RIS / PACS Integration Presented by: Safa Fathi Amini, MD 21 st Iranian Congress of Radiology...

RIS / PACS IntegrationPresented by: Safa Fathi Amini, MD

21st Iranian Congress of Radiology

Tehran, 17-20 Jan, 2006

Rayavaran Co.CIS/HIS/RIS Solutions

“RIS and PACS are more like twins separated accidentally at birth.”

Fred Prior, Ph.D., the Mallinckrodt Institute of Radiology ,St. Louis.

RIS/PACS IntegrationRIS/PACS Integration

21st Iranian Congress of Radiology, Tehran, 17-20 Jan, 2006

•Introduction

•Benefits•Radiologist•Physician•Technologist•Clinic•Patient

•Levels•Physical•Message level•Application Level

•Solutions•Barriers•Brokered

•Problems•Data Mapping•IHE

•Non-brokered•Advantages

•Conclusion•Buyers’ Guide•References and links

• Radiology Information System(RIS) , 1960’s

• Picture Archiving and Communication System (PACS), 1970’s

Digital image management:



•Introduction







Another function of RIS

Common database

and

Workflow engine

• Improved workflow

• Improved productivity

• Improved patient care



•Introduction







Image Request



•Introduction







Modality Worklist



•Introduction







New Image Acquisition



•Introduction







Reporting



•Introduction







Images Back to RIS/CIS



•Introduction







Integrated RIS/PACS



•Introduction







Radiologist/Reporting physician

• All RIS/HIS/CIS information

• Demographics, medical record number

• Orders, results

• Allergies, special precautions

• Other relevant data (priority, clinical indication, transport methods, …)

• Prior reports and images



•Introduction







Full patient history

Full imaging history


• Better flow of images • Complete request workflow

• Automatic pre-fetch

• Immediate distribution of reports

• Immediate access to images and reports for physicians

• No separate RIS terminal

• No identity confirmation



•Introduction







6 to 36-fold increase in time savings!


• Better integration of other systems • Transcription

• Voice recognition



•Introduction







Requesting Physician

• All prior images of the patient

• Advice on duplicate requests

• Advice on possible contra-indications

• No need to wait for the signed transcription



•Introduction







Real-time decision making

Technologist

• RIS supports all DICOM services• Automatic entry in the DICOM Modality Worklists

directly from RIS

• Automatic entry of patient demographicsand study-related information

• Automatic verification

• Reduced risk of inconsistent data

• Reduced risk of “broken studies”



•Introduction







Improved workflow

Guaranteed accuracy

Clinic• Reduced film usage, reprinting, copying, processor

chemicals, service contracts, film room staffing, film storage, and archival costs

• Increased patient throughput

• Increased catchment area

• Increased operating room turnaround

• Reduced lengths of stay

• Competitive advantage with insurance contract negotiations



•Introduction







Reduced costs

Increased efficiency

Clinic

• Better services to referring physician community

• Reduced errors



•Introduction







Marketing advantage

Patient

• Imaging records always available

• Improved safety

• Decreased cost



•Introduction







Increased satisfaction

Overall:

• Clinical goals

• Patient safety and satisfaction

• Physician satisfaction

• Operational goal

• Going filmless and paperless



•Introduction







Integration Levels:

No integration

Physical integration

Messaging level

Application level



•Introduction







No Integration:

• More than one computer on a physician's desk.

• No change in workflow or resources

• Start point to upgrade to higher levels of integration



•Introduction







Physical Integration:

• Visual integration!

