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PACS and IHE Help Solve EMR Implementation
PACS和IHE帮助解决EMR的应用
Edward M. Smith, ScD, FACNP
Healthcare professionals are considering the Electronic Medical Record (EMR) as a requirement now or in the very near future. It will increase productivity, generate cost savings and cost avoidance. More importantly, it will enhance patient care by providing the complete patient record, clinical data and diagnostic images, whether it be on a diagnostic workstation, PC or hand-held device that is connected by either wire or wireless to the infrastructure of the hospital. The Picture Archiving and Communications System (PACS) and Integrating the Healthcare Enterprise (IHE) will facilitate implementing the EMR.
医疗保健专家正在考虑现在或者不久的将来将电子化医疗记录作为一个需求。它将提升生产力，减少花费和费用浪费。更重要的是，它将提高病人照顾通过完整的病人记录、临床数据和诊断影像，无论它是诊断工作站、PC还是手持设备都将通过无线或者有线与医院的基础设施连接在一起。PACS和IHE将促进EMR的应用。
Clinical Databases
The EMR requires clinical reports and data as well as diagnostic images. These reports, data and images are located on different databases supported by different servers throughout the healthcare enterprise (HE). For these databases to accurately and efficiently exchange information, standards must be used. The Health Level-7 (HL-7) (1) standard is used by most clinical databases and Digital Imaging and Communications in Medicine (DICOM) (2) standard is used for radiology images and potentially many other images, structured reports and waveforms generated throughout the HE. The manner in which HL-7 is implemented by the various database vendors is not consistent, e.g. field formats such as date, patient name, etc., and interfaces are required to exchange data between each vendor’s databases and sometimes even between databases from the same vendor.
EMR要求临床报告和数据，也包括诊断图像。这些报告、数据和图像是放置在不同的数据库中被贯穿在医疗企业内的不同的服务所支持。从这些数据库中准确和有效的交换信息，必须使用标准。HL7标准被大多数的临床数据库应用，DICOM标准被放射影像和潜在的很多其他影像，结构化报告和波形生成贯穿在医疗企业内。在不同的数据库供应商中应用HL7的样式并不是一致的，例如,日期的字段格式、病人名字等，而且在每两个供应商的数据库之间，甚至有时在同一供应商的两个数据库之间都有接口要求。
The exchange of data can become further complicated in HEs where institutions use the same HIS for example, but each HIS runs on a separate server generating different Medical Record Numbers (MRNs) or the equivalent for the same patient. This is also true if the institutions use different vendor’s HIS. This makes it very difficult for some one at institution A to obtain medical information about the same patient that was generated at institution B in the HE if institution B generated a different MRN for that patient. Since the patient’s medical information generated at each institution is associated with the MRN generated at that institution, some means must be used to inter-relate these MRNs. The Master Patient Index (MPI) is software that solves this problem and provides the required functionality.
即便是机构内的医疗企业使用相同的HIS，数据交换在未来将变得复杂起来，因为每一个HIS运行在一个不同的服务上，产生不同的医疗记录号（MRNs）或者为同一个病人生成不同的医疗记录号。如果使用不同厂商提供的HIS，这也会是同样的情况。这使得在机构内A去获得在在同一医疗企业内机构B已经生成的同一个病人的医疗信息变得非常困难，因为机构B为这个病人生成了一个不同的MRN，这意味这必须使得这些MRNs能够相互关联。主病人索引就是解决这个问题和提供这些必需的功能的软件。
PACS
Integrating the various patient images from departments within the HE into the EMR is another daunting challenge for which there is a solution that requires cooperation between the departments of the HE. The DICOM electronic archive (3,4), that is part of PACS, was originally used just for radiology images and can, in fact, be used for images from other areas within the HE. This archive should be considered a resource of the HE not just that of radiology. DICOM is an object-oriented standard that provides the capability of storing images, structured reports and waveforms if they are acquired in adherence with the standard. Eliot and Reiner (5) discuss the challenges associated with incorporating images and other objects from cardiology, dermatology, endoscopy, pathology and ophthalmology into the DICOM archive.
