Mulvaney James
Radiol Manage. 2002 May-Jun;24(3):24-9.
Why integrate PACS with the RIS? To improve workflow, of course, but what workflow? Much of the focus is on improving the flow of images for the radiologist, which is certainly a good thing to do, but what about the rest of the order process? Typical PACS system architecture begins with the HIS since this is where the correct patient demographic information and in many cases the orders originate. Correct patient and order information is sent from the HIS to the RIS using HL7 commands for Admission/Discharge/Transfer (ADT) and Order/Entry. HL7 is the communications protocol used in virtually all information systems. For the first step in communicating with PACS, patient and order information from the RIS is sent to a device called a PACS broker. This is necessary because most PACS systems do not support HL7 directly, and a translation is required. Images from each imaging modality are also sent to the broker using the DICOM standard. If an imaging modality does not support DICOM, then an additional box is used to convert the images to a DICOM file. The broker then sends completed DICOM files to the PACS for storage, distribution and viewing. That approach has worked well for the first stage of PACS utilization. However, experienced PACS users have identified the need to improve workflow, and many feel that closer communication with the RIS will solve many of the current limitations. This approach is sometimes called a "brokerless" solution but is probably better described as incorporating broker functions into the RIS. There are several potential advantages of incorporating the broker functions into the RIS: Access to all RIS information on patients, orders and results is available and can be used in many ways to improve workflow. Supporting all DICOM services directly from the RIS ensures that the latest and most complete information is always used. For example, DICOM Modality Worklists can be provided directly from the RIS, which guarantees that they are updated immediately. The RIS can manage the complete order workflow, not just images. License, implementation and support costs can be reduced by eliminating HL7 interfaces to an external broker. Managing workflow is the key to improved productivity and patient care from PACS. However, coordinated management of order workflow from the RIS and image workflow from the PACS is required to get the full benefit. The RIS has immediate and broad access to patient and order information. As a result, it is the natural place to take the lead in managing this coordinated workflow. While many older RIS and PACS systems are not yet capable of some of the integration features described above, several new systems are moving rapidly in that direction.
为什么要将PACS与RIS集成？当然是为了改善工作流程，但是改善何种工作流程呢？大部分关注点都放在改善放射科医生的图像流转上，这无疑是件好事，但订单流程的其他环节又如何呢？典型的PACS系统架构从HIS开始，因为正确的患者人口统计学信息以及在许多情况下订单都源自这里。使用用于入院/出院/转科（ADT）和医嘱录入的HL7命令，将正确的患者和医嘱信息从HIS发送到RIS。HL7是几乎所有信息系统中使用的通信协议。在与PACS通信的第一步中，来自RIS的患者和医嘱信息被发送到一个称为PACS代理的设备。这是必要的，因为大多数PACS系统不直接支持HL7，需要进行转换。来自每个成像模态的图像也使用DICOM标准发送到代理。如果成像模态不支持DICOM，则使用额外的盒子将图像转换为DICOM文件。然后，代理将完整的DICOM文件发送到PACS进行存储、分发和查看。这种方法在PACS使用的第一阶段运行良好。然而，经验丰富的PACS用户已经认识到需要改善工作流程，许多人认为与RIS更紧密的通信将解决当前的许多限制。这种方法有时被称为“无代理”解决方案，但可能更好地描述为将代理功能纳入RIS。将代理功能纳入RIS有几个潜在优势：可以访问有关患者、订单和结果的所有RIS信息，并可以多种方式用于改善工作流程。直接从RIS支持所有DICOM服务可确保始终使用最新和最完整的信息。例如，可以直接从RIS提供DICOM模态工作列表，这保证了它们会立即更新。RIS可以管理完整的订单工作流程，而不仅仅是图像。通过消除与外部代理的HL7接口，可以降低许可证、实施和支持成本。管理工作流程是提高PACS生产力和患者护理水平的关键。然而，要充分受益，需要对RIS的订单工作流程和PACS的图像工作流程进行协调管理。RIS可以立即广泛访问患者和订单信息。因此，它是率先管理这种协调工作流程的自然场所。虽然许多旧的RIS和PACS系统尚不具备上述一些集成功能，但一些新系统正在迅速朝着这个方向发展。
