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Process reengineering: The role of a planning methodology and picture archiving and communications system team building

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 28-31页

作者： Carrino, JA Unkel, PJ Shelton, P Johnson, TG Harvard Univ Brigham & Womens Hosp Sch Med Dept Radiol Boston MA 02115 USA Joint Imaging Technol Project Off Ft Detrick MD USA Int Radiol Grp Dallas TX USA Wilford Hall USAF Med Ctr Lackland AFB TX 78236 USA

The acquisition of a picture archiving and communications system (PACS) is an opportunity to reengineer business practices and should optimally consider the entire process from image acquisition to communication of results. The purpose of this presentation is to describe the PACS planning methodology used by the Department of Defense (DOD) Joint Imaging Technology Project Office (JITPO), outline the critical procedures for each phase, and review the military experience using this model. The methodology is segmented into four phases: strategic planning, clinical scenario planning, installation planning, and implementation planning. Each is further subdivided based on the specific tasks that need to be accomplished within that phase. By using this method, an institution will have clearly defined program goals, objectives, and PACS requirements before vendors are contacted. The development of an institution-specific PACS requirement should direct the process of proposal comparisons to be based on functionality and exclude unnecessary equipment. This PACS planning methodology is being used at more than eight DOD medical treatment facilities. When properly executed, this methodology facilitates a seamless transition to the electronic environment and contributes to the successful integration of the healthcare enterprise. A crucial component of this methodology is the development of a local PACS planning team to manage all aspects of the process. A plan formulated by the local team is based on input from each department that will be integrating with the PACS. Involving all users in the planning process is paramount for successful implementation. Copyright (C) 1999 by W.B. Saunders Company.

关键词：计算机系统诊断显像医院科室/组织和管理医院信息系统/组织和管理职业间关系组织目标放射科医院/组织和管理放射学信息系统/分类放射学信息系统/组织和管理系统综合人类

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Clinical services assessment and reengineering: Lessons learned

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 127-129页

作者： Lyche, DK Richardson, RR Maliff, RP Romlein, J Norton, GS InformaTech Inc ITI Frederick MD 21703 USA

Healthcare enterprises often "acquire and install" picture archiving and communications systems (PACS) without examining many of the care delivery processes and information flows that will be affected. Many times these unexamined factors can delay or be the cause of failure of the PACS project. This article presents issues that were worked through as part of a PACS clinical services assessment and reengineering analysis for several US military medical treatment facilities, Copyright (C) 1999 by W.B. Saunders Company.

关键词：阿拉斯加卫生保健提供夏威夷医院信息系统/组织和管理医院军队/经济学医院军队/组织和管理组织方针人员配备和时间安排质量保证卫生保健放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理技术评估生物医学工艺学放射学电信人类

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Practical considerations for picture archiving and communications systems over the enterprise network

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 84-87页

作者： Miller, MT McLaurin, C Gene Burton & Associates Franklin TN 37067 USA

Network design is a vital element of any PACS implementation. The involvement of Information Systems in PACS planning and implementation is essential to the long-term success of the PACS’s implementation and operation. Radiology equipment and PACS systems are now computer systems. Drawing on the capabilities of the staff in your organization who have computer expertise is essential to the long-term success of PACS implementation and operation.

关键词：预算计算机通信网络/分类计算机通信网络/仪器和设备计算机通信网络/组织和管理计算机系统诊断显像医院信息系统/经济学医院信息系统/组织和管理信息存储和检索放射学信息系统/分类放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/组织和管理工艺学放射学远程放射学/分类远程放射学/仪器和设备远程放射学/组织和管理用户计算机接口人类

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Transparent image access in a distributed picture archiving and communications system: The master database broker

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 175-177页

作者： Cox, RD Henri, CJ Rubin, RK McGill Univ Ctr Hlth Dept Diagnost Radiol Montreal PQ Canada

