The duplication of patient data in a hospital can result in unnecessary procedures, costly billing mistakes, and medication being delivered to the wrong patient. In the radiology department, duplication can cause an image to be associated with the wrong report, a potentially devastating error.
Duplication often occurs as a result of inputting patient information at multiple data-entry points. A high error rate made it nearly impossible to associate images with reports at the department of medical and diagnostic sciences at the University of Padova in Italy, for example. So Dr. Claudio Saccavini and his colleagues at the institution set out to solve the problem by integrating their PACS with their RIS.
The group faced several challenges, Saccavini said in a presentation at the 2001 European Congress of Radiology in Vienna. The department’s PACS consists of one CT (Emotion, Siemens Medical Solutions, Iselin, NJ), one MR (Harmony, Siemens), two computed radiography (CR) units (AC3, Fujifilm Medical Systems, Stamford, CT), and one digital radiography unit (Advantix, GE Medical Systems, Waukesha, WI).
However, only the Siemens devices were enabled to use DICOM’s modality worklist feature to connect directly to the RIS. In addition, the CR devices used a proprietary Fuji protocol to hook into the PACS. In order to shift the department’s workflow from an error-ridden system that required multiple data-entry points to a single-entry process, worklist capabilities first had to function for all modalities in the PACS.
The group looked at available off-the-shelf solutions and found that from a price-and-configuration perspective, they were better off developing their own RIS. Saccavini said the team's success in creating an open source-based PACS influenced the decision to write their own RIS software.
The researchers chose a Linux server (Red Hat, Research Triangle Park, NC) as the backbone of the RIS, and Interbase (Borland, Scotts Valley, CA) as the database engine, then wrote a user interface for the system with Delphi (Borland). The next step was to connect the disparate elements of the PACS via a modified DICOM server application from the OFFIS (Oldenburger Forschungs -- Und Entwicklungsinstitut Fur Informatik -- Wekzeuge Und -- Systeme) open-source project library at the University of Oldenburg in Oldenburg, Germany.
 |
Once the pieces were in place, the authors needed a DICOM modality worklist provider and broker component to integrate the PACS modalities into the RIS. By querying the open-source software community, Saccavini and his colleagues were able to locate and integrate a Linux-based DICOM worklist component developed by Giorgio Cabus and Giovanni Bosco Hospital in Turin, Italy.
The group reported that before the RIS/PACS integration, about 5% of the patient records in the department had clerical errors. "By introducing the worklist integration we have avoided these patient data errors due to the multiple typed data entries [first into the RIS, and then into the PACS]," Saccavini said. He noted that his group found that the most successful way to integrate its RIS/PACS was via a RIS-generated accession number sent via a DICOM worklist to the PACS.
He also cautioned eager adopters of open-source solutions to carefully plan the integration between RIS and PACS, especially when using DICOM worklist protocols. "The difficulty in adopting this integration methodology is that only the last generation of radiological devices has DICOM worklist capability," he said.
The RIS application is available in English, Greek, and Italian versions. The software and its source code can be downloaded free of charge at http://www.rad.unipd.it/raynux/.
Linux penguin graphic courtesy of [email protected]By Jonathan S. Batchelor
AuntMinnie.com staff writer
May 11, 2001
Related Reading
Italian researchers build PACS on a shoestring, April 24, 2001
IHE's effects on PACS implementation, February 21, 2001
How far has systems integration evolved in PACS?, February 20, 2001
IHE looks for more participation by HIS vendors, other specialties, February 6, 2001
Japanese researchers address challenge of multivendor PACS, January 25, 2001
Security, ASP, systems integration to highlight PACS exhibits, November 16, 2000
Click here to post your comments about this story in our PACS Digital Community. Please include the headline of the article in your message.
Copyright © 2001 AuntMinnie.com
