Digital Radiography: Medical Informatics: PACS System and Quality Control-Assurance

Summary

This video script delves into medical informatics, focusing on hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS). It highlights how these systems streamline patient data management, facilitate medical imaging processes, and enhance diagnostic capabilities. The script also touches on the importance of communication standards like HL7 and DICOM, which ensure interoperability between various healthcare systems. Additionally, it addresses the challenges of data security and privacy, emphasizing the role of HIPAA in safeguarding patient information.

Takeaways

• 🏥 The Hospital Information System (HIS) is a central repository for all patient medical information, including billing, scheduling, and medical records, streamlining processes previously done manually.
• 🔑 HIS assigns a unique medical record number to each patient, facilitating departmental interactions and information sharing.
• 📋 Attending physicians can enter orders for lab tests, imaging, and prescriptions through HIS, enhancing accessibility and efficiency.
• 📈 HIS supports clinical research and public health data collection, playing a crucial role in healthcare data management.
• 🤖 The Radiology Information System (RIS) manages radiology-specific tasks like scheduling, billing, reporting, and quality assurance, interfacing with HIS for shared functions.
• 📡 Networks, particularly Local Area Networks (LAN) and Wide Area Networks (WAN), are essential for connecting healthcare devices and sharing resources and data.
• 🖼️ Picture Archiving and Communication System (PACS) is a networked system for managing digital images, replacing traditional film-based methods and enabling remote access and image manipulation.
• 🔍 PACS reading stations provide tools like pan, zoom, and magnify for radiologists to analyze images in detail, enhancing diagnostic accuracy.
• 📏 PACS measurement functions, such as distance and angle measurements, assist in the precise analysis of medical images.
• 💾 The implementation of PACS has eliminated issues like lost or misfiled images, allowing for efficient image storage, retrieval, and simultaneous multi-user access.
• 🛡️ Standards like DICOM and HL7 facilitate communication between medical devices and systems, ensuring interoperability and data integrity.
• 🔒 HIPAA regulations mandate strict security measures to protect patient privacy and data, requiring healthcare institutions to implement safeguards and employee training.

Q & A

What is the primary function of a Hospital Information System (HIS)?

The primary function of a Hospital Information System (HIS) is to house all of a patient's medical information, including billing, scheduling appointments, and medical records. It also assigns unique medical record numbers to each patient for use across all departments.

How does the HIS facilitate communication between different departments within a hospital?

The HIS allows attending physicians to enter orders for lab tests, diagnostic imaging, and prescriptions from various locations. It also communicates with other systems like the Radiology Information System (RIS) for shared functions, using software standards like HL7 for interoperability.

What is the role of the Radiology Information System (RIS) in a healthcare setting?

The RIS houses radiology information and is responsible for radiology functions such as scheduling patient procedures, radiology billing, radiologist dictated reports, and quality assurance data. It communicates with the HIS for shared functions.

What are the basic communication systems used by HIS, RIS, and PACS?

The basic communication systems used by HIS, RIS, and PACS involve networks and communication standards. They use local area networks (LANs) for small geographic areas and wide area networks (WANs) for larger areas. The HL7 software standards are used for communication between these systems and medical devices.

What is the significance of the Picture Archiving and Communication System (PACS) in radiology?

PACS is a networked group of computers, servers, and archives used to manage digital imaging. It has replaced traditional x-ray file rooms and reading rooms, allowing for the storage, retrieval, and distribution of images, and enabling simultaneous access from various locations.

How does PACS enhance the radiologist's ability to analyze medical images?

PACS provides radiologists with tools for post-processing manipulation and enhancements of images, including functions like pan, zoom, and magnify, which allow them to increase the size of specific areas and enhance the image for better diagnostic accuracy.

What are the common measurement functions available on PACS stations?

Common measurement functions on PACS stations include distance measurement, which uses pixel size to measure structures on the image, and angle measurement, which is often used when reading spine studies.

How has the implementation of PACS impacted the traditional radiology file room?

