An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.
We describe the interfacing methods between our departments RIS (Radiological Information System) and PACS database. Sharing information has become an increasingly important issue for both systems. RIS study information should be available at the PACS workstation to complete the image description. Patient scheduling, admission and discharge information are critical to PACS for improving image routing and storage management algorithms. The design of the interface between the RIS and the PACS database involves the development of some standardization methods. These include the network communication protocol between the two database servers, the language mapping operations, the database result format and the error handling. The implementation of the interface is in two steps. In the first one, a subset of RIS data is automatically transmitted to the PACS database when some relevant events occur in the RIS. In a second phase, the user at the PACS workstation can directly initiate queries to the RIS. The PACS SQL server (UNIX based) sends SQL network requests as ASCII text to the RIS MUMPS database server (VAX based). The RIS server translates the SQL requests to MUMPS, executes the statements and returns ASCII results to the SQL server. We have been able to exchange information between the RIS and the PACS display programs. RIS text reports can be displayed on PACS workstations. RIS information can be used into pre-fetch algorithms.
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