Filmless PACS in a multiple facility environment

A Picture Archiving and Communication System centered on a shared image file server can support a filmless hospital. Systems based on this architecture have proven themselves in over four years of clinical operation. Changes in healthcare delivery are causing radiology groups to support multiple facilities for remote clinic support and consolidation of services. There will be a corresponding need for communicating over a standardized wide area network (WAN). Interactive workflow, a natural extension to the single facility case, requires a means to work effectively and seamlessly across moderate to low speed communication networks. Several schemes for supporting a consortium of medical treatment facilities over a WAN are explored. Both centralized and distributed database approaches are evaluated against several WAN scenarios. Likewise, several architectures for distributing image file servers or buffers over a WAN are explored, along with the caching and distribution strategies that support them. An open system implementation is critical to the success of a wide area system. The role of the Digital Imaging and Communications in Medicine (DICOM) standard in supporting multi- facility and multi-vendor open systems is also addressed. An open system can be achieved by using a DICOM server to provide a view of the system-wide distributed database. The DICOM server interface to a local version of the global database lets a local workstation treat the multiple, distributed data servers as though they were one local server for purposes of examination queries. The query will recover information about the examination that will permit retrieval over the network from the server on which the examination resides. For efficiency reasons, the ability to build cross-facility radiologist worklists and clinician-oriented patient folders is essential. The technologies of the World-Wide-Web can be used to generate worklists and patient folders across facilities. A reliable broadcast protocol may be a convenient way to notify many different users and many image servers about new activities in the network of image servers. In addition to ensuring reliability of message delivery and global serialization of each broadcast message in the network, the broadcast protocol should not introduce significant communication overhead.