PACS has replaced the traditional radiology file room, which was costly and inefficient. PACS allows for image manipulation, simultaneous viewing from multiple workstations, and eliminates issues like lost or misfiled images, leading to better patient outcomes.

What is the importance of the DICOM standard in medical imaging?

DICOM (Digital Imaging and Communications in Medicine) is a standard that facilitates the communication between all biomedical imaging files. It includes multiple parts from image display to storage and retrieval, and defines the functions a device can perform as a service class.

What is the role of the Health Level 7 (HL7) standards in healthcare communication?

HL7 standards govern the communication of most clinical and administrative data, such as patient demographics, reports, insurance claims, and physician orders. They aim to improve care delivery, optimize workflow, reduce ambiguity, and enhance knowledge transfer among stakeholders.

How does the Health Insurance Portability and Accountability Act (HIPAA) protect patient information in healthcare systems?

HIPAA mandates security and training measures for healthcare institutions to protect patient privacy. It requires safeguards for all communications concerning medical information, including encryption or removal of patient identifiers for stored or transmitted data, and annual training for employees on HIPAA regulations.

Outlines

00:00

🏥 Hospital Information Systems (HIS)

The paragraph discusses the role of medical informatics in radiography, highlighting the Hospital Information System (HIS). HIS is a digital repository for all patient medical information, including billing, scheduling, and medical records. It assigns unique medical record numbers and automates tasks previously done manually, reducing the need for a large workforce. HIS facilitates orders for lab tests, imaging, and prescriptions from various locations and supports clinical research and public health data collection. It communicates with the Radiology Information System (RIS) and other systems using HL7 standards, which are developed by an accredited organization and are crucial for healthcare applications.

05:01

🌐 Networks and Communication in Healthcare

This section explains the importance of networks and communication standards in healthcare. It introduces the Radiology Information System (RIS), which manages radiology-specific data and communicates with HIS. The paragraph also covers the basics of local area networks (LAN) and wide area networks (WAN), which connect healthcare computers and devices. It emphasizes the need for understanding these systems for grasping the interconnectivity between HIS, RIS, and Picture Archiving and Communication System (PACS).

10:02

📈 PACS: Revolutionizing Radiology

The paragraph focuses on the Picture Archiving and Communication System (PACS), which manages digital imaging in healthcare. PACS replaces traditional x-ray file rooms and reading rooms, allowing simultaneous access to images from various locations. It discusses PACS functions like image storage, retrieval, and distribution, as well as radiologist tools for image manipulation such as pan, zoom, and magnify. PACS also provides measurement tools and is essential for modern radiology departments, streamlining image management and enhancing diagnostic capabilities.

15:03

🖥️ Medical Imaging Display and Standards

This section delves into the specifics of medical imaging display, emphasizing the importance of high-quality monitors for radiologists. It discusses the evolution of image acquisition and display software, leading to the establishment of the DICOM standard by the American College of Radiology and NEMA in 1983. DICOM facilitates communication between imaging equipment and PACS, with its standard defining device functions and image headers that include patient demographics and technical factors.

20:05

🛡️ Data Security and Compliance in Healthcare

The final paragraph addresses the challenges of data security and compliance in healthcare. It mentions the use of RAID and SAN for data storage to prevent loss, and the importance of HIPAA in ensuring patient privacy and data security. HIPAA mandates strict security measures for healthcare institutions, including employee training and data handling protocols to protect against unauthorized access and maintain confidentiality.

🎓 Continuing Education for Medical Professionals

The concluding paragraph promotes continuing education for radiologic technologists, offering resources such as webinars, guides, and courses to enhance professional excellence. It invites viewers to visit the website for more information on earning CE credits and accessing an all-access pass for unlimited credits.

Keywords

💡Medical Informatics

Medical Informatics is the interdisciplinary study of the design, development, application, and evaluation of biomedical informatics and health information technology. In the video, it is discussed as a field that encompasses a wide range of topics, particularly significant to radiographers, highlighting its importance in modern healthcare.

