PACS and Digital Medicine: Essential Principles and Modern Practice PDF

Preface

Healthcare providers and governments around the world are facing an unprecedented challenge to improve the quality of healthcare while simultaneously reducing costs. Medical information technology plays an important role in meeting this challenge. Today, we have more and better medical information technologies than ever before. However, medical information and records are usually maintained separately by various healthcare providers, often in paper format, preventing their optimal use for the treatment and care of patients. In an effort to both improve healthcare quality and reduce costs, healthcare professionals in all specialty areas are moving from paperbased medical records to integrated electronic health records (EHRs). In addition, clinical departments using imaging equipment are moving to picture archiving and communication systems (PACS) for the management of image data.

As PACS matures and advanced information technologies become available, governments around the world now realize that using information technologies to manage patient medical records (including images) is vital for lowering costs and improving quality and effi ciency in healthcare. Over the next decade, health information technologies such as PACS and EHR will be adopted worldwide, providing safer and higher quality healthcare to more people at reduced cost. This transition will involve healthcare organizations such as hospitals, healthcare insurance companies or other payers, and government agencies.

While PACS has been available in radiology for many years, it is only recently that hospitals and clinics have begun to implement large-scale PACS and integrate them with other clinical information systems. These late PACS adopters are implementing state-of-the-art systems for the fi rst time, whereas many early adopters are replacing their legacy systems for the second or third time. PACS is quite different compared to other medical imaging equipment. As radiology PACS matures, its application is extending well beyond radiology into other areas of the healthcare enterprise, such as cardiology, pathology and radiation oncology where other imaging technologies are also used.

This book aims to provide a comprehensive resource for healthcare information technology professionals, including radiologists, PACS administrators, radiology/clinical engineering personnel, radiology/healthcare administrators, and PACS specialists for cardiology, endoscopy, and pathology. Our primary goal has been to present the practical steps for PACS and EHR implementations and their maintenance. Therefore, in each chapter, following the introduction of basic concepts and principles relevant to the topics of the chapter, we discuss practical considerations PACS users may encounter in daily work.

This book covers various components of PACS using state-of-the-art technologies. Unlike the installation of a piece of imaging equipment such a CT or MR, each PACS implementation is unique, requiring customization and workfl ow considerations specifi c to the site. Our approach was to discuss introductory and background information about design principles for various PACS components, theoretical and practical issues to consider prior to implementation, postinstallation quality control, security and privacy policies, maintenance including upgrade/ integration with other information systems, and relevant governing standards. These discussions are supplemented by more than 130 illustrations throughout the book, and case studies of implementation in two institutions.

The book is organized into 12 chapters. Chapter 1 introduces the history and signifi cant milestone contributions by pioneers in PACS and healthcare information technology. Chapters 2 and 3 cover the components of a PACS system, their functionality, and the detailed steps of routine quality control for PACS display monitors. Chapters 4 and 5 discuss IT infrastructures for PACS, essential principles about networks, and various PACS data storage technologies. Chapter 6 covers primary industry standards used in PACS and EHR, such as DICOM, HL7, and IHE, together with their applications for radiology PACS. The use of these standards for nonradiology PACS, EHR, and overall health information technology security is discussed in other corresponding chapters. Chapters 7 and 8 cover practical issues related to implementing radiology PACS and teleradiology, Chapter 9 discusses replacement of legacy systems, and Chapter 10 covers PACS in other medical specialties where imaging equipment is used. Since EHR/PHR will be adopted worldwide, and enterprise PACS is an integral part of patient medical records, Chapter 11 discusses topics unique to implementation and standards of EHR/PHR. Chapter 12 covers security, privacy, and safety regulations, as well as policies related to healthcare information systems including PACS and EHR/PHR.

Given rapid advances in the fi eld of healthcare information technology, the hardware and software we mention in examples will eventually require updating, and standards will continue to evolve. Despite these technology advances, the principles and practical advice presented in this book should remain applicable. Thus, we hope readers will fi nd this book useful, both as a practical guide and as a broad overview of the fi eld, now and in the future.