A view of the workshop.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
Biomedical subjects
A R Bakker
Publications and source records attributed to A R Bakker.
Workshop aims, outline of the program.
This workshop on the Technology Assessment of PACS has been organized as a rounding off of the Technology Assessment activities which were initiated within the Dutch PACS Project (1986-1989). It is made possible by a funding from the Dutch Ministry of Health Care (WVC). We hope it will be not only a rounding off, but will contribute to more intensive cooperations in this area. In the scope of the Dutch PACS project, the software package CAPACITY for cost analyses of PACS has been developed, to stimulate the dialogue and exchange of data. During the workshop, the data which were collected with CAPACITY are used as a framework for discussions. This paper presents the outline of the workshop, its background, its aims and the program.
Cost-Benefit Analysis↗
Do the benefits outweigh the costs of PACS? The results of an International Workshop on Technology Assessment of PACS.
On May 26-27, 1991, an International Workshop on the Technology Assessment of PACS was held at Enkhuizen, The Netherlands. During this workshop 35 experts in the field, from 13 different countries, discussed amongst others the required functionality of PACS, diagnostic aspects and the quality of care and organizational aspects. The key question was whether, when and how PACS is feasible, both from a financial and a clinical point of view. Data which were collected with the aid of the software tool CAPACITY formed the starting point of this meeting. This paper gives an outline of the discussions during this workshop. The main conclusion is that more clinical research is needed, to get a better insight into the costs and the clinical benefits of PACS. Because of the high costs of the PACS technology, international cooperation in this field is requested. It is recommended that the CAPACITY project, which is set up to stimulate the international dialogue and data exchange on PACS, is continued.
Cost-Benefit Analysis↗
Picture archiving and communication system design issues: the importance of modelling and simulation.
Picture archiving communication system (PACS) development turns out to be very complex. Due to both the vast amount of data and the complexity of hospital organizations, currently only small-scale systems have been realized. And although the experiences obtained with these systems are essential, there is a risk for underestimating the complexity and requirements inherent in hospital-wide PACS systems. In this paper, it is advocated that modelling and simulation be used as tools to obtain insight into the behavior and structure of future PACS systems. Modelling and simulation can also be used to actively support the design of PACS, especially its software. In order to capture the full complexity of PACS in a simulation model, and to take full advantage of simulation as a design tool, the development of a new modelling method has begun. This method is based on semantic data models and decision processes, and can be used for both system analysis and design. The first systems modelled with this method were imaging procedures in a hospital and a computer network. The resulting simulation models are a direct reflection of reality, and have a high degree of modularity. Consequently, in spite of the complexity of the systems, their models are easy to understand and maintain.
Computer Simulation↗
Automatic assignment of elliptical ROIs: first results in planar scintigrams of the left ventricle.
Several algorithms for quantitative analysis of 201Tl scintigrams require operator assigned elliptical regions. Therefore these algorithms are hampered by inter- and intra-observer errors. In this paper we present a robust algorithm to determine automatically contours with elliptical shapes. The algorithm is based on the Hough transformation and can determine the parameters describing an ellipse even in low signal-to-noise ratio images and when the contour is only partially visualized such as in non-perfused regions of the left ventricular myocardium. As long as the number of parameters to describe the shape of the contour is not too large, the same kind of algorithm can also be used for differently shaped contours, and for 3D elliptical contours as in SPECT.
Algorithms↗
First experiences with the modelling and simulation package MIRACLES applied to a picture archiving and communication system (PACS) in a clinical environment.
Since the construction of picture archiving and communication systems (PACS) appears to be extremely difficult, computer modelling and simulation are used as decision support tools. The package MIRACLES (Medical Image Representation, Archiving and Communication Learned from Extensive Simulation) has been developed at BAZIS in order to support the construction of simulation models of image information systems. This article discusses the application of MIRACLES to a prototypical PACS as being installed in a clinical environment. Attention is focussed to the required system analysis and difficulties which arose during the construction of the simulation model. The emphasis is on the presentation of the results of the simulation study, which show that simulation can be fruitfully used to predict, to analyse and to assist in solving performance problems. The simulation study confirmed assumptions and suppositions concerning both the system performance itself and strategies to improve the performance. The study also resulted in a number of concrete recommendations which might be useful for the set-up of the prototypical PACS.
Computer Simulation↗
[Computers in nursing. Data like a flow of water].
Explore the source record for details and available documents.
Communication↗
HIS, RIS, and PACS.
In this paper the historical background of the concepts Hospital Information System, Radiology Information System, and Picture Archiving and Communication System (HIS, RIS, PACS) is presented. Next the present situation of the realization of the concepts is considered; the conceptual relation between the three is discussed. Accepting the existence of the three concepts, first the relation between HIS and RIS is analysed, next the relation between PACS and HIS/RIS is considered. It is concluded that such a relation is vital for the realization of a full-scale PACS. Moreover, it is concluded that not only data has to be exchanged but also information. The need for a generic description of an interface between the two is emphasized.
