Medical image data is used increasingly by physicians in hospitals as well as by external physicians taking care of their patients' treatment Not only do external physicians often want to read the report but they also want to see the corresponding images. The expanding, cost-efficient internet is predestined to transfer image data from the hospital to external referring physicians. The described system uses widely available internet technology to grant external physicians access to their patients. A hospital physician can trigger the sending an e-mail to an external physician while viewing the images. The external physician receives an encrypted e-mail and can open an included URL link. With this link he has temporary access to the defined study on the hospital's web server. Images are provided in highest quality format with specific compression algorithms to work efficiently on slow internet connections. The physician can work on these images in his browser using several standard image processing functions as well as view the report. Teleconferences with the hospital's physicians are an additional feature. External physicians need only register once with their e-mail and key. No additional network infrastructure configuration is needed.

Rationale and Objectives. During the last 4 years, Integrating the Healthcare Enterprise (IHE) has worked in establishing a reliable integrated environment for medical imaging devices and other clinical information systems by using existing industry standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7). Because IHE is organized and driven by professional organizations representing both buyers and vendors, it was able to define a common language for the various health care parties who are involved in the integration process. Thus IHE offers a rigorously organized technical framework that provides a comprehensive guide for a coordinated implementation of information standards.Materials and Methods. A multistage plan for incorporating the IHE elements while scaling up general-purpose workstations with teleradiology functionalities to a full-feature picture archiving and communication system (PACS) solution was created. To introduce a pragmatic example, the plan approach was applied to the CHILI workstations (CHILI, Heidelberg, Germany). To implement the proposed plan in making various legacy systems comply with IHE, the effects of available resources and market needs on the plan are discussed. Most implementation challenges and problems were overcome using generic design approaches and well-designed DICOM utilities.Results. On completion of the first stage, the PACS viewer and reporting workstations were IHE-compliant. In addition, the plan facilitates the conformance process while maintaining the planned software development cycle.Conclusion. Based on these positive results and the practical experience acquired during the first stage, further stages will be completed to provide the system with the required plug-and-play interoperability among systems from different vendors. (C) AUR, 2004.

Summary Objectives: Along with the revolution of information technology and the increasing use of computers worldwide, software providers recognize the emerging need for internationalized, or global, software applications. The importance of internationalization comes from its benefits such as addressing a broader audience, making the software applications more accessible, easier to use, more flexible to support and providing users with more consistent information. In addition, some governmental agencies, e.g., in Spain, accept only fully localized software. Although the healthcare communication standards, namely, Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7) support wide areas of internationalization, most of the implementers are still protective about supporting the complex languages. This paper describes a generic internationalization approach for Picture Archiving and Communication System (PACS) workstations. Methods: The Unicode standard is used to internationalize the application user interface. An encoding converter was developed to encode and decode the data between the rendering module (in Unicode encoding) and the DICOM data (in ISO 8859 encoding). An integration gateway was required to integrate the inter-nationalized PACS components with the different PACS installations. To introduce a pragmatic example, the described approach was applied to the CHILI PACS workstation. Results: The approach has enabled the application to handle the different internationalization aspects transparently, such as supporting complex languages, switching between different languages at runtime, and supporting multilingual clinical reports. Conclusions: In the healthcare enterprises, internationalized applications play an essential role in supporting a seamless flow of information between the heterogeneous multivendor information systems.

Structured reporting (SR) was recently added. to the Digital Imaging and Communications in Medicine (DICOM) standard to provide an efficient mechanism for the generation, distribution, and management of clinical reports. The main advantage of SR is the ability to link clinical documents with the referenced images for simultaneous retrieval and display. A generic SR toolkit that covers the different clinical reports used in today's healthcare enterprises was developed for picture archiving and communication system (PACS) workstations. The modules of the SR toolkit collaborate to automatic-ally construct the DICOM SR files from the free-text input presented in hypertext markup language (HTML) by using the associated SR trees. The DICOM toolkit is reused for SR encoding and DICOM services. A setup module was required for creating both the standard and private SR templates used in different healthcare specialties. The SR manager transparently converts between the different SR document presentations, that is, DICOM SR files and HTML documents, to provide the end users with an easy-to-use toolkit. To evaluate and demonstrate the effectiveness of the SR toolkit in a pragmatic setting, the toolkit was integrated into PACS workstations.

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system (PACS). Reports are usually stored in the electronic patient record (EPR) of other information systems, such as the radiology information system (RIS) or the hospital information system (HIS). But high-quality service can only be provided if the EPR data is integrated with the PACS digital images. The clinician should be able to access both systems' data in an integrated and consistent way as part of the regular working environment, the HIS or the RIS. Additionally, this system should allow for teleconferences with other users, e.g., for consultations with a specialist in the radiology department. This paper describes a web-based solution that integrates the digital images of the PACS, the EPR/HIS/RIS data and a built-in teleconferencing functionality. The integration has been successfully tested with three different commercial RIS and HIS products.

This paper describes the communication concept for a regional stroke network for the exchange of medical images and reports. The data transfer is realized with regular e-mail (SMTP). DICOM images are sent as DICOM compliant attachments. Private key encryption is used to ensure data security and privacy. All used protocols are standardized or de-facto standards and allow vendor-independent communication. Different problems and options of the concept realization are discussed.

Teleradiology is one of the most evolved areas of telemedicine, but one of the basic problems which remains unsolved concerns system compatibility. The DICOM (Digital Imaging and Communications in Medicine) standard is a prerequisite, but it is not sufficient in all aspects. Examples of other currently open issues are security and cooperative work in synchronous teleconferences. Users without a DICOM radiological workstation would benefit from the ability to join a teleradiology network without any special tools. Drawbacks of many teleradiology systems are that they are monolithic in their software design and cannot be adapted to the actual user's environment. Existing radiological systems currently cannot be extended with additional software components. Consequently, every new application usually needs a new workstation with a different look and feel, which must be connected and integrated into the existing infrastructure. This paper introduces the second generation teleradiology system CHILI. The system has been designed to match both the teleradiology requirements of the American College of Radiology (ACR), and the functionality and usability needs of the users. The experiences of software developers and teleradiology users who participated in the first years of the clinical use of CHILI's predecessor MEDICUS have been integrated into a new design. The system has been designed as a component-based architecture. The most powerful communication protocol for data exchange and teleconferencing is the CHILI protocol, which includes a strong data security concept. The system offers, in addition to its own secure protocol, several different communication Methods: DICOM, classic e-mail, Remote Copy functions (RCP), File Transfer Protocol (FTP), the internet protocols HTTP (HyperText Transfer Protocol) and HTTPS (HyperText Transfer Protocol Secure),and CD-ROMs for off-line communication. These transfer METHODS allow the user to send images to nearly anyone with a computer and a network. The drawbacks of the non-CHILI protocols are that teleconferences are not possible, and that the user must take reasonable precautions for data privacy and security. The CHILI PlugIn mechanism enables the users or third parties to extend the system capabilities by adding powerful image postprocessing functions or interfaces to other information systems. Suitable PlugIns can be either existing programs, or dedicated applications programmed with interfaces to the CHILI components. The developer may freely choose programming languages and interface toolkits. The CHILI architecture is a powerful and flexible environment for Picture Archiving and Communications Systems (PACS)and teleradiology. More than 40 systems are currently running in clinical routine in Germany. More than 300,000 images have been distributed among the communication partners in the last two years. Feedback and suggestions from the users influenced the system architecture by a great extent. The proposed and implemented system has been optimized to be as platform independent, open, and secure as possible.