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Planning and Management of Cross Hospital of PACS Systems and Remote Reports for Healthcare Sharing- An Example of Min-Shuang Hospital Group


A modern hospital includes many information systems, such as Hospital Information System (HIS), Laboratory Information System (LIS), Picture Archive and Communication System (PACS), Nurse Information System (NIS), and so on. All of the above systems need to consider backup, data exchange, software design, security, etc.
A hospital system which wants to share data with another hospital system should consider some technology issues, such as network, security, database, and data format. The sharing data include images and reports. For example, the Min-Shuang Hospital Group consists of over 100 hospitals in the world, in which modality resources will be shared by the hospital group, DICOM images will be transferred to the Image Data Center (IDC) for image storing and backup, and radiology doctors will finish their reports and transfer them back to source hospital by requirement.
This thesis will focus on the PACS systems for sharing. The required hardware, software, and workflow will be suggested for implementation of transferring and sharing of image and reports.
Key word :  Picture Archive and Communication System ,Electronic Medical Record, Hospital Information System, Digital Image Communication in Medicine,Health Level 7, Integration Healthcare Enterprise


The whole systematic situation of taking a broad view of the medical system is not so perfect, a lot of systems need be combined in fact, thesis will study the medical image and store and planning and management, expect through the discussion and planning of the technological aspect of whole system, to help the hospital reduce the construction cost of the whole and expand its service range.
This thesis planning to holds the alliance hospital of medical system . how to reach      ' exchange image and report ' for resource-sharing . Expect the possibility of expanding and service of the system, let whole medical resources be extremely easy to obtain alliance hospital.

2. Related Work

The medical image centre (IDC) planning with manage DICOM (Digital Imaging and Communications Medic) images and Report data,  stated the planning content of each project and research as follows:

2.1  The medical image stores systematic planning and management:
  • The medical image stores primary element research, DICOM standard, HL7 (Health Level Seven) Standard, IHE ( Integration Healthcare Enterprise) standardize the procedure.
  • Checking all modality should be support DICOM standard of images and store.
  • Analysis of the procedure of the systematic hardware environmental state, such as network ,computer ,security.

2.2  The integrated of Hospital Information System :
  • According to the IHE, the PACS system must be combined with Hospital Information System , include the basic information of patients, patient examination information.IHE scheduled work-follow profile check item :     

        1. Registration: Register patient information on HIS System.
        2. Patient information/Order placed: Order exam case on RIS system.
        3. Examination order/order filled : Transfer patient information and exam information data to Image Manager/Archive.
        4. Image Manager/Archive: DICOM images store and management.
        5. Acquisition /Modality : Modality Group.
        6. Diagnostic Workstation: Diagnostic image of report workstation .
        7. Report Repository : The final report respond to HIS system.
  • The check Hospital Information System database .

Fig. 1. Scheduled Workflow Profile
Fig. 2. HIS/RIS Data transfer to PACS work-follow
2.3  The planning and management of the medical image center (IDC):
  • The Min-Shuang Hospital Group consists of over 100 hospitals in the world, in which modality resources will be shared by the hospital group, DICOM images will be transferred to the Image Data Center (IDC) for image storing and backup, and radiology doctors will finish their reports and transfer them back to source hospital by requirement.
 •  The IDC, consider on storing and managing the images of checking each hospital, can improve medical quality and keep more lowering costs.

3. Result

The IDC PACS system provider others hospital DICOM images store, backup and report service . Radiology doctor can using IDC PACS to finished report in anytime ,anywhere . Min-Shuang Hospital Group clinic doctor can shared IDC PACS images and final report to make sure examination result, expand IDC PACS medical platform can improve medical information service .
3.1 IDC PACS and alliance hospital PACS structure :
The following fig 3 picture show, each Branch Min-Shuang hospital have Cache Server system for receive DICOM images and patient exam data and report exchange. Most of images will store on IDC PACS system and provider report service.


Fig. 3. IDC PACS structure chart
3.2 IDC PACS and alliance hospital PACS order data exchange management:
The alliance’s hospital HIS system and IDC PACS system using ‘Table form was for data exchange. Fig 4 shows, service of main and alliance’s hospital and outside clinic by different MWLWL table exchange, PACS Broker will check different source service to into in PACS main Database . After patient finished exam, its images will store by network of transmission. IDC Server should be check different source and provider images shared. 
Min-Shuang Hospital Group HIS system are all independent at present, that mean the different patient user possible have same ‘Patient ID’ . It really have big problem for data management and shared . We define one rule for fixed this issue ,all of alliance’s HIS system need add more [hospital one code + patient source ( I ,O,E) +patient id ] rule for ‘Patient ID’ after insert into MWLWL table, but will cause checking issue, so we define unique ID number for search. Fig 5 Refer doctor field of MWLWL table note remember alliance hospital code .  