💡Hospital Information System (HIS)

HIS is a critical application for managing patient data such as medical records, billing, and scheduling. The video emphasizes how HIS streamlines these processes, replacing manual labor-intensive tasks with automated systems, thereby improving efficiency in healthcare delivery.

💡Radiology Information System (RIS)

RIS is a software system designed to handle the administrative tasks of medical imaging. The script explains how RIS schedules patient procedures, manages radiology billing, and stores radiologist reports, illustrating its role in enhancing the workflow within radiology departments.

💡Picture Archiving and Communication System (PACS)

PACS is a system that provides economical and efficient access to images and related patient information. The video describes how PACS has replaced traditional film-based methods, allowing for digital storage, retrieval, and distribution of medical images, thus revolutionizing the way radiologists access and interpret images.

💡HL7 Standards

HL7 standards are a set of international standards for the exchange, integration, sharing, and retrieval of electronic health information. The video mentions that these standards are crucial for communication between various healthcare applications, including HIS, RIS, and medical devices.

💡DICOM

DICOM is a standard protocol for the transmission and sharing of medical images and related information. The script explains that DICOM was introduced to establish a standardized format for biomedical imaging files, which is now a cornerstone of digital imaging in medicine.

💡Local Area Network (LAN)

LAN refers to a network that connects devices within a limited area such as a building or a single facility. The video uses LAN as an example of how devices within a healthcare institution can be connected to share resources and data, which is essential for the operation of systems like PACS.

💡Wide Area Network (WAN)

WAN is a network that covers a broad area, such as a city or country, and is used for long-distance communication. The video contrasts LAN and WAN to illustrate different scales of networking in healthcare, where WAN can be used for connecting distant healthcare facilities.

💡Image Manipulation

Image manipulation in the context of the video refers to the ability of radiologists to adjust and enhance medical images for better diagnostic accuracy. The script mentions functions like pan, zoom, and magnify as tools used within PACS to manipulate images, which is crucial for detailed radiological analysis.

💡Health Insurance Portability and Accountability Act (HIPAA)

HIPAA is a US legislation that provides data privacy and security provisions for safeguarding medical information. The video highlights the importance of HIPAA in ensuring that patient information is protected, especially in the context of electronic medical records and image storage systems like PACS.

💡Redundant Array of Independent Disks (RAID)

RAID is a method of storing the same data in different places on multiple hard disks to protect data in the case of a drive failure. The video discusses RAID as a storage system to prevent data loss in healthcare, emphasizing the importance of data redundancy in maintaining the integrity of medical records and images.

Highlights

Medical informatics encompasses a wide range of topics, with a focus on those most relevant to radiographers.

Hospital Information System (HIS) manages all patient medical information, including billing and medical records.

HIS assigns unique medical record numbers to streamline departmental interactions with patients.

Physicians can enter orders for lab tests and imaging from various locations through HIS.

HIS facilitates the collection of clinical research and public health information.

HL7 software standards, developed by the American National Standards Institute, are crucial for healthcare communication.

Radiology Information System (RIS) is responsible for scheduling, billing, and managing radiology reports.

Understanding networks and communication standards is key to grasping the interconnectivity of HIS, RIS, and PACS.

Local Area Networks (LAN) and Wide Area Networks (WAN) are the two major categories of networks in healthcare.

Picture Archiving and Communication System (PACS) manages digital imaging, replacing traditional x-ray file rooms.

PACS allows simultaneous access to images from various locations, enhancing diagnostic collaboration.

Radiologist reading stations in PACS enable post-processing manipulation and image enhancements.

PACS has become essential for image acquisition, display, storage, and retrieval in radiology departments.

DICOM, introduced in 1985 and standardized in 1993, facilitates communication between biomedical imaging files.

Health Level 7 (HL7) standards ensure interoperability and data exchange in healthcare.

Computer systems in healthcare are vulnerable to data loss, necessitating robust storage solutions like RAID or SAN.

HIPAA mandates security measures to protect patient privacy and confidentially in healthcare information systems.

