The effective delivery of health care has become increasingly dependent on a wide range of medical data that includes a variety of images. Manual and computer-based medical records ordinarily do not contain image data, leaving the physician to deal with a fragmented patient record widely scattered throughout the hospital. The Department of Veterans Affairs is currently installing a prototype hospital information system workstation network to demonstrate the feasibility of providing image management and communications functionality as an integral part of an existing hospital information system. The core of this system is a data base management system adapted to handle images as a new data type. A general model for this network-based integration is discussed and various alternative architectures are examined.

https://link.springer.com/content/pdf/10.1007%2FBF03170416.pdf

Integrating medical images into hospital information systems

A Second Generation PACS Concept

Image compression by vector quantization: a review focused on codebook generation

The need for integrating existing heterogeneous databases in a hospital to achieve operational efficiency, effectiveness in diagnostic decision making, cost economy, better risk management, and strategic planning in a competitive health care environment is addressed. Considering all aspects of a hospital's information requirements, a virtual database integration approach is proposed for the database integration needed in a hospital. This approach will bring multiple databases into a logically integrated whole without causing much disruption to current hospital operations. This approach will also provide a high level of flexibility allowing for future system growth. Many technical, as well as behavioral, integration design issues particular to a hospital environment, such as those concerning integration planning, schema integration, mapping definition, and query processing schemes, are discussed. >

Information management in hospitals: an integrating approach

One of the goals of the Dutch PACS-project (a collaborative effort of the Utrecht University Hospital (UUH), Philips Medical Systems and BAZIS Central Development and Support Group Hospital Information Systems) is to perform a clinical evaluation and equipment testing at the UUH. In earlier publications a setup for this clinical evaluation is presented. A target ward, a subdivision of the department of Internal Medicine (IM) with a total number of 15 beds, is selected to be treated fully digital. Two other wards, similar to the target ward, were not digitally treated and served as control group. To exploit the efficiency potential of PACS, a comparison will be made between current procedures and PACS procedures. From February 1st until June 1st 1988, a detailed timing and logistic study of examinations and folder tracking has been carried out for all patients of the 3 wards of Internal Medicine, mentioned above. The first part of the study regarding the conventional distribution process is now completed. For this purpose time-registration forms were added to the patients application-forms for radiological examinations. These forms were required to be filled in by all personnel involved (receptionist, archive, technologist, radiologist, etc.). A total number of 500 usable time-registration forms were gathered. One of the results, indicated that the mean time interval for examinations to cover the total conventional distribu-tion process comes to 53.9 hours. An analysis of the number of disturbances in the conventional distribution process indicated that in 24.1 % of all examinations, some exponent was lacking (missing, loaned, delayed, etc.). These disturbances are analyzed in relation to time-intervals. Data were analyzed statistically by means of the SPSS statistical package. This paper describes and explains in detail: - frequencies and means of the total distribution time and different parts of the current distribution process - total number of disturbances in the current distribution process - disturbances analyzed in relation to time intervals The three wards were statistically not significantly different, so they can be compared with each other. This analysis shows clearly the possibilities for efficiency of the PACS distribution process and the consequences of this innovation for the organization and organizational communication.

"PACS Efficiency : A Detailed Quantitative Study Of The Distribution Process Of Films In A Clinical Environment In The Utrecht University Hospital"

The existence of a link between a HIS, incorporating a RIS, and a PACS is one of the most indispensible prerequisites to perform a clinical evaluation study of a PACS in practice. The two main reasons for realizing a IIIS-PACS coupling are concerned with 1) proper image management e.g. in order to achieve acceptable waiting times and 2) the user need of having all patient relevant data available in the same workstation. A first phase coupling between an existing HIS and a just installed PACS has been realized by BAZIS in the Utrecht University Hospital in the Netherlands. These activities were carried out as part of the Dutch PACS Project, a collaboration in the PACS field of BAZIS, the Utrecht University Hospital (AZU) and Philips Medical Systems. For the first phase only HIS data of the in-patients of one particular ward of Internal Medicine were transmitted using a one-way dataflow (from. HIS to PACS). In phase two the coupling will he hi-directional and more departments will be part of the experiment. In phase three of the coupling project a more general. HIS-PACS interface will be developed, independent of the HIS and PACS manufacturers. In April 1988 the first public data exchange (patient data, order data, reports) between the BAZIS/ZIS and Philips/MARCOM system has been demonstrated. This was the first working example of a HIS-PACS coupling worldwide to our knowledge. This paper gives an overview of the experimental set-up, the demonstration during the 6th EuroPACS meeting , the results and problems encountered thusfar and statistical data from daily practice.

HIS-PACS Coupling In Practice

This paper describes the evaluation of a new image compression technique as a first example of a successful procedure to evaluate image processing techniques. Forty-eight CT images of the abdomen were compressed and then reconstructed by a method called sub-band coding using vector quantization. The compression ratios used were 16:1 and 19:1. Five radiologists participated in this study: two to select the images and help in determining the appropriate training set for development of the code-book for the algorithm, and three to participate in the actual experiment. Data were taken to determine diagnostic certainty, ratings of the visibility of diagnostically important structures in the image, and accuracy of identifying which images were the originals and which were not. Results from this study demonstrate: (1) The areas under the ROC curve were virtually identical for all three sets of images (AUC's of 0.78, 0.77, 0.78 for original, 16:1, and 19:1 respectively) and these were not statistically different; (2) all diagnostically relevant structures in the compressed images were maintained by the compression technique; and (3) half of the 16:1 compressed images were identified as original images and 3 out of 48 of the 19:1. The authors conclude that the compression technique shows promise for use on CT images.

Jan Peter J. de Valk

Papers

HIS-PACS Coupling In Practice

Image Compression Evaluation: An Example Of A Pacs Component Analysis Chain Using Psychophysics