March 28, 2008 - PACS (picture archiving and communication systems) is on the verge of taking the next giant leap forward by becoming Digital Healthcare Information Management Systems.
This was one of the many new concepts brought to light at the DHIMS 2008 conference (formerly the PACS conference), held March 25-29 in San Antonio, TX.
While some radiologists might see DHIMS and PACS as identical except in acronym, according to Steven C. Horii, M.D., FACR, FSIIM, of the University of Pennsylvania Medical Center, Department of Radiology, DHIMS differentiates itself by embracing the integration of RIS-PACS, a step that is essential to putting in motion the automation needed for achieving productivity gains, said Herman Oosterwijk, president of OTech. "Hence, the emphasis on the IHE effort," underscored Dr. Horii.
Lecturers at DHIMS stressed the need for integration amongst PACS and other healthcare information systems, and called for vendors to meet the Integrating the Healthcare Enterprise (IHE) protocols. "As described by the IHE profiles, integration is the key to accomplishing both automation and adaptation," said Dr. Horii. "The step beyond integration is interoperation; integrated RIS-PACS are designed this way."
The ultimate objective of interoperability is achieving greater automation. Dr. Horii's case in point was how patient admission information from a HIS is sent to the RIS and from there to the PACS. Lack of integration today can be illustrated with the RIS. "The RIS knows that a study has been requested, why not pull the associated lab data so the radiologist and technologist will see those results prior to starting the study," suggested Dr. Horii. "My report contains the phrase 'gallbladder wall thickening' in the summary. Why not data mine the report and search the patient lab data for white count, albumin and bilirubin levels?" asked he asked. "Why should my report ever contain the phrase, 'correlation with laboratory data is advised'?"
High levels of smart information transfer, pointing relevant data in the right direction, cannot be a reality unless systems are interoperable. Once they are, it is routine to have automatic set up of advanced visualization and decision support tools, teaching file and case review, patient laboratory and other pertinent information and critical results reporting. "Visualization tools must be seamlessly integrated into routine PACS workstations and workflows, just like window/level, zoom/pan...as well as into overall departmental workflow," said Paul J. Chang, M.D., FSIIM, professor and vice-chairman, Radiology Informatics Medical Director, Pathology Informatics, University of Chicago School of Medicine. "Integrated functionality is a must for both radiology workstations and enterprise web clients," he added. "Integration with computerized order entry (CPOE) and protocol tools will greatly reduce setup requirement."
One way to 'encourage' vendors to comply is to start requesting the IHE profiles in the purchase documents, suggested Dr. Horii. "That was how DICOM became widely implemented," he noted. The take home from Dr. Horii and many of the academicians presenting at DHIMS 2008 was, as Dr. Horii put it, "integration is key for automation and adaptation to work. Automation and adaptation are central to improvement of workflow."