th
1300THE
North
17 Street,
Suite
1847
DICOM
2013
INTERNATIONAL
Rosslyn, VA 22209
CONFERENCE
(703)
841-3285 & SEMINAR
Fax (703)
841-3385
March
14-16, 2013
Bangalore, India
ABSTRACT
Title of
presentation:
IHE for emerging market – Learning from integration experiences
Author(s)
name(s):
Kshitija Thakar (kshitija.thakar@philips.com)
Krishnan PV (krishnan.padmanabhan@philips.com)
Revathy Sreenath(revathy.duddisreenath@philips.com)
Author(s) title(s)
Affiliation
(Company or
organization)
Postal address
Kshitija Thakar - Software Architect
Krishnan PV - Sr. Technical Specialist
Revathy Sreenath - Technical Specialist
Philips Healthcare/Clinical Informatics India,
Philips Electronics India Ltd.
Philips Innovation Campus
Manyata Tech Park,
Nagavara,
Bangalore – 560045
E-mail address
kshitija.thakar@philips.com
Telephone:
+91 80 4189 0000
Preferred
format:
Abstract: (200750 words, in
English)
_X__ Oral presentation or poster
___ Oral only
___ Poster only
The challenges faced with respect to integration of DICOM and HL7 systems in emerging markets,
like India, are entirely different from that in premium markets. In India, small and medium scale
diagnostic centers play a major role in medical imaging. The diagnostic centers have following
expectations from any Imaging Informatics solution:
 Ability to handle high volume of patients at a high throughput
 Richer features at lesser cost
This has led to a large number of vendors who provide quick and tailored solutions as per individual
customer needs. These highly tailored solutions may not be compliant to DICOM / HL7 standards
and IHE recommendations. Additionally, they are not yet regulated by any governing body like FDA.
So any IHE compliant vendor ends up spending high effort on integration activities along with
multiple customizations and configurations. Even the approach of high lenience for any incoming
data and strict compliance for any outgoing data, does not solve all the problems.
In a gist, the Imaging Informatics space faces the following challenges:
 Integration with a wide range of customized solutions which are not up-to-date with the
standards
 Expectations of high tailoring of the application to meet the existing workflow, even if these are
not DICOM/HL7/ IHE standards compliant.
 The computer literacy of the data entry operators along with high inflow of patients, leads to
requirement for custom error correction workflows.
In this abstract, we would like to share some of our experiences and workflow challenges faced in
deploying RIS solution for the Indian market.



BWLM (Basic Work List Management):
o Many patients do not know their date of birth, due to which RIS has to provide
functionality to capture age with an alert to indicate that the DOB is not accurate.
However, in BWLM there is no way to communicate this alert to the modality and
further downstream.
o The deployments have a mix of modalities with BWLM and non-BWLM support. Custom
solutions are required to uniformly cater to all kinds of modalities without disrupting
the order flow.
o Image Laterality (0020, 0062) is not a mandatory tag in DICOM for BWLM. So to support
paperless workflow, alternative mechanisms are needed to communicate the laterality
to the technician at the modality.
MPPS (Modality Performed Procedure Step):
o As per IHE recommendations for MPPS, the N-SET messages from the modality convey
the completion date and time for acquisition. However, there is no mechanism to
convey the estimated time to complete the scan. This will help the user to prepare the
next patient in queue.
o Very often, technicians correct the procedure at the modality directly, in case an
incorrect procedure was placed during data entry. This necessitates custom Order
Reconciliation functionality in RIS for accuracy of data across all entities to ensure
appropriate billing and administration.
o As many modalities do not support MPPS, manual intervention to update order status is
required. However, manual intervention is not preferred due to large volume of
patients. This requires custom solutions in conjunction with the PACS.
o Some deployments expect that an emergency patient scan is directly performed at the
modality without registration. In case the modality supports unscheduled MPPS, the
scan information gets backfilled in RIS. Otherwise, custom solution like emergency oneclick registration is required in RIS, thereby introducing the constraint of not bypassing
RIS.
Reporting:
o The general expectation from Reporting Workflow is that any change to a finalized
report is handled as an addendum. However, it is observed that due to high volumes,
the probability of erroneous data entry increases. So the expectation is that the report
gets re-finalized without the need to capture the correction as an addendum.
o In current techno-savvy situation, both patients and referring physicians expect an
immediate update on report availability e.g. key findings are expected in email as soon
as the report is finalized. So the impact on distribution due to amending /appending a
finalized report needs to be considered in the workflow.
o There are requests to support capturing of textual report directly in HIS/EMR, by
looking up the images from PACS. This requires custom solutions to ensure that the
patient being reported and the images opened are actually for the same patient/order.
To summarize, the workflow needs of the diagnostic centers should also be considered in IHE while
providing Imaging Informatics solutions in India. It can be observed that many other emerging
markets, which are at similar levels as India, can have similar workflow needs. The key factors for
customization could be
 Simplified workflow
 Speed and automation
 Reconciliation workflow
It also necessitates the need for India specific Connectathon forum. This forum will provide the
application vendors a common platform to test and reduce integration challenges during
deployments.
2012 Rev. 3