Hospital Information Systems↗
Top-down design of a picture archiving and communications system (PACS) by means of simulation.
The development of picture archiving and communications systems (PACS) for medical applications can be regarded as a challenging field in medical informatics. Since 1982, several projects have been started into this direction worldwide. The Dutch IMAGIS (Image Information System) project, started in 1984, is one of them. Within this project, a top-down design strategy is chosen, with the following first steps: (1) A thorough information analysis for a Radiology Department, in which both qualitative and quantitative aspects are included. Such an analysis can be used to estimate the workload on a future PACS system. (2) The construction of a flexible performance prediction tool, based on discrete even simulation. Such a tool can be used to predict the performance of a certain computer system configuration under a certain workload. Based on the information analysis, and using the performance prediction tool, a PACS system is drafted for the thorax section of the Diagnostic Radiology Department of the Leiden University Hospital. In this first design attempt, the assumption was made that current working procedures concerning images will be maintained as much as possible.
Archives↗
An analysis of the costs of a hospital-wide Picture Archiving and Communication System with the software package CAPACITY.
Within the scope of the Dutch PACS project, the costs of a hospital wide PACS in the Utrecht University Hospital were estimated, with the help of the software package CAPACITY. The cost analysis was based on the most recent specifications of the costs of the equipment, on extrapolations, and on the experience acquired with a PACS prototype in the Utrecht University Hospital. Savings due to a possible reduction in the length of stay, or due to logistic improvements were not taken into account. The results indicate that the extra costs of a hospital wide PACS would amount to 3.2% of the total hospital budget. By taking into account the expected price movements, it is predicted that a hospital wide PACS may allow enough savings to pay itself back, when installed near the turn of the century. The result of this cost analysis depends on a large number of assumptions. Therefore two sensitivity analyses are carried out, i.e., concerning the number of workstations required and concerning the organizational impact of PACS.
Computer Systems↗
EuroPACS: a catalyst for PACS in Europe.
The EuroPACS organization and its intended role in PACS development in Europe is briefly described. EuroPACS was initiated at Braunlage FRG, August 1984. Its aim is to stimulate mutual contacts between various groups in Europe being active in the PACS field. Its main activities are: organization of EuroPACS conferences (once or twice per year), publication of a newsletter and organization of special sessions in larger congresses.
Computer Communication Networks↗
PACS costs: modelling and simulation.
The advantages to be expected of full-scale PACS implementation are widely described in the literature. In the decision to introduce such systems, costs will also play an important part. The benefits to be achieved should at least outbalance the costs. In this paper the set-up of a software package for cost assessment is described. The configuration requirements have to be determined based on the workload of the radiology department and a PACS model using results of simulation studies. Of course additional user requirements are important input parameters (e.g. number of workstations, screen resolution, etc.). Data on costs of the various configuration components and the expected future trends in these costs will be used to estimate the costs of a specific PACS configuration as a function of time. Savings to be achieved in the various categories of resources will be input (again with their trends) to lead to an overview of the total savings to be expected. The package will result in a graph of the net annual costs as a function of the timing of PACS introduction. In the package a critique module is foreseen that checks whether the data fed into the system are of reasonable agreement with expert opinions.
Computer Simulation↗
Background of the demonstrated IMAGIS activities and future expectations.
In The Netherlands a national PACS development programme has been started, supported by the Dutch Society of Radiology and funded by the Dutch Department of Health because of the national character of the project. Three main partners are cooperating in this development: the Utrecht University Hospital (AZU), BAZIS and Philips International (Product Division Medical Systems), with the Delft University of Technology as the main BAZIS subcontractor. The non-profit foundation BAZIS, developing and supporting the ZIS Hospital Information System (in use in some 30 Dutch hospitals, over 15,000 acute beds), initiated its current IMAGe Information System (IMAGIS) projects in 1984. The activities were later integrated into the Dutch PACS project started in 1986. The final goal of the project is to achieve a PACS which is fully integrated with already existing hospital information systems (HIS). The development and operation of a HIS-PACS include many aspects of technical and clinical. The current efforts of BAZIS are concentrated on three main issues: diagnostic image quality evaluation (e.g. effects of data compression); modelling, software simulation and technology assessment of a prototype PACS (both general and detailed aspects); and coupling and integration of PACS and HIS (e.g. the BAZIS ZIS). Philips, Hamburg, is supplying equipment, particularly prototype components. A systematic clinical evaluation will take place at the Utrecht University Hospital.2+ We outline the background of the intermediate results as demonstrated during the 6th EuroPACS Conference:the psychophysical software package for Feature Evaluation And System Inspection By Logged Experiments (FEASIBLE); the modelling and simulation software package for Medical Image Representation, Archiving and Communication, Learned by Extensive Simulation (MIRACLES); and first results of the coupling experiments.(ABSTRACT TRUNCATED AT 250 WORDS)
Computer Communication Networks↗
Prediction and analysis of PACS performance with the simulation tool MIRACLES.