• Single computer / OS

• Different applications

• Different workflow

• Advantages:• Less usage of space and power

• Disadvantages:

• No real integration

• No communication among applications

• No effective change in workflow



•Introduction







Message Level Integration:

• Context integration • Different applications sharing common

context

• A "context manager" passes any context changes between applications

• Information exchange as defined by the CCOW (Clinical Context Object Working group) standard

• Advantages:• Provides some degree of integration



•Introduction








• A common user interface through standard messaging (DICOM, HL7, …)

• A “broker” software/hardware to do the “translation”

• Seamless integration requires the definition of standard “profiles”



•Introduction








• Advantages:

• Different products with different capabilities can coexist and communicate

• The basis for more distributed architecture

• Disadvantages:

• Very precise and complex translation/mapping required

• Increased data management

• Higher purchase and maintenance costs



•Introduction







Application Level Integration:• API/Procedure call level

• The application can talk both HL7 and DICOM

• Directly connects RIS to different modalities

• Advantages:

• Most reliable solution

• Less purchase and maintenance costs compared with “brokered” solutions

• Less points of failure

• True “desktop”, bidirectional integration

• Disadvantages:

• Needs retirement of old RIS

• Does not allow systems from different vendors



•Introduction







HIS/RIS/PACS Integration

• Connectivity vs. integration

• Bi-directional data exchange requires common language

• Health Level-7 (HL7) between RIS and HIS/EPR

• The Digital Communications in Medicine Standard (DICOM) between imaging modalities and PACS

• HL7 to DICOM barrier inhibits data flow to PACS



•Introduction







HIS/RIS/PACS Compatibility Issue



•Introduction







The Broker

• A software and hardware device

• Accepts HL7 messages from the RIS

• Translates, or maps, the data to produce DICOM messages for transmission to the PACS



•Introduction







Uni-directional Brokered Integration



•Introduction







Technologist workflow:Patient and exam information from the RIS to broker

Modality Query for Patient and Exam Information



•Introduction







Broker-based Workflow Problems

• Source (RIS) is unaware of updates

• Risk of being out of date

• Must be kept synchronized

• Requires data mapping

• Increased data management



•Introduction







Data Mapping

• A one to one relationship between the components of the two databases

• A precise and strict mapping of HL7 elements to DICOM elements



•Introduction







Mapping of HL7 Elements to DICOM Elements



•Introduction







IHE

Integrating the Healthcare Enterprise• Established by the Hospital Information

Management Systems Society (HIMSS) and the Radiological Society of North America (RSNA)

• Establishes a set of common integration protocols

• Provides a framework for the standards to communicate more easily

• Recognizes HL7, DICOM, CCOW, MPI,…

• IHE Integration Profiles are sets of the two standards with the exact specifications on how to map the specific attributes between the two standards



•Introduction







Importance of IHE• Vendors can explicitly state their products’

integration capabilities

• Users can hold vendors to their IHE commitment

• Promotes systems integration

• Promotes the use of standards

• Enables interaction among multiple systems

• Improves communication standards by removing excessive flexibility

• Enables systems to communicate more efficiently

• Provides a clear integration framework



•Introduction







Non-brokered Solutions• RIS

• RIS-driven workflow controls the PACS

• RIS natively supports DICOM (DMWL)

• Image data verification directly by RIS

• Pre-fetching and auto routing directly by RIS

• PACS

• PACS sends updates to the RIS

• PACS directly queries the RIS to access full patient data and not just the data in the broker

• Broker

• The broker is absent or reduced to interface engine and not data storage



•Introduction







Bi-directional Non-brokered Integration



•Introduction







Non-brokered Solutions• Advantages

• RIS directly integrates to imaging modalities

• RIS has bi-directional communication to PACS

• Full desktop integration is achieved to enable the PACS workstation to access full RIS information

• The Electronic Patient Record (EPR) is “image-enabled”



•Introduction







Conclusion

• Most configurations do not offer optimal integration

• Fully examine dataflow and workflow before making purchase decisions

• Require vendor accountability for system integration as part of the contracting process



•Introduction







Buyer Beware!• Does the system support bidirectional

integration?

• Which system drives the radiologist workflow, the PACS, the RIS, or paper?

• Are radiology reports duplicated (or stored temporarily) in any system other than the RIS?

• Does the integration include desktop integration between the RIS and PACS and, if so, what level of desktop integration?

• Will paper be required for any part of the workflow (technologist, radiologist, report generation, etc.)?



