Advertisement

Long-term experience with setup and implementation of an IHE-based image management and distribution system in intersectoral clinical routine

  • F. Schwind
  • H. Münch
  • A. Schröter
  • R. Brandner
  • U. Kutscha
  • A. Brandner
  • O. Heinze
  • B. Bergh
  • U. Engelmann
Original Article

Abstract

Purpose

Sharing of medical data is crucial for the proper treatment of patients as it could reduce the risk of duplicated medical tests and speed up the care process if all documents are readily available. Despite great technical progress, sharing patient data while maintaining full control over the process in an intersectoral (in Germany, this describes the different actors in the healthcare system consisting of clinic, ambulatory care, etc.) setting remains a particular challenge. This paper focuses on the successful implementation of a privacy compliant, standards-based image-management component of a personal electronic health record.

Methods

Over a 5-year period, a sharing system based on readily available IHE profiles constructed around XDS has been built. It was necessary to create interfaces for the existing hospital sub-systems to become part of the network. Specifically, the imaging workflow had to be adapted to allow for fast and easy access to DICOM images utilizing a flexible web-based image viewer. In addition to the standard XDS workflow, an Imaging Cache was established which combines the Imaging Document Source and Consumer to guarantee fast and streaming-based access to all images in the network observing the high security standards of the hospital network.

Results

The authors of this paper have proven that it is possible to build a fast and reliable sharing system based on IHE profiles using most of the transactions of XDS-I with some adaptions to the clinical workflow. Primary hospital systems were enabled by building adapters to overcome lack of IHE compatibility. The established system embraces the existing security mechanisms in hospital networks while connecting patients and referring physicians from outside in a secure and convenient manner.

Conclusions

A state-of-the-art sharing system that is used in a productive clinical environment has been established and is ready to grow with more partners. The system is the basis for an elaborated interdisciplinary collaboration where data, and in particular images, can now be shared between medical professionals.

