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Monief Eid
BSc, Lean Six Sigma Black Belt, PROSCI, C A P, ITIL V3 Foundation and Prince2 Certified
National PACS Program Director
The National BIG Picture: Tele-medical Imaging, The Vision
for Patient Services (modified based on non-disclosing
information about MOH)

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Design Strategy
MOH PACS Roadmap & Organization Structure

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2020
Stage 4
Will focus on
Continuous
Integration &
Maintain the
standard
2018
Stage 3
Will focus on
Increasing PACS
Deployment
2016
Stage 2
Will focus on
Maintaining
Interoperability
2014
Stage 1
Will focus on
Building The Core
&
Interoperability
National PACS Program Road Map
MOH PACS Roadmap Main Milestones

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(Medical Imaging Services “Radiology, Cardiology Pathology, Dental , Ophthalmology & Breast
Cancer)
- Stand
Alone image
System with
Specialty info
System at sites.
- Build RFP ,
standard and
Business process
With system
Owner.
- Execute projects
and maintain it.
1- Create National
Specialty Application
Solution on national level
i.e. National Cardiac
Registry/Repository,
National Dental
Registry/ Repository, etc
2- This will take MOH to
Wider services i.e.
Tele-Cardiology,
Tele- Pathology
Tele- Dental
etc
NationalMedicalImagingandTele-ServicesPlatform
MOH Tele-Medical Imaging Project Overview

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MOH Tele-Medical Imaging Project Overview
Radiology – CT, MRI, PET,
Diagnostic Radiology, Fluoroscopy,
Ultrasound, Nuclear Medicine,
Breast Imaging, Interventional
Radiology, DEXA
Dermatology - Visible
Light Imaging
Cardiology – Cardiac
Cath, Echocardiology,
Nuclear
GI Lab Ophthalmology
Pathology Wound Care Otorhinolaryngology Neurosurgery Oncology

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MOH Tele-Medical Imaging Project Overview
Before After
 A True Vendor Neutral Archive solution is a single
set of software tools to centralize all medical
imaging systems into one perpetual repository.
 Simpler management
 Seamless migrations
 Independent of PACS deployment
 Scales to meet all MOH capacity needs

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E-health Portfolio ManagementE-health Portfolio Management
PACS Program AssistancePACS Program Assistance
PACS Program ManagerPACS Program Manager
PM
coordinator
Based on
Western
Region
PM
coordinator
Based on
Western
Region
Senior PM
(Zone
Manager)
Covers
Western
Region
Senior PM
(Zone
Manager)
Covers
Western
Region
Technical
Director
Covers whole
Kingdome
Technical
Director
Covers whole
Kingdome
Change
Management
& Training
Director
Covers whole
Kingdome
Change
Management
& Training
Director
Covers whole
Kingdome
Senior PM
(Zone
Manager)
Covers Central
Region
Senior PM
(Zone
Manager)
Covers Central
Region
ICT
PACS Program
Organization Chart
PACS PMs
Based in
Central Region
PACS PMs
Based in
Central Region
PACS PMs
Based in
Western
Region
PACS PMs
Based in
Western
Region
Admin SupportAdmin Support
PACS
Technical
Managers/
specialists
Covers
Integration,
Interface,
DICOM, HL7,
IHE, etc.
Based in
Western and
Central Regions
PACS
Technical
Managers/
specialists
Covers
Integration,
Interface,
DICOM, HL7,
IHE, etc.
Based in
Western and
Central Regions
Change
Management
& Training
Managers/
specialists
Based in Western
and Central
Regions
Change
Management
& Training
Managers/
specialists
Based in Western
and Central
Regions
PM
coordinator
Based on Central
Region
PM
coordinator
Based on Central
Region
Senior PM
(Zone Manager)
Covers Eastern
Region
Senior PM
(Zone Manager)
Covers Eastern
Region
PACS PMs
Based in
Eastern Region
PACS PMs
Based in
Eastern Region
PM coordinator
Based on Eastern
Region
PM coordinator
Based on Eastern
Region
Service Director
Covers the whole
Kingdom
Service Director
Covers the whole
Kingdom
Service
Managers/
specialists
Based in Western
and Central
Regions (Divided
by Zones)
Service
Managers/
specialists
Based in Western
and Central
Regions (Divided
by Zones)
PMO Director, Covers whole Kingdome
(This could be Zone Role Manager too)
PMO Director, Covers whole Kingdome
(This could be Zone Role Manager too)

