Questions: 1/ From Page 3, currently radiologist should be able to access/view patient’s clinical records from the EPR on one of the screens (Dr. Dugar had 3 separate screens/systems, for illustration). Why on Page 9, the article said in the future, “with adoption of XDS, radiologist can access to XDS based EPR”? Shouldn’t user able to access clinical data from EPR now on one of the screens currently? Plus on Page 28, “PACS Radiology Data Silo” the paper said “Today PACS is producing a radiology data silo as it is separate from the rest of the clinical record.” I am a bit confused here. 2/ Or was the author implying with XDS based EPR, users can have patient’s clinical data (from the EPR system) be display along side with the DICOM images on the RIS or PACS system? Is this the rationale the author said “This improves radiologists reporting accuracy & patient safety” on Page 11? Is this the reason why on Page 47 (Future PACS: CDA display), the paper said “In future radiology reports must have a proper document structure when displayed by PACS”? 3/ On Page 69 (Future PACS: XDS-1 Consumer EPR Access), the paper said "In the future PACS will be XDS-I consumer & will have access to images & reports registered to an XDS registry ...” What is the role of RIS in Dr. Dugar version of future health information system? It seems to me, in the author’s view, RIS is almost redundant if all the qualities Dr. Dugar wishes for in PACS are fulfilled – probably with the exception of scheduling, but that scheduling task can be absorbed by the “future” PACS or EPR. Agree? 4/ On Page 22 (Today-PACS & PPR), the paper said “However, today we have a PACS (a digital record for radiology images) & PPR”. If an institution has PACS, RIS & EPR (with or without SSO), there should not be a scenario where users should generate PPR. Agree? I can understand if a facility has only PACS and no RIS, then PPR is unavoidable – in particular dealing with voice dictate by radiologists. 5/ On Page 25 (PACS Failure), should a typical radiologist or technician read reports from a RIS or a viewing station rather than from a PACS? 6/ On Page 31 (Clinical Document Architecture), the paper advocates the use of CDA in EPR. Is it true that most of the current EPR systems uses proprietary reporting format? Is this the reason why Dr. Dugar said “We must encourage our RIS & Ordercomms Vendors to support CDA structure” on Page 32? 7/ In describing the future system, from Page 62 (SSO) to Page 65 (Reporting Workflow), does Dr. Dugar envisions a single fully integrated system (PACS, RIS, EPR) can have a higher chance of delivering Dr. Dugar vision of the health info system (rather than SSO to different systems)? Is there such integrated system (non-propriety) out there by major vendors? I know in US, lots of large medical centers such as Mayo Clinics, Massachusetts General has this integrated system, and there are papers describing such integrated national systems in Singapore, Hong Kong etc. But all these were developed in-house. Such integrated system if exist, can have an easier task to deliver the content Dr. Dugar described from Page 52 to Page 61. 8/ When I read Page 80, I cannot stop asking myself this question: Where are we (the technology) now (Jan 2013) – exactly one year after Dr. Dugar wrote this informative article? Would someone be able to tell me has Dr. Dugar’s vision fully or partly fulfilled?
Regards, John Lai
posted on Wednesday, January 09, 2013 - 09:38 pm
I think this can be explained via a discussion on a telephone call. I will be in touch.
posted on Wednesday, January 09, 2013 - 09:56 pm
"I cannot stop asking myself this question: Where are we (the technology) now (Jan 2013) – exactly one year after Dr. Dugar wrote this informative article? Would someone be able to tell me has Dr. Dugar’s vision fully or partly fulfilled? "
One thing I will confirm is that this vision is moving towards fulfillment http://www.ehi.co.uk/news/ehi/8188/ge-healthcare-launches-vna Now GE is a very big player in this market. XDS based VNA is being bought by almost every hospital replacing their PACS. DICOM is now globally accepted as standard for medical images CDA (pdf with XDS metadata wrapper as the most basic form) is the emerging global standard for storage & display of medical documents In the near future our RIS supplier is going to send CDA reports to our XDS VNA, & PACS viewer as a native XDS consumer will display these. --3 different vendors For patient management-- we need to have a history is consists of well indexed medical images & medical documents Standards--DICOM & CDA with XDS indexing will allow us to change suppliers with ease--as patient data is held in vendor neutral formats--currently data in EPRs is held in proprietary formats.
Ability to change system vendors is very important to ensure that technology is kept up-to-date. If vendors get to know that we cannot change our system, they is no incentive to update their technology. NHS has suffered from old out-dated PAS systems which are difficult to replace, as data is difficult to migrate. That is why standards like XDS, CDA & DICOM are key to the future of global healthcare.
posted on Friday, January 18, 2013 - 08:37 pm
Hello Dr. Neelam, Thanks for your response. I have been away. I am located in the US so making a phone call is probably not as convenience. If you prefer, we can continue this communicate in private email. Thanks. John