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Architectural design and tools to support the transparent access to hospital information systems, radiology information systems, and picture archiving and communication systems.

The fragmentation of the electronic patient record among hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) makes the viewing of the complete medical patient record inconvenient. The purpose of this report is to describe the system architecture, development tools, and implementation issues related to providing transparent access to HIS, RIS, and PACS information. A client-mediator-server architecture was implemented to facilitate the gathering and visualization of electronic medical records from these independent heterogeneous information systems. The architecture features intelligent data access agents, run-time determination of data access strategies, and an active patient cache. The development and management of the agents were facilitated by data integration CASE (computer-assisted software engineering) tools. HIS, RIS, and PACS data access and translation agents were successfully developed. All pathology, radiology, medical, laboratory, admissions, and radiology reports for a patient are available for review from a single integrated workstation interface. A data caching system provides fast access to active patient data. New network architectures are evolving that support the integration of heterogeneous software subsystems. Commercial tools are available to assist in the integration procedure.

Computer Systems↗

An integrated picture archiving and communications system-radiology information system in a radiological department.

In this report we present an integrated picture archiving and communication system (PACS)--radiology information system (RIS) which runs as part of the daily routine in the Department of Radiology at the University of Graz. Although the PACS and the RIS have been developed independently, the two systems are interfaced to ensure a unified and consistent long-term archive. The configuration connects four computer tomography scanners (one of them situated at a distance of 1 km), a magnetic resonance imaging scanner, a digital subtraction angiography unit, an evaluation console, a diagnostic console, an image display console, an archive with two optical disk drives, and several RIS terminals. The configuration allows the routine archiving of all examinations on optical disks independent of reporting. The management of the optical disks is performed by the RIS. Images can be selected for retrieval via the RIS by using patient identification or medical criteria. A special software process (PACS-MONITOR) enables the user to survey and manage image communication, archiving, and retrieval as well as to get information about the status of the system at any time and handle the different procedures in the PACS. The system is active 24 hours a day. To make the PACS operation as independent as possible from the permanent presence of a system manager (electronic data processing expert), a rule-based expert system (OPERAS; OPERating ASsistant) is in use to localize and eliminate malfunctions that occur during routine work. The PACS-RIS reduces labor and speeds access to images within radiology and clinical departments.

Austria↗

Interfacing aspects between the picture archiving communications systems, radiology information systems, and hospital information systems.

Information relevant to radiological applications is commonly managed by several autonomous medical information systems including hospital information systems (HIS), radiological information systems (RIS), and picture archiving and communications systems (PACS). In this report, we explain the need to coordinate these systems and to provide some framework in which they can exchange information. In the first half of this report, we describe the integration of a PACS system into a hospital operation. Next, we present the interfacing methods between the HIS and the RIS, and between the RIS and the PACS. Two methods are further detailed for the communication between the RIS and the PACS (1) the triggered database to database transfer, and (2) the query protocol. The implementation of the first method successfully allows RIS reports, procedure and patient demographic information to be displayed at the request of the user along with the associated images at a PACS workstation. The query protocol allows a PACS to dynamically query RIS information. It will be eventually integrated into the design of a scientific multimedia distributed medical database system built on top of the HIS, the RIS, and the PACS.

Academic Medical Centers↗

Time and flow study results before and after installation of a hospital information system and radiology information system and before clinical use of a picture archiving and communication system.

The effectiveness of a hospital information system (HIS) and a radiological information system (RIS) was evaluated to optimize preparation for the planned full clinical operation of a picture archiving and communication system (PACS), which is now linked experimentally to the HIS and the RIS. One thousand IC (integrated circuit) cards were used for time studies and flow studies in the hospital. Measurements were performed on image examination order entry, image examination, reporting, and image delivery times. Even though after the HIS and the RIS operation only a small amount of time savings were realized in each time fraction component, such as in the patient movement time, examination time, and film delivery time, the total turn-around time was shortened markedly, by more than 23 hours on average. It was verified that the HIS and the RIS was beneficial in the outpatient clinics of the orthopedic department. Our method of measurement employing IC cards before and after HIS and RIS operations can be applied in other hospitals.

Computers↗

A literature review on communication between picture archiving and communication systems and radiology information systems and/or hospital information systems.

The purpose of this literature review is to present the concepts surrounding the issue of communication between imaging systems and information systems in radiology and the literature about them. Picture archiving and communication systems (PACS) were developed to combine viewing of modality images, archiving, and distribution of images. When PACS is integrated/interfaced with radiology information systems (RIS) or hospital information systems (HIS), it can merge patient demographics, medical records, and images. To address several issues surrounding communication between PACS and HIS/RIS and to make interface development easier and faster, various organizations have developed standards for the formatting and transfer of clinical data. Additional work continues to better handle these issues. Communication protocol Health Level 7 (HL7) is a standard application protocol used for electronic text data exchange in health care by most HIS/RIS. The imaging communication protocol for PACS is the Digital Imaging and Communications in Medicine (DICOM) standard specification protocol that describes the means of formatting and exchanging images and associated information.