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Thank You ………. Q & A

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PACS Project Integration and IHE
MOH Approach
is
Cross
Enterprise
Document
Sharing
XDS/XDS-I Solutions
(Profiles)
IHE

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IHE Value Construct
(Enterprise Cross Sharing)
Medical
Imaging
Exchange
Sharing the
Reports
Sharing Images
Referrals
Cross Reporting
Other
Government
(Non-MOH)
Private Services
PACS Project Integration and IHE

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Medical
Imaging
Exchange
Sharing the
Reports
Sharing Images
Referrals
Cross Reporting
Other Government
(Non-MOH)
Private Services
Electronic business
services
Automated
Government Process
Avoided redundant
imaging, Electronic
imaging ordering
and results delivery
Electronic access,
second opinion and
patient travel
Electronic
submission of
reportable
conditions and
specialty
Electronic referrals,
consultation letter
delivery, chart
requests
PACS Project Integration and IHE

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Management & Administration
Referring Community
Radiologists
Radiographers & Technologists
Receptionists &
Secretaries
- RIS streamlines workflow within a Radiology Department by managing every step of
a patient's journey through... Order Receipt, Scheduling, Registration, Examination
and Documentation.
- DIRS/TRS Enables the sites without an existing RIS/PACS solution to have order,
scheduling , modality worklist and exam documentation capabilities. DITS/TRS will
enable facilities to do cross reporting and scheduling.
- DIRS/TRS will improve medical image reporting time especially for CT/MRI.
- DIRS/TRS will create national medical imaging platform
PACS Project Integration and IHE

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Document
Source
Document
Repository
Document
Registry
Document
Consumer
Provide & Register
Document Set
Register
Document Set
Patient
Identity Feed
Query
Documents
Retrieve
Documents
Patient
Identity
Source
PACS Project Integration and IHE
IHE
XDS/XDS-I Principle

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Document
Source
Document
Repository
Document
Registry
Document
Consumer
Provide & Register
Document Set
Register
Document Set
Patient
Identity Feed
Query
Documents
Retrieve
Documents
Patient
Identity
Source
PACS Project Integration and IHE
IHE
XDS/XDS-I Principle
RIS/PACS
Generates and Stores
Images,
Image Manifest,
Reports
Stores
Index
RIS/PACS,
HIS or EMR
Interprets/
Retrieves
Images Manifest,
Images,
Reports
Adds/stores
Report

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XDS Actors
1. Document Source
– Produces and publishes documents
– Responsible for sending documents and metadata to a repository
2. Document Consumer
– Queries a registry for documents
– Retrieves selected documents from one or more repositories
3. Document Registry
– Maintains metadata about each registered document in a document entry
– Includes a link to the document in the repository
4. Document Repository
– Responsible for the persistent storage of documents
– Assigns a URI to documents for subsequent retrieval by a consumer
5. Patient Identity Source
– Provides a unique identifier for each patient and maintains a collection of
identity traits
PACS Project Integration and IHE

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XDS Concepts
* The XDS registry is the cornerstone of the document sharing process
– The source registers information to be exchanged in the registry
– The registry only maintains metadata for the document (and not the
document itself)
– Clinical information is not exposed
* The XDS repository maintains the actual clinical document
– Clinical documents can be kept within the enterprise’s repository or they can
be transferred to another enterprise’s repository.
– Allows for data encryption.
* Source initiates the sharing process and provides the clinical document
and the associated metadata
* Consumer queries the registry and retrieve the data from the relevant
repository
PACS Project Integration and IHE

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- A Document Source actor initiates the Provide and Register Document
Set Transaction.
- For each document in the submitted set, the Document Source Actor
provides both the documents and the corresponding metadata to the
Document Repository.
-The Document Repository is responsible to persistently store these
documents, and to register them in the Document Registry using the
Register Documents transaction.
PACS Project Integration and IHE
Document
Source
Document
Repository
Provide & Register
Document Set
Provide & Register Document
Set [ITI-15]
Provide and Register Document Set

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PACS Project Integration and IHE
- A Document Repository actor initiates the Register Document Set
transaction.
- This transaction allows a Document Repository Actor to register
documents with a Document Registry, by supplying metadata about each
document to be registered. This document metadata will be used to
create an XDS Document Entry in the registry.
Document
Repository
Document
Registry
Register Document
Set [ITI-14]
Register Document Set

