waning.  the Electronic Medical Record is no longer a mere goal but rather a mandate by the Federal Government.  HL7 and its human readable coding will eliminate point of care data entry.  The Government has mandated a truly transportable, universally readable and comprehensive system be implemented to create the EMR or electronic medical record.
                   
                  Current solutions are far to labor intensive, prone to error and redundant.  To create folders unless adjunctive and specific to a certain need seem to me antiquated.  The ability to correct items such as duplicate UIDs and patient information are certainly required now and should be present even with the advent of the EMR.  XML with its human readable coding coupled with robust and compliant databases will reduce time spent entering data, correcting mistakes and performing valuable data mining.
                   
                  I appreciate very much you reply and value your perspective even though I disagree.
                   
                  Regards
                  cmb 

                  Stam Kapetanakis <stam66@...> wrote:
                  In theory, this may be correct. In practice, particularly if echoes are
                  performed by busy clinicians, you may find that patient data entered
                  onto the machine is not always correct (e.g. a single digit error in
                  the medical records number), or even absent. And what happens if the
                  patient has changed name or MRN between serial studies?

                  Creating a "folder" does not influence the integrity of the study or
                  series. It's essentially an entry in the "patient" table of the
                  database, i.e. a unique patient identifier. While there are no perfect
                  solutions for the scenarios above, I have found this approach practical
                  - creating a "folder" is simply a matter of confirming patient identity
                  or choosing/creating a new one.

                  The "human intervention" is necessary - you may create a patient
                  unique ID on the echo machine or on the database system, the potential
                  for error is there. I would argue that this is less significant in such
                  systems, as the user has to confirm the patient identity.

                  As for grouping study files into folders... well, suffice to say that
                  we perform over 10,000 echoes per year, each with 30-80 digital loops.
                  Our current storage exceeds 2 terabytes. Is it really feasible to have
                  a database solution that stores this enormous amount of files under the
                  same directory?

                  This is not to say that systems such as EnConcert or Xcelera do not
                  have their problems, but creating is a patient folder is not really an
                  issue.

                  Regards,
                  Stam

                  On 3 Jun 2004, at 0:29, Christopher Bohl yahoo.com> wrote:

                  > The fact that you must create folders for patients is quite risky. A
                  > DICOM solution with conformant database, i.e. structured reporting,
                  > really should not require the creation of a folder.
                  >
                  > The DICOM standard is constructed with a heirearchy of patient, study,
                  > and series. Every study and the series within the study must be
                  > attached to the patient. A separate database creates a significant
                  > potential for lost study and series information. Not to mention the
                  > analysis data.
                  >
                  > A DICOM solution should automatically save and manage the patient,
                  > study and series data without any operator intervention assuring the
                  > integrity of the patient information without any risk of loss.
                  >
                  > Each DICOM image or loop contains all of the information regarding the
                  > patient. This information includes vital data such as name,
                  > birthdate, medical record numbers and other information. This was
                  > quite deliberate in the DICOM standard development because it helps
                  > assure patient image data management and integrity.
                  >
                  > Any product which does not automatically and seamless file patient,
                  > study and series information and requires human intervention for study
                  > management is deficient. Care should be taken when evaluating such
                  > solutions and selection of product should really be within the DICOM
                  > standard.
                  >
                  > Regards
                  > cmb




                  Yahoo! Groups Links

                  <*> To visit your group on the web, go to:
                  http://groups.yahoo.com/group/echocardiography/

                  <*> To unsubscribe from this group, send an email to:
                  echocardiography-unsubscribe@yahoogroups.com

                  <*> Your use of Yahoo! Groups is subject to:
                  http://docs.yahoo.com/info/terms/


                  Do you Yahoo!?
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                • Christopher Bohl
                  Interesting question. Maybe there is a oblique perspective on this question. How much on-line data do you require? How much near-line data do you require?
                  Message 8 of 9 , Jun 3, 2004
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                    Interesting question.  Maybe there is a oblique perspective on this question.
                     
                    How much on-line data do you require?  How much near-line data do you require?  How long does it take to get to near-line data?  What about the recurrent patient being seen of several weeks or months?
                     
                    Any solution requires different tools to get to the patient data expeditiously.  The amount kept in on line archive needs intelligent algorithms in order to keep information available for some patients while being able to send studies not accessed often off to near line storage.  Also a method to access today, last two days, or last week should be present.  If you access thirty days of echoes you will have a large number of studies open.... not very efficient.  Studies not used often should be sent near line archive.  We use an LRU algorithm which sends the least recently used patients to the archive where they are backed up to DVD.
                     
