Albert Reinder Bakker

Integration of information systems: assessing its quality

Due to organizational and technological changes the need for integrating information systems within healthcare institutions, has increased enormously. Although the technical means for systems integration have definitely matured, integration methodologies are still in their infancy. Two important questions regarding systems integration are hardly ever addressed in a systematic way: how to derive integration requirements, and how to check whether the requirements are met in a given integrated system. These two questions must be answered if we want to assess or improve the quality of integration of a given set of systems. In this article we present a nine-step method for deriving integration requirements from a business process model, and we assess the quality of integration of a given integrated system against these requirements. The method is demonstrated by elaborating two case studies from the health care domain.

Constructing an enterprise viewpoint: evaluation of four business modelling techniques

Business process modelling is presented as an important first step in the process of designing a distributed system by integrating pre-existing components. The elements describing a business process are derived from the ODP-enterprise viewpoint language. One of the viewpoints distinguished in the Open Distributed Processing standard is the enterprise viewpoint. This viewpoint describes the organizational context in which the distributed system to be constructed will be used. In this paper we will review four business modelling techniques and their suitability for expressing the enterprise viewpoint is evaluated.

Prefetching: PACS image management optimization using HIS/RIS information

From the users point of view -- and that should be the starting point for the development of any information system -- a full-scale PACS has to do at least two things: (a) offer access to all available patient data, both the pictorial and the alphanumeric data, from the workstation, and (b) the response time related to the retrieval and display of these data must at least be acceptable. In order to be able to meet both requirements, the PACS must be linked with the HIS/RIS. For the first requirement, the HIS/RIS will in general be the main source for supplying alphanumeric patient data. The second demand can only be fulfilled if the PACS is able to manage its image database properly. A strategy which provides a way to optimize PACS image management using information generated elsewhere (e.g., by the HIS/RIS) is called prefetching. In this paper, a model of prefetching is presented, and a number of possible parameters for the prefetching algorithm are discussed. Finally, a method for evaluating the effectiveness of the algorithm is proposed and illustrated with the first results of a pilot study carried out in the Leiden University Hospital.

Traffic between PACS and HIS/RIS: data or information?

When studying the functions to be supplied by a PACS the need for a link with the HIS/RIS turns out to necessary for two classes of reasons: - the first class deals with the need to supply as much clinical information at the workstations as possible. Whether this information is stored within the HIS/RIS should be transparant to the user. - modelling and simulation of PACS gives evidence that thetraffic load in a PACS can only be handled adequately when the image management system can take into account patient flow and patient medical story. As typical example can be mentioned prefetching algorithms that take care of activation of images from the archive before they are actually needed. The activation process is controlled by events in the hospital that indicate an increased probability that these images will be needed. The first class of reasons lead in general only to use of data that in principle can just be presented on the screen of the workstation. The PACS does not need to be aware of the meaning of the data: no common understanding is necessary. So just data can be transfered that will be presented in a transparant way. The second class of reasons deals with data from the HIS/RIS that should be understood by the PACS to be able to take the required action. So the meaning of the data is to be known. In this second class we have to deal with exchange of information while for the first class exchange just data is sufficient. Since the concepts of PACS and HIS are to a large extent similar it is not evident to which of the two certain functions will be assigned. This assignment of functions is considered and some suggestions for implementation of a link between PACS and HIS/RIS are given.

