CS4172 Report: E-Health Systems:

Report On Some National ICT Systems.



This Report briefly consider the implementation range and uses in some Irish Hospitals.

1.1 Section 1.1 Introduction

With the advent of technology in the 21st century. Medical imaging has adopted the integrated technology in advancing treatment proficiency and delivery in Healthcare sector. Picture Archive And Communication System (PACS) is the name given to the adoption.[1]
In Ireland, National Integrated Medical Imaging System(NIMIS)was created which serves the same function as PACS or say another name for PACS in Republic of Ireland. NIMIS allows the rapid transfer of images between clinicians for consultation.(Naas General Hospital. Aug 2012). This a brief reports of NIMIS uses and progress in Ireland. [2]

1.1 Section 1.2 What is Picture Archive And Communication System.(PACS)

The uses of manual Films in medical imaging such as X-ray films put a limitation on the use of such images because it can only be in one place at a time. If need arises to use it by another Hospital the consideration of transportation, security, protection and cost process has to be put in place. This may reduce service efficiency.[5]
Picture Archive And Communication System is the management, storage ,retrieval, and online exchange or distribution of medical imaging(Search HealthIT 2001 -2004). [3]

Picture Achiving And Communication System(PACS) is a collection of technologies used to carry out digital medical imaging. PACS is used to digitally acquire medical images from the various modalities, such as Computed Tomography(CT), Magnetic Resonance Imaging(MRI), Ultrasound and digital projection radiography. The images data and pertinent information are transmitted to other and possibly remote locations, thus permitting simultaneous consultations and almost instant reporting from radiologist at a distance. Data are secured and archived on digital media such as optical disk or tape, and may be automatically retrieved as necessary. Close integration with the Hospital Information System(HIS)-Radiology Information System(RIS) is critical for system functionality. Medical image management systems are maturingg, providing access outside of the radiology department to images throughout the hospital via the Ethernet, at different hospital, or from a home workstation if teleradiology[A means of electronically transmitting radiographic patient images and consultative text from location to another]. has been implemented [4]

1.1 Section 1.3 PACS and NIMIS

The influence of Information Technology spur a lot of creativity and invention. In Ireland the creation of National Integrated Medical Imaging System (NIMIS) project which aims to function the same as PACS . NIMIS project implementation aims at enhancing quality and efficiency in medical imaging services in Healthcare Sectors in Ireland through the implementation of PACS process. [5]

1.1 Section 1.4 What is NIMIS

National Integrated Medical Imaging System (NIMIS) is the integration of Picture Archive And Communication System(PACS), Radiology Information System (RIS) and Speech Recognition Facilities to provide required functionality in all Hospitals, thereby promoting Health Service Excutive (HSE) transformation programmes for the Healthcare Sectors. [5] The NIMIS project is growing rapidly. Four Irish Hospital has implemented it and few other to follow soon. [6]

1.1 Section 1.5 Benefits

The NIMIS project benefits the people of Ireland by:

    • Integrating PACS/RIS in Irish Hospital. Delivery and using images electronically rather than in films.
    • Enabling the online ordering and result delivery of all medical imaging.
    • Implementaion of Speech Recognition Technology to report diagnostic images
    • To expedite the completion of Health Service Executives (HSE) programmes requirement for implementation of Standard Healthcare Sectors.
    • Reduce the cost of transportation and increase protection of images

About 35 Irish Hospital will implement NIMIS. Over 40million euro has been provided for this project.The completion will help deliver all the benefits outlined above and more.

1.1 Section 1.6 Summary

Ireland successful Integration of PACS and relevant technology via the NIMIS project is increasing in scope in all Irish Hospital. 17 Hospital has successfully implement the NIMIS[irishmedicalnews, March 22, 2013(]. The success is a key factors to effective Health service delivery to all patients .


HealthlinkOnline is an arm of Healthlink project. This report considers the function, benefits, scope , usage and future of Healthlink in Ireland and beyond.

2.2 Section 2.1 Introduction

Healthlinkonline is an extension of National Healthlink project. Healthlink Project provides a web-messaging service which allows the secure transmission of clinical patient information between Hospitals, Healthcare Professioners and General Practioners. In 1995 at Mater Hospital in Dublin,a group of professioners initiated Healthlink projects. It was funded by Health Service Executive(HSE). The aim is to facilitate the use of online exchange of medical or clinician information free of charge by General Practitioners(GPs) but attached a little cost to some private Healthcare Professioners. HealthlinkOnline exchange of messages divides into; in-bound and out-bound categories. It is a two way communication that uses HealthLevel 7(HL7) and formatted in XML 2.0 (Healthlink newsletter page 4)[7] & (page 1)[8]

2.2 Section 2.2 What Is HealthlinkOnline

HealthlinkOnline is a branch of Healthlink project. It was lunched in 2003. It is an online message system that replaces some of the manual refferals or service delivery. It includes service process such as

    • Laboratory Ordering
    • General Practitioner messaging
    • Patient refferals

It is a trending application in Ireland and Globally as well. In Ireland Healthlinkonline is link with few participant who use the application. Among such are:

  • Health Service Excutives(HSE)- who use it to enchance the monitoring and implementing safety and policy guidelines.
  • Hospitals- Use it for various test order and connection between various hospitals.
  • Healthcare Professioner- Use it to facilitate the treatment information and result of patients for effective and efficient delivery.



