The IHE (Integrating the Healthcare Enterprise) initiative provides essential guidelines for the deployment of a digital health information management environment. IHE, while not inventing new standards, creates a system-level and component-level design, based on the products of the leading standards, HL7, DICOM, and more. As such, IHE can be viewed as the "Standard of Standards".
The most significant value of IHE is that vendors can work on specific components of the enterprise solution, playing one or more of the IHE actor roles. IHE defines, for each actor, its external interface to the other actors in the system. Yet, the integrator of an entire IHE solution may find this job extremely difficult. The larger the number of vendors involved in the solution, the tougher the job. The complexity of coordinating all the components to work as one coherent solution multiplies and may become intractable. IHE defines very well "what" should be done, but not "how."
IHE-Bus offers a practical solution for the "how" question, with many advantages. This solution is borrowed from the business integration sphere. IHE becomes a platform, and each actor can be "plugged" into it in a simple step. New actors are independent of other actors already in the system. Missing actors can be simulated (by a "stub") until replaced with the real product in the future. Moreover, the entire IHE network is managed as a single coherent system with powerful tools encapsulating the enormous amount of knowledge and expertise deemed necessary to uphold this job.
Proc. SPIE. 5371, Medical Imaging 2004: PACS and Imaging Informatics
KEYWORDS: Image compression, Data storage, Databases, Medical imaging, Legal, Telecommunications, Java, Standards development, Distributed interactive simulations, Picture Archiving and Communication System
Managing medical digital information objects, and in particular medical images is an enterprise-grade problem. Firstly, there is the sheer amount of digital data that is generated in the proliferation of digital (and film-free) medical imaging. Secondly, the managing software ought to enjoy high availability, recoverability and manageability that are found only in the most business-critical systems. Indeed, such requirements are borrowed from the business enterprise world. Moreover, the solution for the medical information management problem should too employ the same software tools, middlewares and architectures. It is safe to say that all first-line medical PACS products strive to provide a solution for all these challenging requirements. The DICOM standard has been a prime enabler of such solutions. DICOM created the interconnectivity, which made it possible for a PACS service to manage millions of exams consisting of trillions of images. With the more comprehensive IHE architecture, the enterprise is expanded into a multi-facility regional conglomerate, which presents extreme demands from the data management system. HIPPA legislations add considerable challenges per security, privacy and other legal issues, which aggravate the situation. In this paper, we firstly present what in our view should be the general requirements for a first-line medical PACS, taken from an enterprise medical imaging storage and management solution perspective. While these requirements can be met by homegrown implementations, we suggest looking at the existing technologies, which have emerged in the recent years to meet exactly these challenges in the business world. We present an evolutionary process, which led to the design and implementation of a medical object management subsystem. This is indeed an enterprise medical imaging solution that is built upon respective technological components. The system answers all these challenges simply by not reinventing wheels, but rather reusing the best “wheels” for the job. Relying on such middleware components allowed us to concentrate on added value for this specific problem domain.
The sheer amount of digital data generated by the proliferation of filmless medical imaging, poses great scalability and manageability challenges to PACS systems. Manageability challenges are aggravated when weighing legislative requirements. An architecture for an enterprise level PACS should support the management of assorted medical objects (e.g., images and reports). Additionally, the architecture should allow services, including performance and reliability, to be tailored to classes of objects according to complex and possibly varying rules. The design should be flexible, allowing for on-demand cost-effective scaling, using a mix-and-match selection of hardware, operating systems, and storage devices. In light of the increased reliance on stored data, it should ensure 24x7 availability, even during system upgrade, and allow pluggable support for future formats. The Medical Object Management System (MOMS) presented in this paper, is an enterprise medical imaging solution architectured to meet the above demands. Flexible, configurable and scalable content and source based management of
objects enables administrators to define and modify policies that govern various aspects of the objects' life-cycles, using either configuration files or a Web-based GUI. The modular architecture of MOMS includes (possibly multiple) instances of interface (DICOM, HL7 and Tivoli Storage Manager), storage management and administration agents. Agent instances are hot-pluggable, allowing for zero-downtime upgrades, and can be deployed on a heterogeneous and distributed infrastructure. Leveraging the expertise gained in the development and deployment of the IDMR research PACS project, combined with recent technological advances and modern middleware, MOMS delivers a solution for the present and future requirements of medical objects management.