A distributed design is the most cost-effective system for small- to medium-scale picture archiving and communications systems (PACS) implementations. However, the design presents an interesting challenge to developers and implementers: to make stored image data, distributed throughout the PACS network, appear to be centralized with a single access point for users. A key component for the distributed system is a central or master database, containing all the studies that have been scanned into the PACS. Each study includes a list of one or more locations for that particular dataset so that applications can easily find it. Non-Digital Imaging and Communications in Medicine (DICOM) clients, such as our worldwide web (WWW)-based PACS browser, query the master database directly to find the images, then jump to the most appropriate location via a distributed web-based viewing system. The Master Database Broker provides DICOM clients with the same functionality by translating DICOM queries to master database searches and distributing retrieval requests transparently to the appropriate source. The Broker also acts as a storage service class provider, allowing users to store selected image subsets and reformatted images with the original study, without having to know on which server the original data are stored. Copyright (C) 7999 by W.B. Saunders Company.

关键词： CD-ROM 计算机通信网络/经济学费用效益分析数据库(主题)/分类数据库(主题)/经济学数据库(主题)/组织和管理诊断显像信息存储和检索因特网放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理人类

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Reengineering the picture archiving and communication system (PACS) process for digital imaging networks PACS

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 59-61页

作者： Horton, MC Lewis, TE Kinsey, TV USN Joint Imaging Technol Project Off Ft Detrick MD 21702 USA

Prior to June 1997, military picture archiving and communications systems (PACS) were planned, procured, and installed with key decisions on the system, equipment, and even funding sources made through a research and development office called Medical Diagnostic Imaging Systems (MDIS). Beginning in June 1997, the Joint Imaging Technology Project Office (JITPO) initiated a collaborative and consultative process far planning and implementing PACS into military treatment facilities through a new Department of Defense (DoD) contract vehicle called digital imaging networks (DIN)-PACS. The JITPO reengineered this process incorporating multiple organizations and politics. The reengineered PACS process administered through the JITPO transformed the decision process and accountability from a single office to a consultative method that increased end-user knowledge, responsibility, and ownership in PACS. The JITPO continues to provide information and services that assist multiple groups and users in rendering PACS planning and implementation decisions. Local site project managers are involved from the outset and this end-user collaboration has made the sometimes difficult transition to PACS an easier and more acceptable process for all involved. Corporately, this process saved DoD sites millions by having PACS plans developed within the government and proposed to vendors second, and then having vendors respond specifically to those plans. The integrity and efficiency of the process have reduced the opportunity for implementing nonstandard systems while sharing resources and reducing wasted government dollars. This presentation will describe the chronology of changes, encountered obstacles, and lessons learned within the reengineering of the PACS process for DIN-PACS. This is a US government work. There are no restrictions on its use.

关键词：行政管理人员生物医学工程资本筹集计算机通信网络/分类计算机通信网络/经济学计算机通信网络/组织和管理计算机用户培训费用节省决策诊断显像效率组织在职培训职业间关系军事医学所有权放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理系统综合人类

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Acceptance testing of integrated picture archiving and communications systems

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 163-165页

作者： Lewis, TE Horton, MC Kinsey, TV Shelton, PD USA Joint Imaging Technol Project Off Ft Detrick MD 21702 USA

An integrated picture archiving and communication system (PACS) is a large investment in both money and resources. With all of the components and systems contained in the PACS, a methodical set of protocols and procedures must be developed to test all aspects of the PACS within the short time allocated for contract compliance, For the Department of Defense (DoD), acceptance testing (AT) sets the protocols and procedures. Broken down into modules and test procedures that group like components and systems, the AT protocol maximizes the efficiency and thoroughness of testing all aspects of an integrated PACS. A standardized and methodical protocol reduces the probability of functionality or performance limitations being overlooked. The AT protocol allows complete PACS testing within the 30 days allocated by the digital imaging network (DIN)-PACS contract. AT shortcomings identified during the testing phase properly allows for resolution before complete acceptance of the system. This presentation will describe the evolution of the process, the components of the DoD AT protocol, the benefits of the AT process, and its significance to the successful implementation of PACS. This is a US government work. There are no restrictions on its use.

