Purpose To integrate multiple DICOM image webservers into the currently existing enterprise-wide web-browsable electronic medical record (MINDscape). Over the last six years the University of Washington has created a clinical data repository combining in a distributed relational database information from multiple departmental databases (MIND). A character cell-based view of this data called the Mini Medical Record (MMR) has been available for four years. MINDscape, unlike the text-based MMR, provides a platform independent, dynamic, web browser view of the MIND database that can be easily linked with medical knowledge resources on the network, like PubMed and the Federated Drug Reference. There are over 10,000 MINDscape user accounts at the University of Washington Academic Medical Centers. The weekday average number of hits to MINDscape is 35,302 and weekday average number of individual users is 1252. DICOM images from multiple webservers are now being viewed through the MINDscape electronic medical record (EMR). Methods - We have implemented three commercial webservers that act as DICOM Storage Service Class Providers to our computed radiography (CR), computed tomography (CT), digital fluoroscopy (DF), magnetic resonance (MR), nuclear medicine (NM) and ultrasound (US) scanning modalities. These DICOM images can be accessed through web URLs or by linking the image server databases using ODBC or SQL gateways. This allows the use of dynamic HTML links to the images on the DICOM webserver through CGI queries from MINDscape, so that radiology reports already resident in the MIND repository can be married with the appropriate images through the unique examination accession number generated by our Radiology Information System (RIS). Results - CR, CT, DF, MR, NM and US DICOM images from multiple DICOM webservers are displayed with associated exam reports for referring physician and clinicians anywhere within the widespread academic medical center on PCs, Macs, X-terminals and Unix computers. New Work - The integration of standalone DICOM image webservers and PACS archive webservers from multiple vendors into the MINDscape EMR represents new work by the authors to be presented at MI99. A main goal in this effort was to provide a single sign on solution for MINDscape and associated clinical department webservers so that our users only have to type their username and password once per MINDscape session. Given that we had multiple authentication schemes, a particular scheme (MCIS Cookies) has been devised to grant authentication to users without asking for a password. That is, MCIS Cookies authenticates a user into an associated clinical department webserver based on the fact that the user has been authenticated (given the cookie) by MINDscape through the MINDscape authentication process. MCIS cookies are strings containing information such as username and issue timestamp which are encrypted using a symmetric, private key. The encrypted string is then encoded using HTTPS for easy transport. Future authentication plans call for implementation of either Kerberos or SSH (secure shell). Conclusions - Multiple DICOM webservers can be effectively integrated into an enterprise-wide web-based electronic patient record, allowing physician access to radiological images using low-cost, ubiquitous web browser technology and wavelet compression.
