Integrating external data in your PACS or EPR

Jan Willem Kuiper, Kees BroekmanLeen de Baat, Peter Speksnijder

Rotterdam, The Netherlands

A patient with data on CD, now what?

INTRODUCTIONThe Rotterdam situation

• Data production radiology: 10 Tb year• Full redundant environment installed over 2 Main

Equipment Rooms (MER) in separated buildings• Mirrored working storage with uncompressed data: 15

Tb and counting ….• SAN archive (compressed) data: 10 Tb and counting ….• 45 modalities including 64-, 16- and 4-slice CT scanners• 35 diagnostic viewing stations at radiology• >1200 medical workstations• >1200 potential EPR users

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• 160.000 annual first outpatient visits• Estimate: 10% with data from referring hospitals• 70% of Dutch hospitals with a full radiology PACS• Amount of incoming digital data is increasing

dramatically

• That means: a lot of CD’s!

INTRODUCTIONgeneral reference data

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• Security/Administrative: no CD drive in medical workstations

• Images cannot be viewed in doctor’s office, but only in private quarters on personal PC’s

• Many different user interfaces in viewers• Some viewers don’t work• The clinician’s need to archive images temporary or

permanent can’t be fulfilled• Images not available in Radiology PACS for comparison

or second-opinion consult

PROBLEMSexternal data on CD

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• Some patients not registered in HIS• Patients not registered in RIS• Results in extra administrative work (radiology)• Images not always in DICOM available• Radiology is not responsible for storing these images

(producer’s responsibility)• More need for temporary storage, deleting images in

radiology PACS not possible after archiving (legal issue)• 16.000 CD’s annually is a lot of work and data

PROBLEMS”just archive the data in your PACS”

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SOLUTIONS”short term solutions in Erasmus MC”

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• Extra PC’s in clinic and ER with CD player for reviewing images, stand-alone systems

• In Radiology extra PC’s for reviewing images drawback• Results in extra cost for hardware• Clinicians need to be able to handle various viewers• Still no solution for storing images in EPR• Current ß-version PACS viewer (Philips MS IDS5-web)

not yet available as standard viewer• Standard for storing radiology data on CD (vendors)?

SOLUTIONS”current solutions in Erasmus MC”

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• Locally developed ‘shell’ for Hospital Information System incorporates viewers for various clinical applications including PACS data.

External data on CD’sIn Erasmus MC

PCMedical Docter

HIS Registered?

Administrator8-5

new XReadable?

Archive needed?

No

Yes

EndNo Yes

DICOM workstation

CD drive

HIS Registration

No

Adapt DICOM header with

HIS patient ID

Yes

PACSServer

HIS

EPD

Workstation

EPD

Workstation

EPD

Workstation

SOLUTIONS”Data flow in Erasmus MC”

SOLUTIONS”CD Data integrated in EPD”

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• Locally developed ‘shell’ for Hospital Information System incorporates viewers for various clinical applications including PACS data.

• Video animation showing external data radiology viewer

FUTURE NEEDS”for solving the CD problem”

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• Awareness that there is a problem with data on CD• One web based viewer for all radiology images• Possibility to use viewer in stand-alone situation

• Standardization needed for CD Data

– DICOM and no proprietary vendor specific formats– DICOM Dir in main directory

• Connecting all local and national hospitals and implementing nationwide unique patient ID number

• Have “old-fashion” hardcopy films available as long as needed.