关键词：计算机系统数据显示诊断显像效率组织政府机构卫生资源医院信息系统投资质量控制放射学信息系统/分类放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/标准软件系统综合时间因素人类

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Integration, acceptance testing, and clinical operation of the medical information, communication and archive system, phase II

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 144-147页

作者： Smith, EM Wandtke, J Robinson, A Univ Rochester Med Ctr Dept Radiol Rochester NY 14642 USA

The Medical Information, Communication and Archive System (MICAS) is a multivendor incremental approach to picture archiving and communications system (PACS). It is a multimodality integrated image management system that is seamlessly integrated with the radiology information system (RIS). Phase II enhancements of MICAS include a permanent archive, automated workflow, study caches, Microsoft (Redmond, WA) Windows NT diagnostic workstations with all components adhering to Digital Information Communications in Medicine (DICOM) standards. MICAS is designed as an enterprise-wide PACS to provide images and reports throughout the Strong Health healthcare network. Phase II includes the addition of a Cemax-Icon (Fremont, CA) archive, PACS broker (Mitra, Waterloo, Canada), an interface (IDX PACSlink, Burlington, VT) to the RIS (IDXrad) plus the conversion of the UNIX-based redundant array of inexpensive disks (RAID) 5 temporary archives in phase I to NT-based RAID 0 DICOM modality-specific study caches (ImageLabs, Bedford, MA). The phase I acquisition engines and workflow management software was uninstalled and the Cemax archive manager (ANI) assumed these functions. The existing ImageLabs UNIX-based viewing software was enhanced and converted to an NT-based DICOM viewer. Installation of phase II hardware and software and integration with existing components began in July 1998. Phase II of MICAS demonstrates that a multivendor open-system incremental approach to PACS is feasible, cost-effective, and has significant advantages over a single-vendor implementation. Copyright (C) 1999 by W.B. Saunders Company.

关键词：密集磁盘计算机通信网络计算机系统费用效益分析数据库管理系统数据库(主题) 诊断显像可行性研究放射学信息系统/分类放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/组织和管理软件系统综合人类

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Branching out with filmless radiology

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 134-136页

作者： Carbajal, R Honea, R Texas Childrens Hosp Edward B Singleton Diagnost Imaging Serv Houston TX 77030 USA

Texas Children's Hospital, a 456 bed pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archiving and communications system (PACS), including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Until recently, filmless radiology operations have been confined to the imaging department, the outpatient treatment center, and the emergency center. As filmless services expand to other clinical services, the PACS staff must engage each service in a dialog to determine the appropriate level of support required. The number and type of image examinations, the use of multiple modalities and comparison examinations, and the relationship between viewing and direct patient care activities have a bearing on the number and type of display stations provided. Some of the information about customer services is contained in documentation already maintained by the imaging department, For example, by a custom report from the radiology information system (RIS), we were able to determine the number and type of examinations ordered by each referring physician for the previous 6 months. By compiling these by clinical service, we were able to determine our biggest customers by examination type and volume. Another custom report was used to determine who was requesting old examinations from the film library. More information about imaging usage was gathered by means of a questionnaire. Some customers view images only where patients are also seen, while some services view images independently from the patient. Some services use their conference rooms for critical image viewing such as treatment planning. Additional information was gained from geographical surveys of where films are currently produced, delivered by the film library, and viewed. In some areas, available space dictates the type and configuration of display station that can be used. Active participation in the decision process by the clin

关键词：计算机通信网络计算机系统决策诊断显像急诊室医院/组织和管理医院儿科磁共振成像门诊部医院/组织和管理病人医疗护理病人医疗护理计划 X线影像增强放射学信息系统/分类放射学信息系统/仪器和设备放射学信息系统/组织和管理转诊和会诊得克萨斯体层摄影术 X线计算机超声检查人类

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