10 POWERFUL REASONS WHY
HEALTHCARE FACILITIES &
PROFESSIONALS PREFER
SYNAPSE PACS
•
STREAMLINED DEPLOYMENT
•
ON DEMAND ENTERPRISE INFORMATION
•
UNIFORM, POWERFUL GUI FOR ALL USERS
•
WEB BASED, OPEN SYSTEMS ARCHITECTURE
•
SUBSCRIPTION
•
IMAGE PROCESSING
•
BROKERLESS INTEGRATION: HIS/RIS/EMR (HL7 & URL)
•
HARDWARE INDEPENDENCE
•
CASCADABILITY (PEERLESS SCALABILITY)
•
WEB PORTAL INTEGRATION
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Synapse provides the cleanest, most streamlined implementation than any other PACS
available on the market today. It was developed by the industry’s premier team of
engineers who had already designed a leading legacy PACS in the early nineties.
However, IT technology revolutionized after the design of that legacy PACS when the
World Wide Web was “discovered” by the business community in the mid-to-late 90’s.
Web technology proliferated and fast bandwidth became practical. This presented an
irresistible opportunity to redesign a PACS, taking these modern technologies into
account.
Synapse is able to afford the customer the advantages of modern technologies like no
other major PACS available on the market today. Here are some of the significant
reasons Healthcare professionals choose Synapse.
STREAMLINED DEPLOYMENT
Synapse requires zero infrastructure or equipment outside of the data center to support
countless thin client workstations. All sites may be deployed as “thin” sites, that is, the
sending modalities would send images through the network into the data center (or
computer room) and the workstations would query directly to the data center/computer
room server for patient information and images. No storage servers or other
infrastructure equipment is required at the primary site, remote sites, remote clinics,
homes etc.
Thin Client Implementation
All workstations are web stations and all web stations are workstations. As a thin client
application, SYNAPSE will run on virtually any Wintel (Windows Intel) device with
Microsoft’s Internet Explorer (5.5/SP2 or 6.0). No PACS application software needs to
be preloaded onto any workstations.
The user interface and privileges are not restricted to particular high resolution
workstations or certain locations; a user’s log on credentials entitles him/her to the same
GUI and privileges regardless of location or workstation. The users credentials follow
them from workstation to workstation, thus so do their assigned privileges.
The efficiency that this thin client implementation offers is enormous: with conventional
PACS, the “powerful” radiologist’s workstations and full data set are confined to the
radiology departments or specific, dedicated workstations. With SYNAPSE, the full data
set and identical powerful toolset available in the reading room is provided to every PC
that accesses Synapse (some user types will not have all privileges within the toolset,
e.g. referring physicians cannot mark an exam as “read”).
Synapse’ thin client design is the reason a PACS installation was able to occur at one
software-only site in less than three hours. Fuji’s technicians did not have to install
software on any workstations or in any of the radiologists’ homes.
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Active-X Toolsets
Active-X web technology offers an unparalleled open PACS, and it works like this: when
the workstations launch Internet Explorer the first time, a small file of ActiveX™ Data
Object (Active-X) controls will be automatically downloaded onto the PC. From that time
forward, that workstation will be able to utilize all of the tools available per that particular
user’s privileges. Fuji’s engineers will not need to install software on each workstation
individually or the workstations in the off-site locations. Windows Internet Explorer and
Windows operating systems are absolutely the only software elements needed at any
workstation. By utilizing off the shelf Intel PCs and Fuji’s unlimited user license allows
Synapse sites to provide PACS access to anyone, anywhere.
ActiveX is Microsoft’s application-level programming interface to data and information.
Active-X allows the creation of front-end database thin clients using applications, tools,
languages or Internet browsers. Active-X is designed to be the one data interface
needed for client/server and Web-based data-driven information systems.
Whenever there is a Synapse upgrade, which would require an upgrade to the Active-X
file, it will be auto-updated the next time the PC is used to log into Synapse. The
Synapse application is simply a plug in, like Flash media or real audio.
