Post on 23-Dec-2015
transcript
Where are we going anyway?
….and what are the chances of getting there via the NPfIT
Dr Keith FoordConsultant Radiologist,
East Sussex Hospitals,
United Kingdomwww.esht.nhs.uk
keith.foord@esht.nhs.uk or secretary@pacsgroup.org.uk
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
PACS
HL7 i/for ‘Gateway’
HIS RIS
HL7/DICOMI/f = PACS Broker
HL71 HL72
HL72
DICOM
DICOMDICOM
20/11/03Keith D. Foord
Nov. 20 2003Foord, Keith D.
SPF
SPFModality
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 MWLDemographic 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
Unidirectional RIS/PACS I/fwithout Modality DICOM MWL
RIS PACS Broker
Non – MWL Modality
Modality QA station
HL7
Reporting Workstation
Archive
DICOM minus MWL
DICOM data, no MWLManual correction of data to match
RIS dataIf not done up to 20% of studies are ‘orphaned’
Manual input of data. Prone
to error
Unidirectional RIS/PACS I/fwith Modality DICOM MWL
RIS PACS Broker
MWL Modality
HL7
Reporting Workstation
Archive
DICOMData incl MWL
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
Bi-directional RIS/PACS I/fwith DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
RISMWL/MPPS PACS Broker
MWL/MPPS Modality
HL7 +
Reporting Workstation
Archive
DICOM
DICOM
DICOM +
HL7
Integrated RIS/PACS with DICOM MWL and Modality Performed Procedure
Step installed in both RIS and Modality
RIS/PACSInternal HL7- DICOM
& DICOM – HL7transactions
MWL/MPPS Modality
Reporting Workstation
Archive
DemographicsMWL MPPS
DICOMGeneral Purpose Worklist
(if provided allows choice Of WS independent
of PACS Vendor)
PACS companies which haveacquired RIS company products.Still basic brokering, but added internal HL7/DICOM transactions.
RIS PACS
Internal Transactions
Broker
Voice
De-novo combined RIS-PACS products.Some internal interfacing plusInternal HL7/DICOM transactions.
RIS PACS
Internal Transactions
Voice
Different vendors with all the HL7/DICOM transactions in RIS withina ‘PACS integration module’. Advantage – best of breed
RIS
PACSInternal Transactions
Voice
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!
Complete Integration of RIS into PACS: Dream or Reality?
Objective 2 for this Group
The same complete Integration of RIS-PACS and non-Radiological Images
Example: UGI Tumour managementText and image data gathered at initial presentation and diagnosis plus local staging – followed by centre assessments
History + added HistoryClinical examinationBlood testsEndoscopyHistopathologyCT/CXR/Ultrasound AbdoECG/PET/EndoultrasoundSpirometry/Cardiac NM
Text
Images
Text
TumourTypeTNM
GeneralCondition
ofPatient
Images
Text
RIS PACS
Internal Transactions
Broker
Voice
HIS
EPR
PACS needs to store more than Radiology images !
EndoscopyColposcopy
HistopathologyECGs
Medicalphotographs
Opthalmology
Dermatology
Cytology
Blood films
EEGsVideos
‘X’IS/PACSInternal
HL7/DICOM/XMLtransactions
Viewing
Archive
But….we need the same standard of integrationas with a modern Radiology RIS-PACS
‘X’IS
Webserver
DICOM 2o capture
HL7 and / or XMLdata
Non-DICOMimages
DICOMimages
HIS
EPR
Objective 3 for this Group
Full Integration of RIS-PACS and non-Radiological Images intoa comprehensive National Integrated Clinical Information System working with NPfIT
Integrated National Multi-IS/PACS
ASPArchive
WiderNHS
Wider NHS
Local ICRS
PACS
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 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
From www.pacsgroup.org.uk data
RIS systems installed in UK by supplier
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 LSPEven 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……………………………”
1. 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.
2. 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.
3. 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.
4. The bigger, or more complex, the system the more important it is to manage the risk. 5. 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.
6. The easy way to select a supplier of a development system is on cost, where he who underestimates most wins.
7. He who has never implemented such a new system before is the more likely to underestimate.
8. He who does not have ‘buy in’ from the end users advances at peril.