基于IHE技术框架实现工作流集成

探讨基于医疗信息系统集成（IHE）技术框架实现医院工作流集成。北美放射学会（Radiology Society of North America，RSNA）和医疗卫生信息与管理系统学会（Healthcare Information and Management Systems Soeietv，HIMSS）联合发起的IHE项目从工作流集成的角度出发，基于医疗标准制定了在各种医疗信息源间交换数据的技术框架。我们利用这个技术框架，从放射科的实际工作出发，尝试在复杂而异构的医院环境中实现信息集成与工作流集成。基于IHE技术框架，通过协调各种医疗设备和信息系统，实现了放射科的工作流集成。在复杂而异构的医院环境中，基于IHE技术框架能实现工作流集成，同时对IHE技术框架在我国的应用前景进行了展望。     

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.     

HIS/RIS/PACS integration: getting to the gold standard

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced dramatically in recent years. The push is toward enterprise-wide image management solutions, where digital images from radiology, cardiology, and other "ologies" are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point of end-user interaction. The "gold standard" of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost. Unfortunately, the gold standard remains elusive in most healthcare environments, even those with new systems. One of the earliest issues that plagued the progress of hospital information system/radiology information systems/picture archiving and communication systems (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. This barrier was solved by the broker--a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS. Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL). Two primary problems are inherent in most brokered configurations. Workflow is driven by paper, and RIS information flows in 1 direction only, which leads to duplicative databases. Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users improved access to critical patient and clinical information across all systems within the healthcare delivery network. While the IHE initiative began to facilitate more efficient, predictable, and functional integration between disparate systems, vendors still had technology hurdles to overcome. System integration continues to be significantly hampered, not by technology limitations, but instead by business and political issues. In response to these challenges, several vendors have begun to offer consolidated RIS/PACS solutions and/or HIS/RIS/PACS solutions. Consequently, the prospect of the gold standard appears to be on the horizon. Single vendor consolidated systems are not, however, feasible for deployment in many healthcare organizations, and they are not necessarily the panacea.     

The integration of medical images with the electronic patient record and their web-based distribution

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system. Reports are usually stored in the electronic patient record of other information systems, such as the radiology information system (RIS) and the hospital information system (HIS). But high-quality services can only be provided if electronic patient record data is integrated with digital images in picture archiving and communication systems. Clinicians should be able to access both systems' data in an integrated and consistent way as part of their regular working environment, whether HIS or RIS. Also, this system should allow for teleconferencing with other users, eg, for consultation with a specialist in the radiology department. This article describes a web-based solution that integrates the digital images of picture archiving and communication systems with electronic patient record/HIS/RIS data and has built-in teleconferencing functionality. This integration has been successfully tested using three different commercial RIS and HIS products.     

Change in process management by implementing RIS,PACS and flat-panel detectors

Implementation of radiological information systems (RIS) and picture archiving and communicating systems (PACS) results in significant changes of workflow in a radiological department. Additional connection with flat-panel detectors leads to a shortening of the work process. RIS and PACS implementation alone reduces the complete workflow by 21-80%. With flatpanel technology the image production process is further shortened by 25-30%. The workflow-steps are changed from original 17-12 with the implementation of RIS and PACS and to 5 with the integrated use of flatpanels. This clearly recognizable advantages in the workflow need an according financial investment. Several studies could show that the capitalisation-factor calculated over eight years is positive, with a gain range between 5-25%. Whether the additional implementation of flatpanel detectors results also in a positive capitalisation over the years, cannot be estimated exactly, at the moment, because the experiences are too short. Particularly critical are the interfaces, which needs a constant quality control. Our flatpanel detector-system is fixed, special images--as we have them in about 3-5% of all cases--need still conventional filmscreen or phosphorplate-systems. Full-spine and long-leg examinations cannot be performed with sufficient exactness. Without any questions implementation of integrated RIS, PACS and flatpanel detector-system needs excellent training of the employees, because of the changes in workflow etc. The main profits of such an integrated implementation are an increase in quality in image and report datas, easier handling--there are almost no more cassettes necessary--and excessive shortening of workflow.     

Developing a self-learning training program for RIS computer skills

The demonstration of competency by healthcare professionals remains a priority for hospital administrators, as well as for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Unfortunately, staff members who have to complete competency exercises often describe the process as a burden. Ineffective training processes may be the culprit. Our teaching hospital developed a training program for the radiology information system (RIS) computer system used by an imaging department of more than 200 staff members. The emphasis of our training program was on the design phase and the contribution of subject-matter experts (SMEs) to the content and testing of training materials, which included a computer-assisted, self-learning manual (SLM) and a pocket guide. The first step in the design process was to identify subject matter experts (SMEs) within the imaging department. Seven SMEs were shadowed by the IT educator. The role of the SME was to demonstrate current practices with RIS, to state principles involved and to serve as a reference for questions during training development. The steps that followed planning and design were: training delivery, evaluation and ongoing training. These steps were implemented in a series of workshops, which included soliciting feedback about the training program. Feedback was used to revise the SLM. The RIS SLM training project was a huge success for everyone involved. The average score for the core-skills test was higher than 90 percent. Seventy-five percent of the current staff was trained in the first phase, including radiology students. Our yearly cost savings using SLM workshops instead of on-the-job training will be about $35,000. We attribute the success of this project to a detailed timeline, SME contributions, the pilot testing phase, and the positive attitude of the imaging staff.     