IMPORTANT NOTE: Other Web-based PACS system implementations of thin client
architecture utilize a pure thin client design with Java Virtual Machine, where no
application software or toolsets reside on the workstation. In that type of
implementation, all functionality and data are sent across the network each time the
archive is accessed, which introduces unnecessary potential points of failure, high
network demands and reduced application speed. Synapse utilizes an ActiveX
implementation of thin client, causes a small ActiveX file with the Synapse toolset to be
downloaded onto the PC by the Synapse server upon the PC’s first access to Synapse
and that toolset permanently resides on the PC from that time forward. Some
processing functions (e.g. decompression) are performed at the PC.
The ability of a clean, “thin” implementation will greatly simplify the phasing of the
multiple installations such as a Hospital, Imaging Center and Outpatient Center. From
the moment Synapse is brought up live, access by all privileged physicians is inherent.
A separate teleradiology or web system is not required. As each location that acquires
images is brought on line, the modalities simply need to point their images to the
network.
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ON DEMAND ENTERPRISE INFORMATION:
The Radiologist presents an integration challenge that suits Synapse’ second
generation, open systems architecture perfectly. Synapse was designed to excel in
environments where the Radiology departments at multiple sites need to be integrated
such that the entire enterprise will appear as one virtual entity.
Provided that the LAN and WAN are set up appropriately, the data from any site is
available to any privileged user at any location upon demand. The user will log into the
Synapse server that is residing in a data center or at a designated site’s computer room.
At any time and upon demand, then, the viewer has access to the up-to-the-moment
work list and images for all sites. This applies to all users, not just the Radiologist. The
physical limitations of Thick Client PACS of pre-routing (pre-loading of images onto a
local server or desktop) are eliminated.
Below is a snapshot of Synapse from an actual site. This illustration shows where the
sites are visualized for the user as different tabs. In this example, the customer does
Telerad reading for some of its clients, and also has two other databases, one for “ARA”
and one for a “Seton” site. For Radiologist, these tabs might be “Hillsboro”, “Forest
Grove”, “Outpatient Center”, etc if Radiologist wants to maintain a distinct visualization of
each site.
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** This example is taken from a large Radiology Private Practice supporting Multiple
Hospitals and performing over 750,000 exams a year. Additional Note: one database
network can be contained within a single server rack. This example is of 3 separate
databases each its own financial and clinical model and each supporting multiple
Hospitals and clinics.
UNIFORM, POWERFUL GUI FOR EVERY USER, AT EVERY WORKSTATION:
Windows “Look and Feel”
We find that our customers enjoy a tremendous advantage when it comes to
learning curves for users. Synapse operates right from within Internet Explorer
and presents a familiar look and feel. An easy, intuitive GUI is a powerful
predictor for a successful PACS. Many of the users in our existing sites are not
able to free themselves up for training sessions, and are pleasantly surprised to
find that they can navigate through Synapse anyway. Of course, we strongly
recommend training and believe that PACS usage will be optimized with proper
training, but simply mentioned the untrained users as an illustration of Synapse’
ease of use.
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Intuitive, Ease of Use = Successful
PACS!
Synapse provides one universal user interface. This is an enterprise image and
information system that is afforded to all. From a business perspective, the Radiology
department has generated an excellent product, and Synapse offers a modern, webbased mechanism to get the Radiology product distributed rapidly and efficiently
wherever it needs to be in the enterprise.
Not only do the Radiologist have robust tools sets, advanced imaging processing
capabilities,Flexible worklist, etc… BUT the Referring Physicians, Specialist, Clinicians,
PACS Administrators = ALL USERS enjoy the same GUI.
The illustration on the next page shows how a single server supports not only the inhouse users, but the remote facilities, clinics and homes with the same GUI and tool
sets.
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WEB BASED, OPEN SYSTEMS ARCHITECTURE
Web based technology is becoming more and more the de facto standard of IS
acquisitions. As research and development in the major technological vendors are
poured into this area, the technology itself advances at a dizzying pace. Standardizing
the IS infrastructure with web technologies opens many areas of compatibility among
systems (“open systems”) which naturally provide synergies that benefit the entire
enterprise.
