CIS Integration with RIS & PACS

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By Stephen S. Boochever

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced strongly in recent years (PACS). The push is toward enterprise-wide image management solutions, where digital images linked with information from clinical information systems and other databases (CIS & RIS), and they are accessed from a single point of end-user interaction.

Clinical information system (CIS) is integrated system designed to manage the administrative, financial and clinical aspects of a hospital,

Radiology information system (RIS) is the system responsible for producing and managing clinical images, scheduling of examinations, registration of patients, review and analysis of studies by radiologists, creation of interpretations, distribution of radiology reports to referring physicians, and for billing services.

Picture Archiving and communication system (PACS) is the System dedicated to the storage, retrieval, distribution and presentation of images. The medical images are stored in a standard format DICOM.

The “gold standard” of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost.

One of the earliest issues that hampered the progress of (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM.

This barrier was solved by the broker—a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS.

Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL).

Two primary problems are inherent in most brokered configurations, Workflow is driven by paper, and RIS information flows in one direction only, which leads to duplicative databases.

Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users access to clinical information across all systems within the healthcare delivery network.

Mostafa Elhefnawy