Keywords

IHE XDS XDS-I PACS Image management Data management Interoperability 

Notes

Acknowledgements

The INFOPAT project and especially the corresponding development sub-project P2 was co-funded by the German Federal Ministry of Education and Research (BMBF, funding code 01KQ1003B) [41]. We would like to thank all other project partners working with us during this project.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animals rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Internet Society (2018) Global internet maps. https://www.internetsociety.org/map/global-internet-report/. Accessed 03 Jan 2018
  2. 2.
    NEMA/MITA (2017) Standard Publications PS 3.1. Digital imaging and communications in medicine (DICOM), medical imaging and technology alliance (MITA), 1300 North 17th Street, Suite 900, Arlington, VA 22209, USA. http://www.dicomstandard.org/current/. Accessed 03 Jan 2018
  3. 3.
    Health Level Seven (HL7) Inc. Standard for electronic data exchange in all healthcare environments. http://www.hl7.org. Accessed 03 Jan 2018
  4. 4.
    Integrating the Healthcare Enterprise (IHE). https://www.ihe.net. Accessed 03 Jan 2018
  5. 5.
    Hussein R, Engelmann U, Schröter A, Meinzer HP (2004) Implementing a full-feature PACS solution in accordance with the IHE technical framework. Acad Radiol 11:439–447.  https://doi.org/10.1016/S1076-6332(03)00821-3 CrossRefPubMedGoogle Scholar
  6. 6.
    Teleradiologie-Projekt Rhein-Neckar-Dreieck. http://www.teleradiologie-rnd.de/. Accessed 03 Jan 2018
  7. 7.
    Engelmann U, Schröter A, Schweitzer T, Meinzer HP (2003) Teleradiologie per E-Mail und DICOM: Ein neues Konzept für das Schlaganfall-Netzwerk in Rheinland-Pfalz. Fortschr. Röntgenstr 175:S310CrossRefGoogle Scholar
  8. 8.
    Weisser G, Engelmann U, Ruggiero S, Runa A, Schröter A, Baur S, Walz M (2007) Teleradiology applications with DICOM-e-mail. Euro Radiol 17(5):1331–1340.  https://doi.org/10.1007/s00330-006-0450-8 CrossRefGoogle Scholar
  9. 9.
    Weisser G, Walz M, Ruggiero S, Kämmerer M, Schröter A, Runa A, Mildenberger P, Engelmann U (2006) Standardization of teleradiology using Dicom e-mail: recommendations of the German radiology society. Eur Radiol 16(3):753–758CrossRefPubMedGoogle Scholar
  10. 10.
    Engelmann U, Schütze B, Schröter A, Weisser G, Walz M, Kämmerer M, Mildenberger P (2005) DICOM-e-mail: the German minimal standard for teleradiology. In: Lemke HU, Inamura K, Doi K, Vannier MW, Farman AG (eds) Proceedings of the 19th international congress and exhibition computer assisted radiology and surgery CARS 2005. Elsevier, Amsterdam, pp 926–931Google Scholar
  11. 11.
    Engelmann U, Seidel B (2009) DIN 6868-159: a German standard for quality assurance in teleradiology. Int J CARS 4(Suppl 1):158–159Google Scholar
  12. 12.
    Schwind F, Münch H, Schröter A, Meinzer HP, Engelmann U (2011) Advanced transfer statistics for acceptance and constancy testing of teleradiology networks. Int J CARS 6(Suppl 1):65–66Google Scholar
  13. 13.
    Schwind F, Münch H, Schröter A, Engelmann U, Weisser G (2013) Ein Whitepaper zur Administration und Qualitätssicherung von DICOM E-Mail basierten Teleradiologie-Netzwerken. Duesberg F. (Hrsg.): e-Health, pp 196–199Google Scholar
  14. 14.
    Staemmler M, Walz M, Weisser G, Engelmann U, Weininger R, Ernstberger A, Sturm J (2012) Establishing end-to-end security in a nationwide network for telecooperation. In: Mantas J et al (eds) Quality of life through quality of information. Proceedings of MIE2012. IOS Press, Amsterdam, pp 512–516Google Scholar
  15. 15.
    Staemmler M, Walz M, Weisser G, Engelmann U, Luitjens KD, Schmucker U, Sturm J (2014) TKmed—Telekooperation für die einrichtungsübergreifende Versorgung. Duesberg F. (Hrsg.): e-Health, pp 217–220Google Scholar
  16. 16.
    Engelmann U, Münch H, Rimmler B, Schwind F, Staemmler M, Sturm J (2016) Tkmed Direkt: Spontaner Austausch von medizinischen Bilder und Dokumenten mit Kollegen, Zuweisern und Patienten. Duesberg F. (Hrsg.): e-Health. pp 84–87Google Scholar
  17. 17.
    Staemmler M, Rimmler B, Münch H, Engelmann U, Sturm U (2017) Ad hoc participation in professional tele-collaboration platforms. In: Hayn D, Schreier G (eds) Health informatics meets eHealth.  https://doi.org/10.3233/978-1-61499-759-7-55
  18. 18.
    Engelmann U, Schwind F. Bildkommunikation in der Medizin: Vom PACS zum flächendeckenden E-Health-System. Müller-Mielitz S, Lux T (Hrsg.): E-Health-Ökonomie.  https://doi.org/10.1007/978-3-658-10788-8
  19. 19.
    Schwind F, Münch H, Schröter A, Weisser G, Meinzer HP, Engelmann U (2012) Using control messages for administrative tasks and constancy testing of DICOM e-mail based teleradiology networks. Int J CARS 7(Suppl 1):98–99Google Scholar
  20. 20.
    Bergh B, Brandner A, Heiß J, Kutscha U, Merzweiler A, Pahontu R, Schreiweis B, Yüksekogul N, Bronsch T, Heinze O (2015) The role of integrating the healthcare enterprise (IHE) in telemedicine. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 58(10):1086–1093.  https://doi.org/10.1007/s00103-015-2226-2 CrossRefPubMedGoogle Scholar