Prototyping a PACS-RIS/HIS interface in Europe

Prototyping a PACS-RJS/HIS interface in Europe.Fenno P. Ottes, Albert R. Bakker, Carl A. Schulz, Frans J. MartensBAZIS Central Development and Support Group HIS,Schiphoiweg 97, 2316 XA, Leiden, The Netherlands.ABSTRACTCurrently a large european project in the area of PAS research and prototyping is being performed. The EurIPACSproject is subdivided into a dozen topics. One of these topics is involved in the integration of PACS, RIS and HIS onconceptual, functional and technical level. Within the scope of this topic, which is called HIPIN (HIs/ris-PacsINtegration), a prototype PACS-RIS/HIS interface will be specified, designed, realized, clinically implemented andevaluated. The interface software, together with the computer configuration on which it runs, is called the HIPIN box.This HIPIN box will be designed in such a way that it can be applied (with minimal adaptations) to interface anyRISIHIS with any PACS in a multi-vendor environment. Two incarnations of the HIPIN box will be realized and willbe implemented in the clinical routines of a Belgian and a German hospital. The functionalityof the interface will befocussed to support the clinical requirements in these hospitals. The HIPIN box will support communication facilities,integration of the textual databases, and data-protection measures. Furthermore, it will contain intelligent modules tocontrol image file archival and migration (prefetching).2. BACKGROUNDSIt is widely recognized now that PACS can only be implemented successfully when it is sufficiently well interfaced withthe existing hospital information system environment [1,2]. This environment in most cases consists of an RIS and anHIS. Various kinds of integration are needed:Information integration, e.g.:

The complexity of transactions: a means for assessing interoperability

Interoperability seems to be a major focal point of the activities within the Informatics Society in general, and the Medical Informatics society in particular. In both Europe and the USA standardization efforts are pursued in order to enable interoperability. However, even if the technical requirements are met, interoperability is sometimes not feasible because the message exchange needed is too complex. This complexity is influenced by at least three factors: the volume of the data to be exchanged, the functionality of the information exchange, and the communication standard adopted.

PACER: a software package for cost evaluation of PACS--first results

The PC-based software package PACER supports cost analysis of PACS. PACER is one of the products of the EU subsidized project EurIPACS. The installation of either partial or hospitalwide PACSystems typically involves a number of changes in requirements for resources like equipment, personnel, and use of film. These changes can to some extent be expressed in monetary units: costs or (quantifiable) benefits. The analysis thereof however, is not as straightforward as it seems. The system may grow over the years, and effects on for instance personnel are not always clear. The software package PACER assists in the process of establishing the cost components of the current film based situation and a possible PACS and allows cost analysis to be performed on the results. The calculation of results can not only be performed for a full scale PACS, but also for the various stages of transition. This paper describes the structure of the software package and possible application areas are illustrated with an example case composed of two European partial PACSystems.

Are Hospital-wide PACS Implementations Possible now (soon)?

Until now, clinical trials of PACS have been limited in two dimensions. Firstly, the implementation concerned only part of the hospital or specific categories of images. Secondly, the PACS was used in parallel, and not instead of film. Recently, three large PACS implementation projects have been announced, i.e. SMZO-Vienna, MDIS-USA and Hammersmith-London. These projects break new ground, since they are concerned with hospital-wide and virtually fdmlers PACS.

Comparison of worldwide opinions on the costs and benefits of PACS

As PACS mature and their integration in hospitals can be expected in the not too distant future, insight into the costs and benefits of these systems is needed. A major problem in the assessment of the costs and benefits of PACS is the lack of international consensus on, e.g., the functional requirements of PACS, on the costs of some major components of the system, and on the impact of the implementation of PACS in a hospital on logistics and patient care. The authors have developed and distributed the software package, CAPACITY, which supports cost and benefit analyses and facilitates the exchange of data. This paper presents an overview of some opinions on the costs and benefits of PACS. It is based on literature data and on data which have been assembled through CAPACITY. Most experts agree that a hospital-wide PACS is more expensive than film, at least now, but the opinions on the costs and the required functionality of PACS components show a wide variation. The costs of PACS however must be weighed against their benefits. PACS has the potential of improving the hospital logistics and patient care. More quantified data on the effect of PACS on, e.g., the availability of images and on the length of patient stay is needed.

Implementation of Picture Archiving and Communication Systems in Hospitals Guided by Dedicated Software

The IMAGIS project of the BAZIS foundation is concerned with research and software development to support the hospital implementation of PACS. IMAGIS participates in various PACS projects. The Dutch PACS project focusses on the design, implementation and clinical evaluation of a prototype PACS coupled with an existing HIS in a university hospital. The HIPACS project is concerned with the development of the foundations needed to create a PACS concept.