Challenges to DICOM Interoperability in India

1. Challenges to DICOM Interoperability in India Madhusudan Sreenivas GE Healthcare Sr. System Specialist Bangalore, India

2. Challenges to DICOM Interoperability in India Outline: • Introduction • Challenges to Interoperability • Conclusion • References • Contact info Challenges to DICOM Interoperability in India

3. Introduction • India, one of the fastest growing countries in the world, has seen tremendous growth in medical field in a very short span of time. • DICOM and other standards have contributed immensely in improving the quality of healthcare services provided in India. They have made the life of healthcare providers a little less complex. • Though DICOM brings in many advantages, there are challenges in India that pose hurdles to its wide spread use. Some of those challenges are highlighted here. Challenges to DICOM Interoperability in India

4. Challenge : Cost • Medical Devices & Systems are very expensive in India as most of them are imported • Hospitals/Clinics look for alternatives to reduce cost by : • Purchasing old refurbished equipment with no digital & networking capabilities • Purchasing less-expensive ones with limited/no DICOM capabilities • Not purchasing required licenses for DICOM/Interoperability features • Continue to use & buy analog imaging devices Challenges to DICOM Interoperability in India

5. Challenge : Cost • Effects: 1. Manual & complex workflows leading to overheads • 2. Devices not interoperable, though sometimes capable • There is a need for bringing awareness to the medical & finance departments of hospitals / clinics to assess the long term benefits of using Digital, DICOM supported devices. Challenges to DICOM Interoperability in India

6. Challenge : Infrastructure Lack of infrastructure is obstructing the reach & popularization of systems that are capable of interoperating • India has almost ~68% of its population in rural areas • Most of the rural areas have very limited or no access at all to electricity and network • The most feasible solution seen in this case is to use the Film based workflows, which inadvertently discourages the healthcare providers from moving to digital devices with DICOM capabilities as they do not see any value add from them Challenges to DICOM Interoperability in India

7. Challenge : Infrastructure DICOM communication over WAN is still a huge challenge for Tele-Radiology applications due to irregular network connectivity • This has been a major driving factor for many Tele-Radiology application vendors to develop and use proprietary protocols instead of DICOM Challenges to DICOM Interoperability in India

8. Challenge : Infrastructure • Referral doctors in India still do not have computers in their office. • They would prefer the patients to bring in Films and paper Reports instead of CDs / DVDs. • Hospitals charge a very high amount to provide the images on CD/DVD. • Patients prefer Film prints to avoid paying extra money from their pockets for the CD/DVD, unless really necessary Challenges to DICOM Interoperability in India

9. Challenge : Awareness & Expertise • There are not many DICOM & standards experts available in India. • Hospital IT staff is not much aware of DICOM/IHE standards and their importance. • Their worries are usually limited to "Are we able to scan the images and view them or not?” • DICOM & interoperability features are not given proper consideration while purchasing medical equipment • Effects: 1. Hospitals end up buying non-interoperable systems • 2. Challenges and delays during deployment and system usage leading to inefficient workarounds Challenges to DICOM Interoperability in India

10. Challenge : Awareness & Expertise • Hospitals usually end up buying department specific software such as RIS, LIS from different vendors, due to various factors • When these systems do not interoperate fully, the data ends up lying duplicated in multiple systems also causing problems during future migrations • Bringing awareness in Hospital IT staff about DICOM and other standards is crucial for smooth integration and efficient workflows. Challenges to DICOM Interoperability in India

11. Challenge : Awareness & Expertise • There has been a fast growth in number of local healthcare device and IT system manufacturers in India. Sometimes these vendors do not fully respect the interoperability capabilities needed in their systems. • Quality of these capabilities is usually compromised for lesser cost and early introduction of the products into the market. • This could also be due to lack of sufficient test environments and opportunities for these vendors to test their systems with other vendor systems. • Cross-vendor testing events such as IHE Connectathon if conducted in India would encourage local manufacturers to test their systems for interoperability. Challenges to DICOM Interoperability in India

12. Conclusion • Bringing awareness in Hospital IT & radiology staff about DICOM and other standards is crucial for smooth integration and efficient workflows. • This awareness will empower the end users to properly assess their workflow needs and demand the necessary interoperability capabilities in the medical devices/systems before purchasing and deploying them in their hospitals. • The demand for these capabilities will force the device vendors to keep up with DICOM and other standards. Challenges to DICOM Interoperability in India

13. References http://dicom.nema.org/ http://www.IHE.net/ Challenges to DICOM Interoperability in India

14. Author Contacts • Madhusudan Sreenivas madhusudan.s@ge.com GE Healthcare • John F Welch Technology Centre, • Plot # 122, EPIP, Phase 2, Whitefield Road, • Bangalore – 560066, • India Thank you for your attention ! Challenges to DICOM Interoperability in India