Across the healthcare enterprise, and among its many stakeholders, there is universal agreement that “images must be securely and widely shared.” Referring physicians need to see the studies referenced in the radiologists’ reports. Specialists from ophthalmology to cardiology need to review patient images from a variety of sources. Patients and their PCPs need access to complete patient records—including images to foster collaboration. And because this is a challenge that has traditionally been in our wheelhouse, if you’re using Carestream PACS you already have the basis of an enterprise integration solution embedded in your system.
Teams are often surprised at how quickly integration can be accomplished.
On a daily basis, I meet with PACS administrators, IT managers and radiologists to discuss the “hidden functionality” of their Carestream PACS.
Often they are surprised at how easy it can be to integrate their PACS with their EHR. A single-site enterprise integration can typically take less than a month to implement. Multiple-site enterprises take longer—but we’re talking months, not years.
Once your EHR, RIS and PACS are synchronized, Carestream’s universal viewer, Vue Motion, becomes the secure zero-footprint system that allows access from virtually any workstation or device. Vue Motion is FDA-cleared for diagnostic reading on both IOS and Android devices.
Embedded integration tools.
The Carestream PACS has tools embedded within it that make integration very efficient. As part of our applications we use EIS—Extensible Interface Software—as one of our interface engines to our PACS. It takes in data from the RIS and uses that data to provide DICOM modality worklists electronically, so the technologists never have to type in patient or study information. The EIS is also an information router, making it possible for the PACS to cross-check images against the RIS data and to self-correct a potential mismatch between an image and a patient ID or order.
We also use the MIRTH interface engine that allows us to take in data in any type of format and convert it to what we need on the fly. And when we take data out of PACS we can send it in virtually any format that the end system wants. We use industry-wide protocols to make it happen—like HL7 and DICOM to share patient information between the EHR and PACS, and we use industry standard methodologies like Web Services to do it. It does not require much development work—if any—from either application. Most EHRs already have processes in place to allow third parties to integrate into their application.
How the integration with your EHR can work.
The first step is to integrate the backend. This involves integrating the RIS with the PACS so that the same patient identifiers and ordering numbers are used across the enterprise, and the reports and images will have those identifiers as well. When referring physicians log into the EHR and look at a report, they’re going to see a link there that says, “view PACS report.” When they click on that link, it will actually load our viewer and set the context of the study as it opens in our PACS, using patient IDs based on the original order that would have been sourced from the RIS.
The time investment to make this happen for a single enterprise might be a matter of several weeks or as much as a month. For multiple sites it will take longer. Some EHRs like to be notified of image availability from PACS so we need to create a bidirectional interface. Some EHRs know about the study from their RIS and code a template to link to current studies. Some want both the notification and the link.
Radiologists can benefit from more complete patient information.
We recommend that the interface with the EHR be made bidirectional, to allow radiologists and other specialists to see the complete patient record. Workflow is streamlined when information flow is made easier.
You can choose to work with a global patient record or a site-specific patient record—or both. The system is set up according to the security audit trail you require to maintain full compliance with privacy regulations such as HIPAA in the U.S. There are a number of ways we can handle that, depending on the configuration of the system:
- If actual user credentials are sent over to PACS when they launch our viewer, and PACS has a synchronized user database, then we audit the user once they’re in the PACS.
- If a synchronized user account is used to launch the PACS viewer for all users, then PACS locks the user down so that they can only view what they launched—and the EHR audits who the actual account is.
- If a single sign-on token methodology is used, it combines technologies such as Web services, AES Encryption and Base 64 encoding so that URLs containing user credential and patient details can be used securely without being visible to end users.
So in all cases we still have a complete audit trail of which users are launching a particular study. And no, your users won’t have to log in again once they’re authorized—the system can be designed so that the user logs in once and your security goal can be accomplished by the option you choose.
The option will be based on the level of security you choose for the integration.
Getting started to integrate your PACS and your EHR.
If you are participating in the discussion about image-enablement of your enterprise, whether (in the U.S.) to meet Meaningful Use requirements or simply because it’s the right thing to do, keep in mind that with your Carestream PACS you have a big head start.
If you’d like to know more about how this can work, feel free to reach out.