Medical Professionals offers resources for radiology continuing education and professional development.

Transcripts

[Music]

medical informatics covers a multitude

of topics

the ones of most significant to

radiographers will be discussed in this

particular series

the hospital information system or his

houses all of the patients medical

information

including billing

scheduling appointments and medical

records

the his

assigns a unique medical records numbers

to each patient that is used by every

department for interactions with that

particular patient

these are functions that were previously

done

by hand and required a large workforce

and significant coordination among the

workforce

the his

allows attending physicians to enter

orders for lab tests

diagnostic imaging

and prescriptions for their patients

from many different locations

the his

also allows the collection of clinical

research

and public health

information in the health care system

the his communicates with the radiology

information system or r i s

and all other computered

shared systems within the institution

for shared functions

the

hl7 software standards

were set by the american national

standards

institute

they accredited the hl7 standards

developing organization

they are used in most

most healthcare applications

including the communication between

h i s

r i s

and other medical devices

the radiology information system or ris

houses radiology information

and is responsible for radiology

functions

such as the scheduling of patient

procedures

radiology billing

radiologist dictated reports

and quality assurance data

the system communicates with the

hospital information system or his

for shared functions

in order to understand the

interconnectivity

and the basic communication systems

used by his

ris

and the picture archiving and

communication system or pax

it is necessary

to have a basic understanding of

networks

and communication standards

the term network is used by a computer

scientists to describe the connection

between computers and other hardware

devices

that share resources

data and information

computers that are used in healthcare

institutions

are connected through networks

networks can be sorted into two major

categories

local area networks or lans lan

and wide area networks or wan w-a-n

local area networks are the most common

and serve a small

geographic area

such as a single facility or building

devices connected in a land

typically share one server

the pacs for an institution

is typically connected in a local area

network or

lan wide area networks can extend across

a city

a state

or country and even worldwide

computers connect using the services of

telecommunication

and cable companies

a picture archiving and communication

system

or pax

is defined as a

networked group of computers

servers

and archives that can be used to manage

digital imagings

according to carlton and adler

the pax is designed

to fit the particular needs of the

specific healthcare facility

but for the most part performs the same

general functions

of storing digital images

retrieval

and distribution of the images

in fact

the pax has replaced the traditional

x-ray file room

the radiology reading room

and the delivery services

previously utilized to distribute images

multiple users are able to access images

simultaneously

from various locations

including different cities

states and countries

johnston and fauber describe the pax as

an integral part of the radiology

department today

the pax provides a method for

communication

between the imaging modalities and the

storage and retrieval systems of the

radiology departments

in addition

radiologist reading stations allow the

radiologists to perform

post-processing manipulation

and enhancements

of the images that they are interpreting

pan

zoom and magnify

are functions used by the radiologist

to increase the size of a specific area

the magnify function is used to enhance

the square area of an image

this square can be moved around the

image to see various areas enlarged

zoom and pan functions are usually used

together

first the image is zoomed up to the

desired magnified level

then the pan icon is activated

so that the zoomed portion can be moved

around

allowing the radiologists

to view the different areas of the image

various measurement functions are

available on pax stations

the most common one

is the distance measurement

where the software uses the pixel size

which is a known measurement to measure

structures on the image

another common function

is the angle measurement

it measures the angle between two

structures

and is commonly used when reading spine

studies

the pax has become an essential part of

every radiology department

the system can be divided into image

acquisition

image display and image storage and

retrieval

pax basically

functions

as the radiology file room

and the radiology reading room

in the film screen environment

images could only be viewed on site or

copied and mailed out

lost or misfiled images had to be

repeated

leading to unnecessary exposure to the

patient

implementation of pacs has eliminated

these problems

pax allows for image manipulation and

simultaneous viewing of images from a

number of workstations

referring positions

consulting specialists

and radiologists

can now view images from different

locations

and perhaps

more effectively

reach a diagnosis and a treatment plan

leading to better outcomes for the

patient

pax has replaced the traditional

radiology file room

