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For other articles and previous issues click here. June 21, 2004 Unified Architecture
Means True PACS/RIS Integration A hospital and a company join forces to show us where radiology information systems are headed. Integrating PACS and RIS enhances the benefits of each separately. A good system improves workflow, patient care, and operational efficiency. Over time, a facility should even save money once its information management systems are linked to filmless image acquisition. Typically, that integration involves interfacing two disparate systems. Often, this approach yields only a visual integration. Cerner Corporation, the Kansas City, Mo.-based provider of clinical and management information systems, is one of the companies leading the way toward a world of truly integrated radiology networks with both RIS and PACS built on the same system architecture. Cerner believes its architecture goes beyond integration. “Integration has become a much maligned word,” says Hemant Goel, Cerner’s vice president of radiology. “We’ve actually gone past integration into what we call a unified architecture.” To illustrate what he means by unified, Goel makes an analogy using common PC programs available on the commercial market, such as WordPerfect, Lotus 123, and Corel Draw. “Many of us use these applications every day. They can be considered ‘integrated’ if you put them on your desktop because you can view them from the same location,” he explains. “But that’s a visual integration. Now, compare that to something like Microsoft Office.” The different Microsoft Office applications have achieved a truer integration, he says, because they have all been built on a single architecture. Cerner basically applied a similar approach to medical information technology. Sacred Architecture To achieve that true integration, Cerner developed its own PACS and RIS upon its Millennium architecture. “The requisite for any unified system is that you have to own both,” explains Goel. “If I have a PACS and I decide to partner with a company that has an RIS, the best integration I’d most likely be able to do is a visual integration. The databases, schemas, and platform would still be separate.” Other companies offering their own PACS and RIS products are working toward integration, Goel says. “Some companies will say they have integrated systems, too, but it is not a single-architected system,” says Goel. Right now, says Goel, integration in terms of a single architecture is still a developing idea in the industry. However, as the concept of integration evolves—and people understand it strictly as a single architecture, a truly unified solution—the line between PACS and RIS will ultimately disappear, he believes. Getting there hasn’t been easy because the idea of true unification was not well understood. “We’ve had to blaze a lot of trails and take a lot of arrows in the back, but what we now have is true integration,” says Goel. “This is really going to take off,” he adds. “When that happens, others will start to put together truly single-architected, filmless sites. We think the market is very close to that.” In an article on RIS/PACS integration in the March 29 issue of Radiology Today (Integrating RIS & PACS — Where It Is, Where It’s Going; Vol. 5, No. 7; p. 17), Kenneth P. Bonner, director of radiology systems for Misys Healthcare Systems, summed up the view of many in the radiology information technology field. “It will take two or three years to get the integration worked out,” Bonner says, “then maybe another two to three years for it to reach every facility, but I think we’re only two to three years away from just about all the major players having what I would call an image management information system.” Louisiana Purchase The largest hospital in Louisiana, Our Lady of the Lake serves more than 600,000 outpatients and inpatients each year. Obviously, efficiency is vital in an enterprise of that size and scope, and the hospital has been able to achieve that efficiency. The complex implementation process culminated in the creation of a comprehensive digital medical record—including data and images—accessible by all authorized caregivers within the system. What provides Our Lady of the Lake with the “world’s only” distinction is the fact that Cerner’s unified architecture—which includes the Cerner PACS solution and RadNet RIS—has made it possible for the hospital’s clinicians to view a patient’s medical history and images on a single application. Other hospitals that integrate RIS and PACS accomplish their integration by interfacing different systems. The major components of the Our Lady of the Lake
implementation include the following: Before the integration, Our Lady of the Lake had already purchased most of its information systems from Cerner, so management continued their integrated strategy and stayed with the company when it decided to implement RIS and PACS. First it purchased RadNet RIS, then ProVision PACS, and later ProVision Web. The hospital began implementation in 2002 and went completely filmless in October 2003. Goel reports that Our Lady of the Lake divided its goals into the clinical and operational. Clinical goals included improved patient care and safety. “A unified system provides checks and balances,” he says. “You won’t have a mismatch between a patient’s exams and their other information. Access and validation of information provide patient safety.” Operational goals included improved efficiency by improving workflow and going filmless and paperless, which allows a facility to operate faster and more effectively. Goel recalls, “There is an old saying: ‘Wherever the paper and film is, that is where you are not.’” Implementation The second and third phases completed implementation in radiology and then gradually rolled out the system to all areas of the hospital. “We started the rollout with [the] ER,” reports Gary Jump, the hospital’s chief information officer. “After radiology, that was the first area to go filmless. The physician leader helped us understand workflow and to gain acceptance by the ER staff. Then we went online and stopped producing film for that area. After that, we rolled through the different areas [specialties] of the hospital until we stopped producing patient films, except for special requests.” The technology has helped integrate radiology, nursing, laboratory, pharmacy, and emergency department (ED) workflows. The second phase also included the integration and implementation of a digital dictation solution integrated with the PACS, which reduced problems associated with information exchange that negatively impact report turnaround time. The hospital has reduced the time between report creation and delivery. Our Lady of the Lake also uses Cerner’s PowerChart EMR, which creates a comprehensive EMR that includes all patient information and images. The record becomes part of radiology workflow and is accessible to authorized personnel, who can view it anywhere they wish: in different areas of the hospital, in a clinic, or at home. With improved access to a complete record, hospital clinicians can make more informed decisions at the bedside and ED personnel have immediate access to vital information. Referring physicians also have ready access to patient data. They no longer have to wait to receive a patient’s chart or images from another department. Everything can be viewed electronically. “This is a significant improvement in the whole process,” says Jump. “The physician can just go to the nearest PC, whether it’s in the facility, in their office, or even in their homes. They can call up the exam online and review without having to go to the radiologists’ reading room, which is really disruptive to their workflow.” This is where the Web technology is a huge advantage, says Jump. “It can integrate with the EMR on the presentation of the record. Instead of having to find a specialized workstation, you can go to any PC and bring up a review quality image.” How It’s Going However, Jump says the real return on investment comes from the increased efficiency. The improved workflow, he indicates, starts with the radiology staff. “There’s no more paper shuffling throughout the department as everything is done online—from the requestor right through to the dictation and delivery of the results,” he says. Jump admits that such a significant transition took some getting used to at first. “That’s why we rolled it out one area at a time.” But, as with most technological implementations, staff cannot imagine going back to the way things operated before. “This has clearly been one of the biggest wins we’ve had in automation in the clinical environment,” says Jump. — Dan Harvey is a contributing editor for Radiology Today. |
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