整合不同病人的影像从医疗企业内部不同部门到EMR中是另一件让人畏缩的挑战，因为这个解决方案要求医疗企业内部不同部门之间的合作。DICOM的电子存档(3.4)，关于PACS的这一部分，通常是仅用于放射科室的影像，但事实上，它也用于在医疗企业内部其他方面获取影像。这种存档应该被考虑作为医疗企业的一种资源而不仅仅是在放射科室中。DICOM是一种面向对象的标准，提供存储影像、结构化报告和波形的能力，这些已经在标准中被坚持下来。Eliot and Reiner探讨过将合并的影像以及来自于心脏病、皮肤病、内窥镜、病例学和眼科学的影像加入到DICOM存档的挑战。
When an institution implements PACS, they should require the PACS vendor to guarantee in writing that all studies are stored in the permanent electronic archive adhering to DICOM Part 10 standards and that these studies can be queried and retrieved via the DICOM protocol. The vendor should state what could be stored and retrieved from their DICOM archive:
当一个机构应用PACS时，他们应当要求PACS供应商书面担保在长久的电子存档中所有的数据分析结果和存储坚持符合DICOM 第10章，而且他们的分析结果可以经由DICOM接口被查询和取回。供应商应该申明在他们的DICOM存档中哪些是可以被存储和取回的：
_ Which modalities - all modalities not just modalities from radiology, 哪些形态（？），所有的形态而不仅仅是来自放射科
_ Multi-frame studies and from which modalities, 多帧分析以及从哪些形态中（可以进行多帧分析）
_ Color studies and from which modalities and 色彩分析以及从哪些形态中（可以进行色彩分析），和
_ What types of compression algorithms, waveforms and structure reports. 什么类型的压缩算法、波形和结构化报告
The vendor should state when they would be able to store studies or images generated from cardiology, dermatology, gastroentology, pathology, ophthalmology, etc.
供应商应该申明他们什么时候可以存储分析结果或者从心脏病、皮肤病、内窥镜、病例学和眼科学等等科室的生成的影像。
IHE
The IHE technical framework will streamline the flow of data throughout the databases used by radiology (6). The objective of the IHE is to remove the barriers that inhibit the sharing of data and images in a seamless manner between different vendors’ data and image databases and modalities throughout the healthcare enterprise. The initial effort is being directed at radiology and it is anticipated that this initiative will impact other areas within the HE. The IHE committees made up of representatives from industry and the healthcare profession have held demonstrations since 1999 at the Radiological Society of North America (RSNA) and the Healthcare Information Management Systems Society (HIMSS) showing interoperability of systems from different vendors. At the 2001 RSNA and 2002 HIMSS meeting the group will demonstrate the following seven Integration Profiles (7,8):
IHE技术框架使得在数据库中被放射使用的数据成流线型（简化并更有效率）。IHE的目标在不同的供应商的数据和影像数据库之间用一种无缝的方式消除限制共享数据和影像的屏障，而且可以预料到这种首创精神对医疗企业内部的其他地方影响效果。由来自工业界和医疗保健专业人员代表组成的IHE委员会已经在1999年在北美放射协会（the Radiological Society of North America (RSNA) ）和（医疗保健信息管理系统协会，the Healthcare Information Management Systems Society (HIMSS) ）展示了来自于不同的供应商的系统的协同工作能力。在2001年RSNA和2003年HIMSS会议，这个委员会将演示一下七种整合框架：
_ Scheduled Work Flow 预定工作流
_ Patient Information Reconciliation 病人信息的一致性
_ Consistent Presentation of Images 影像信息的可靠表现（注：应当是指影像信息在不同的环境下表现效果一致）
_ Presentation of Grouped Procedures 分类程序的表现（注：指同一次多部位影像资料分组归并进行表现，如胸部和腹部）
_ Access to Radiology Information 放射信息的授权访问
_ Key Image Note 关键影像标记
_ Simple Image and Numeric Reports 简单影像和数字化报告
Institutions should ask vendors which integration profiles（整合框架） they support and have demonstrated.
