Deploying PACS/RIS Healthcare Applications with VMware View and
Complete Integration of RIS into PACS: Dream or Reality?
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Transcript of Complete Integration of RIS into PACS: Dream or Reality?
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Dr Keith FoordConsultant Radiologist,
East Sussex Hospitals,
United Kingdom
www.esht.nhs.uk
Complete Integration of RIS into PACS: Dream or Reality?
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History 1970-2001
• 1970s – First RIS systems– To manage departmental workflows and store information
• Late 1980s/early 1990s – First operational PACS– But did not link information in RIS with images
• Mid 1990-2001 - Image centric PACS with RIS interfaces
• Incompatible communication protocols forced ‘Brokers’• Image centric – PACS image DB has to be additionally populated
with information INTRODUCED to the system• Some RIS functions have to be duplicated in PACS• Problems with correlation of RIS & PACS data - requires
administrator intervention to correct
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History 2001+
• RIS centric PACS– The RIS is prime and controls information flows,
including images– Simplifies information management– RIS becoming integrated – integrated Brokers or
‘Brokerless’– IHE integration profiling– Provides DICOM Modality Worklist (MWL) directly
to modalities– Uses DICOM Modality Performed Procedure Step
(MPPS) – if supported by both modality and RIS
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Communication issues between IS databases, PACS and modalities
PACS
HL7 i/for ‘Gateway’
HIS RIS
HL7/DICOMI/f = PACS Broker
HL71 HL72
HL72
DICOM
DICOMDICOM
03/10/01Keith D. Foord
Oct. 01 2003Foord, Keith D.
SPF
SPFModality
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Many RIS vendors have provided Uni-directional data to PACS via a PACS Broker. Data not sent back to RIS to update fields related to the exam.
If RIS does not support DICOM MWL or modality does not support MWLDemographic data must be entered manually at modality – high risk of errors.
Errors manually corrected at the Archive or QA station,Reducing productivity and delaying availability of images. If not corrected images ‘orphaned’ and not available.
Unidirectional RIS/PACS
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Unidirectional RIS/PACS I/fwithout Modality DICOM MWL
RIS PACS Broker
Non – MWL Modality
Modality QA station
HL7
Reporting Workstation
Archive
DICOM minus MWL
DICOM data, no MWLManual correction of data to match
RIS dataIf not done up to 20% of studies are ‘orphaned’
Manual input of data. Prone
to error
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Unidirectional RIS/PACS I/fwith Modality DICOM MWL
RIS PACS Broker
MWL Modality
HL7
Reporting Workstation
Archive
DICOMData incl MWL
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Data on start/finish exam, procedure changes, resource utilisation, number of images and series in study if sent back to RIS enhance QA, increase productivity and allow full integration into Integrated Clinical Systems.
To do this both RIS and Modality must support not just MWL but also DICOM Modality Performed Procedure Step (MPPS)
Bi-directional RIS/PACS
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Bi-directional RIS/PACS I/fwith DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
RISMWL/MPPS PACS Broker
MWL/MPPS Modality
HL7 +
Reporting Workstation
Archive
DICOM
DICOM
DICOM +
HL7
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Integrated RIS/PACS with DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
RIS/PACSInternal HL7- DICOM
& DICOM – HL7transactions
MWL/MPPS Modality
Reporting Workstation
Archive
DemographicsMWL MPPS
DICOMGeneral Purpose Worklist
(if provided allows choice Of WS independent
of PACS Vendor)
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PACS companies which haveacquired RIS company products.Still basic brokering, but added internal HL7/DICOM transactions.
RIS PACS
Internal Transactions
Broker
Voice
De-novo combined RIS-PACS products.Some internal interfacing plusInternal HL7/DICOM transactions.
RIS PACS
Internal Transactions
Voice
Different vendors with all the HL7/DICOM transactions in RIS withina ‘PACS integration module’
RIS
PACSInternal Transactions
Voice
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Incorporated into the report are captured images of key findings (which can be exploded to full screen presentation), structured diagnosis information, recorded audio, the ability to sort findings by anatomy or priority, to view prior findings associated with the corresponding patient and hyperlinks to related information.
DICOM SR – is an ‘envelope’, but within this useful structure is available.
User decides how much structure to use and controls with templates the type of content, if it is mandatory or optional and modes of expression
Structured reporting
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Link Features to Description
New nodulesuperimposedwith rightfourth rib
Free air
10% Pneumothorax
Cavitation
Structured reporting
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David Clunie
Development Director, Imaging Products
ComView Corporation – Paper at SPIE, 2001
Structured reporting
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With an old non HL7 RIS – forget it
With an old HL7 Brokered RIS – limited
With a new HL7(IHE) RIS - very nearly a reality with a PACS integration module
- this allows freedom to choose best RIS and best (IHE) PACS
With a same vendor combined RIS-PACS – internal HL7/DICOM transactions
….But what about the modalities, DICOM MWL and MPPS?
Don’t forget the need to integrate the HIS and Integrated Clinical Systems too!
Complete Integration of RIS into PACS: Dream or Reality?
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With thanks to Dr Jan SchillingbeekWith thanks to Dr Jan Schillingbeek
RIS PACS
Internal Transactions
Broker
Voice
HISEPR
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HIS
Access to HIS
No access to HIS Extern callPaper document
General Scheduler
Order placed
Request
RIS
OrderCommunication
Part I: Administration
Order filledAnalogue request
available as scanned image
Analogue request
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DICOM ModalityWorklist
PACS
Image manager +
archive
Long-termArchive
RISOrder filled
Modality
Display station
DS
Prefetching
Prefetched images
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PACSModality
Imagemanager +
archive
RIS
Registration
Part II: Image production
Order filled
Listed
StartedArrived
Finished
DS
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-MPR-MIP-Volume Rendering
-Access to HIS-Access to RIS-Access to EPR
Part III: Reporting
- Speech recognition
-Desktop integration:1 mouse &
1 keyboard
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PACSPart IV: Distribution
Imagemanager +
archive
RISreport
DS
Webserver Paperprint
URL
EPRElectronic Patient Record
Billing
Report
CD
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Complete Integration of RIS into PACS: Dream or Reality?
DEFINITELY POSSIBLE !