Transcript Integrated RIS-PACS Myth or Reality?

Where are we going
anyway?
….and what are the chances of
getting there via the NPfIT
Dr Keith Foord
Consultant Radiologist,
East Sussex Hospitals,
United Kingdom
www.esht.nhs.uk
[email protected] or [email protected]
Objective 1 for this group?
Complete Integration of RIS
and PACS
or as near as possible,
with some points from history
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
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
Communication issues between IS
databases, PACS and modalities
20/11/03
Keith D. Foord
HL71
HL7 i/f
SPF
or ‘Gateway’
HIS
Nov. 20 2003
Foord, Keith D.
HL72
RIS
HL72
DICOM
HL7/DICOM
I/f = PACS
SPF Broker
Modality
DICOM
PACS
DICOM
Unidirectional RIS/PACS
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 MWL
Demographic 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 I/f
without Modality DICOM MWL
Archive
HL7
RIS
PACS Broker
DICOM minus MWL
Modality QA station
DICOM data, no MWL
Manual input
of data. Prone
to error
Non – MWL Modality
Manual correction
of data to match
RIS data
If not done up to
20% of studies
are ‘orphaned’
Reporting Workstation
Unidirectional RIS/PACS I/f
with Modality DICOM MWL
Archive
HL7
RIS
PACS Broker
DICOM
Data incl MWL
MWL Modality
Reporting Workstation
Bi-directional RIS/PACS
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 I/f
with DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
Archive
RIS
MWL/MPPS
HL7 +
DICOM
DICOM +
PACS Broker
HL7
DICOM
MWL/MPPS Modality
Reporting Workstation
Integrated RIS/PACS
with DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
RIS/PACS
Internal HL7- DICOM
& DICOM – HL7
transactions
Demographics
MWL MPPS
Archive
DICOM
General Purpose Worklist
(if provided allows
choice Of WS independent
of PACS Vendor)
MWL/MPPS Modality
Reporting Workstation
Voice
RIS
Broker
PACS
Internal Transactions
PACS companies which have
acquired RIS company products.
Still basic brokering, but added
internal HL7/DICOM transactions.
Voice
RIS
PACS
Internal Transactions
De-novo combined RIS-PACS
products.
Some internal interfacing plus
Internal HL7/DICOM transactions.
Voice
RIS
Internal
Transactions
PACS
Different vendors with all the HL7/
DICOM transactions in RIS within
a ‘PACS integration module’.
Advantage – best of breed
Complete Integration
of RIS into PACS:
Dream or Reality?
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!
Objective 2 for this Group
The same complete Integration of
RIS-PACS and non-Radiological
Images
Example: UGI Tumour
management
Text and image data gathered
at initial presentation and
diagnosis plus local staging –
followed by centre
assessments
History + added History
Clinical examination
Blood tests
Endoscopy
Histopathology
CT/CXR/Ultrasound Abdo
ECG/PET/Endoultrasound
Spirometry/Cardiac NM
Text
Images
Text
General
Condition
of
Patient
Text
Tumour
Type
TNM
Images
PACS needs to store more than
Radiology images !
Colposcopy
Endoscopy
Histopathology
ECGs
HIS
Cytology
EPR
Voice
RIS
Blood films
Broker
PACS
Internal Transactions
EEGs
Medical
photographs
Opthalmology
Dermatology
Videos
But….we need the same standard of integration
as with a modern Radiology RIS-PACS
‘X’IS/PACS
Internal
HL7/DICOM/XML
transactions
DICOM
images
DICOM
2o capture
HIS
Archive
EPR
HL7 and
/ or XML
data
Non-DICOM
images
‘X’IS
Web
server
Viewing
Objective 3 for this Group
Full Integration of RIS-PACS and nonRadiological Images into
a comprehensive National Integrated
Clinical Information System working
with NPfIT
Integrated National Multi-IS/PACS
PACS
ASP
Archive
Wider NHS
Local ICRS
Wider
NHS
RIS systems installed in UK by supplier
Huge and long term International efforts have gone into
protocol optimisation and framework standards with RIS and
PACS to make them fully synergistic - DICOM HL7 IHE
These deep integration issues need to be matched by other
Clinical IS systems – not just ‘top layer’ with XML but using
From www.pacsgroup.org.uk data
HL7 and DICOM
Old RIS systems have been a compromise and need replacing
wholesale across the country to make PACS fully efficient, but
must not be replaced ‘with just any’ new RIS
So..What are the chances of getting
there via the NPfIT? cont..
The best ‘buy’ PACS, from an LSP view, might not be the best
clinical PACS. *LSPs appear to have 3 or 4 recognised suppliers each, so this is unlikely to be a
problem
The best ‘buy’ PACS may not integrate well with the best ‘buy’
RIS or particularly an historic RIS!
Integrated RIS-PACS or a RIS with an Pacs Integration
Module/DICOM MWL/DICOM MPPS may not be available
from your LSP
Even if they are is your imaging equipment base up to it?
If the LSP has only one system per clinical speciality and
these come from multiple sub-suppliers how will these fit
‘deeply’ with existing clinically satisfactory systems? *LSPs appear to
have only ONE prime EPR supplier each, so this may be a problem with some hereditary systems.
What if clinicians on the ground don’t like what the LSP
supplies – could there be clinical IT wastelands?
With thanks to Simon Daniell’s friend
“Messages to NPfIT……………………………”
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A good specification which must be achievable is paramount. This is usually
acknowledged by the purchaser but they fail to recognise the responsibility this
places on them.
Where risk persists, you must have a work around solutions. This often means
spending more money in the early phases on alternative solutions; each being
dropped as their need diminishes.
The prime contractor must identify the risks at the outset, but to declare the risks
fully to the purchaser before contract award may reduce their chance of winning.
The bigger, or more complex, the system the more important it is to manage the
risk.
Purchasers can relax too much when they force their supplier into fixed price
contracts involving significant development. If the supplier gets into trouble it
can rebound on the purchaser, especially with regard to timescale and even
occasionally cost. If one major sub-contractor falls down there can be
considerable cost impact on the other sub-contractors.
The easy way to select a supplier of a development system is on cost, where he
who underestimates most wins.
He who has never implemented such a new system before is the more likely to
underestimate.
He who does not have ‘buy in’ from the end users advances at peril.