The increasing use of images in hospitals in recent years, such as x-rays, ultrasound, MRIs and CAT scans, created the need to develop systems to manage them. With an eye on this market, large information technology companies such as Siemens, Toshiba, Agfa, GE, Carestream and Philips have created solutions, which are generically known as picture archiving and communication systems or PACS. Now a small company based in the city of Ribeirão Preto, São Paulo State, is positioned alongside these large companies to develop its own PACS. The system is already in use and has had good results after more than two years at the Hospital das Clínicas of the University of São Paulo School of Medicine (HCFMRP-USP).
The system, which is called LyriaPacs, was created by i-Medsys, a company founded in 2005 in Ribeirão Preto by three young USP trained researchers, postgraduates in information technology and computer science. “Lyria is a storage, communication, distribution and visualization system that follows the DICOM (digital imaging and communication in medicine) protocol specifications, which is the standard for the archiving and distribution of medical images,” explains Diego Fiori de Carvalho, a founding partner of the firm. “It is a complete solution for medical image management in hospitals, diagnostic centers and clinics and by health professionals,” says Carvalho.
“Based on the functionalities of the DICOM standard, Lyria is able to interconnect with the health information systems of the hospital and allows full control of the flow of image data,” says Paulo Mazzoncini de Azevedo Marques, a professor of biomedical computer science and medical physics and coordinator of the medical physics and radiation protection service of the Ribeirão Preto Hospital das Clínicas. Lyria is connected to the hospital’s computer system and receives information about patients who will have certain tests on a specific day, and the system generates a list. It then connects to the equipment generating the images for those tests—for example, an MRI machine—and enters the patient data. Following the test, Lyria transfers the images to a filing system, maintaining the link between the patient data already in the hospital information system and the new test data that were generated. “Data remain on file as long as necessary, or as defined by the institution under current law,” says Azevedo Marques.
Tests can be viewed by means of the hospital’s information system, which oversees the rights of whoever is allowed to access the data according to predefined user profiles. For example, the radiologist is allowed data access when making the patient report. With a password, the radiologist can connect to Lyria from a computer anywhere in the hospital, s/he selects a test, downloads the images and makes the report using the interface of the information system of the appropriate hospital. The document is then linked to its respective test and available for consultation, which can be done by a clinician, for example, in order to read the report prepared by the radiologist or see the image.
To develop Lyria, i-Medsys received funding from two projects of the FAPESP Innovative Research in Small Businesses Program (Pipe), both started in 2005. The first project, which was coordinated by José Antonio Camacho Guerrero, a partner of the company, involved developing a system for linking documents. It was called Linkdigger and its purpose was to create innovative solutions for individuals and businesses that needed to link data available from various sources of information. The second project resulted in the ArcaMed system to develop various software programs for hospital use, which led to Lyria, in addition to other products.
Hospital das Clínicas (HC) implemented ArcaMed as a pilot program in 2007. “In 2008 we obtained funding from CNPq [National Council for Scientific and Technological Development] to hire professionals,” said Fiori. “The pilot project at HC Ribeirão Preto created the need for a computer platform that would enable the consistent and automatic exchange and storage of images. Thus, i-Medsys created Lyria.” According to Fiori there are few companies in Brazil with the ability to develop this type of solution. “Most are representative of foreign systems, just the translation of software into Portuguese,” he says.
Contract and customization
“There are interesting PACS out there, but none offers a complete solution. For example, there are viewers that are often used, such as KPACS, OsiriX (for Apple), E-Film, and servers for storage and distribution, which have been developed by large companies. Such solutions typically require customization, at an additional cost, plus spending on acquisition.”
In another hospital at the same university, Hospital das Clínicas of the University of São Paulo School of Medicine, located in the capital city of São Paulo, has a contract for services with Philips to supply the system used to manage medical images throughout the hospital complex. “Under this agreement, Philips is responsible for providing the hardware, software and system maintenance of the RIS [radiology information system] / PACS, which allows the hospital staff to remain focused on patient care,” explains Vilson Cobello Junior, Systems Manager of the Information Technology Center at the Hospital. According to Cobello, the project began in 2007 and became operational in December 2008. “This solution is responsible for managing the entire work flow of the Hospital’s Department of Radiology,” he says. “This includes not only patient registration, scheduling, patient preparation, performance of the test, storage and distribution of images, but also completion and distribution of radiological reports throughout the Hospital complex by means of an electronic portal that consolidates medical imaging, follow-up reports and the results of laboratory tests.”
Fiori says that in the case of Lyria the results after two years of use at the hospital in Ribeirão Preto are good and showed costs in line with the competition. As of December 2012, 389,764 studies were stored—sets of medical images of patients—for various tests such as x-rays, ultrasound, CAT scans and others. “In total, these studies comprise 53,020,858 images, which are stored in the hospital system,” says Fiori. According to the prevailing market prices for storage, printing images and reports, an institution the size of the Ribeirão Preto Hospital saves about R$7,000,000 per year with this system. The Hospital performs close to 600,000 consultations or procedures per year. “The cost of system implementation in a hospital that generates about 14,000 images per month is R$1,000,000, including equipment, installation services and training,” says Fiori.
1. ArcaMed: a framework for building systems to support medical diagnosis (No. 2005/60038-5); Grant Mechanism Innovative Research in Small Businesses Program (Pipe); Coordinator Diego Fiori de Carvalho – i-Medsys; Investment R$164,733.15 (FAPESP).
2. Linkdigger: services created to link information available on the Web (No. 2003/07968-9); Grant Mechanism Innovative Research in Small Businesses Program (Pipe). Coordinator José Antonio Camacho-Guerrero i Medsys. Investment R$397,632.09 (FAPESP).