IHE Success Story University Hospitals of Bordeaux (France) C. BERTINI, N. MAGOT

Transcription

1 IHE Success Story University Hospitals of Bordeaux (France) C. BERTINI, N. MAGOT

2 The University Hospitals of Bordeaux (CHU de Bordeaux) 4 th French University Hospital Complex 1 st employer of the Aquitaine Region employees 3 hospital groups : Pellegrin Saint-André Sud (South)

3 The University Hospitals of Bordeaux CHU Bordeaux has a total of : 3107 beds &195 places

4 Local context at the beginning of the PACS project (2002) 3 main hospitals with 3 different RIS* No unique patient identifier (neither national nor local) New patient-centered shared medical record was planned Radio link between the 3 main hospitals (32 mbps) * RIS : Radiology Information System

5 The challenges PACS : financing limited to the first step (film saving whole hospital center PACS development) First hospital : only CT and MR examinations in the PACS, for 7 clinical and surgical departments (main users of this kind of images) Second hospital : only CT and MR examinations in the PACS, for 8 clinical and surgical departments Third hospital (the smallest) : all radiology modalities to all clinical and surgical departments PACS sold by Kodak- Carestream with Medasys PACS (DXServer, DXSra) and Carestream Archive (VIP Archive)

6 The challenges In 2003, average film expenditures : > 3 Euros/ CT-MR examination After the first phase (2005), savings : ~ 2 Euros/ CT-MR examination We had the money to buy the second phase (all imaging modaties available for all the clinical and surgical departments)

7 Today 3 PACS synchronized 10 Gbps 10 Gbps One Unique hospital patient identifier One new RIS (XPlore from EDL) A new patient record (Thalès and Médasys) Film savings (no films inside hospitals)

8 What about IHE in this process? IHE was new and not well known in the hospitals. Interoperability was a big challenge Private Dicom field were frequent We began without IHE, but we were interested by the future advantages.

9 IHE and EAI Integration Several constraints : No IHE Patient management Necessary to make integration using PFI (EAI) PFI is not an IHE EAI Make supervision simplest

10 IHE and EAI Integration Classic IHE Integration Sender IHE sending HL7/TCP IHE Listener data processing Receiver ACK/NOACK TCP return Log writing Log writing

11 IHE-like and EAI Integration IHE Integration using PFI (EAI) Sender Log writing 1- IHE sending (HL7/TCP) 3- ACK TCP return (NOACK only if listener is turned off) IHE Listener 2- XML Encoding P F I 4- XML Decoding IHE sending (HL7/TCP) 6- ACK/NOACK TCP return IHE Listener 5 -data processing Receiver Log writing

12 IHE-like Service Patient Integration SP * products XML only Service Patient (Patient Managment) 1- XML sending P F I 2- XML HL7 (ADT) encoding IHE sending 4- ACK/NOACK TCP return IHE Listener 3 -data processing RIS (XPLORE) *SP: Service Patient

13 IHE-like EAI Supervision

14 IHE-like Service Patient Integration ADT message encoding : A01, A02 A07, A08 (patient admission messages) A11, A12, A13, A38, A40, A52, A53 (cancel messages) A21, A22, A28, A29, A38, A40 (Identitiy, merging messages)

15 XPLORE / DxServers Integration IHE-like Integration using PFI (EAI) 4- XML Decoding IHE sending IHE Listener 5 -data processing XPLORE (RIS) 1- IHE sending (ADT, SIU) 3- ACK TCP return (NOACK only if listener is turned off) IHE Listener 2- XML Encoding P F I 6- ACK/NOACK TCP return DxServer Pellegrin DxServer St André DxServer Ht Lévèque

16 XPLORE / DxBrokers Integration Advantages : Only one message is sent by the RIS Every ACK/NOACK is logged on PFI Every message can be replayed by the EAI, with no need to connect to the RIS

17 The Radiology Workflow Storage Commitment RAD 10 Patient Examination Query/Retrieve RAD 14, 15 Archive Clinical departments KIN RAD 30, 31 Record a REPORT MPPS (RAD-6, 7) Archival retreive Worklist (RAD-5) Selected Images and report, all examination REPORT Radiology and Nuclear Medicine RIS

18 Why? Highlight : the KIN (Key Image Notes) Challenge : to set the same rules for all radiologists Number of key images per kind of examination To tag images also for «normal» examination «Autotag» for small number of images (CR, DX, )

19 Highlight : the KIN The imaging modalities consoles were not KIN Need : tag the key images on the PACS consoles

20 Why KIN? Because 12 % of the examinations are accessed the year after the examination, only 3% after 5 years To plan the archival and the image migration To help the physician by viewing first the key images (CT, MR > 1000 images), he can also view the whole examination. To find first the KIN on the CD-Rom To print the KIN without additional work (when needed) To be ready for the National Patient Record

21 Key Image Selection (KIN) A Unique image selection for several purposes : 1000 images Digital reporting National Patient Record? Clinical and surgical department KIN are seen first Vxced cedce gbgyurecrc yucdeg qsi qsdcoi s yucde oihcqdsoi byucsdq oikujc sdq uc qsdi qsdo qs csdfu Digital Media with KIN (outside patient) Paper Prints of KIN (outside patient) Intelligent archival of KIN, and/or a portion of the original examination

22 Next steps Connexion of PACS : hospitals, clinics, private practice radiology in the Aquitany region. Create a Dicom hospital Gateway in SOA* technology to intermediate between archive, servers and post-processing consoles National Electronic Patient record (DMP) New functions * SOA : Service Orientied Architecture

23 QUESTIONS?