Integration between systems is vital for patient safety and increased productivity. We have integration between McKesson RIS (the UK version) and Agfa PACS. The integration works very well and we have gained huge advantages with productivity increase.
1. Rather than getting a Integrated RIS-PACS system from single vendor, it is more worthwhile to get best of breed of independent systems and insist on integration. 2. Replacement of systems at end of contract is easier, and allows you to look for better systems in the future (if you have not put all your eggs in one basket). 3. Remember that front-end integration does not end with RIS and PACS. A reporting radiologist would report more safely and accurately, if they had easy access to pathology results, clinical letters etc. So in the future you will require integration with systems for Clinical documents, results acknowledgement system, PACS etc. This leads to a Integrated Health Record (with parts of the record supplied by best of breed systems from different vendors) 4. Adoption of CCOW (HL7 standard for context synchronization) enable a standards based front-end integration between different clinical systems. 5. National adoption of CCOW is important if we are to improve patient safety in Clinical IT. 6. We have seen the problems with Lorenzo and Cerner EPR when a single system is trying to replace all departmental systems. The ethos of the national programmme needs to change with adoption of CCOW for a Integrated Health Record in a multi-vendor environment (rather than a single monolithic system which is a logistic nightmare to implement). 7. GE and Sectra already support CCOW (Agfa does not as far as I know). If you can get a RIS supplier who supports CCOW you can get the plug and play integration using standards. That will improve your ability to integrate with other Clinical systems within the Trusts as more suppliers adopt CCOW. 8. Free SDK (software development kit) is available to suppliers to adopt CCOW. 9. On our last meeting there are presentations on DTI and CCOW which are worth looking at, if you were unable to attend the meeting. 10. Vendors who presented at the meeting also did recognise the importance of CCOW, and I remain optimistic that many suppliers will adopt CCOW in the future as a proof of their integration committment.
We have been looking at Trust-wide Digital Dictation and a Clinical Document management system (for Clinical Letters). I enclose a requirements document that has been written which identifies the role of CCOW for systems integration, for patient safety. One needs to take a broader perspective for systems integration rather than just a RIS and PACS perspective. We need to see how RIS and PACS fit into an integrated health record (keeping the patient in the centre of the requirements).