All notes


HIS/RIS-PACS integration.


Integration provides a more complete patient record, increased consistency, accuracy, and availability of information, automation of mundane and error prone activities, reduced data entry errors, workflow enhancements and improved productivity, lower costs, increased quality of care, and better outcomes.

It also allows automation of value-added functions including data store and forward, database synchronization, record linking, worklists and scheduling, image prefetching and routing, quality control, clinical event tracking, vocabulary services, electronic patient record (EPR) access, and outcomes analysis.

Centralized or Distributed

A centralize'd gateway, however, represents a processing bottleneck and single point of failure.

A distributed gateway model provides all of the benefits of integration, while minimizing the drawbacks. It increases throughput and ensures the availability, fault-tolerance, and consistency of the interface at all times through the use of redundant servers, data replication, load balancing and network monitoring.


At the conceptual level, the gateway is implemented using a client-mediator-server architecture.

  1. Clients receive unsolicited messages from external applications, which are normalized into an infernal format and routed to the mediator.
  2. The mediator provides the business intelligence, routing the messages to the appropriate destination servers.
  3. Servers translate the messages into protocol dependent formats and sends them to external systems. Responses are then routed back from the servers to the originating client.

Distributed Gateway Model


A distributed implementation of the model allows multiple instances of each class of client, server, and mediator to run simultaneously, but requires that the duplicates share state data. Should one instance fail, another can then assume responsibility for the failed instance's tasks without loss, corruption, or inconsistency of data.

Distributed Architecture Requirements