Open Systems Technology
The following elements of Synapse contribute towards its unparalleled openness. Some
of these elements are discussed in more depth in this document as an individual reason
to purchase Synapse:
•
Synapse is a software-based PACS solution, and is hardware independent.
Standard off-the-shelf hardware components can now easily meet and exceed the
demands of PACS; specialty industrial machines are no longer necessary as they
were seven years ago. This allows Synapse customers to leverage existing
infrastructure or procure hardware separately. Many of our customers procure most
or all of the reference users’ workstations on their own.
•
Synapse’ core consists of standard commercial software components integrated with
Fuji’s own PACS specific software. This design offers not only the lowest initial
capital investment, but also the lowest total cost of ownership combined with the
greatest protection from obsolescence.
•
Fuji’s modern and greatly simplified deployment of PACS offers a widely available
and highly standardized method of access: Internet Explorer browsing. Users on
and off site all access Synapse via Internet Explorer 5.5/SP2 or 6.0.
•
Recognizing that multiple disparate methods of communicating and exchanging
information was a significant barrier to delivering free and open access to critical
information, the computer industry formed a group of engineers from various
companies to guide the standardization of the different areas of exchanging
information, the Worldwide Web Consortium (W3C). In particular, W3C developed
several standards which are fundamentally incorporated into SYNAPSE by virtue of
its later lineage. The crucial standards include: HTML, HTTP, URL and XML.
Obviously, the goal with these standards was to create the ability to universally
exchange information. Developers who design applications to organize and move
data with these elements will know that their applications are open and can be easily
integrated with a plethora of similarly open applications.
Developers across the board in all industries are becoming more and more excited
about the use of HTML to facilitate a universal document format. In times past, the
operating system would be responsible for painting the screen and mapping out the
dialog boxes that the user would encounter during his/her use of the system. Now,
however, HTML presents a very powerful way to universally manage the format of
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the screens, especially with its rich and attractive visual options. Because it’s an
open, universal standard, the tools for creating and working with HTML are already
very good but are also continuing to improve at a rapid pace. Microsoft has noticed
this trend towards HTML and has already included support for HTML within Microsoft
Windows®, relieving developers of the need to write the code necessary to display
HTML within their own programs.
All of SYNAPSE’ screen displays are written in the universal HTML language,
making it poised for unprecedented openness in a PACS and also available to be
easily integrated into a wide array of other similarly open products and systems.
Microsoft’s recent commitment to XML has added even greater synergies between
the homogenous Windows operating environment. Already SYNAPSE is utilizing
XML to offer dynamic reading protocols with defined logical “next” steps instead of
the static hanging protocols which are common today. Imagine the productivity
advantages of having the entire reading process automated with “next” technology
rather that having the radiologists manually direct each step of their reading process.
•
As further standardizations occur and are incorporated into the Windows operating
systems or Internet Explorer, SYNAPSE automatically progresses along with them
without any effort in that direction from Fuji’s engineers, leaving them free to
concentrate on PACS specific development. Having the power of Microsoft’s
research and development investment so intricately linked to SYNAPSE is a
tremendous asset.
•
As a thin client application, SYNAPSE will run on virtually any Wintel (Windows Intel)
device with Microsoft’s Internet Explorer. No software (other than Internet Explorer)
needs to be preloaded onto any workstations. This allows virtually any PC to access
SYNAPSE anywhere in the world (provided the user has proper sign in credentials).
Whenever a PC logs into SYNAPSE for the first time, a small file of Active-X controls
is downloaded and from that time on, the PC is able to support the SYNAPSE toolset
and image manipulation. Logging into SYNAPSE looks and feels to the user like
logging into a web site. All workstations are web stations and all web stations are
workstations. The user interface and privileges are not restricted to particular highresolution workstations or certain locations; a user’s log on credentials entitles
him/her to the identical user interface and privileges regardless of location or
workstation.
The efficiency that this thin client implementation offers is huge: with conventional
PACS, the “powerful” radiologist’s workstations are confined to the radiology
departments on dedicated terminals. With SYNAPSE, the identical powerful toolset
given to radiologists in the reading room is distributed to every PC he or she will use
to access SYNAPSE.
