T02 HIS, RIS, PACS PDF

TOPIC 2 Hospital Information System (HIS) Radiology Information System (RIS) Picture Archiving & Communications System (PACS)  Learning Ministerial...

TOPIC 2 Hospital Information System (HIS) Radiology Information System (RIS) Picture Archiving & Communications System (PACS)  Learning Ministerial CAMRT Topic 2 Objectives Outcome Competency Competency 1- Explain what a Hospital Information System (HIS) is LO#10 2- Define the communication language used by a HIS and RIS LO#10 01XT; E3 3- Explain the Electronic Medical Records module of the HIS LO#10 4- Explain what a Picture Archiving & Communication System (PACS) is LO#10 01XT; E3, 5- Explain what a Radiology Information System (RIS) is LO#10 01XT; E4 6- Define DICOM and explain its importance in a PACS. LO#10 1.1.1 1.1.2 7- Define and contrast the various types of PACS workstations LO#10 01XT; E3 1.1.3 8- Describe the typical image workflow from modality to long term archive LO#10 1.1.4 1.2.3 9- List the common functions of a PACS LO#10 01XT; E3, 10- Define the function of the DSQ & XDS LO#10 01XT; E4 11-Define the relation between PACS, DI-r & DSQ LO#10 12- Define the function of the XDS LO#10 13- Define the function of the Québec Health Booklet LO#10 01XT; E3 14-Define the relation between Canada Health Infoway, DSQ and the DI-r LO#10 2  Links to Informational Videos & Websites DSQ https://www.quebec.ca/en/health/your-health-information/quebec-health-record/ Quebec health Booklet or Carnet Sante: https://carnetsante.gouv.qc.ca/portail https://carnetsante.gouv.qc.ca/a-propos PACS PACS Fundamentals - YouTube PACS Fundamentals - YouTube How DICOM works https://www.youtube.com/watch?v=eCECXr-HxVs https://www.youtube.com/watch?v=9sV8le1tqjI 3  What is a Hospital Information System (HIS) It is a comprehensive, integrated information system designed to manage the administrative, financial and clinical information of a hospital. Examples of the functions and tasks managed by the HIS: o Manges the Admission, Discharge and Transfer of patients (ADT), medical records, appointment scheduling, etc. o Clinical laboratory, pharmacy, radiology, and patient monitoring o Statistics and assessment of outcomes o Hospital Billing, finance, insurance and accounting o Supplies, inventory, maintenance, and orders management o Quality Assurance Program – Risk management The Electronic Medical Record (EMR) A very important module of the HIS containing patient’s information on lab test results, radiology reports, pathology results, and nurses' and doctors' notes 4  Hospital Information System (HIS) The EMR module of the HIS interfaces with most of the ancillary service systems in the hospital. Examples: Radiology Information System (RIS) Laboratory Information System (LIS) Emergency Information System (EIS) Pharmacy Information System (PIS) 5  Hospital Information System (HIS) Benefits of a HIS: Easy access to patients’ medical and demographic information Efficient and accurate administration of finance, diet of patient, and distribution of medical services Improves monitoring and effectiveness of drug usage leading to a reduction of adverse drug interactions Enhances information integrity - reduces transcription errors, and reduces duplication of information entries Easy to use and eliminates errors caused by handwriting It helps as a decision support system for developing health care policies 6  Health Level 7 (HL-7) Health Level Seven or HL7 refers to a set of international standards for computer transfer of clinical and administrative data between ancillary applications and the HIS These standards: o oversee most clinical and administrative data such as demographics, reports, claims, and orders in a HIS o focus on the application layer or "layer 7“ in the Open Systems Interconnection (OSI) model used in networks 7  Dossier Santé Quebec (DSQ) or Québec health Record The DSQ is a secured provincial tool that is used to collect, store and share patients’ medical information in the province of Quebec The aim is to improve the quality of care and efficiency of Québec’s health system For example, the DSQ allows: o HCW to access certain health information directly, no matter what region in Québec o Medical attention to be provided more quickly, especially in an emergency, since it takes less time to find certain health information o Better management of examinations, avoiding to have the same examination taken several times if patient has to consult more than one health or social service. o Optimal adjustment of medication, through sharing of medication history and results which helps prevent adverse interactions between the medications. o More efficient interprofessional collaboration, since information can be shared between health institutions and professionals caring for the same patient. LegisQuebec - chapter P-9.0001 - Act respecting the sharing of certain health information DSQ is part of Canada Health Infoway 8  Canada Health Infoway is an independent, federally funded, not-for-profit organization tasked with accelerating the adoption of digital health solutions, such as electronic health records, across