                    Importantly, how long does it take for me to find a patient/study/series in the near line archive?  We have a solution which finds and loads the patient/study/series in less than fifteen seconds from DVD.  The device can scale from 250 Gigabyte to 6.6 Terabytes in one appliance and further it has no upward ceiling. Retrieved patient/study/series data is then kept in on line archive.  The solution also supports simple tools such as media tracking and a robotic media creation station where studies are automatically burned to media, labeled and tracked.
                     
                    Hardware is cheap and getting cheaper.  500 gigabyte of on line RAID should be able to store one year  of resting echoes with a terabyte not being much more costly.  Compression will also be a determinate in this question.  JPEG 2000 will a impact on on line storage needs because even with high compression ratios there is not image degradation..
                     
                    The answer to your question is difficult because requirements and needs are quite varied.  The tool sets to solve any permutation are however available and their cost keep dropping.  I recommend getting the largest amount of on line RAID you can afford and finding a robust near line archive appliance.
                     
                    Regards
                    cmb
                    Andrew Horning <ahorning@...> wrote:
                    I agree that human correction of human mistakes is sometimes required!
                    But I have a question for y'all:
                    How much do you need to keep online? I've been in this business with
                    several different manufacturers for a while now, and have seen that serial
                    analysis is relatively rare across a broad range of users (hospital, private
                    practice...).
                    Any offline files feature allows you to (theoretically) keep only unread
                    studies online, and still offer fairly quick serial analysis if required.
                    In practice, we've found that people using our Biopacs system keep a little
                    more than a week's worth of studies online as a contingency buffer. On the
                    rare occasion that they do need to look up a prior study's images for
                    side-by-side comparison, it's a simple matter to click on a prior study
                    icon, see the location of the study, and pop in a disk or whatever.
                    Is there a magic number of months/studies/whatever that you think needs to
                    be online? Are online archival requirements dependent upon practice type or
                    something I might be missing?

                    Andrew Horning, RDCS
                    Clinical Product Engineer
                    Biosound Esaote
                    8000 Castleway Drive
                    Indianapolis, IN 46250

                    Toll Free: 800.428.4374, ext. 6048
                    Direct: 317.813.6048

                    ahorning@...


                    -----Original Message-----
                    From: Stam Kapetanakis [mailto:stam66@...]
                    Sent: Thursday, June 03, 2004 1:57 AM
                    To: echocardiography@yahoogroups.com
                    Subject: [echocardiography] Re: Re: Excelera digital system

                    In theory, this may be correct. In practice, particularly if echoes are
                    performed by busy clinicians, you may find that patient data entered
                    onto the machine is not always correct (e.g. a single digit error in
                    the medical records number), or even absent. And what happens if the
                    patient has changed name or MRN between serial studies?

                    Creating a "folder" does not influence the integrity of the study or
                    series. It's essentially an entry in the "patient" table of the
                    database, i.e. a unique patient identifier. While there are no perfect
                    solutions for the scenarios above, I have found this approach practical
                    - creating a "folder" is simply a matter of confirming patient identity
                    or choosing/creating a new one.

                    The "human intervention" is necessary - you may create a patient
                    unique ID on the echo machine or on the database system, the potential
                    for error is there. I would argue that this is less significant in such
                    systems, as the user has to confirm the patient identity.

                    As for grouping study files into folders... well, suffice to say that
                    we perform over 10,000 echoes per year, each with 30-80 digital loops.
                    Our current storage exceeds 2 terabytes. Is it really feasible to have
                    a database solution that stores this enormous amount of files under the
                    same directory?

                    This is not to say that systems such as EnConcert or Xcelera do not
                    have their problems, but creating is a patient folder is not really an
                    issue.

                    Regards,
                    Stam

                    On 3 Jun 2004, at 0:29, Christopher Bohl yahoo.com> wrote:

                    > The fact that you must create folders for patients is quite risky. A
                    > DICOM solution with conformant database, i.e. structured reporting,
                    > really should not require the creation of a folder.
                    >
                    > The DICOM standard is constructed with a heirearchy of patient, study,
                    > and series. Every study and the series within the study must be
                    > attached to the patient. A separate database creates a significant
                    > potential for lost study and series information. Not to mention the
                    > analysis data.
                    >
                    > A DICOM solution should automatically save and manage the patient,
                    > study and series data without any operator intervention assuring the
                    > integrity of the patient information without any risk of loss.
                    >
                    > Each DICOM image or loop contains all of the information regarding the
                    > patient. This information includes vital data such as name,
                    > birthdate, medical record numbers and other information. This was
                    > quite deliberate in the DICOM standard development because it helps
                    > assure patient image data management and integrity.
                    >
                    > Any product which does not automatically and seamless file patient,
                    > study and series information and requires human intervention for study
                    > management is deficient. Care should be taken when evaluating such
                    > solutions and selection of product should really be within the DICOM
                    > standard.
                    >
                    > Regards
                    > cmb




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