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PACS Project Integration and IHE
- The Query Registry transaction is issued by the Document Consumer Actor
on behalf of a care provider to a Document Registry
- The Document Registry Actor searches the registry and returns a list of
matching document entries including the locations and identifier of each
document in the Document Repository
Document
Registry
Document
Consumer
Query
Documents
Query Registry
[ITI-16]
Query Registry

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PACS Project Integration and IHE
Document
Repository
Document
Consumer
Retrieve
Documents
- A Document Consumer Actor initiates the Retrieve Document transaction.
- The Document Repository will return the document that was specified by the
Document Consumer
Retrieve Document
Retrieve Document
[ITI-17]

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PACS Project Integration and IHE
Document
Registry
Patient
Identity Feed
Patient
Identity
Source
- This is IHE ITI Transaction 8, defined as part of the Patient Identifier Cross-
Referencing Integration Profile
- It conveys the patient identifier and corroborating demographic data.
- Its purpose in the XDS Integration Profile is to populate the registry with
patient identifiers that have been registered for the affinity domain
Patient Identity Feed
Patient Identity Feed [ITI-8]

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Patient
Identity
Source
Patient
Identity
Source
Feeds identity of known patients
to Document Registry
Patient Identity Cross-
referencing (PIX) Manager
Index of
everything
Index of
everything
Can be any type
of system, but
often a HIS or
EMR
Can be any type
of system, but
often a HIS or
EMR
Can be any type
of system, but
often a HIS or
EMR
Can be any type
of system, but
often a HIS or
EMR
Similar to a
Master Patient
Index (MPI)
Similar to a
Master Patient
Index (MPI)
Document
Consumer
Source
Document
Source
Document
Registry
Document
Repository
Source of
documents and
meta-data
Initiates search
and retrieval for
consumer of
documentsIndexes
documents
and supports
search (query)
PIX ManagerPIX Manager
Document
Consumer
Document
Consumer
Document
Source
Document
Source
Document
Registry
Document
Registry
Document
Repository
Document
Repository
Patient Identify
Feed
Query
Documents
Retrieve
Document
Register
Document
SetProvide &
Register
Document Set
Stores documents,
requests indexing in
Document Registry, and
supports retrieval
Documents
stored here
Documents
stored here
Overview:
XDS Actors
and
Transactions
PACS Project Integration and IHE

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Patient
Identity
Source
Patient
Identity
Source
Feeds identity
of known
patients to
Document
Registry
Patient Identity
Cross-
referencing
(PIX) Manager
Document
Consumer
Patient Identity
Source
Document
Source
Document
Registry
Document
Repository
Source of
documents and
meta-data
Initiates search
and retrieval for
consumer of
documentsIndexes
documents
and supports
search (query)
PIX ManagerPIX Manager
Document
Consumer
Document
Consumer
Document
Source
Document
Source
Document
Registry
Document
Registry
Document
Repository
Document
Repository
Patie
nt
Ident
ify
Feed Query
Documents
Retrieve
Document
Register
Document
Set
Provide &
Register
Document Set
Stores
documents,
requests
indexing in
Document Regi
Stuff
Going In
Stuff
Coming
Out
Stuff Stored
& indexed
PACS Project Integration and IHE

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Patient
Identity
Source
Patient
Identity
Source
A DICOM image
viewer, such as
PACS
A DICOM image
viewer, such as
PACS
This is where the
images are stored
This is where the
images are stored
Document
Consumer
Source
Document
Source
Document
Registry
Document
Repository
Overview:
XDS-I Actors
and
Transactions
Source of
documents and
meta-data
Initiates search
and retrieval for
consumer of
documentsIndexes
documents
and supports
search (query)
PIX ManagerPIX Manager
Imaging
Document
Consumer*
Imaging
Document
Consumer*
Imaging
Document Source
Imaging
Document Source
Document
Registry
Document
Registry
Document
Repository
Document
Repository
Patient Identify
Feed
Query
Documents
Retrieve
Document
Register
Document
Set
Provide &
Register
Document Set
Image
Manager/Archive
Image
Manager/Archive
Retrieve Images & Related DICOM
Objects
(C-MOVE, Web Service (SOAP) or
WADO-URI)
Stores documents, requests
indexing in Document
Registry, and supports
retrieval
Feeds identity of known patients
to Document Registry
Patient Identity Cross-referencing
(PIX) Manager
*XDS Document Consumer not shown, but would
be present
PACS Project Integration and IHE