•
Another aspect of SYNAPSE’ openness is a product of its tight integration with
Windows. SYNAPSE can actually drag DICOM images from SYNAPSE to any
Windows application which allows users to drag-and-drop images from SYNAPSE
into a Power Point or into an e-mail and forward to colleagues for consult or use in
presentations. Images may also be dropped into a CD or zip drive and SYNAPSE
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will automatically convert the image into a “.bmp” file. Images can be anonymized to
protect confidentiality.
•
A crucial element of openness is achieving scalability – the ability to increase size
and scope without materially affecting performance levels. This concept is discussed
and illustrated in more depth as a separate point later in this document.
•
Because of its standard, open technology, Synapse servers can support clustering.
"Cluster-aware" applications can use the MSCS services through the MSCS
Application Programming Interface (API) to perform dynamic load balancing and
scale across multiple servers within a cluster.
•
SYNAPSE customers often use a commercially available software package for the
network management functions for a seamless extension to network management
capabilities. In fact, any utilities, which are compatible with Microsoft NT, may be
used in conjunction with SYNAPSE. As an open system utilizing Windows NT, the
opportunities to add third party applications are vast.
•
To leave SYNAPSE open to newer archiving strategies as they become available,
Fuji manages the storage layers and any off-line (shelf) media through a
commercially available, media independent Hierarchical Storage Manager (HSM). It
is inevitable that archiving technology will change over time and the use of a
commercially available HSM module allows for the implementation of new
technologies via a relatively simple process.
By using a commercially available, media independent HSM, Fuji has retained its
openness and hardware independence because it did not need to write proprietary
device drivers to ensure compatibility with any specific archive device. This HSM
has literally has validated over one hundred different archives.
Seamless Integration With External Web Environments
Due to its web based architecture, Synapse integrates beautifully with web based
clinical information systems, by allowing the web based information system to
generate the syntax to retrieve images from the PACS through a “Go to Images” or
similar button, truly allowing a seamless enterprise wide distribution of data like no
other PACS can offer today.
This functionality leapfrogs the evolving CCOW standard by launching the view
directly to the image level within Synapse rather than opening Synapse at the patient
level and leaving the user to navigate to the image level.
Following is a visual depiction of how the web based clinical information system
integration works. We think you will agree that this is a very powerful and elegant
enterprise integration tool.
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http://<host>/explore.asp?path=/AllStudies/accessionNumber=[acc.#]
Synapse Screen
URL to
Images
Back Button
returns you
to WebCIS
By pressing this
link Synapse will
automatically
launch.
Sample WebCIS Screen
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SUBSCRIPTION
Specific workflow lists can be generated by Modality, combination of Modalities and/or for
specific Physicians, Specialist and Referring Physicians in the form of folders. Physicians
can then “Subscribe” to a specific folder for instance: Unread Stat Exams & ER. While
working off a non-stat unread worklist, that physician would be notified by audio or dialog
box/pop up that a Stat case needs his/her immediate attention/interpretation. After
opening the Stat and completing any unread Stat cases, the physician would then be
taken back to the previous worklist they were working from before the alarm. In this
manor, many Synapse users set up a rotation for physicians that subscribe to this type of
list radically improving patient encounter times as well as quality of care. Specialist can
also set up to subscribe to specific worklist/folders. In this example, when a Physician
loggings in, they would automatically receive a dialog “pop up” box like below when there
are studies for them to read. Once the “Open Folder” is selected in this example, they
would be immediately taken to the day’s unread CR studies.
IMAGE PROCESSING
Fuji’s Synapse is the only PACS in the industry that allows the user to post process and
change the dynamics of the image at the desk top. ALL other vendors only allow
Window leveling (change in contrast & brightness).
An exam of a single chest film sent across on the left is modified with a single mouse
click to provide the results on the right. This unique image processing ability allows
Physicians to analyze multiple views from a single image. For ALL other PACS
systems in the industry, the technician would need to process the image at the CR or
Modality station and send it over each time a different processing algorithm is desired.
Not only is the clinician’s time and impact on Network traffic effected, but the storage
requirements to preserve these images in these views from any other PACS will double,
triple or worse, depending on the number of views requested by the Radiologist.