机构应当询问供应商他们支持整合框架中的哪些部分，并进行演示。
Summary
The EMR should be the goal of every hospital and HE. EMR software is currently available, however, the institution’s data and image databases must efficiently communicate with each other and the EMR. Once it is decided that an EMR will be implemented, the institution must assess the inter-compatibility of all databases to be interfaced to the EMR and determine what interfaces need to be developed, what they will cost and how long it will take to bring the interface on-line. The HE must establish standards for all clinical databases and modalities that are to be purchased or upgraded to ensure there is inter-compatibility and they will interoperate with an EMR.
The clinical database vendors must help resolve the issues relating to the efficient and timely exchange of information between their databases and PACS. The Health Insurance Portability and Accountability Act (HIPPA) (9,10) mandate requires that a unique universal patient identifier be implemented which should eliminate the need for the MPI. PACS and the DICOM standard will help resolve the availability of images by having them stored in a single enterprise electronic archive for the HE. The IHE initiative is demonstrating that vendors can work together within the radiology environment to improve workflow and productivity. These initiatives should spread to other areas within the HE, which should further promote the implementation of the EMR.
References
1. Available at www.hl7.org
2. Available at www.rsna.org/practice/dicom
3. Smith, EM: Introduction to image acquisition, archive managers and storage,Archiving Issues in the Digital Medical Enterprise, SCAR, great Falls, VA" pp 1-16,2001.
4. Smith, EM: Electronic archive remains critical to PACS\' new calling, But HIS, RIS PACS and modalities must communicate, Supplement to Diagnostic Imaging, pp 24-26,August 2001.
5. Siegel, EL and Reiner, BI: Clinical Challenges Associated ith Incorporation of Non-Radiology Images into the Electronic Medical Record, SPIE Vol. 3980, Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues, G. James Blaine"Eliot L. Siegel" Eds.
6. Available at www.rsna.org/IHE
7. IHE Integration Profiles: Guidelines for Buyers: Available at www.rsna.org/IHE/pdf/IHE_integ_profiles.pdf
8. Channin, DS: Integrating the Healthcare Enterprise: A Primer Part 2. Seven Brides for Seven Brothers: The IHE Integration Profiles, Radiographics, 21: pp 1343-1350,2001.
9. Collman, J" Cooper, T" Sostrom, K: HIPPA Data Security: Guidelines for organizational development in health Information assurance, Archiving Issues in the Digital Medical Enterprise, SCAR, great Falls, VA" pp 89-104,2001.
10. Hughes, KK" Health Insurance Portability and Accountability Act of 1996: Fact or Fiction. Legally Speaking, Archiving Issues in the Digital Medical Enterprise, SCAR, great Falls, VA" pp 105-113,2001.
Biography（作者介绍）
Edward M. Smith, ScD, FACNP is Professor of Radiology (part-time) at the University of Rochester Medical Center. Dr Smith has published and lectured extensively for SCAR and in other venues on PACS. Consulting with Integration Resources in Lebanon, NJ,Dr. Smith provides PACS and RIS consulting services including business case development, workflow analysis, technology availability and RFP preparation. Dr. Smith can be contacted at nlschile@rochester.rr.com or 716-275-1050.
Dr. Smith is the conference director for the 2nd annual PACS conference sponsored by the Dept. of Radiology, University of Rochester that will be offering up to 26 Category 1 CME credits. The conference will be held March 13 to 17, 2002 in San Antonio, TX at the Westin Riverwalk. The faculty with over 90 years of clinical and technical experience will present lectures on PACS fundamentals and clinical applications, CR and DR,integrating the healthcare enterprise including the HIS, RIS, modalities and PACS and storage technologies. Optional PACS site visits will be offered and over 20 vendors will be participating in computer workshops and technical presentations. For complete information on PACS 2002 visit www.urmc.rochester.edu/pacs2002.
翻译欠妥的地方，欢迎指教
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发表于 2003-12-8 16:36:33
发表于 2003-12-9 11:47:09