Canada. It is intended to improve access to care for Canadians, improve the efficiency of individual health care providers and make the health care system more efficient. CHI is focused on two strategic goals: o Providing Canadians and health care providers with access to personal health information and digital health services. o Providing safer access to medications. Electronic health records connected through digital health systems such as diagnostic imaging, medication profiles, laboratory test results and other clinical reports produce $1 billion in value for the Canadian health care system every year. 9 Benefits of the Canada Health Infoway 10 Access to information and privacy – Health Canada  Québec Health Booklet The Québec Health Booklet = Carnet Santé Québec: online service that enables all Quebecers to access their health information and certain services This online service provides all Quebecers access to their: o list of medications o lab test results o medical imaging reports o Schedule or cancel an appointment with a family doctor online. o Register with the Québec Family Doctor Finder (GAMF) 11  Radiology Information System (RIS)  a computerized database used by radiology departments to store, manipulate, and distribute patient radiological related data (excluding images)  RIS Tasks: Create and update Requisitions (prescriptions) Create Reports patient tracking and scheduling result reporting Billing of examinations  Communicates with PACS, modalities and the HIS  HL7 standards of communication are used in the interface between the HIS and the RIS  The RIS does not store or manages any images!!!! 12  Benefits of a RIS 1.Elimination of paper folders, and manual methods of tracking data 2.Integrated patient scheduling ensures smooth running of the department 3.It ensures that all necessary steps will be taken without key tasks being forgotten 4.Automated reporting - Medical Imaging reports are readily accessible 5.Automated claims submission makes billing more efficient 13 Remember: The HIS holds patient's full medical history, from hospital billing to inpatient ordering system The RIS holds all radiology-specific patient data, from the patient scheduling information to the radiologist's dictated and transcribed report 14  REQUISITION IS CREATED IN THE THE EXAM IS REQUISITION STATUS & WORKFLOW PATIENT RIS BY RADIOLOGY SCHEDULED DATE OF EXAM ARRIVES FOR OR RECEIVED FOR THE NEXT THE EXAM FROM HIS FOR THE MORNING EXAM REQUESTED PATIENT’S REQUISITION REQUISITION STATUS IS STATUS IS REQUISITION MEDICAL FILE STATUS IS IS UPDATED IN “FUTURE “EXPECTED NOT APPOINTMENT” ARRIVED” “ARRIVED” THE HIS EXAM REPORT EXAM EXAM IS SIGNED BY DICTATED BY EXAM ENDS EXAM STARTS TRANSCRIBED RADIOLOGIST RADIOLOGIST REQUISITION REPORT IS REQUISITION REQUISITION STATUS IS REQUISITION STATUS IS TRANSCRIBED STATUS IS “TO BE STATUS IS “TO FINAL – STATUS “EXAM IN TRANSCRIBED” BE DICTATED ” “REPORT” “TO BE SIGNED” PROGRESS”  Image Storage System – Picture Archiving and Communications System PACS An image storage system such as a PACS should have the following characteristics: o Data storage Capacity o Speed o Reliability o Security Digital Imaging and Communication in Medicine (DICOM) o international conformance standards for exchange of medical images between different devices o DICOM standardizes the communication and data exchange between devices such as the modalities and the PACS or between PACS o DICOM was created by the National Electrical Manufacturers Association (NEMA) 16  Picture Archiving and Communications System (PACS) Picture Archiving and Communications System (PACS) consists of a network of computers and servers dedicated to store, retrieve, distribute and display images on high resolution monitors First PACS – early 80s First modality: US 17  PACS Main PACS components: Database Directory Server o It maintains a directory of the locations of all RID images, image attributes, and patient data o A second copy of the database server exists for redundancy in the event of device failure or system maintenance Short Term Archive Server o RAID – also called online storage Long Term Archive Server o Magnetic Tapes – also called nearline storage Diagnostic workstations o For exams reporting by Rads Clinician workstations o Mainly for viewing images Web browser Server o Image viewing in jpg format only 18  Short Term Archive Server Redundant Array of Independent Disks (RAID) The Short-term Archive server uses a RAID (Redundant Array of Independent Disks) storage device made of several hard disks linked together in an array RAIDs can hold large amount of data – 500G per disk on most recent models using disks RAID 5 MODEL: Data is striped along on all disks within the RAID providing redundancy o RAID 5 is the most common model used for a PACS archive short term system because it provides adequate redundancy and fault tolerance 19 RAID explained 20  Long Term Archive Digital Magnetic Disks or Digital Magnetic Tapes A long-term system can be composed of magnetic disks or tapes with a larger capacity of storage compared to a RAID. However, the data retrieval time is slower Nowadays hospitals