Healthc Inform Res.  2013 Dec;19(4):293-300. 10.4258/hir.2013.19.4.293.

XDS-I Gateway Development for HIE Connectivity with Legacy PACS at Gil Hospital

• Simalango
• Kim Y
• Seo YT
• Choi YH
• Cho YK

• KMID: 2229505
• DOI: http://doi.org/10.4258/hir.2013.19.4.293

Abstract

OBJECTIVES
The ability to support healthcare document sharing is imperative in a health information exchange (HIE). Sharing imaging documents or images, however, can be challenging, especially when they are stored in a picture archiving and communication system (PACS) archive that does not support document sharing via standard HIE protocols. This research proposes a standard-compliant imaging gateway that enables connectivity between a legacy PACS and the entire HIE.
METHODS
Investigation of the PACS solutions used at Gil Hospital was conducted. An imaging gateway application was then developed using a Java technology stack. Imaging document sharing capability enabled by the gateway was tested by integrating it into Gil Hospital's order communication system and its HIE infrastructure.
RESULTS
The gateway can acquire radiology images from a PACS storage system, provide and register the images to Gil Hospital's HIE for document sharing purposes, and make the images retrievable by a cross-enterprise document sharing document viewer.
CONCLUSIONS
Development of an imaging gateway that mediates communication between a PACS and an HIE can be considered a viable option when the PACS does not support the standard protocol for cross-enterprise document sharing for imaging. Furthermore, the availability of common HIE standards expedites the development and integration of the imaging gateway with an HIE.

Keyword

Health Information Exchange (HIE); Cross-Enterprise Document Sharing for Imaging (XDS-I); Picture Archiving and Communication System (PACS); Digital Imaging and Communications in Medicine (DICOM); Web Access to DICOM Persistent Objects (WADO)

MeSH Terms

Archives
Delivery of Health Care
Indonesia

Figure

• 

  Figure 1 Staging environment for PACS-HIE connectivity at Gil Hospital. PACS: picture archiving and communication system, HIE: health information exchange, OCS: order communication system.

• 

  Figure 2 Cross-enterprise document sharing (XDS) for imaging specified in the Integrating Healthcare Enterprise-Radiology (IHE-RAD) Technical Framework. MTOM: Message Transmission Optimization Mechanism, XOP: XML-binary Optimized Packaging.

• 

  Figure 3 Size distribution of sample Digital Imaging and Communication in Medicine (DICOM) images for tests and the JPEG equivalents. US: ultrasound, CT: computed tomography, CR: computed radiography.

• 

  Figure 4 Image loading time via Web Access to DICOM Persistent Objects calls. US: ultrasound, CT: computed tomography, CR: computed radiography.

• 

  Figure 5 Digital Imaging and Communication in Medicine image loading time for a window image level adjustment task.

Reference

1. Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing? J Am Med Inform Assoc. 2011; 18(5):678–682.

2. Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005; Suppl Web Exclusives. W5-10–W5-18.

3. Choplin RH, Boehme JM 2nd, Maynard CD. Picture archiving and communication systems: an overview. Radiographics. 1992; 12(1):127–129.

4. Huang HK, Taira RK. Infrastructure design of a picture archiving and communication system. AJR Am J Roentgenol. 1992; 158(4):743–749.

5. Bidgood WD Jr, Horii SC. Introduction to the ACR-NEMA DICOM standard. Radiographics. 1992; 12(2):345–355.

6. Medical Imaging and Technology Alliance. The DICOM standard version 2011 [Internet]. Rosslyn (VA): National Electrical Manufacturers Association;c2013. cited at 2013 Sep 5. Available from: http://medical.nema.org/standard.html.

7. Main C, Moxham T, Wyatt JC, Kay J, Anderson R, Stein K. Computerised decision support systems in order communication for diagnostic, screening or monitoring test ordering: systematic reviews of the effects and cost-effectiveness of systems. Health Technol Assess. 2010; 14(48):1–227.

8. Park DK, Jung EY, Jeong BH, Moon BC, Kang HW, Tchah H, et al. Smart information system for Gachon University Gil Hospital. Healthc Inform Res. 2012; 18(1):74–83.

9. Integrating Healthcare Enterprise. IHE Technical Frameworks [Internet]. Oak Brook (IL): Integrating Healthcare Enterprise;c2013. cited at 2013 Sep 5. Available from: http://www.ihe.net/Technical_Frameworks/.

10. Valente F, Viana-Ferreira C, Costa C, Oliveira JL. A RESTful image gateway for multiple medical image repositories. IEEE Trans Inf Technol Biomed. 2012; 16(3):356–364.