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As seen at the RSNA 2004, Fuji recently applied the same imaging processes from CR
to CT. Both image on left and right were generated from a single series sent over from a
CT scanner. The image on the Right represents an industry 1st. The image on the
Right is actually a processing algorithm that highlights Bone density as well as lung
tissue. None of the Imaging Venders are able to do this with their own modalities. If the
impact on time, network traffic and storage requirements were improved with CR, think
of the impact on Multislice CT!
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BROKERLESS RIS INTEGRATION
In the early to mid-nineties, RIS interfaces needed to be individually crafted - a very
tricky task that consumed thousands of engineering hours. Eventually several nonPACS engineering companies discovered the need for these interfaces and began
developing interface capabilities which would eventually be compatible with nearly every
recognized RIS available in the market. At this point, many PACS companies wisely
chose to add a third party RIS/PACS interface server to the topography of their PACS
rather than continue their individual interface development efforts.
The third party interface design occasionally proved to be problematic, however,
because it became a potential single point of failure and introduced a third party into a
critical element of the functionality of the PACS. Both the PACS vendor and the
customer were dependent upon a third party provider that had a relatively low stake,
financially, in the success of a multi-million dollar installation. Because each interface
“box” could cost anywhere from $40k to $60k+, customers were not eager to pay for a
redundant interface which would only be utilized as a spare or backup. Most PACS
were configured with only one RIS interface “box”.
When Fuji began development of its PACS, the translation tables and indices of the RIS
interfaces had become widely standardized. This allowed Fuji to integrate the actual
interface functionality directly into the SYNAPSE server without utilizing an external or
third party “box”. An integrated interface translates between the standard HL7 serviced
by Synapse and that of any external information system. Multiple, simultaneous HL7
dialects can be supported.
This approach to integrating the PACS to the RIS is referred to as “Brokerless”, i.e. no
separate, appended broker box is required. The interface engine is integrated into the
SYNAPSE multi-function RAID server so that a vended box (which also represents a
single point of failure) would not be necessary. The RIS interface is protected by all of
the robust protections designed into the multifunction RAID server – obviously a
tremendous technological advantage.
HARDWARE INDEPENDENCE
The physical independence from the logical database allows for technology to be
deployed over centralized or distributed platforms. Synapse is entirely hardware
independent and can be implemented in virtually any imaginable configuration that will
support a Windows 2000/3 infrastructure environment. Server Infrastructure can be
configured to the scope of not only hi-availability with redundancy at every point, but the
Storage Architecture can also be expanded to support a true “Business Continuance”
model. Business Continuance simply translated means that there is an on-line duplicate
back up so that if there is a failure on the primary SAN, a second (back up) SAN with
failover servers can kick in, thus the facility is never out of action even if they have a
catastrophic event. Please see examples in the next section.
We see hardware technologies evolving rapidly along industry standards, and believe
that our customers are best served by purchasing anywhere from 18 to 24 months of
capacity at one time, and adding additional capacity as needed. Synapse scales
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beautifully to support this, and will allow our customers to avoid buying massive depths
at today’s prices and at today’s processing speeds.
CASCADABILITY (PEERLESS SCALABILITY)
Additionally, processing power may be added to the infrastructure as needed. There are
a number of ways in which the equipment can scale, and the scaling method deployed
will depend upon the utilization that is achieved by the current equipment as well as
future growth that is foreseeable at that point in time. Most traditional PACS are limited
to scale by forklift upgrading any hardware, which has been outgrown. This type of
scaling may be accommodated by almost any system, Synapse included.
The more desirable scalability, however, is outward scaling, which Fuji refers to as
“cascadability”. Cascadability allows Fuji to maintain a logically centralized system, but
combine several servers together to support a single function, or load balance.
Since Synapse is a Software Based Product, all functions are written in software
Modules. For example, the RIS, DICOM Acquisition, Database, Storage/Achieve and
WEB GUI are all software modules. A single multifunction server can support up to
70,000 studies easily. The same code, software functions and features are available
and installed at all sites no matter how many procedures are performed. Thus facilities
are able to scale according to loading and budgets with a “cascadable” upgrade path.
