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RIS / PACS Integration Presented by: Safa Fathi Amini, MD 21 st Iranian Congress of Radiology Tehran, 17-20 Jan, 2006 Rayavaran Co. CIS/HIS/RIS Solutions.

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Presentation on theme: "RIS / PACS Integration Presented by: Safa Fathi Amini, MD 21 st Iranian Congress of Radiology Tehran, 17-20 Jan, 2006 Rayavaran Co. CIS/HIS/RIS Solutions."— Presentation transcript:

1 RIS / PACS Integration Presented by: Safa Fathi Amini, MD 21 st Iranian Congress of Radiology Tehran, Jan, 2006 Rayavaran Co. CIS/HIS/RIS Solutions

2 “RIS and PACS are more like twins separated accidentally at birth.” Fred Prior, Ph.D., the Mallinckrodt Institute of Radiology,St. Louis. RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

3 Radiology Information System (RIS), 1960’s Picture Archiving and Communication System (PACS), 1970’s Digital image management: RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Another function of RIS

4 Common database and Workflow engine Improved workflow Improved productivity Improved patient care RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

5 Image Request RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

6 Modality Worklist RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

7 New Image Acquisition RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

8 Reporting RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

9 Images Back to RIS/CIS RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

10 Integrated RIS/PACS RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

11 Integrated RIS/PACS RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

12 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Full patient history Full imaging history

13 Radiologist/Reporting physician 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 6 to 36-fold increase in time savings!

14 Radiologist/Reporting physician Better integration of other systems Transcription Voice recognition RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

15 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Real-time decision making

16 Technologist RIS supports all DICOM services Automatic entry in the DICOM Modality Worklists directly from RIS Automatic entry of patient demographics and study-related information Automatic verification Reduced risk of inconsistent data Reduced risk of “broken studies” RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Improved workflow Guaranteed accuracy

17 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Reduced costs Increased efficiency

18 Clinic Better services to referring physician community Reduced errors RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Marketing advantage

19 Patient Imaging records always available Improved safety Decreased cost RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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 Increased satisfaction

20 Overall: Clinical goals Patient safety and satisfaction Physician satisfaction Operational goal Going filmless and paperless RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

21 Integration Levels:  No integration  Physical integration  Messaging level  Application level RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

22 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

23 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

24 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

25 Message Level Integration: 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” RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

26 Message Level Integration: 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

27 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

28 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

29 HIS/RIS/PACS Compatibility Issue RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

30 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

31 Uni-directional Brokered Integration RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

32 Technologist workflow: Patient and exam information from the RIS to broker Modality Query for Patient and Exam Information RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

33 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

34 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

35 Mapping of HL7 Elements to DICOM Elements RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

36 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

37 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

38 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

39 Bi-directional Non-brokered Integration RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

40 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” RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

41 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 RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

42 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.)? RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

43 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? RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

44 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: ] 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: ] Mulvaney J, The case for RIS/PACS integration, Radiology Management, 2002 May-Jun;24(3):24-9, [PMID: ] Bellon E, Feron M, Deprez T, Integrating images into a central medical information system, Stud Health Technol Inform. 2002;93: [PMID: ] Worthy S, Rounds KC, Soloway CB, Strengthening your ties to referring physicians through RIS/PACS integration., Radiol. Manage Mar- Apr;25(2):18-22., [PMID: ] de Azevedo-Marques PM, Integrating RIS/PACS: the web-based solution at University Hospital of Ribeirao Preto, Brazil. J Digit Imaging Sep;17(3): Epub 2004 Jul 13., [PMID: ] Oosterwijk H., DICOM versus HL7 for modality interfacing., J Digit Imaging Aug;11(3 Suppl 1): Review., [PMID: ] RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

45 Herman Oosterwijk, The seven levels of PACS integration, 2004, Keith Foord, A Powerful Tool in Advancing Healthcare – Picture Archiving and Communication System, 2000, Nicholas Joseph Jr., Introduction to Picture Archiving & Communication, 2004, Integrating the Healthcare Enterprise, John S. Webster, Solving the Data Sharing Dilemma, April 2005, Unified Architecture Means True PACS/RIS Integration, June 2004, RIS/PACS integration -- what is it and what are its benefits?, June 2003, _____________________________________________ Link to this presentation: RIS/PACS Integration, Integration/RIS-PACS-Integration Integration/RIS-PACS-Integration RIS/PACS Integration 21st Iranian Congress of Radiology, Tehran, 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

46 RIS / PACS Integration 21 st Iranian Congress of Radiology Tehran, Jan, 2006 Rayavaran Co. CIS/HIS/RIS Solutions


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