1. Desktop Integration Rhidian Bramley PACS & Teleradiology Group Meeting November 2005

2. What is Desktop Integration? Clinical definition… “… the functional integration between workstation applications to optimise clinical workflow and patient safety”

3. How do you achieve it? Hardware Integration Software Integration –‘Front-end’ workstation application integration –‘Back-end’ server side integration

4. Desktop Hardware Integration Technically easy, contractually challenging Single physical workstation running all applications Single keyboard and mouse One or more screens configured as a single virtual desktop.

5. OBS Functional Specification All functions permitted to the user of the specialty information solution and PACS shall be available (including digital dictation where installed) through the single workstation with desktop integration. Workstation display devices shall be controlled by a single keyboard and mouse. The workstations provided for desktop integration shall, according to user preference, be provided in one of the following configurations: –2 display devices for viewing images and 1 colour display device for specialty information solution (in the case of radiology, commonly referred to as a RIS). –1 display device for viewing images and 1 colour display device for specialty information solution. –2 display devices for viewing images with the option of interacting with specialty information solution on 1 of these display devices.

6. Desktop Hardware Integration

7. Desktop Software Integration Front-end integration (desktop integration) –Client side or application integration –Proprietary as ‘limited’ use of standards –Application Program Interface (API) e.g. COM Back-end integration –Server side integration –Standard IHE defined transactions –HL7 & DICOM Interfaces

8. Which applications? PACS RIS Other specialty information systems Digital dictation system 3 rd party applications (e.g. 3D software & orthopaedic templating) Electronic patient record application

9. RIS-PACS integration functions Is the other application active? Launch/shutdown other application Request login, password update, log out Show primary studies (from worklist) Show additional studies

10. OBS Functional Specification There shall be a single log on to the services such that a user logging on to the PACS shall also be logged on to the specialty information solution and vice versa, where it is appropriate for a user to be logged on to both systems. The PACS and specialty information solution (in the case of radiology, commonly referred to as a RIS) application shall be linked in such a way that examination information selected on the specialty information solution display device shall cause relevant images to be shown on the PACS display devices according to the relevant default display protocols (DDPs) and selection of images/examinations on the PACS display devices shall cause the relevant specialty information solution examination data to be displayed on the specialty information solution display device.

11. Suggested OBS Enhancements The PACS image display should indicate primary studies to be reported, to distinguish them from additional studies loaded manually or by default display protocols. The speciality information system should show a list of all scheduled and prior studies on the active patient, indicating the study status, the number of available images for each study on PACS, and which of these studies are loaded on the PACS display device at any moment.

13. HL7 CCOW (Clinical Context Object Workgroup) Subjects Standard Custom Dependent Common Secure Action

14. Conclusion Desktop integration means different things to different people and should be specified clearly in functional terms HL7 CCOW should be specified as the strategic mechanism for desktop application integration Functionality can be achieved through desktop emulation, but will co-exist with front end desktop integration for the foreseeable future. Desktop integration is not just RIS-PACS, it is a key component of the wider EPR functionality

15. Radiology Desktop Integration Workflow Questions Which application should drive PACS reporting workflow? –RIS worklist? –PACS worklist? Which application should drive PACS web client workflow for clinicians? –PACS web client?, RIS?, EPR?

16. Back End Integration Can achieve functional desktop integration through desktop emulation –PACS can emulate RIS E.g. procedure information, status, reports –RIS can display PACS information E.g. availability of images …but NOT actual DICOM images

17. IHE Scheduled Workflow Profile ↓ Procedure Scheduled ↓ Procedure Updated ↓ Performed Work Status Update ↑ Performed Work Status Update ↑ Image Availability Query ↑ Instance Availability Notification Radiology Information System (IHE Department System Scheduler) PACS (IHE Image Manger/Archive)

18. IHE Reporting Workflow Profile Worklist Provider RIS or PACS (IHE Report Manager) Image Provider PACS (IHE Image Manager) Report Creator RIS or PACS Image Display PACS DICOM GPWL DICOM Query/Retrieve Workstation

19. Desktop Emulation PACS can emulate RIS functionality… “The RIS is dead” …but with HL7 CCOW “ Long live the RIS”

20. Conclusion Desktop integration means different things to different people and should be specified clearly in functional terms HL7 CCOW should ideally be the preferred mechanism of desktop application integration Functionality can be achieved through desktop emulation, but will co-exist with front end desktop integration for the foreseeable future. Desktop integration is not just RIS-PACS, it is a key component of the wider EPR functionality