IHE provides guidelines for RIS/PACS integration

January 15, 2004

No longer separate entities, the technologies of imaging and informatics are irreversibly linked. It is impossible for even the most modality-focused attendee who enters the technical exhibitions in McCormick Place not to recognize this. "Integrated

No longer separate entities, the technologies of imaging and informatics are irreversibly linked. It is impossible for even the most modality-focused attendee who enters the technical exhibitions in McCormick Place not to recognize this. "Integrated RIS/PACS" is the buzzword of the day, replacing the ubiquitous "enterprise solution" of so many past years.

Is it just this columnist's imagination that the aura of heavy-handed promotion, so pervasive at recent exhibitions, has dissipated now that PACS has come of age? Sunday's first impression is one of sameness and sedateness. There are more ways than ever to enter the digital informatics age. At first glance, the scores of vendors providing PACS are visually not well differentiated - the sign of a maturing technology.

How well do all these systems work? Not so perfectly if one attends the RSNA scientific sessions, sits through some infoRAD presentations, or reads some scientific posters. Amazingly well, according to the vendors, if one purchases their fully integrated RIS/PACS solutions. A brokerless system with integrated workflow functionality may deliver fewer hassles - if the product really does work as described, and if the buyer is impressed with each end of the product.

Ease of connectivity and comprehensive communication of data should be the buzzword of the day. Once again, this column cannot stress enough the importance of becoming educated about and supporting the Integrating the Healthcare Enterprise initiative. The 12 IHE integration profiles provide guidelines for common workflow processes that enable data to be digitally entered into a system or entity only once and then be accurately and invisibly passed on to the user. To quote the IHE:

"The guidelines (of the Technical Framework) will simplify the process of connectivity, identify potential problems, and make system integration faster, more efficient, less expensive and more successful."

Any RSNA attendee with PACS purchasing in mind is foolish not to spend some quality time at the Lakeside Center becoming knowledgeable about the IHE. What does not seem to be particularly well known is that IHE committee members collectively represent the most esteemed developers, inventors, and pioneers of PACS from radiologist, physicist, and IT user communities and from the R&D side of industry. The collective visionary genius this group represents is extraordinary.

Even more extraordinary is that the printed material is written with clarity in understandable prose. Unlike DICOM, the language is not written in "engineerese" or "computerese."

The IHE advises purchasers of PACS to demand that their vendor of choice develop products with IHE integration functionality. (It is one thing for a vendor to participate in the annual Connectathon; it is another matter to make the investment to commercialize the demonstrated functionality.)

Montefiore Medical Center in New York City has stepped up to the plate, mandating that IHE profiles define a portion of the acceptance test for its new radiology information system (IDX) and PACS (GE Medical Systems). In a Sunday radiology Informatics session, Dr. Nogah Haramati discussed how six IHE profiles are being used to test procedures that mirror the functionality of a new RIS and a PACS being installed. The vendors have agreed to financial penalties for nonperformance, with a scheduled date for completion and launch in 2004.


Each IHE profile stipulates the exact terms of the transactions that need to occur in real-world data flow, thus leaving no doubt about who is responsible for making the action happen successfully, Haramati said. Vendor finger-pointing is eliminated. Throughput performance, including synchronization and timing, is outside the purview of the IHE. These issues are key elements of a total acceptance test to ensure that these standards are met. Both can be nightmares in PACS implementations.

Real-world situations can be very complex to manage in an all-digital environment. Haramati cited as an example an accident victim needing immediate imaging. No name, no scheduled exam, and a stat report, all requiring merging and coordination of electronic records at a later date. Using acceptance testing that incorporates IHE profiles will verify that a RIS and PACS will perform as promised.