which was a costly operation

and not an efficient method of managing

medical images and reports

the traditional file room

occupied a great deal of space

within the institution

and was labor intensive

in large medical centers

trauma centers or teaching hospitals

the file room needed to be staffed 24

hours per day

every day of the year

today's radiology room file room can be

operated out of a small office

with space for a workstation

printer

digitizer and dry laser for copying

images

here we see a sample of lcd monitors

which predominate in medical imaging due

to the size

price

and quality

workstation monitors for medical imaging

must be of higher quality than monitors

used for other applications

monitor resolution is dependent on the

number of pixels in the display

the greater the number of pixels the

higher the resolution

pixels are arranged in a matrix

a larger matrix size means more pixels

which equals better resolution

radiologists require the highest

resolution monitors for the particular

modality

prior to

1983

computers used in medical imaging

departments

used vendor-specific software

for image acquisition and display

as pacs became the norm in medical

imaging departments

and with multiple vendors and equipment

types in the marketplace

all operating on their own software

language

problems

arose some vendors did not communicate

with some pax platforms

vendors began to make available software

programs

that would facilitate

the communication between imaging

equipment

and the pacs

for an additional cost

in

1983

the american college of

radiology and the national electrical

manufacturers association

or nema

joined together in an effort to

establish a standardized public format

and

protocol

for communication between all

biomedical imaging files

according to carlton and adler

dicom was first

introduced in 1985

and became the standard in 1993.

the dicom is made up of multiple parts

from image display

to storage and retrieval

the dicom standard defines the functions

a device can perform as a service class

a device can be a service class user

or a service class provider or both

the functions

a device can perform

are spelled out in the devices dicom

conformance standard

dicom is digital imaging and

communications in measure in medicine

the dicom header is part of each image

acquired

the information recorded in the header

includes the patient demographics

such as name

medical records identification number

and the referring physician

the header also records the number of

images

in the study

the technical factors used for the image

and the exposure index for the exposure

in all

but psp systems

according to carter and veal

any image manipulation

is also recorded in the header

and radiographers should be aware

that he or she is legally responsible

for any image manipulation that occurs

the dicom standards is not the only

standard governing communication

between various computer systems

health level 7 international

is an ansi standard developing

organization

the stated

purpose of hl7 standards

is

to provide standards for

intraoperability

that improve care delivery

optimize work

flow

reduce ambiguity

and enhance knowledge transfer

among all our stakeholders

hl7 standards

govern the communication

of most clinical and administrative data

such as patient demographics reports

insurance claims

and physicians orders

according to carter and veal the ris

can either pull patient information

through a dicom interface

or

through a gateway that creates an

interface with the hl7 device

and the dicom device

computer systems that store medical

information and images

are vulnerable to loss or corruption of

files

through the crashing of computer hard

drives

electrical malfunctions

file corruption

institution fires floods or other

natural disasters

therefore

to prevent the loss of patient

information

a storage system must be in place

such as redundant array of independent

disks

or raid

or a storage area network or s-a-n

the use of computers in health care has

seen rapid expansion

and that trend will only continue to

grow while there are many advantages to

electronic access to medical information

including medical imaging

there are some drawbacks

the main concern

is

unauthorized and ill illegitimate access

to information

through a computer workstation

or information that is transmitted

over the internet

hipaa

first enacted in 1996

mandates the security and training that

healthcare institutions

and other covered entities

must have in place to protect

patient privacy

under hipaa

all communications concerning medical

information

must be must have safeguards that cover

both the identity of a patient

and the confidentiality of the

information being communicated

patients must give their authorization

for the release of their information

and health care facilities may only

disclose the minimum necessary

information for the purpose of the

disclosure

information that is stored

electronically by the institution

or any covered entity affiliated with

the institution

for example a billing company

or a medical devices company

must either be encrypted

have all patient identifiers removed

or be scrubbed of all except the

relevant data fields according to

carlton and adler

health care facilities

must have procedures in place

that control access and security of

patient information

all employees must have documented

annual training

that is related to hipaa regulations and

safeguards

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