2.2 Section 2.3 How It Works

HealthlinkOnline use HL7 and XML 2.0 messaging format [7]. The ordering of tests follow three processes:

  • Demographics collection-
    A step where users (Doctors/Healthcare Professioners) can browse and pick patient from the list of database of patients who have used HealthlinkOnline and had visited Hospital previously. Or user can enter a new patient information. Visited Hospital previously here means a patient that have had a test performed on.
  • Test Selection-
    A process of choosing, adding or removing relevant test from the bank of online available test storage. The test are grouped according to the type of test specimen. e.g blood, Bone Density, genetic, etc test.
  • Order Placement-
    This is when the user selection is completed, reviewed, submitted and printed out after clicking submit button. There is a bar code in the printed form which signifies the number of specimens ordered. A pop up window also tells the user how many specimens must be supplied with the order. This is calculated from the number of specimens selected by the user. The form is then sent to the lab.


2.2 Section 2.4 Benefits

The practises such as lab ordering and online messaging has huge benefits to the user and the process. To user such as GPs-

  • It removes the stress of manual paper form filling for order test
  • It enchance retrieval and storage of previous order because is already stored online.


It reduced the time spent on order processing by avoiding repetition of information entry.
To the processing channel or laboratory.

  • Storage and availability of patients clinical information is increased which will help in future retrieval or consultation


Receipt of calculated number of specimens reducing the need to split specimens.[10]

2.2 Section 2.5 Summary

HealthlinkOnline is an avenue for speedy service delivery for quality and better treatment of patients. It is already gaining global recongnition in Europe and United State of American. The future of HealthlinkOnline may include the linkage with other Social services for informed and efficient delivery of services to an individual or patients.


A brief look into how National Cancer Screening Services function, the transition and the advantage it carries in relation to Breast check and Cervical Check..

3.3 Section 3.1 Introduction

With the advent of Breast and Cervical Cancer diseases affecting women globally, the need to prevent the spreading of the diseases and control the damage effects became paramount. National Cancer Sreening Services(NCSS) was created in Ireland in January 2007 by minister for Health and Children for the purpose of providing cancer screening programmes to the populace, to detect early or prevent, treat and manage cancer occurrence in an individual.[11]

3.3 Section 3.2 What is NCSS

The need to prevent spreading of cancer and help find adequate treatment through various research gives birth to National Cancer Screening Services(NCSS). Following the lunch of a Strategy For Cancer Control in Irealnd in 2006, which advocates a comprehensive cancer control progamme in Ireland. In April 2010, NCSS became part of the Health Service Executive.(HSE) NATIONAL CANCER CONTROL PROGRAMME(NCCP).
National Cancer Screening Service(NCSS) is a sreening services which examines prevention, screening ,detection, treatment and management of cancer in ireland. National Cancer Screening Service .[11a].
Screening is a means of detecting diseases before it has developed to the point where it results in symptoms. It can allow detection of cancer at an early stage of invasiveness or even before the become invasive. Screening is aim to improve survival, limit morbidity and to improve the quality of life of those who have develop cancer Screening does not diagonise illness, its purpose is risk reduction. (A Strategy for Cancer Control in Ireland;page 32)[11b]

3.3 Section 3.3 How It Works

National Cancer Sreening Service(NCSS) covered screening for

  • Breast Check- The National Breast Screening Programme.
  • Cervical Check- The National Cervical Screening programme.
  • Bowel Sreen- The National Bowel Sreening Programme.
  • Diabetic RetinaScreen- The National Diabetic Retinal Screening Programme



The Breast Check process; The screening of women aged 50 -64 is aimed and it is by personal invitation. It process sreening on area by area basis in all the Ireland county. It has Breast Check unit located in each area as it has been divisionally designated. e.g
Eccles Unit -Located in Dublin.
Southern Unit- Located in Cork.
Western Unit- Located in Galway.
There are other additional mobile digital screening units provided as well. Screening is done by X-ray mammograpghy. The first worldwide transition to full digital mammography service was first provided by Breask Check. This happened in April 2008. The transition to full Digital mammography is one of the success of Breast Check. Screening invloved specialist clinicians, radiographers and breask care nurses. You need to register with Breask Check register in order to get personal invitation from Breask Check.[11d]

Cervical Check – The programme perform a free smear test by appointment to the person concern. An appointment has to be sceduled with a smeartaker. A smear test is a test to detect a sign of Cervical Cancer) A smear taker is any qualify medical practitioners, nurse and GPs. It operates on active call or recall system. Active call is first appointment scheduled and a recall is a second appointment after the smear test is due. [11e]

3.3 Section 3.4 Advantages

National Cancer Screening Service aim to provide quality assured cancer screening programmes for the people of Ireland using various expertise across its programmes and improve the efficiency by cancer screening model implementation and policy governance.Advantage may include

  • Advising on the current Health technology
    National Cancer Screening Service benefits the populace. innovation that help in maximising purpose. e.g vaccines to prevent cervical cancer.
  • Create avenue for disadvantage people to get involve.
  • Give advice on the benefits of other cancer sreening programmes.