Within this single Rack illustrated above, Synapse comes complete with all the same
features and functions running at our largest sights. This package contains a Production
Server running all applications along with a clone Test Server, DLT to back up the
database, on-line RAID and LTO for long term storage.
For the same customer, with the same software purchased, they have the option of
breaking out the software modules onto separate servers for better load balancing of all
the software modules. This is a true example of “cascadability.” This example illustrates
what is referred to as a “Hi-Available” network. All single nodes of failure have built in
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redundancy and back up. This means if one node/server/path fails, there is another
path/server that will kick in automatically. This ensures continued production for the
clinicians, technologist and a stable network to support modalities and users in the event
of a failure. One node fails, the IT department can address that failure, while business
continues as normal our on the floor, in the reading rooms, to the referring physicians
and specialists.
NON-WEB based PACS may try to deploy a Content Switch for load balancing.
HOWEVER, since their GUI is thick client – a Content Switch (displayed above) would
only load balance the images on the Network traffic, not the USERS.
Below is an example of Business Continuance. This customer chose to have an exact
copy of their SAN/Storage along with failover servers at a completely different site. If the
primary data center experiences complete and total failure to do a fire, hurricane,
tsunami or other acts of nature, the facility is still operational = Business Continues on.
Below is a diagram from a real customer implementation.
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WEB PORTAL INTEGRATION
The original design philosophy of the Fuji Synapse product was to provide an
information system capable of integrating a multi-site environment, with multiple
information systems and multiple radiology reading groups.
For this reason, the original software design embraced the notion of directly integrating
the PACS with the information system both to achieve the design criteria and improve
the manageability of the integration.
These integrations fall into several categories.
•
•
•
Unidirectional integration with RIS using HL-7 messaging.
Bi-directional integration with RIS using HL-7 messaging.
Any combination of the above with a “URL” based integration.
Fuji’s RIS integration does not employ any third party “brokers” or software
modules to provide the above functionality. This makes the overall management of the
interface much easier by ensuring that a single vendor controls the PACS side of the
integration.
By using standards such as HL-7 and URL as integration platforms, the overall
management of the integration is improved. Fuji believes that by leveraging a
combination of domain specific industry standards and computer industry standards, the
quality, function, and management of the integration are improved.
Examples of the URL based integration include the ability of the Synapse application to
dynamically construct a URL (web address such as http://patient.study.report ) to
present information from an external system such as a RIS, EMR/EPR, or HIS. In
addition, this information is presented in a window, contained within the Synapse
application which is web enabled, allowing interaction with this information on the
external system.
Further, external systems can also access information on Synapse to bring image
content into the external application. For example, an EMR application can construct a
URL (such as http://patient.study.images or http://patient.study.documents). Some
screenshots showing this integration follows (next page):
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http://<host>/explore.asp?path=/AllStudies/accessionNumber=[acc.#]
URL to
Images
Back Button
returns you
to WebCIS
Synapse Screen
By pressing
these links,
Synapse will
automatically
launch.
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URL INTEGRATION WITH IDX
SCREEN SHOTS OF IDX WITHIN SYNAPSE POWER JACKET
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URL Integration: SYNAPSE within IDX
Images from exams can easily be accessed by the referring physician without entering
into and having to surf around PACS to find the images. In this case, it’s a one-click
button to the chest film for their patient.
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URL integration: SYNAPSE within Mirror Image
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The following 3 screen shots are from a real site. These shots show how a WEB Portal
can manage users and direct traffic. For instance in this illustration, a physician with
dictation privileges follows the same prompts on the screen as a referring physician.
However, instead of being directed to the EMR, he/she is directed right to their
personalized worklist (bottom).
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URL integration with Modalities outside of Radiology
This example is of Cardiology PACS
URL is light years ahead of DICOM when it comes to streamlining workflow between
different systems. Links are easy to establish and the speed of moving between two
independent applications (without leaving the primary application) are unparalleled and
the future of the industry.
NOTE: when the Radiology tab is accessed from Cardiology PACS – it opens Synapse
to that specific patients data (no surfing required).
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