EPR builds case for integration architecture

Integration of hospital systems leading to an enterprise-wide multimedia electronic patient record (EPR) has emerged as a major theme in healthcare, as reflected in neighboring infoRAD exhibits at the RSNA meeting last week.

In one, the U.S. Department of Veterans Affairs demonstrated their ability to integrate DICOM image data objects from multiple systems into its multimedia EPR.

The VA showed how it can capture new color applications using DICOM for gastrointestinal endoscopy, ophthalmology, dentistry, and other specialties - the first DICOM offerings to support Modality Worklist and Storage service classes from these vendors.

"The VA is using DICOM to integrate image data objects from multiple systems for use across the enterprise," said Peter Kuzmak of the VistA Imaging Project in the VA in Silver Spring, MD.

DICOM, with its communication mechanism and structured representation of image data, allows the VA to acquire radiology images from multiple sources, store them directly into the online patient record, and then display them on low-cost clinician's color workstations throughout the medical center.

Integration is a special challenge at the VA, whose 172 medical centers and numerous outpatient clinics serve a population of 24 million patients, because of differing workflow and software support within the VA HIS environment. The VA's DICOM capabilities interfaces with several different PACS and more than 20 different image acquisition modalities.

Next door, a Dutch exhibit displayed Zouga, an EPR architecture that claimed to simplify the integration process by creating a single view of the medical data for the clinician using services from RIS, PACS, and other systems.

In the Netherlands, as elsewhere, vast amounts of digital information are generated, distributed, and used daily in patient treatment, in research, and in teaching, resulting in a variety of information systems used to control the data. Zouga, a sort of miniature IHE on a local scale, is one of the first attempts to bring all available data systems together in one system to provide any type of medical information through a single user-friendly interface.

"Over 1000 clinicians are using client applications on the Zouga platform, on which more than 10 information systems are integrated, including four from the radiology department," said Maurits G. Ros, a computer scientist at the Academic Medical Center of the University of Amsterdam. "This enables the clinician to request studies electronically, view the progress of the request, read the report, and view the images without having to switch applications."