H. Lodder

HIS-PACS Coupling In Practice

The existence of a link between a HIS, incorporating a RIS, and a PACS is one of the most indispensible prerequisites to perform a clinical evaluation study of a PACS in practice. The two main reasons for realizing a IIIS-PACS coupling are concerned with 1) proper image management e.g. in order to achieve acceptable waiting times and 2) the user need of having all patient relevant data available in the same workstation. A first phase coupling between an existing HIS and a just installed PACS has been realized by BAZIS in the Utrecht University Hospital in the Netherlands. These activities were carried out as part of the Dutch PACS Project, a collaboration in the PACS field of BAZIS, the Utrecht University Hospital (AZU) and Philips Medical Systems. For the first phase only HIS data of the in-patients of one particular ward of Internal Medicine were transmitted using a one-way dataflow (from. HIS to PACS). In phase two the coupling will he hi-directional and more departments will be part of the experiment. In phase three of the coupling project a more general. HIS-PACS interface will be developed, independent of the HIS and PACS manufacturers. In April 1988 the first public data exchange (patient data, order data, reports) between the BAZIS/ZIS and Philips/MARCOM system has been demonstrated. This was the first working example of a HIS-PACS coupling worldwide to our knowledge. This paper gives an overview of the experimental set-up, the demonstration during the 6th EuroPACS meeting , the results and problems encountered thusfar and statistical data from daily practice.

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.

Prefetching Offers Prospects for a Quick Responding PACS

A quick retrieval of the images will be one of the main promises to be fulfilled by the next generation of PACS systems. Even when present day advanced technology is applied the waiting times will be far too long. This is mainly due to the tremendous amounts of digital data needed to represent radiological images.

Communication Between Hospital and Radiology Information Systems and Picture Archiving and Communication Systems

Appropriate medical care is determined by data on the patient’s condition on the one hand, and the knowledge and experience of the physician on the other. In the early days of health care, a patient had to deal with only one physician, who collected the observations himself and had the knowledge and experience stored in his own brain. With the advancement of medicine, increasing amounts of data had to be recorded, and these were no longer stored only in the brain of the physician, but gradually also recorded on paper: the medical record was born.

HIS-PACS coupling: BAZIS/ZIS and Philips/MARCOM on speaking terms.

Nowadays a growing number of experts in the PACS field agree on the necessity of having an integrated HIS-PACS combination available in modern hospitals in order to manage the enormous amounts of patient data, both textual, numerical and image information, in an effective way. Since 1986 BAZIS (the Development and Support Group of the Hospital Information System), Philips Medical Systems and the University Hospital of Utrecht (AZU) are partners in the so-called Dutch PACS Project in the development and evaluation of a fully integrated image information system. The first phase of the coupling (sub)project consists of establishing a communication link between the BAZIS/ZIS and the Philips/MARCOM system with the following restrictions: the only data sent concerns the inpatients of one ward; data will only flow one way, from BAZIS/ZIS to Philips/MARCOM. In the second phase two-way communication will be realized and more departments can be part of the experiment. In phase 3 a more general HIS-PACS interface will be developed, independent of the manufacturers of HIS and PACS. In this paper the technical solution chosen for the first phase coupling, the format of the messages being transferred, and the events which result in sending the messages, will be described. Also, reference is made to the demonstration of the working HIS-PACS link, given during the 6th EuroPACS meeting in Utrecht and Leiden on 25-26 April 1988.

Background of the demonstrated IMAGIS activities and future expectations

In The Netherlands a national PACS development programme has been started, supported by the Dutch Society of Radiology and funded by the Dutch Department of Health because of the national character of the project. Three main partners are cooperating in this development: the Utrecht University Hospital (AZU), BAZIS and Philips International (Product Division Medical Systems), with the Delft University of Technology as the main BAZIS subcontractor. The non-profit foundation BAZIS, developing and supporting the ZIS Hospital Information System (in use in some 30 Dutch hospitals, over 15,000 acute beds), initiated its current IMAGe Information System (IMAGIS) projects in 1984. The activities were later integrated into the Dutch PACS project started in 1986. The final goal of the project is to achieve a PACS which is fully integrated with already existing hospital information systems (HIS). The development and operation of a HIS-PACS include many aspects of technical and clinical. The current efforts of BAZIS are concentrated on three main issues: diagnostic image quality evaluation (e.g. effects of data compression); modelling, software simulation and technology assessment of a prototype PACS (both general and detailed aspects); and coupling and integration of PACS and HIS (e.g. the BAZIS ZIS). Philips, Hamburg, is supplying equipment, particularly prototype components. A systematic clinical evaluation will take place at the Utrecht University Hospital.2+ We outline the background of the intermediate results as demonstrated during the 6th EuroPACS Conference:the psychophysical software package for Feature Evaluation And System Inspection By Logged Experiments (FEASIBLE); the modelling and simulation software package for Medical Image Representation, Archiving and Communication, Learned by Extensive Simulation (MIRACLES); and first results of the coupling experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Looking for Indicators of a Reference Hospital

As with hospital information systems (HIS) and radiology information systems (RIS), picture archiving and communication systems (PACS) have been (and are still being further) developed for use in hospitals. Since each hospital has its own characteristics, it is not sufficient to buy and implement a standard HIS, RIS, and/or PACS; adjustments to the local dimensions and working methods, for example, will be necessary. Nevertheless, for both the hospital management and the vendors, a reference hospital is evidently needed. PACS vendors, for example, need a reference hospital to serve as the basis for the definition of their standard product. Within the context of this study, the concept of a reference hospital is limited to those aspects related to PACS.

HIS-PACS coupling in perspective

Within the framework of the Dutch PACS project (a cooperation in the PACS field of BAZIS, the Utrecht University Hospital and Philips Medical Systems) a coupling between a HIS and a prototype PACS was realized and evaluated during clinical practice. This one-way coupling is a first step towards a so-called Image Information System, which can be seen as (logically) one system instead of two (a HIS for storage and retrieval of administrative and medical data, and a PACS for the images). The BAZIS/HIS is an integrated HIS, containing about 70 subsystems including a RIS, which is now used in about 40 hospitals in the Netherlands. The main reasons for coupling/integrating a HIS and a PACS can be summerized as: a) the user need for both functional and information integration and b) the need to have access to HIS data for optimizing image database and network management in order to get acceptable response times. As follow-up to the paper presented in the 1989 conference this paper will focus on the experiences gained with this one-way coupling. The event-driven communication took place by sending messages from HIS to PACS in ACRNEMA format. From these experiences recommendations for a next phase: a two-way link between a HIS and a PACS will be given. The necessity for bidirectional datatransfer will be discussed. Directions for future research e.g. on prefetching strategies will be pointed out.