| Importing Foreign Images – If non local/foreign images are imported into local systems for viewing there are a number of considerations. One needs to consider how the image movement will occur. If it is an on demand model, then the speed of transmission and rendering are critical requirements. If the image movement is to be automatic based on a trigger of some kind then relevancy and pre-fetch criterion become critical components. A trigger requires an event of some kind, such as an order being placed at the local facility. The timing of the order must also be considered, as many implementations do not drop orders at the time of scheduling but, rather, at the time that the patient presents. It is important to consider the speed of transmission as well as the impact to the network, if a large number of images are being transmitted during peak hours.
Another key consideration is how the PACS is able to manage the ingested foreign images. Some PACS systems require an order with an existing patient identifier to profile the images into a patient jacket in order to apply protocols and comparisons. If this is the case, the image may need to go through a data manipulation process prior to ingestion. It is important to understand how foreign images will be purged from the system, in order to satisfy privacy and security requirements. Consideration must also be given to whether foreign images can or should be modifiable. If modifications are applied the updates, that must be communicated to the repository and the originating owner of the images. The PACS should be capable of using IHE Audit Trail and Node Authentication (ATNA) Integration Profiles to perform tasks such as user authentication, connection authentication, and audit logging. Otherwise, in the event of a breach, event collection of information will be very difficult.
Viewing radiology reports in the local PACS will also be a challenge. Clinical findings are, for the most part, stored in the hospital patient database. In order for this information to be pushed to the local PACS, it must be in a format that can be understood. Some systems can support reports that have been published in DICOM structured report format. Otherwise, the PACS will have to be able to communicate and retrieve the result data from a document repository via IHE Cross-enterprise document sharing protocols.
Viewer Access – View the longitudinal set through a viewer attached to the DI-r. With this option one must consider the capabilities of the viewer and whether it is certified for diagnostic viewing. Adoption can be an issue with the introduction of yet another application to the clinical user community. However, this can also be mitigated, in some cases, by integrating the DI-r viewer with the local PACS application via an application programming interface (API) that allows for the passing of user credentials and exam or patient context information.
This option requires patient demographic, order and results interfaces from the hospital information systems to the DI-r and either a patient matching solution, or the ability to connect to a Client Registry. The support and administration related to maintaining data integrity must be considered and planned for as the application interfaces from regional RIS and PACS applications require error monitoring and exception resolution. However, data integrity checking can be easier when the information is in a centralized repository. It is also easier to maintain Privacy and Security controls, as access to the images and reports is controlled through an application layer. Centralized auditing should be provided by the application layer and/or the application should be capable of using IHE Audit Trail and Node Authentication (ATNA) Integration Profiles to perform tasks such as user authentication, connection authentication, and audit logging.
If a consent management service is available, integration between the repository application and the service will be required. Other options such as “lock box” functionality may be provided at the application layer or, alternately, it may be possible to block information at the source input system. |