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Picture archiving and communication System

(PACS):

A networked group of computers

Servers and archives that can be used to manage digital images.
Digital Acquisition (Image Acquisition):
o Images are acquired in digital format and are transferred
via a computer network
Display Workstation:
o Computer that a health care worker can access to view a
digital image.
o Receives image from the archive and present them for
viewing
o Technologist may perform image manipulation techniques
to optimize the image
Archive Servers (also known as the storage devices):
o File room of PACS
o Database server or Image manager
o Short term or long term storage
o Archive central part of PACS and holds all historical and
current data being generated
o Receives all images prior to them being sent to radiologist
for interpretation

Radiology information system (RIS):

A database of images and patient records specific to the imaging

department
RIS FUNCTIONS:
Patient management
o A RIS can track a patient's entire workflow within the
radiology department; radiology providers can add images
and reports to EHRs, where they can be retrieved and
viewed by authorized radiology staff.
Scheduling
o The RIS allows staff to make appointments for both
inpatients and outpatients.
Patient tracking
o Using a RIS system, providers can track a patient's entire
radiology history from admission to discharge and
coordinate the history with past, present and future
appointments.
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Results reporting
o A RIS can generate statistical reports for a single patient,
group of patients or particular procedures.
Image tracking
o Traditionally, radiology providers use RIS to track individual
films and their associated data. But as EHRs have become
standard across the healthcare industry and digitized
images and PACS have been widely adopted, radiology
departments and their RIS-PACS systems have been more
drawn into the clinical workflow of the entire medical
enterprise.
Billing
o RIS systems provide detailed financial record-keeping and
process electronic payments and automated claims,
though these functions are becoming incorporated into
medical organizations' overall EHR systems.

Hospital Information System (HIS):

Information system used throughout the hospital, includes direct
patient care information, billing systems, and reporting systems
HIS FUNCTIONS:

Health Information Systems Resources:

o These include the legislative, regulatory and planning

frameworks required for a fully functioning health information
system, and the resources that are required for such a system to
be functional. Such resources involve personnel, financing,
logistics support, information and communications technology
(ICT), and coordinating mechanisms within and between the six
components

Indicators:

o A core set of indicators and related targets is the basis for a

health information system plan and strategy. Indicators need to
encompass determinants of health; health system inputs,
outputs and outcomes; and health status

Data Sources:
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o These can be divided into two main categories; (1) population-

based approaches (censuses, civil registration and population
surveys) and (2) institution-based data (individual records,
service records and resource records). A number of data-
collection approaches and sources do not fit into either of the
above main categories but can provide important information
that may not be available elsewhere. These include occasional
health surveys, research, and information produced by
community based organizations

Data Management:

o This covers all aspects of data handling from collection, storage,

quality-assurance and flow, to processing, compilation and
analysis

Information Products:

o Data must be transformed into information that will become the

basis for evidence and knowledge to shape health action

Dissemination and Use:

o The value of health information is enhanced by making it readily

accessible to decision-makers and by providing incentives for, or
otherwise facilitating, information use.

Health Metrics Network (HMN)

Digital Imaging and communications in Medicine

(DICOM):
Global information technology standard that allows network
communication between a modality and a PACS
DICOM FUNCTIONS:
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Exchanging Objects

o The first level is the basic mechanism to exchange objects, such

as images and diagnostic reports provided by the Storage SOP
Classes. With regard to imaging, new acquisitions techniques are
continuously being defined that require information objects to be
modified, so that the appropriate information is exchanged. The
nice thing is that there is often already a DICOM infrastructure in
place that allows the exchange, archival and retrieval of these
new objects.

o Radiology is becoming a provider of archiving and storage

services for the other specialties. This is confirmed by the ever
increasing popularity of Picture Archiving and Communication
Systems (PACS).

Information Management Services

o The next dimension of DICOM deals with information

management services. As soon as we exchanged images, users
found that they had to have a PACS system administrator, who
would pretty much spent all of his time dealing with 'orphan'
images. Orphan images are images that have been lost or are
being temporarily stored in the so-called penalty box at the
archive or QA station. The DICOM Modality Work List allows
scheduling information to be retrieved by a modality. It has been
widely implemented and should be a requirement for all new
modality purchases.

Image Quality

o Image quality is another major area in which a lot of

improvements have been made due to DICOM standardization.
The problem is how to achieve consistency in the image
presentation on different monitors, as well as on film,
independent of the make or type of characteristics of the media.

Structured Reporting

o DICOM Structured Reporting deserves a discussion by itself. It is

just an object that can be exchanged, very similar to an image,
except that instead of pixel data, the message body is a
Structured Report (SR).
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Security Mechanisms

o Another dimension is related to the DICOM Security mechanisms.

First of all, one should note that the DICOM standard facilitates
the exchange of information. It is only part of the overall
information chain. Therefore, it is also only a relatively small part
of everything an institution has to do to create a secure
environment. Before a person accesses an image, there are
procedures and rules about the placement of the monitor. There
are access control and authorization rules that are taken care of
by the application level software using passwords or even
biometric access controls. There is an audit and logging
mechanism required that logs any data access and by whom.
When there is finally access to the information and want to
retrieve it using a non-secure line, such as the Internet, is when
DICOM has to worry about the security. This is a relatively easy
extension; the data can just be encrypted using standard
mechanisms and utilities. Electronic signatures are another
aspect of DICOM security. The electronic signatures prevent
someone from changing the information without the receiver
noticing it.

Exchange Media

o Media is a part of the DICOM standard that often creates

confusion. Vendors who claim to offer a 'DICOM archive' mostly
cause this misunderstanding. Since the DICOM standard is a
communications standard, there is no such thing as a DICOM
archive, though there can be a device that supports the DICOM
way of exchanging information. DICOM does standardize
exchange media, though.

o The exchange media is intended to be used to store images or

other DICOM objects in a standard format. These images or other
DICOM objects can then be exchanged and potentially be read by
another device that can read that format. The applications are
typically for portable Ultrasound units that collect images on a
CD. The CD is later used to download the images to a
workstation. Another good application is the collection of a
cardiology study on a CD so that the patient can take it with him
to another hospital.
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