Fig. 4. Exchange the structure chart
Fig. 5. Refer _ Doctor note remembers alliance hospital code.
The following 6 pictures show MWLWL Table form field and data .  
Fig. 6. MWLWL Table
The procedure interface of PACS Broker is as Fig. 7 shows.
Fig. 7. PACS Broker
Start button : Begin to exchange HIS with PACS system.
Table Setting : MWLWL define .
Save : Save HIS and PACS database configure.
Fig. 8. HIS table and MWLWL table configure.
Item 1 :
HIS Source (Table ) : Source Table name
Search Command : : SQL command for Search .
Update Command : :SQL command for Upgrade the state.
Item 2:
Order (MWLWL):: Enable insert into MWLWL table.
3.3 IDC PACS report data exchange management:
  IDC PACS system provider ‘Web Report’ for report entry, fig 9 web report picture.
The Web report was easy to achieve Tele-Radiology ,It can use any place and any work station in hospital or outside, have expanded the doctor’s service time, even can finish the report at home. 
Fig. 9 Web report picture
The procedure of whole system is as Fig.10 shows, we design report Text file for data exchange and let doctor free for HIS report system or PACS report system to finish their report job. Whether which system , the report text file will save to Inbound or Outbound folder for data exchange.

Fig.10  Report Exchange

Inbound ::Report Text file sample 1 .
GE3980708004|992037|20090709|1353|M2005|Head CT for brain study performed without contrast injection.
1.no focal density change within visible brain parenchyma.
2.no obvious ICH.
3.the size and shape of ventricles are normal.
4.no definite bony change.
no obvious intracranial lesion.Please correlate with clinical history and exam.
Outbound :: Report Text file sample 1.

Clinical information: abdominal pain
Technique: Abdominal CT scan with and without contrast enhancement performed by 64MDCT (LightSpeed VCT, GE)
Limitations: None
Comparison: No comparison study available

The result shows normal configuration, shape and contour of the major organs (liver, spleen, pancreas and kidneys). The appendix can be identified without swelling. Local inflammatory process is not found. There is no visualization of any tumor mass, hematoma, free air or considerable lymph node in the abdomen. Minimal ascites is disclosed at the deep portion of the pelvic cavity. Numerous lymph nodes are increased at the mesentery especially in RLQ of abdomen.   Following contrast medium injection, no particularly abnormal lesion can be identified.

1. probably mesenteric lymphadenitis
2. no CT evidence of appendicitis



 3.4 DICOM WADO supporting :
DICOM offers Web Access to DICOM Persistent Ojects standard ,WADO using HTML (HyperText Markup Language) Page or XML (eXtensible Markup Language) for DICOM image execute, HTTP (HyperText Transfer Protocol) /HTTPs(HyperText Transfer Protocol,secured) Protocol about use DICOM UIDs ( Unique Identifiers) to query .
Fig. 11. DICOM WADO(Web Client & Web Enabled DICOM Server)
  Have support way of WADO, all report system can ordering to combine the image through URL easily, the following command that obtained for the image:
The image type:: image/jpeg , application/dicom, etc.
Image size: 256 (Size of image).
Image UID: instance uid.

The WADO command can easy combine the image + report ,Please check fig 12 shows. 
 Fig. 12. combine the image + report picture.
4 . Conclusion
2006 IHE also defines Cross Enterprise Registry in order to shared images and report , fig 13 shows, Physician office doctor has request imaging report & study from Enterprise A. The patient id=3547F45 must be registered Cross Enterprise Registry after take CT exam in Radiology Enterprise B and Chest X-ray in Radiology Enterprise A before . Cross Enterprise Center have patient id=3547F45 report and study document for prepare for query. After Physician office doctor send query request for patient id=3547F45 Radiology Enterprise A documents. Cross Enterprise Center will send notification to Radiology Enterprise A to execute document request of report and study .
Fig. 13. Physician office doctor request imaging report & study from Enterprise A picture.


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