  21. 21.
    INFOPAT. https://www.infopat.eu. Accessed 03 Jan 2018
  22. 22.
    INFOPAT (2012) Abteilung MIS—Universitätsklinikum Heidelberg. INFOrmationstechnologie für die PATientenorientierte Gesundheitsversorgung in der Metropolregion Rhein-Neckar. https://mis-hd.eu/de/projekte/infopat/. Accessed 03 Jan 2018
  23. 23.
    BMBF. Federal ministry of education and research. https://www.bmbf.de
  24. 24.
    IHE-D (2013) IHE-D cookbook v1, pp 36–37. http://www.ihe-d.de/projekte/ihe-d-cookbook/. Accessed 03 Jan 2018
  25. 25.
    Brandner A, Schreiweis B, Aguduri LS, Bronsch T, Kunz A, Pensold P, Stein KE, Weiss N, Yüksekogul N, Bergh B, Heinze O (2016) The patient portal of the personal cross-enterprise electronic health record (PEHR) in the Rhine-Neckar-region. Stud Health Technol Inf 228:157–161.  https://doi.org/10.3233/978-1-61499-678-1-157 Google Scholar
  26. 26.
    Pensold P, Schneider G, Aguduri LS, Brandner A, Bronsch T, Schreiweis B, Stein KE, Weiss N, Yüksekogul N, Bergh B, Heinze O (2016) Implementing the patient portal of the PEHR in the metropolitan region Rhine-Neckar—experiences with liferay. Stud Health Technol Inf 228:105–109.  https://doi.org/10.3233/978-1-61499-678-1-105 Google Scholar
  27. 27.
    Yüksekogul N, Schreiweis B, Weiss N, Aguduri LS, Brandner A, Bronsch T, Pensold P, Stein KE, Helmer A, Bergh B, Heinze O (2016) Patient portal integration—a native IHE connector implementation for PEHR. Stud Health Technol Inf 228:172–176.  https://doi.org/10.3233/978-1-61499-678-1-172 Google Scholar
  28. 28.
    Ose D, Kunz A, Pohlmann S, Hofmann H, Qreini M, Krisam J, Uhlmann L, Jacke C, Winkler EC, Salize HJ, Szecsenyi J (2017) A personal electronic health record: study protocol of a feasibility study on implementation in a real-world health care setting. JMIR Res Protoc 6(3):e33.  https://doi.org/10.2196/resprot.6314 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Baudendistel I, Winkler E, Kamradt M, Brophy S, Längst G, Eckrich F, Heinze O, Bergh B, Szecsenyi J, Ose D (2015) The patients’ active role in managing a personal electronic health record: a qualitative analysis. Support Care Cancer 23:2613–2621.  https://doi.org/10.1007/s00520-015-2620-1 CrossRefPubMedGoogle Scholar
  30. 30.
    Bozorgmehr K, Szecsenyi J, Ose D, Besier W, Mayer M, Krisam J, Jacke CO, Salize HJ, Brandner R, Schmitt S, Kiel M, Kamradt M, Freund T (2014) Practice network-based care management for patients with type 2 diabetes and multiple comorbidities (GEDIMAplus): study protocol for a randomized controlled trial. Trials 21(15):243.  https://doi.org/10.1186/1745-6215-15-243 CrossRefGoogle Scholar
  31. 31.
    Baudendistel I, Winkler E, Kamradt M, Längst G, Eckrich F, Heinze O, Bergh B, Szecsenyi J, Ose D (2015) Personal electronic health records: understanding user requirements and needs in chronic cancer care. J Med Internet Res 17(5):e121.  https://doi.org/10.2196/jmir.3884 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Projekt INFOPAT: GESIS Teilprojekt M1, Methodische Unterstützung des BMBF-Projekts “Metropolregion Rhein-Neckar, Raum für Gesundheit” (INFOPAT). https://www.gesis.org/forschung/drittmittelprojekte/archiv/infopat/. Accessed 30 April 2018
  33. 33.
    Bresser L, Köhler S, Schwaab C (2014) The development of an application for data privacy by applying an audit repository based on IHE ATNA. Stud Health Technol Inf 198:219–225.  https://doi.org/10.3233/978-1-61499-397-1-219 Google Scholar
  34. 34.
    Weiss N, Aguduri LS, Yüksekogul N, Schreiweis B, Brandner A, Bronsch T, Pensold P, Stein KE, Bergh B, Heinze O (2016) Implementing PEHR: design and integration of a consent creator service. Stud Health Technol Inf 228:167–171.  https://doi.org/10.3233/978-1-61499-678-1-167 Google Scholar
  35. 35.
    IHE (2017) IHE IT infrastructure technical framework, volume 2a ITI TF-2aGoogle Scholar
  36. 36.
    IHE (2017) IHE IT infrastructure technical framework, volume 2b ITI TF-2bGoogle Scholar
  37. 37.
    IHE. Wiki—cross-enterprise document sharing, actors and transactions. https://wiki.ihe.net/index.php/Cross-Enterprise_Document_Sharing. Accessed 30 April 2018
  38. 38.
    IHE (2017) IHE radiology (RAD) technical framework, volume 3 IHE RAD TF-3Google Scholar
  39. 39.
    IHE. Wiki—cross-enterprise document sharing for imaging, actors and transactions. https://wiki.ihe.net/index.php/Cross-enterprise_Document_Sharing_for_Imaging. Accessed 30 April 2018
  40. 40.
    IHE (2017) IHE radiology (RAD) technical framework, volume 2 IHE RAD TF-2Google Scholar
  41. 41.
    BMBF. Metropolregion Rhein-Neckar—Raum für Gesundheit. https://www.gesundheitsforschung-bmbf.de/de/teilprojekte-m1-p0-p2-p3-p4-p5-p7-p8-p9-4178.php. Accessed 03 Jan 2018

Copyright information

© CARS 2018

Authors and Affiliations

  1. 1.CHILI GmbHDossenheim, HeidelbergGermany
  2. 2.ICW AGWalldorfGermany
  3. 3.Department of InformaticsMannheim University of Applied SciencesMannheimGermany
  4. 4.Department of Medical Information SystemsHeidelberg University HospitalHeidelbergGermany

Personalised recommendations