University-developed CIS adds PACS

Jun 4, 2003

In a little over a decade, radiology-based information systems have undergone a sea change. In the late 1980s and early 1990s, many clinical information system (CIS) products ran on Unix-based workstations, or even on proprietary viewing platforms developed by individual vendors.

In response to the high cost of ownership and maintenance of these systems, many vendors began switching to software based on Microsoft Windows operating systems. By the end of the decade, when high-speed Internet connections were de rigueur, Web-based clients and open-system products began appearing to address the challenges of patient information management.

"The continued development of PACS and important standards such as DICOM have led the way to more technologically savvy radiology departments and hospitals," said Dr. Rasu Bickram K. Shrestha at the 2003 American Roentgen Ray Society meeting in San Diego.

Shrestha, a clinical research fellow in the department of radiology at the Keck School of Medicine at the University of Southern California in Los Angeles, presented an overview of a Web-based CIS with integrated PACS. The application was developed from research conducted at the Imperial College of Science, Technology and Medicine at the University of London and USC, and is now marketed by ComMedica of Woking Surrey, U.K.

The system, named PiRiLiS (an acronym for Patient Records Library System), is designed to run on any computer platform, provided the user is able to access a standard Web browser. The product is capable of integrating with legacy RIS and PACS applications via a number of integrated software connectors and brokers such as XML, HL7, and DICOM.

The PACS portion of PiRiLiS is based on a DICOM library written at the Imperial College, University of London, with research and development conducted at USC, Shrestha said.

"The library comprises all 16 parts of the DICOM standard, including those parts of the standard that are related to color images, a feature that is absent from many DICOM libraries," he said.

The system, currently in use at USC’s Health Sciences Center, is connected to multiple modalities, both DICOM and non-DICOM, in three hospitals on the university campus. Clinicians are able to access a complete range of clinical data, including all image types, from anywhere on campus, and offsite through a secure connection, according to Shrestha.

"We’ve been able to fully support the full range of clinical color images, such as retinal and arthroscopic images, including all the meta-data, via the system," he said.

A DICOM viewer is integrated into the product, and is invoked on the user desktop by clicking on a series in the patient record. Pre-fetching capabilities permit the product to query for all previous images and reports across the enterprise, and deliver them to a desktop via the thin-client browser interface, Shrestha said.

Storage is based on open database connectivity (ODBC)-structured query language (SQL) standard database architecture. It is integrated with standard storage hardware such as RAID, DVD, and other near-line storage media.

The data is RC4-encrypted and is Zlib lossless-compressed for efficiency. In addition, an audit trail is created for all data down to its individual history item detail, and secure socket layer (SSL) encryption is employed for all data transmissions.

"A key trend in both the electronic patient record and PACS is the development of a fully integrated system which also connects to the HIS and RIS, anywhere at any time. We are on the verge of a dramatic change in the way that images and associated information is archived, retrieved, and displayed," said Shrestha.

By Jonathan S. Batchelor
AuntMinnie.com staff writer
June 5, 2003

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