[11a] and [11c]

  • Online result delivery through the use of full Digital mammography. for Breast Check category.
  • Governance and management of Colposcopy Services


3.3 Section 3.5 Summary

National Cancer Screening Service ensure the quality, safety and effectiveness of the screening programmes; collaborating all efforts with all Healthcare professional.


The report looks at What Medlis is and the benefits resulted when the project is completed.

4.4 Section 4.1 Introduction

National Medical laboratory System(MedLIS) is new proposed projects in Health sector in Ireland. It is a projects that aim at improving the medical laboratory system to meet the IT standard of operation by :
– Installing a Mordern Laboratory Information Management System to support the clinical and business needs of the laboratory medicine service.
– To support Health Service Executive(HSE) objectives in relation to laboratory service usage to care for patients.{page 12}[12]

4.4 Section 4.2 What is MedLIS Project

National Medical laboratory System (MedLIS). MedLis project is a project that will deliver a standardised commercial off the shelf product that meets the requirements and supports the delivery of Laboratory Medicine and the needs of the broader Health Community, Hospital consultants, nursing staff, Hospital management and general practitioners. [12a] The MedLIS project commenced in 2009 but was put on hold due to failure of the preffered supplier to meet critical milestones. But an update has been done and is currently awaiting proceeding approval by Department of Health.{Page 12} [12]
The mordernisation of Laboratory medicine in standardized National IT integrated format to replace the many fragmented configuration of different laboratory now in use. MedLIS projects will upgrade the public Hospital laboratories to a modern, time saving, effective, efficient, cost reducing for patients test and results, because most them are incapable of supporting the intended practices in Laboratory medicine. It will perform these in three steps:

  • Cold Lab Test- Use of automated and non automated section with the help of some expertise.
  • Hot lab Test-More access to clinical Lab Medical advice and more direct patient care
  • Point of Care Testing – An immediate testing is perform wherever the need or emergency arises without the delay to get to the laboratory for a test. [12b]

    4.4 Section 4.3 Benefits

    The completed projects will

  • Give access to Health professional for speedy laboratory result delivery
  • Security of laboratory test and results
  • Easy access to patient information.
  • Reduced test repetition
  • Increase efficiency and capacity for more workload
  • Improved patient care quality
  • Quick and timely services for patients.
  • Enhance Health Service Executive(HSE) for proper monitoring and management of laboratory practices.
  • {page 11}[12c]

    4.4 Section 4.4 Summary

    The implementation of MedLIS project is timely requirement in Ireland. MedLIS Will ensure Patients Healthcare Provider have rapid 24hrs access to complete and up-to-date accurate laboratory data across all sites. &nbsp It Will support the HSE key service stategy and objectives such as laboratory mordernisation process. Clinical strategy and care programmes, integration of patient records. It will build on work completed during the Laboratory Information Management System(LIMIS).


    Reports briefly on Patient Administration System (PAS) in Ireland. The importance and functions.

    5.5 Section 5.1 Introduction

    The independent of Hospitals from the voluntary organisation that provide Hospital services in the early 20th century, create state involvement in Irish Hospitals. The standard of operation in relation to hospital networking interoperability, data defination and patient Identification become a priority implementation in all Hospital in Ireland.
    Patient Administration System was initiated to march up with the integration of 21st century computerisation. [13a]

    5.5 Section 5.2 What Is PAS

    Patient Administration System (PAS) is a computerised administrative system used to manage and record patient demographic details and any treatments that the Patient has, as an in-patient or out-patient. It is important to effective operation and mangement of a Hospital, producing such documents as labels and letters and providing information to monitor contrats and report performance against key targets.{A personal experience of Patient Adminstration Systems, Coding and Information in the UK NHS by Charles Carson: April 2008, page 3} [13]

    5.5 Section 5.3 Benefits

    Patient Administration System helps

  • Create a patient index database.
  • Help Track patient informations.
  • Booking of Admissions, Transfer schedules, Discharge and Bed Management.
  • Management reporting
  • Management of Patients Billing
  • Waiting list management,/li>
  • Clinical coding or information management. [13a]
  • 5.5 Section 5.4 Summary

    The inclusion of PAS in Irish Health sector is gaining ground and enchance effective Patient treatment delivery. Patient Administration System is at the heart of all other Hospital Patient Mangement Systems and is integrated with them to provide the core Demographic and Local patient identier details. e.g Radiology System, Laboratories, Accident and Emergency(A&E) System. [13]


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