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PACS and RIS: Surviving a consolidated enterprise in the EMR era

February 21, 2017
From the January 2017 issue of HealthCare Business News magazine

Dealing with procedures and body parts
Most PACS and VNAs rely on some form of mapping tables to assign a normalized body part value to an imaging study. Most values coming from the various modalities are unreliable, so the input to the mapping is normally the order. Many PACS do not persist the body part value within a DICOM attribute when the data is migrated (though one called Body Part Examined exists for this purpose). And even if the value was persisted, the defined list of body parts will vary from organization to organization and system to system.

Often an extract of all the procedures from the source organization’s RIS is performed and an experienced resource performs a mapping from the procedure name value (which is typically the value stored in the Study Description) to one of the managed body part values in the destination system.

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Shared EMR with separate facility RIS
Often when a shared EMR is implemented, the included RIS module is adopted at each facility as part of the rollout plan. In the case where the facilities continue to operate their own RIS, unless procedure information is normalized to a common set of values, imaging records will continue to contain facility-specific values, making it much more complex to define system rules and configurations based on procedure-level information.

Advice for imaging informatics professionals
When managing patient imaging records in a consolidated enterprise, there are several approaches that are recommended: Before migrating any data or consolidating any facility systems into a shared enterprise, first do a detailed inventory of the data. If the tools are available, this analysis may be performed by qualified staff, but the source system vendor may need to be engaged.

Assess how the source system manages patient IDs and any related domain information. Determine how ordering, acquisition, verification and quality control workflows are managed, as well as any rules to normalize DICOM attribute values. Assess whether the source system has any controls in place to determine imaging record attribute value compliance or uniqueness. Does the system ensure unique DICOM Study, Series and Instance UID values? Does it make use of the Issuer of Patient ID along with Patient ID values to identify the patient within a domain? Does it ensure accession number value uniqueness?

Assume that the current workflows have not always been in place and that some imaging records will have been acquired elsewhere and entered the system without a complete reconciliation of attribute values. Remember, many source systems have experienced many upgrades, have been managed by several different staff and have received information from many external information sources. What is true today may not have always been true.

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