Computer Communication Networks↗

The National Institutes of Health Clinical Center Digital Imaging Network, Picture Archival and Communication System, and Radiology Information System.

In this work, we describe the digital imaging network (DIN), picture archival and communication system (PACS), and radiology information system (RIS) currently being implemented at the Clinical Center, National Institutes of Health (NIH). These systems are presently in clinical operation. The DIN is a redundant meshed network designed to address gigabit density and expected high bandwidth requirements for image transfer and server aggregation. The PACS projected workload is 5.0 TB of new imaging data per year. Its architecture consists of a central, high-throughput Digital Imaging and Communications in Medicine (DICOM) data repository and distributed redundant array of inexpensive disks (RAID) servers employing fiber-channel technology for immediate delivery of imaging data. On demand distribution of images and reports to clinicians and researchers is accomplished via a clustered web server. The RIS follows a client-server model and provides tools to order exams, schedule resources, retrieve and review results, and generate management reports. The RIS-hospital information system (HIS) interfaces include admissions, discharges, and transfers (ATDs)/demographics, orders, appointment notifications, doctors update, and results.

Hospital Information Systems↗

Radiology information systems help radiology departments operate more efficiently.

Many department managers identify radiology information systems (RIS) as one way to increase efficiency and reduce expenses. Ms. Rowe explains various ways that an RIS can help you compete in an increasingly competitive marketplace, handle higher patient volume and fulfill requirements for recording and transferring patient information.

Efficiency↗

Integrated radiologic information system: a radiology multimedia communication system.

A multimedia radiologic communication system has been developed that achieves the system design goal of providing a clinical communication service that is an efficient improvement over present methods of communication. The system allows users to access, through a workstation, digitized radiographic images, voice reports, and other patient data. Physicians can consult with each other while simultaneously accessing this information through a shared visual workspace, even though they are in different places. The system was designed by a multidisciplinary team including radiologists, clinicians, engineers, user-interface specialists, and psychologists from hospital, university, and research settings in an effort to maximize system performance and clinical utility.

Computer Communication Networks↗

An automated radiology information system.

An automated radiology department information system, serving the diagnostic radiology and nuclear medicine divisions, has been developed. Radiology applications are part of a centralized data processing operation which incorporates clinical, administrative, research, and teaching subsets. The radiology subset includes remote on-line ordering/reporting, automated examination census and statistics, an on-line audit trail/workload control program, and financial reports. The software is linked to other hospital applications. This system improved report turn-around times, decreased clerical loads, and provided better financial management.

Computers↗

The radiology information system: its evolution and current status.

Radiology information systems (RIS) have developed over the past 20 years as a specialized area of medical informatics. Although an increasing number of radiology departments utilize such systems, the majority do not. Perhaps this is because no commercially available system has yet demonstrated its ability to provide cost-effective solutions to the diverse problems of different departments. This review begins with a brief history of RIS to point out some approaches that have proven successful and some that have not. Learning about the historical development of RIS also helps understand many of the features that are found in current systems. The bulk of the article is devoted to a detailed discussion of the functional modules found in RIS, including patient registration and data base management, examination scheduling, process control, film file management, diagnostic reporting, financial packages, and management statistics. These discussions emphasize the wide range of activities and problems found in different radiology departments and the wide range of techniques utilized by RIS. General issues of designing or selecting, installing, operating, and optimizing a RIS are discussed briefly. A final section points out areas for future development and expansion of RIS, giving special attention to the incorporation of digital image information into overall radiology systems.

Appointments and Schedules↗

Authentication and management of radiologic reports: value of a computer workstation integrated with a radiology information system.

An increasing number of radiology departments are using computers to facilitate management of radiologic information. Transcription, storage, and printing of radiologic reports are among the primary functions of a radiology information system. Consequently, manual signature of radiologic reports is being replaced by on-line electronic authentication. However, the utilities provided on most radiology information systems to review, edit, and otherwise manipulate radiologic reports are relatively crude compared with commercial word-processing and data-base management software available for personal computers. We have developed a personal computer software system that is integrated with our existing radiology information system; expedites the radiologist's task of reviewing, editing, and authenticating (i.e., signing) radiologic reports; provides a teaching file data base on the workstation into which radiologic reports and patients' demographics can be instantly transferred; and provides a similar data base to facilitate follow-up on those examinations deemed appropriate for quality-assurance procedures. These features improve the radiologist's efficiency and increase his or her willingness to more fully exploit the intended purposes of a radiology information system.

Humans↗

Demystifying radiology information systems.

