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Finally, without a uni ed DICOM data structure in the enterprise level from the beginning, data compatibility between add-on PACS modules can create confusion in the systemwide worklist, and cause problems with the image distribution roll-out Outright Purchase with Maintenance Contract of PACS with Image Distribution Solution No off-the-shelf enterprise-level PACS/image distribution is offered by any manufacturer, and therefore outright purchase is not possible Outsourcing Outsourcing to maintain the technical components of the PACS with image distribution may be considered after the PACS equipment has been installed, provided that the cost is justi able But when planning the PACS with image distribution is de novo, no outsourcing manufacturer is knowledgeable enough about the intricacies of the enterprise-level operation, let alone the cluster or the hospital operation, without embarking on a long learning process.

(12a) (12b)

Dim clrObj As AcadAcCmColor Set clrObj = myCircle.TrueColor clrObj.ColorMethod = acColorMethodByACI clrObj.ColorIndex = acBlue myCircle.TrueColor = clrObj

The outsourcing company must further learn the design of the enterprise ePR in order to interface PACS to its architecture The time required for such a process is too long to be bene cial for the enterprise operation ASP Model (Application Service Provider) Currently the ASP model is an attractive option for smaller subsets of the PACS with image distribution Supporting off-site archive, long-term image archive/retrieval or second copy archive, DICOM Web server development, and Web-based image database are some such workable models But for a large comprehensive enterprise PACS with image distribution, ASP implementation requires investigation by the enterprise on locating a suitable manufacturer The advantages and disadvantages of the ASP model versus equipment procurement are shown in Table 163 Pay per Procedure Pay-per-procedure is attractive in a smaller scale operation This model is popular for smaller clinics where IT support is scarce.

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quality assurance principles and GMPs as the council may determine [32]. As a part of the license application the manufacturer must provide acceptable documentary proof of the ability to comply with GMP as determined by the council [33]. The current set of South African GMP code determined by the council is entirely based on the PIC/S GMP guide version PE 009-2, published in 2004 with some minor modi cations [34]. As shown in Table 11 the South African GMP code consists of 9 chapters and 17 annexes. The chapters present the general requirements of GMP for the production of drug products covering the requirements for quality management and control, personnel, premises, equipment, documentation, production, contract services, complaints, product recall, and self-inspection. The annexes give speci c guidance on the manufacture of sterile drug products, biological drug products, radiopharmaceuticals, veterinary drug products, medical gases, herbal drug products, oral liquids, external preparations (creams, ointments), aerosols, investigational new drugs, and blood and blood products. They also cover sampling of materials, computerized systems, use of ionizing radiation, quali cation and validation, organization, and

This model does not work well in large, multifaceted healthcare operations The formula for pay per procedure can be complicated Other disadvantages are similar to those of the outsourcing and ASP models..

Packet filtering Each incoming and outgoing packet is inspected against a set of requirements or rules. Packets that satisfy all the criteria are allowed to go through. All other packets are discarded. The criteria to allow or deny access are based on source and destination names or IP addresses, ports, and protocol (TCP, UDP, ICMP, SNMP, and so forth). Proxy service Firewalls often work as a proxy server. A proxy server is an application that acts as an intermediary between two end systems. Proxy servers operate at layer 7 (the application layer) of the OSI model and they are also, therefore, referred to as application-layer firewalls. A proxy service must be run on the firewall for each Internet application. You set up an HTTP proxy for Web services, an SMTP proxy for e-mail, and so on. A Web proxy server, for example, is used to retrieve Web pages from the Internet for internal requests. The internal machines are never allowed to go out to the Internet to get data. Similarly external users are never allowed to access the internal servers. The firewall intercepts each incoming request, gets the data from the internal server, and forwards it to the requestor. Proxy servers increase the efficiency of Internet access. They cache (locally store) all data that it has retrieved for requestors. Data is kept locally for a certain period of time (10 minutes, 2 hours, or any other period). Future requests for the same data, if found in the cache, are answered instantaneously from cache without contacting the remote server.

P1: FCH WY050-11 WY050-Ulick-v4 September 19, 2004 12:4