Since the construction of image information systems appears to be extremely difficult in practice, BAZIS has decided to use computer modelling and simulation as decision support tools. In order to support the construction of simulation models, the simulation package and modelling environment MIRACLES (Medical Image Representation, Archiving and Communication Learned from Extensive Simulation) has been developed by BAZIS. This paper describes modelling and simulation techniques in general, as well as the benefits of simulation within the scope of designing Picture Archiving and Communication Systems (PACS). In order to illustrate the theory, results of a concrete yet simple PACS, which has been simulated with MIRACLES, will be described and discussed.
Computer Communication Networks↗
HIS-PACS coupling: BAZIS/ZIS and Philips/MARCOM on speaking terms.
Nowadays a growing number of experts in the PACS field agree on the necessity of having an integrated HIS-PACS combination available in modern hospitals in order to manage the enormous amounts of patient data, both textual, numerical and image information, in an effective way. Since 1986 BAZIS (the Development and Support Group of the Hospital Information System), Philips Medical Systems and the University Hospital of Utrecht (AZU) are partners in the so-called Dutch PACS Project in the development and evaluation of a fully integrated image information system. The first phase of the coupling (sub)project consists of establishing a communication link between the BAZIS/ZIS and the Philips/MARCOM system with the following restrictions: the only data sent concerns the inpatients of one ward; data will only flow one way, from BAZIS/ZIS to Philips/MARCOM. In the second phase two-way communication will be realized and more departments can be part of the experiment. In phase 3 a more general HIS-PACS interface will be developed, independent of the manufacturers of HIS and PACS. In this paper the technical solution chosen for the first phase coupling, the format of the messages being transferred, and the events which result in sending the messages, will be described. Also, reference is made to the demonstration of the working HIS-PACS link, given during the 6th EuroPACS meeting in Utrecht and Leiden on 25-26 April 1988.
Computer Communication Networks↗
Practical issues and examples of data protection.
Explore the source record for details and available documents.
Computer Communication Networks↗
Using hospital information systems for clinical epidemiological research.
We address the question of how data collected during routine medical practice and stored in a hospital information system to support the various functions of the hospital can be used for clinical epidemiological research. The hospital information system HIS developed by BAZIS and implemented at the Leiden University Hospital is used as an example because the availability of data for clinical research is considered a potential benefit of the BAZIS-HIS. After a brief outline of the research area of clinical epidemiology and the BAZIS-HIS has been given, three different ways in which a hospital information system can be used in clinical epidemiology, are discussed: (1) as a sampling frame to select the study population; (2) to collect data from patients taking part in the study; (3) to register data specifically collected for the study. Whether or not the hospital information system is used in a particular study depends on the specific research question, the design of the study, the content of the database and the completeness and accuracy of the registration. We shall argue that retrieval facilities alone are not sufficient to support clinical research. To decide which items can best be used to select a study population, it is necessary to know how medical events take place in daily practice and how they are registered. Therefore when data stored in hospital information systems are used for epidemiological research, close collaboration is required between the clinical epidemiologists, the hospital administrative personnel and the data processing experts.
Data Collection↗
A package for cost and critical analysis of picture archiving and communication indicating its true yield (CAPACITY).
The hospital-wide use of picture archiving and communication systems (PACS) promises a number of advantages in the future. These benefits will only be obtained at considerable costs, however. In view of the rapidly developing technology the costs of hardware can be expected to decrease. The ideas about the expected moment when the benefits will exceed the costs show wide variation. In order to get a better view on the cost comparison between PACS and the classical film-based system and also to stimulate discussions on this topic, a software package called CAPACITY (cost and critical analysis of picture archiving and communication indicating its true yield) has been developed by BAZIS within the scope of its IMAGIS (image information system) project. CAPACITY calculates the costs in the year of introduction for both situations, conventional and PACS, based on the consumption or use of the various resources (e.g. film, optical disks, manpower in the archive, operators, network, workstations etc.) needed for the production of the radiological department. These two costs are calculated for a series of years, thus giving an indication for the moment of breakeven. User-supplied data is interrelated and checked for plausibility against a number of expert given rules of thumb by CAPACITY's critique module. The first results and experiences acquired during a pilot study using a prototype version of the package will be discussed. The CAPACITY package is available for evaluation and trial (only distribution costs will be charged if experiences and results are returned).
Computer Simulation↗