Selecting the right radiology information system (RIS) can be a difficult and tedious task for radiology managers. Sometimes the information systems department ends up selecting the RIS. As a radiology manager, you can help yourself and your department greatly by becoming more educated concerning the technology and terminology of radiology information systems. You can then participate in one of the most important decisions that will ever be made regarding your department. There is much confusion about the meanings of the terms interfaced and integrated. Two applications are generally considered integrated if they freely access and update each other's databases. Two applications are generally considered interfaced if they pass data to each other but don't directly access nor update the other's databases. Two more terms are centralized and decentralized. Centralized is the concept of "putting all of your eggs in one basket." Decentralization means you spread your resources out. The main difference between centralized and decentralized is that all components of a centralized system share the same fate (good or bad), while decentralized components operate independently and aren't affected directly by failures in another system. Another significant term relevant to RIS systems is HL7, which is a standardized data format that allows one application to pass data to another application in a format that the receiving application understands. RIS vendors generally fall in three categories: single-source vendors, multiproduct vendors and single-product vendors. Single-product vendors include best-of-breed vendors. No one approach is necessarily better than the others; which you choose will depend on your needs. When considering the purchase of an RIS system, there are important questions to ask yourself, the vendor and the vendors' customers as you gather information and prepare to make a decision.

Centralized Hospital Services↗

Qualitative and quantitative evaluation of charge capture by a radiology information system.

Installation of a radiology information management system (RIS) is usually justified on the basis of improved departmental efficiency and improved charge capture. However, evaluation of the success of these expected improvements is often difficult. The installation and operation of such a system in a medium-sized tertiary care hospital has permitted the effects of the RIS on the operation of the department to be studied and the improvements in charge capture provided by the system to be quantitatively assessed. As a result of a side-by-side comparison with a conventional check-sheet manual billing system, it is apparent that the RIS reduces the errors inherent in manual systems. Subjectively, it is also apparent that personnel prefer the computerized system to the manual charge sheets.

Accounting↗

Purchase considerations for a radiology information system.

Since choosing a radiology information system can be a trying endeavor, this "nuts and bolts" article offers some practical advice. The authors first emphasize that a strong partnership between the institution and vendor must exist for successful implementation to happen. Ms. Rowe and Ms. Parrish then proceed to outline the commitment, tasks and training necessary to ensure that your organization undertakes this project with favorable results!

Computer User Training↗

Radiology information systems: looking to the future.

Radiology information systems will soon be able to help store and access digital images by interfacing with picture archiving and communication systems, and will include voice-recognition technology to speed up report transcription. Before these systems are molded to the technologic advances, however, they will likely be interfaced first with hospital information systems and upgraded to solve existing management problems in radiology departments.

Efficiency↗

Development and implementation of the Veterans Administration's multihospital radiology information system.

Unknown to most radiology professionals, the Veterans Administration (VA) is implementing an automated radiology information system as an integrated component of its Decentralized Hospital Computer Program. The basic design has been evaluated and refined over the past 5 years. It is now becoming available in all 172 VA medical facilities. Radiology services are provided in a complex management and fiscal environment. The primary purpose of the information system is to improve the efficient processing, performance, and reporting of requests for radiologic consultations and procedures. The automatic capturing of demographic and medical statistics will provide local and national managers more complete data with which to plan future financial, equipment, and personnel requirements. The VA radiology module has the potential to influence the shape of all future systems, commercial and public. This report describes the development of this radiology information system, its current status, and its potential impact on the largest health care system in the country. The module serves as an example of what can or should be expected from the radiology portion of a comprehensive medical information management system.

Computer Systems↗

[The building and practice of the emergency isolation radiology information system at the department of radiology in polyclinic during the epidemic outbreak stage of SARS].

OBJECTIVE: To clarify the characteristics of the hardware and software in the emergency-isolation-radiology-information-system(EIRIS) from the running experience of EIRIS during the epidemic outbreak stage of SARS(serious acute respiratory syndrom). To summarize the experience and the effects of the system, and to discuss the benefits and problems of the system. METHODS: To set the dependent IP subnet address for the EIRIS. The server was in high available(HA) style. The text information was transmitted by TCP/IP protocol, and the chest X ray film information was transmitted by DICOM protocol. The client workstations were set in the SARS isolation region(at the SARS outpatient department and the SARS x-ray examination room) and the non-SARS isolation region respectively. The incidence of the SARS in medical staffs was recorded before and after the EIRIS was employed. RESULTS: EIRIS made the suspected and the diagnosed SARS cases away from the non-isolation area effectively. The incidence of the disease after the EIRIS running was in a downward trend compared with the incidence before the system run. CONCLUSION: EIRIS was an effective method to break the transmission route of SARS within the hospital. Network and software preparation, the training in computer of the staffs at radiology department, network maintenance and the management system are the keys to the smooth running of the EIRIS.

China↗