The University of Nevada at Las Vegas School of Dental Medicine was moving to a new location two years after its inception in 2002. The Shadow Lane campus, right in the heart of the University Medical Center area of Las Vegas, was soon to be home to one of the most high-tech dental schools in America. With a large volume of clinic visits from residents of the community, the School quickly found that paper and film weren’t a practical method for keeping records. The vision that UNLVSDM had was to become one of the first completely paperless and digital dental schools in the country.

Situation

UNLVSDM had no digital radiography components prior to their relocation. Based partially on private practice clinical management software, the school’s needs weren’t being met to efficiently run a dental school and clinic.The school’s decision on a digital imaging solution was to be based on a strict set of criteria. With the leadership of Dean Pat Ferrillo, UNLV’s School of Dental Medicine was being brought into the digital age.

Multiple digital radiography devices would be implemented in the school, from phosphorus plate capture, CCD sensor capture, and digital panoramic/cephalometric devices. Using the vendor’s software wasn’t the ideal situation. It would require faculty and students to learn three different imaging applications that stored images in proprietary formats. The school needed a solution – one application for capturing from all devices that minimized the learning process, was easy to maintain, and stored images in a standard format at a centralized location.

UNLVSDM needed a standard format for image storage – one that they would truly own, where they wouldn’t be forced to store images in proprietary formats. The images needed to be stored to a single location, where backup would be uncomplicated. The school needed a system that operated on such a standard so that it could interface with other PACS systems in hospitals and clinics. Additionally, the images needed to be available at any location in the school, including satellite clinics, at any time.

Based on the volume of patients that the clinic sees on a regular basis, as well as the number of students, a load balanced and failover-capable server solution was desired as well. They needed a system that was robust, scalable, expandable, and available 24/7.

A concern at UNLV was compliance with HIPAA regulations to ensure the privacy of patients and the integrity of the images stored. They needed a system that would limit students’ ability to store X-rays without the approval of qualified faculty members (which is a feature in MiPACS Viewer for teaching environments that was a perfect fit for UNLV). Additional limitations to access rights were needed for students, such as restrictions on who can capture, view, and print patient images. They needed the ability for students to access images on their personal laptops as well, without actually storing the images and patient information on them, which could violate HIPAA regulations.

The School of Dental Medicine needed a system that was efficient, user-friendly, and easy to use. The system needed to link with the clinical management software seamlessly without having to login or search for a patient twice, reducing the chance for data entry errors. The automation of much of the capture process was important, as well as access time for the images to keep workflow as smooth and quick as possible.

The key to success for the School of Dental Medicine was the simplification of the user learning process. With hundreds of students to train, the school needed one application for students to learn that would take care of all aspects of digital imaging, from capture to diagnostics.

The University had chosen Two-Ten Health’s Salud Suite for clinical management, and needed an imaging system that could give the school a fully digital solution. After researching several options, the UNLV School of Dental Medicine selected Medicor Imaging’s MiPACS Dental Enterprise as their comprehensive solution to digital imaging.

Medicor Imaging cooperated with UNLV and Two-Ten Health to ensure that the integration of MiPACS Dental Enterprise with the school’s network and clinicalmanagement software went as smoothly as possible. Medicor customized several elements of MiPACS to meet the challenges and obstacles that were faced in UNLV’s network.

Open System Architecture
UNLVSDM’s need for an imaging application that provided functionality with all of their imaging devices was fulfilled with MiPACS Dental Enterprise Viewer. Support for all devices, such as Air Techniques Scan-X phosphorus plate scanner, Dexis Dexray digital intraoral sensors, and Planmeca’s Promax digital panoramic/cephalometric device, was included in a single software product.

There was no need for the vendor’s imaging applications, which stored images and patient information in proprietary formats. Instead of three applications to learn and maintain, the School of Dental Medicine had only one.

MiPACS Storage Server also incorporates the idea of open architecture by using the DICOM standard. All DICOM compliant devices, whether they are printers, applications, or even network-based X-ray or scanning devices, can communicate with the server regardless of the vendor.

Solution

The Idea of One Application for All Stations
The functional diversity of MiPACS Dental Enterprise Viewer provided UNLV with a single interface for all types of stations, as well. Diagnostic stations, capture stations, and both thick- and thin-client review stations are all powered by the same imaging application. Costs for training and the learning curve of students and faculty were reduced drastically because only one user-friendly application took care of all aspects of imaging.

DICOM
UNLV adopted the DICOM standard when moving to MiPACS. DICOM (Digital Imaging and Communications in Medicine) standard was developed to meet the needs of both users and manufacturers of medical imaging equipment for interconnection of devices on standard networks. Because DICOM is a worldwide standard, it instantly offered them compatibility with thousands of other devices as well as other hospital and school PACS systems through MiPACS Dental Enterprise Viewer.

User-friendly and efficient workflow
Medicor Imaging met the school’s demand for a seamless integration between Salud and MiPACS. With only the press of a button, MiPACS Dental Enterprise Viewer is launched from Salud, and the current patient’s record is retrieved along with security permissions for that particular user. Data entry errors are greatly reduced using this link, since patient demographics are pulled into MiPACS straight from Salud.

The capture process is also simplified by using MiPACS’ smart templates (hanging protocol), which helps by automatically encoding the resulting DICOM objects with proper anatomic information. This drastically reduces the time required to encode images for storage to the DICOM server.

With the load many students place on the network and the volume of patients seen, images at the school need to be retrieved quickly. MiPACS reduces the access and download time for images by using image compression as well as running many of the clients on the Citrix platform.

Reduction of Maintenance and Support Costs
To ease the process of upgrades and maintenance, Medicor Imaging created a customized version of MiPACS Dental Enterprise Viewer to run on the Citrix platform. Jumping the hurdles associated with creating a Citrix-compatible application, Medicor Imaging succeeded and UNLV is the first implementation of the software in a Citrix environment. Using thin clients throughout most of the school resulted in reducing the cost of maintenance to a fraction of what it would have cost for thick clients.

The UNLV School of Dental Medicine will never have to depend on proprietary image formats that are incompatible with many systems. Since MiPACS Storage Server uses the DICOM 3.0 standard with a database powered by Microsoft SQL Server, they truly own the images in a standardized format, and have the freedom to import and export patient images and records in a variety of formats compatible with nearly every system on the market.

Storage Server
A server powerful and reliable enough to process the volume of requests that UNLV’s School of Dental Medicine would create was provided for them in MiPACS Storage Server. With two servers in a network load balanced cluster, backed by a separate Microsoft SQL Server, UNLVSDM was provided with a powerful, failover solution. All of the school’s images are stored in one place, making the archiving of this data an easy task for the school’s IT team.

Security
To keep the school compliant with HIPAA regulations, Medicor enhanced the security and privacy features available in MiPACS. Security permissions allow only certain users to view, capture, print, import, export, and approve images. Because of the integration with Salud, users aren’t required to login a second time to MiPACS to determine these security permissions.

Patient records are kept private by auto-deleting them from capture stations after they are captured, approved, and stored to the server. Even considering that students are using personal laptops to view images, the privacy of patient data is not being compromised. No patient data is downloaded to student laptops since they are running a thin client version of MiPACS Dental Enterprise Viewer.

As an added means of protection, security features on the server protect the School of Dental Medicine’s database and images by only allowing verified clients on the school’s Citrix and Windows network to connect.