Complete Integration of RIS into PACS: Dream or Reality?

1. Complete Integration of RIS into PACS: Dream or Reality? Dr Keith Foord Consultant Radiologist, East Sussex Hospitals, United Kingdom www.esht.nhs.uk keith.foord@esht.nhs.uk

2. 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

3. 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

4. Communication issues between IS databases, PACS and modalities 03/10/01 Keith D. Foord Oct. 01 2003 Foord, Keith D. HL71 HL72 SPF RIS HIS HL7 i/f or ‘Gateway’ HL72 DICOM SPF HL7/DICOM I/f = PACS Broker Modality PACS DICOM DICOM

5. 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.

6. Unidirectional RIS/PACS I/fwithoutModality DICOM MWL Archive HL7 RIS PACS Broker DICOM minus MWL Modality QA station Manual correction of data to match RIS data If not done up to 20% of studies are ‘orphaned’ DICOM data, no MWL Manual input of data. Prone to error Non – MWL Modality Reporting Workstation

7. Unidirectional RIS/PACS I/fwith Modality DICOM MWL Archive HL7 RIS PACS Broker DICOM Data incl MWL MWL Modality Reporting Workstation

8. 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)

9. Bi-directional RIS/PACS I/fwith DICOM MWL and Modality Performed Procedure Step installed in both RIS and Modality Archive HL7 + DICOM + RIS MWL/MPPS PACS Broker DICOM HL7 DICOM MWL/MPPS Modality Reporting Workstation

10. 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 Archive DICOM General Purpose Worklist (if provided allows choice Of WS independent of PACS Vendor) Demographics MWL MPPS MWL/MPPS Modality Reporting Workstation

11. Voice PACS companies which have acquired RIS company products. Still basic brokering, but added internal HL7/DICOM transactions. RIS Broker PACS Internal Transactions Voice De-novo combined RIS-PACS products. Some internal interfacing plus Internal HL7/DICOM transactions. RIS PACS Internal Transactions Voice RIS Different vendors with all the HL7/ DICOM transactions in RIS within a ‘PACS integration module’ Internal Transactions PACS

12. 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. Structured reporting 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

13. Structured reporting Link Features to Description New nodule superimposed with right fourth rib 10% Pneumothorax Cavitation Free air

14. David Clunie Development Director, Imaging Products ComView Corporation – Paper at SPIE, 2001 Structured reporting

15. 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!

16. Voice RIS Broker PACS Internal Transactions IMELDAHOSPITAL Bonheiden, Belgium HIS EPR With thanks to Dr Jan Schillingbeek

17. Extern call Paper document No access to HIS General Scheduler Access to HIS HIS Order filled Order placed RIS Order Communication Analogue request Analogue request available as scanned image Request Part I: Administration

18. Prefetched images Order filled Display station RIS PACS DS Image manager + archive Prefetching DICOM Modality Worklist Modality Long-term Archive

19. Registration Finished RIS Listed Started Order filled Arrived PACS RIS DS Imagemanager + archive Modality Part II: Image production

20. -Access to HIS -Access to RIS -Access to EPR -MPR -MIP -Volume Rendering -Desktop integration: 1 mouse & 1 keyboard - Speech recognition Part III: Reporting

21. Billing EPR report Webserver PACS Paper print RIS DS Imagemanager + archive Report print URL CD Electronic Patient Record Part IV: Distribution

22. Complete Integration of RIS into PACS: Dream or Reality? DEFINITELY POSSIBLE !