This paper presents a case study of single point data entry in a multi-system radiology environment implemented at BreastScreen Victoria (BSV) in Australia. BSV embarked on a Rural Broadband Digital Mammography Project to trial the implementation of digital mammography in the population breast cancer screening program. The IT digital radiology environment at BSV consists of a workflow management system (WMS) developed in-house, an off-the-shelf Picture Achieving and Communication System (PACS) acquired from a well known PACS vendor, and a mixture of fixed and mobile Mammography modalities. WMS is unique in a population screening environment when compared with a diagnostic radiology environment. The BSV WMS has business rules and processes which are specific for breast cancer population screening. WMS serves the role of CIS combined with RIS. The components of the system are connected by communication links varying in speed and quality from high grade gigabyte LAN to wireless links over 3G mobile technologies.

1. information consistency across multiple systems involved;

2. ultimate flexibility in workflow control as breast cancer population screening has a unique and frequently changing workflow; and

3. a solution that complies with Integrating the Healthcare Enterprise (IHE) integration scenarios(1).

The implementation targeted two key areas of radiographer and radiologist functions to achieve the single point data entry objective. In a typical radiology setup a radiographer generally enters clients demographic data directly into the modality. At BSV, since the client’s details already exist in the WMS, the integration effort enables the client’s demographic information to be sourced electronically from the WMS and to populate the modality with the DICOM work list. Similarly, the radiologist function required integration at the radiologists reporting station where the BSV WMS took control of the reporting function and extracted images based on the work list sourced from the WMS. The integration was applied to both back- and front-end levels. The back-end communications were implemented using the HL7 protocol. Every time a client’s demographic details changed in the WMS, an appropriate HL7 message was sent to PACS, updating the client details there. Every time an appointment is booked, cancelled, or modified in WMS, a HL7 message is sent to update the PACS examination details.

The integration on a client level was implemented using the PACS vendor’s proprietary desktop interface. PACS reporting workstation software runs in the background while the WMS desktop client assumes control and provides user interaction. When the radiologist logs onto the WMS client, the software forces user logon onto the PACS client. When the radiologist selects an examination to read, the WMS client changes an active client in the PACS reporting workstation. In essence, the radiologist is unaware that they are interacting with multiple systems.

The WMS has been extended by implementing a DICOM Modality Work list (DMWL) Server, allowing digital modalities to obtain the work list directly from the WMS as prescribed by the IHE integration scenarios. Apart from following the IHE recommendations, the rationale behind this decision was to allow certain flexibility in work list generation. BSV is a state-wide program with a central appointment booking system and screening facilities across various locations. These facilities have a number of modalities that share the same work list if they are located at the same premises, however, modalities that have different geographical locations should have a different work list. The rules are quite complex and vary significantly from a typical hospital setup.