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Tech Trends
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Tech Trends
When introducing PACS to the hospital environment, it is critical to establish a HIS or RIS before a PACS. Often a retrospective merger of the PACS database lends itself to higher costs and data entry inconsistencies. All components of HIS or RIS and PACS must also be bidirectional and integrated fully with electronic patient records if present. If this is not coordinated, a hospital may find itself film-less in the radiology department, but resigned to copying images on costly laser film for other departments to use, which is an incredibly costly state of affairs.
“More hospitals are budgeting for technologies like PACS based on the positive experience and advantages offered to existing clients who have opted for this technology” Dr Ashish Dhawad Founder & CEO Medsynaptic Pvt Ltd
Protocols
Modelling the Future An integrated RIS-PACS solution lessens the manipulation of image manually and gives more time to the expert for faster evaluations By Dhirendra Pratap Singh
T
he increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging in clinical and radiological environments. PACS is an integrated set of information technology systems designed to provide a complete solution for image management in a film-less radiology department. Further to its importance in the radiology department, emergence
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of high-end modalities in cardiology and oncology requires archiving and postprocessing of images where PACS is becoming mandatory. When introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) beforehand. Integration of RIS with PACS is a defining trend in the imaging market. Gaurav Mundra, Director & Chief Operating Officer, Truworth Infotech Pvt Ltd, while sharing his perspective on this technology, said, “RIS/PACS is going to be the next big wave in Healthcare IT for
> www.ehealthonline.org > March 2011
larger hospitals. They will need special support in integration with existing systems and legacy equipment. They must look at the cloud as an option to expensive hardware and maintenance. Pricing should move to an ASP model too.” An integrated system, which already knows certain information like patient’s history, reason for the examination, and the tests ordered, these systems can now automatically predict or rather anticipate specific views to the radiologist. It lessens the manipulation of image manually and gives more time to the expert for faster evaluations.
According to Frost & Sullivan technical insights, interactions between PACS and radiology RIS require compatible hardware, a common protocol for handling the data, and commensurate operational definitions. However, PACS and RIS are based on different protocols. PACS operates on the Diagnostic Imaging and Communications in Medicine (DICOM) standard, while RIS operates on Health Level Seven (HL7). DICOM is a transmission protocol that formats, stores, prints and transmits images to and from the imaging modalities and the PACS. HL7 is used to register patients, process orders, and store reports, but it cannot manage DICOM image data. In order for the PACS to do its job, it must be able to communicate with RIS. Therefore, interfaces are used to create an interface between the two systems. The interface (also known
as a PACS ‘gateway’ or ‘broker’) is a hardware- and/or software-based module that allows PACS to communicate with the RIS. However, it has its drawbacks, including added cost to the PACS, and a potential point of failure that may result in orphaned studies (studies that are ‘lost’ or inaccessible to the data system).
Common Database Although the leading vendors continue to support RIS/PACS integration through the standard HL7 interface, current developments in image management technology are leaning towards a completely integrated RIS-PACS solution that manages all radiology-related numerical and imaging data from a single database. This is known as the fully integrated RIS-PACS. Although a number of current systems use the embedded or internal PACS
Key Players • Agfa
• Medsynaptic
• Carestream
• Ashva Technologies
• GE Healthcare
• Napier (Karishma Software)
• Siemens
• Perfint Technologies
• Fuji
• Sobha Renaissance IT Ltd. (SRIT)
• Vepro
• Softlink International
• 21st Century Healthcare solutions
• Srishti Software
• Medsphere
broker and call them ‘brokerless’, a truly integrated RIS-PACS is one in which both types of data are indexed in a common database allowing immediate interaction of both types of data within the complete RIS-PACS system. Dr Adam CHEE, Chief Advocate (Director), binaryHealth Care.com says, “There is no standard core body of knowledge in medical imaging, which is a major drawback. Further, though everybody thinks that medical imaging informatics is limited to radiology, it is not. PACS is not just limited to images—it is offers much more than that.”
Trends PACS implementation is slowly catching up in India with more hospitals aiming towards a paper-less environment. The Indian PACS market is estimated to beUS $5.5 - 6 Million and is expected to grow at a compound annual growth rate of 27 percent from 2007 – 2011. Corporate hospitals are the front-runners with some of the mid-size and government hospitals following suit. Private hospitals are opting for PACS to provide services efficiently and have an edge over their competitors, whereas, government hospitals use it to help in keeping patient records, reduce the number of films used, and also the cost of record maintenance. Gaurav Mundra says, “Compatibility with legacy systems is the biggest driver as
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