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Patient
Identity
Source
Patient
Identity
Source
A DICOM image
viewer, such as
PACS
A DICOM image
viewer, such as
PACS
This is where
the images are
stored
This is where
the images are
stored
Document
Consumer
Patient Identity
Source
Document
Source
Document
Registry
Document
Repository
Source of
documents and
meta-data
Initiates search
and retrieval for
consumer of
documentsIndexes
documents
and supports
search (query)
PIX ManagerPIX Manager
Imaging
Document
Consumer*
Imaging
Document
Consumer*
Imaging
Document
Source
Imaging
Document
Source
Document
Registry
Document
Registry
Document
Repository
Document
Repository
Patie
nt
Ident
ify
Feed Query
Documents
Retrieve
Document
Register
Document
Set
Provide &
Register
Document Set
Image
Manager/Arc
hive
Image
Manager/Arc
hive
Retrieve Images & Related DICOM
Objects
(C-MOVE, Web Service (SOAP) or
WADO-URI)
Feeds identity
of known
patients to
Document
Registry
Patient Identity
Cross-
referencing
(PIX) Manager
These Parts
are
Different
for Imaging
These
Parts are
Different
for
Imaging
These Parts
are the
same for
XDS & XDS-I
PACS Project Integration and IHE

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PACS Project Integration and IHE

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PACS Project Integration and IHE

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PACS Project Integration and IHE

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PACS Project Integration and IHE

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Integration Profile Implemented Actors Implemented
Scheduled Workflow (SWF) Image Manager/Image Archive
Patient Information Reconciliation (PIR) Image Manager/Image Archive
Consistent Presentation of Images (CPI) Image Manager/Image Archive
Access to Radiology Information (ARI) Image Manager/Image Archive
Key Image Note (KIN) Image Manager/Image Archive
Post-Processing Workflow (PWF) Image Manager/Image Archive
Evidence Documents (ED) Image Manager/Image Archive
Mammography Image (MAMMO) Image Manager/Image Archive
Consistent Time (CT) Time Client
Imaging Object Change Management (IOCM) Image Manager/Image Archive
Change Requestor
Audit Trail and Node Authentication (ATNA) Secure Node
Patient Identity Cross-Reference (PIX) Patient Identity Cross Reference Consumer
Patient Identity Cross Reference Manager
Patient Demographics Query (PDQ) Patient Demographics Query
Patient Demographics Query Manager
Cross-Enterprise Document Sharing (XDS) Document Source
Document Repository
Document Registry
Document Consumer
Cross-Community Access
Cross-Enterprise Document Sharing for Imaging (XDS-I) Imaging Document Source
Document Repository
Document Registry
Imaging Document Consumer
Cross-Community Access
PACS Project Integration and IHE

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ConsumerRegistry
Repository
1. Sources post
document packages
to the Repository
2. Repository registers
the documents
metadata and pointer
with the Registry
3. Consumers
search for
documents with
specific information
4. Consumers retrieve
selected documents
from Repository (-ies)
XDS Document
(Metadata):
Class
Patient Id
Author
Facility
Date of Service
…
XDS Document
(Metadata):
Class
Patient Id
Author
Facility
Date of Service
…
PACS Project Integration and IHE

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• Achievements:
1. Having MOH Sharing Image/Report Use Cases.
2. Having MOH IHE Imaging/Reports profiles.
3. Having MOH Radiology procedures exam codes.
4. Having MOH HL7 Specification for all HL7 integration with all information require to have
the best connectivity quality.
5. Having MOH HL7 test environment and simulation to be use by deferent companies and
minimize the time of integration.
6. Setup Business Intelligence center where we can improve the quality of work within PACS
/ RIS in all MOH hospitals.
7. Having business Intelligence central data warehouse for all PACS / RIS systems, neutral
vendor based on MOH with maximum security ,low internet connectivity and high quality.
8. Run MOH Business Intelligence application to analyze all systems and workflows across
MOH PACS / RIS systems.
9. Monitoring systems performance through dashboards and interactive tools
10. Monitor all suspicious or mess usage of the system by Business Intelligence indicators.
11. Generate Daily, Weekly, Monthly And Yearly Report
MOH PACS Project Integration and IHE

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Thank You ………. Q & A