•Introduction







Buyer Beware!• Does the PACS support DICOM queries and

requests from third-party systems, including the RIS?

• How are dictation/report creation systems integrated?

• How are images verified (against the RIS directly or by a duplicated database)?

• Does the EPR support integration to third-party PACS viewing systems?



•Introduction







References and Links• Boochever SS, HIS/RIS/PACS integration: getting to the gold standard, Radiology

Management, 2004 May-Jun;26(3):16-24; quiz 25-7, [PMID: 15259683]

• Nogah Haramati, MD, PACS and RIS: Approaches to Integration,Journal of Healthcare Information Management, vol. 14, no. 3, Fall 2000, HIMSS

• Kinsey TV, Horton MC, Lewis TE, Interfacing the PACS and the HIS: Results of a 5-year Implementation, Radiographics, 2000 May-Jun;20(3):883-91, [PMID: 10835134]

• Mulvaney J, The case for RIS/PACS integration, Radiology Management, 2002 May-Jun;24(3):24-9, [PMID: 12080929]

• Bellon E, Feron M, Deprez T, Integrating images into a central medical information system, Stud Health Technol Inform. 2002;93:53-60. [PMID: 15058414]

• Worthy S, Rounds KC, Soloway CB, Strengthening your ties to referring physicians through RIS/PACS integration., Radiol. Manage. 2003 Mar-Apr;25(2):18-22., [PMID: 12800559]

• de Azevedo-Marques PM, Integrating RIS/PACS: the web-based solution at University Hospital of Ribeirao Preto, Brazil. J Digit Imaging. 2004 Sep;17(3):226-33. Epub 2004 Jul 13., [PMID: 15534755]

• Oosterwijk H., DICOM versus HL7 for modality interfacing., J Digit Imaging. 1998 Aug;11(3 Suppl 1):39-41. Review., [PMID: 9735430]



•Introduction


•Levels•Physical•Message Level•Application Level




•Conclusion•Buyers’ Guide•References and Links

References and Links• Herman Oosterwijk, The seven levels of PACS integration, 2004,

http://www.ringholm.de/docs/02040_en.htm

• Keith Foord, A Powerful Tool in Advancing Healthcare – Picture Archiving and Communication System, 2000, http://www.wma.net/e/publications/pdf/2000/foord.pdf

• Nicholas Joseph Jr., Introduction to Picture Archiving & Communication, 2004, http://www.radiographicceu.com/article13.html

• Integrating the Healthcare Enterprise, http://www.ihe.net

• John S. Webster, Solving the Data Sharing Dilemma, April 2005, www.Healthimaging.com

• Unified Architecture Means True PACS/RIS Integration, June 2004, www.RadiologyToday.Net

• RIS/PACS integration -- what is it and what are its benefits?, June 2003, www.AuntMinnie.com

_____________________________________________

• Link to this presentation: RIS/PACS Integration, http://www.rayavaran.com/articles/showarticle.htm?a=../RIS-PACS-Integration/RIS-PACS-Integration



•Introduction


•Levels•Physical•Message Level•Application Level




•Conclusion•Buyers’ Guide•References and Links

http://www.ringholm.de/docs/02040_en.htm

http://www.wma.net/e/publications/pdf/2000/foord.pdf

http://www.radiographicceu.com/article13.html

http://www.ihe.net/

http://www.ihe.net/

http://www.healthimaging.com/

http://www.radiologytoday.net/

http://www.auntminnie.com/

http://www.rayavaran.com/articles/showarticle.htm?a=../RIS-PACS-Integration/RIS-PACS-Integration

http://www.rayavaran.com/articles/showarticle.htm?a=../RIS-PACS-Integration/RIS-PACS-Integration

www.Rayavaran.com

[email protected]

RIS / PACS Integration

21st Iranian Congress of Radiology

Tehran, 17-20 Jan, 2006

Rayavaran Co.CIS/HIS/RIS Solutions

RIS / PACS Integration Presented by: Safa Fathi Amini, MD 21 st Iranian Congress of Radiology...

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