Managing different registries and repositories within healthcare regions grows the risk of having
almost the same information but with different status and with different content. This is due to the
fact that when medical information is created it´s done in a dynamical process that will lead to that
information will change its contents during lifetime within the "active" healthcare phase. The
information needs to be easy accessible, being the platform for making the medical decisions
transparent. In the Region Västra Götaland (VGR), Sweden, data is shared from 29 X-ray
departments with different Picture Archive and Communication Systems (PACS) and Radiology
Information Systems (RIS) systems through the Infobroker solution, that's acts as a broker between
the actors involved. Request/reports from RIS are stored as DIgital COmmunication in Medicine
(DICOM)-Structured Reports (SR) objects, together with the images. Every status change within this
activities are updated within the Information Infrastructure based on Integrating the Healthcare
Enterprise (IHE) mission.
Cross-enterprise Document Sharing for Imaging (XDS-I) were the registry and the central repository
are the components used for sharing medical documentation. The VGR strategy was not to apply one
regional XDS-I registry and repository, instead VGR applied an Enterprise Architecture (EA)
intertwined with the Information Infrastructure for the dynamic delivery to consumers. The
upcoming usage of different Regional XDS registries and repositories could lead to new ways of
carrying out shared work but it can also lead into "problems". XDS and XDS-I implemented
without a strategy could lead to increased numbers of status/versions but also duplication of
information in the Information Infrastructure.
In the Region Vastra Gotaland (VGR), Sweden, sharing of data from 4 PACS system has been done through the Radiology Information Infrastructure that where deployed in 2007, and during 2008 and 2009 also including the information obtained from three different RIS systems installed in the region. The RIS information stored in the Radiology Information Infrastructure is Structured Reports (SR) objects that derivatives from the regional information model. In practice, the Enterprise solution now offers new ways of social collaboration through information sharing within a region.
Interoperability was developed according to the IHE mission, i.e. applying standards such as digital imaging and communication in medicine (DICOM) and Health Level 7 (HL7) to address specific
clinical communication needs and support optimal patient care.
Applying standards and information has shown to be suitable for interoperability, but not appropriate for implementing social collaboration i.e. first and second opinion, as there is no user services related to the standards. The need for social interaction leads to a common negotiated interface and in contrary with interoperability the approach will be a common defined semantic model.
Radiology informatics is the glue between the technical standards, information models,semantics, social ruleworks and regulations used within radiology and their customers to share information and services.
Proc. SPIE. 7264, Medical Imaging 2009: Advanced PACS-based Imaging Informatics and Therapeutic Applications
KEYWORDS: Transparency, Medicine, Data modeling, Data storage, Telecommunications, Photoacoustic tomography, Radiology, Data communications, Standards development, Picture Archiving and Communication System
There is today a lack of interoperability in healthcare although the need for it is obvious. A new healthcare enterprise environment has been deployed for secure healthcare interoperability in
the Western Region in Sweden (WRS). <i>This paper is an empirical overview of the new enterprise environment supporting regional shared and transparent radiology domain information in the WRS.</i>
The enterprise environment compromises 17 radiology departments, 1,5 million inhabitants, using different RIS and PACS in a joint work-oriented network and additional cardiology, dentistry and clinical physiology departments. More than 160 terabytes of information are
stored in the enterprise repository. Interoperability is developed according to the IHE mission, i.e. applying standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level 7 (HL7) to address specific clinical communication needs and support optimal patient care. The entire enterprise environment is implemented and used daily in WRS.
The central prerequisites in the development of the enterprise environment in western region of Sweden were: 1) information harmonization, 2) reuse of standardized messages e.g. HL7 v2.x
and v3.x, 3) development of a holistic information domain including both text and images, and 4) to create a continuous and dynamic update functionality. The central challenges in this project were: 1) the many different vendors acting in the region and the negotiations with them to apply communication roles/profiles such as HL7 (CDA, CCR), DICOM, and XML, 2) the question of whom owns the data, and 3) incomplete technical standards.
This study concludes that to create a workflow that runs within an enterprise environment there are a number of central prerequisites and challenges that needs to be in place. This calls
for negotiations on an international, national and regional level with standardization organizations, vendors, health management and health personnel.