The case for RIS/PACS integration

Why integrate PACS with the RIS? To improve workflow, of course, but what workflow? Much of the focus is on improving the flow of images for the radiologist, which is certainly a good thing to do, but what about the rest of the order process? Typical PACS system architecture begins with the HIS since this is where the correct patient demographic information and in many cases the orders originate. Correct patient and order information is sent from the HIS to the RIS using HL7 commands for Admission/Discharge/Transfer (ADT) and Order/Entry. HL7 is the communications protocol used in virtually all information systems. For the first step in communicating with PACS, patient and order information from the RIS is sent to a device called a PACS broker. This is necessary because most PACS systems do not support HL7 directly, and a translation is required. Images from each imaging modality are also sent to the broker using the DICOM standard. If an imaging modality does not support DICOM, then an additional box is used to convert the images to a DICOM file. The broker then sends completed DICOM files to the PACS for storage, distribution and viewing. That approach has worked well for the first stage of PACS utilization. However, experienced PACS users have identified the need to improve workflow, and many feel that closer communication with the RIS will solve many of the current limitations. This approach is sometimes called a "brokerless" solution but is probably better described as incorporating broker functions into the RIS. There are several potential advantages of incorporating the broker functions into the RIS: Access to all RIS information on patients, orders and results is available and can be used in many ways to improve workflow. Supporting all DICOM services directly from the RIS ensures that the latest and most complete information is always used. For example, DICOM Modality Worklists can be provided directly from the RIS, which guarantees that they are updated immediately. The RIS can manage the complete order workflow, not just images. License, implementation and support costs can be reduced by eliminating HL7 interfaces to an external broker. Managing workflow is the key to improved productivity and patient care from PACS. However, coordinated management of order workflow from the RIS and image workflow from the PACS is required to get the full benefit. The RIS has immediate and broad access to patient and order information. As a result, it is the natural place to take the lead in managing this coordinated workflow. While many older RIS and PACS systems are not yet capable of some of the integration features described above, several new systems are moving rapidly in that direction.     

Integration of a picture archiving and communication system with videocapture and computed radiography in a dental hospital.

A method for the integration of a picture archiving and communication system (PACS) at Kyushu University Dental Hospital with radiological information (RIS) and hospital information (HIS) systems is described. CT, US and DSA from different manufacturers were integrated by videocapture and then subsequently integrated with computed radiography (CR) by means of DICOM. The approximate amount of data stored each month on optical discs is 2 GB. The system does not incorporate intra-oral radiography.     

Systems integration: requirements for a fully functioning electronic radiology department.

Disparate computer-based information systems such as hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) have been introduced into radiology departments at various times to meet specific operational objectives. Typically, these systems are implemented without an integration strategy. Systems integration, which optimizes integrity of data and labor savings, can be achieved by two general approaches. The first links the HIS to the PACS; the second involves interlinking of the HIS, RIS, and PACS, with the RIS as the central controlling system. Standardization in hardware, operating systems, and data base formats--which will allow true integration--is being addressed nationally and worldwide. Operational issues to resolve include ways to increase network capacity, control of data flow, and strategies for dealing with downtime. In the future, systems integration will enable prefetching, two-way interfaces, interfaces with digital dictation systems, and improved linkages with external digital input devices.     

Radiology report turnaround: expectations and solutions

The ultimate work product of a radiology department is a finalized radiology report. Radiology stakeholders are now demanding faster report turnaround times (RTAT) and anything that delays delivery of the finalized report will undermine the value of a radiology department. Traditional reporting methods are inherently inefficient and the desire to deliver fast RTAT will always be challenged. It is only through the adoption of an integrated radiology information system (RIS)/picture archiving and communication system (PACS) and voice recognition (VR) system that RTAT can consistently meet stakeholder expectations. VR systems also offer the opportunity to create standardized, higher quality reports.     

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.     

Prerequisites for the introduction of a computer-assisted radiologic organization system

This paper describes the steps necessary for the introduction of a radiological information system (RIS) for organizational and work-flow support within a large radiology department. The authors experience with a pilot trial of a system purchased and adapted to departmental needs is reported.     

Construction of a bed management system using widely available software: departmental information integration including the department of radiological technology

In recent years, the distribution of medical information through Internet technology has been increasingly promoted as a result of the December 2001 initiative of the Ministry of Health, Labor and Welfare known as "the grand design for the application of welfare and medical care information technology in the field of health." In June 1999, we developed a bed management system that uses a local area network (LAN). The ultimate goals of this systems configuration were the development of an order-entry system, an electronic health-record system, and improved information sharing. The system, which was created by employing widely used software, rationalized daily work by integrating patient information, hospitalization information, radiological examination reservation information, physiological examination reservation information, and rehabilitation reservation information. The radiological examination reservation information system that our radiology department uses is one of these systems. Electronic preservation of the reservation list is carried out in the radiology department, and information on examinations is input. The resulting full-scale order-entry system was introduced in July 2002, and it has improved the sharing of information among staff members.     

Selection and integration of a radiology information system

A comprehensive and reliable computer-based RIS can significantly improve patient care. The authors present case studies that illustrate different approaches to selection and implementation of an RIS. Detailed coverage is given to criteria for the RIS, the selection process, integration with hospital information systems and planning for the future.