are replacing tapes/disk systems with RAIDs long-term storage as the costs are going down 21  PACS NETWORK SYSTEMS 1. Client/Server-Based System Preferred network system by most PACS images are sent directly to the archive server Users query the archive server to receive exams The PACS software must be installed in each client computer o Advantages: Any image sent to the PACS is available anywhere without other interventions; Images can be accessed simultaneously o Disadvantages: The server is seen as a single point of failure; network dependent; bottlenecked server 22  PACS NETWORK SYSTEMS 3. Web Based System: In this system both the images and the application software for the client are held centrally in the PACS server. The user connects to the PACS server through the PACS Web server. o Advantages: the client’s computer does not require any PACS specific hardware o Disadvantages: ▪ The system's functionality may be limited because the software is not installed locally ▪ JPEG format only 23  Diagnostic Imaging Repository (DI-r) or Repositoire des image diagnostic RID Provincial long-term archiving system for medical images and reports from in every hospital in Quebec. It gives users access to images and medical reports, regardless of location in the province via the Cross Document Sharing Mediator (XDS-M) server of the DSQ system Medical imaging departments in hospitals and private clinics archive copies of their exams in the DI-r or RID enables centralized storage and retrieval of diagnostic images and corresponding reports that are produced in all and any of the provincial hospitals and any other government medical institution it is part of a national diagnostic imaging repository initiative funded by Canada Health Infoway 24  Benefits of a DI-r or DIR The RID connects to the DSQ through a Cross-Document Sharing mediator (XDS and XDS-i) to share radiology related data such as images and reports Rads and clinicians have quick and easy access to images and able to diagnose regardless of the patient’s location Previous Exams can be pre-fetched to a specific hospital o When a requisition for a radiology exam is created in a Quebec hospital HIS or RIS, a message requesting copies of any previous exams stored in the RID is sent to the DSQ. If there are any relevant previous exams stored in the RID, the transaction will be managed through the XDS mediator server component of the DSQ which serves as a bridge between the DSQ DI-r. faster handling of ER cases Improved medical treatments by enhancing clinicians’ collaboration and knowledge sharing, e.g., Reduction of wait times The # of patients transferred between facilities and patient travel time may be ↓ 25  exam is patient is Clerk scheduled Patient brought in x- updates in RIS & arrives to ray room and Req. in RIS req. updated info. is x-ray as “patient to sent to dept. arrived” “in progress” PACS Exam requisition images entered in RIS QC by manually or tech & PACS DATA thru’ the HIS sent to Exam is BASE DIRECTORY PACS from performed & SERVER modality req. updated Images sent to be to to the Long- dictated “to dictate” term storage Server (DLT) Dictation of Copy exam exam by in CD/DVD Film Radiologist at & external printer diagnostic exams Clinician workstation uploading Wrksttn Images sent Dictated Report FINAL Report COPY OF to the transcribed FINAL available in RIS IMAGES TO Short-term & HIS. either by REPORT PACS WEB image SIGNED Requesting MD WORKFLOW speech BROWSER storage recognition BY RAD receives hard OF A SERVER (RAID) software or copy RADIOLOGY secretary 26 EXAMINATION  PREFETCHING OF PREVIOUS EXAMS DSQ REQUESTS TO XDS TO DOWNLOAD XDS COORDINATES THE DOWNLOADING PREVIOUS EXAMS TO HOSPITAL PACS OF PREVIOUS EXAMS TO HOSPITAL PACS XDS DSQ MEDIATOR REQUEST IS RIS: DI-R EXAM ENTERED RIS NOTIFIES MADE FOR PREVIOUS HIS THAT EXAM OR RECEIVED IS SCHEDULED EXAMS IN RID FROM HIS RIS NOTIFIES PACS THAT EXAM IS SCHEDULED PREVIOUS EXAMS ARE SENT TO ORDERED EXAM IS SENT TO RIS HIS LOCAL PACS BY RID PACS DATA BASE NOTIFICATION OF SCHEDULED DIRECTORY EXAM IS SENT TO MODALITY TO ADD EXAM TO IMAGING SERVER MODALITY WORKLIST MODALITY E.G., MRI 27  WORKFLOW OF PERFORMED EXAM DSQ RID EXAM REPORT (DI-r) RIS SENT TO DSQ EXAM REPORT SENT TO HIS EXAM REPORT EXAM SENT TO LONG TERM STORAGE PACS DATA SENT TO RIS HIS BASE LONG DIRECTORY TERM SERVER EXAM IMAGES SENT TO PACS BY MODALITY STORAGE Imaging EXAM IMAGES SENT Modality TO PACS BROWSER e.g., EXAM IMAGES SENT TO SHORT TERM WRKSTTN FOR REPORT EXAM REPORT PACS WEB MRI SENT TO PACS BROWSER STORAGE RAD WRKSTTN 28  WORKFLOW OF PERFORMED EXAM WHAT IS WRONG WITH THIS FLOW DESCRIPTION? EXAM REPORT DSQ SENT TO DSQ RIS EXAM REPORT EXAM REPORT SENT TO RIS SENT TO HIS PACS DATA EXAM IMAGES HIS BASE SENT TO RIS BY MODALITY DIRECTORY SERVER EXAM REPORT EXAM IMAGES SENT TO Imaging SENT TO RAD Modality MODALITY WORKSTATION e.g., EXAM REPORT SENT MRI BACK TO PACS FROM RAD WORKSTATION EXAM REPORTED BY RAD 29  What is Digital Imaging? The basic definition of digital imaging is any imaging acquisition process that produces an electronic image that can be viewed and manipulated on a computer. 30