Transcript Review and update IHE – The Future XDS – 1

Review and update of IHE
The Future & XDS–I
Overview - IHE Updates
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IHE Organisational Changes
The Infrastructure Domain
Radiology Update
XDS-I
IHE Political Update
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IHE has moved on from Radiology
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Cardiology
Laboratory
Patient Care Coordination
(Vetinary)
Moved on from US-centric
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Established Regional and National
Committees
Current IHE Domains
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IT Infrastructure
Radiology
Cardiology
Laboratory
Nuclear Medicine
Profiles of Interest - ITI
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Established:
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Trial:
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Patient Synchronized Applications (PSA)
Patient Identifier Cross-referencing (PIX)
Patient Demographics Query (PDQ)
Personnel White Pages (PWP)
Audit Trail and Node Authentication (ATNA)
Enterprise User Authentication (EUA)
Retrieve Information for Display (RID)
Cross-Enterprise Document Sharing (XDS)
Document Digital Signature (DSG)
Notification of Document Availability (NAV)
Development:
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Cross-enterprise User Authentication (XUA)
New Profiles of Interest Radiology
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Established:
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Trial:
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Reporting Workflow (RWF)
Portable Data for Imaging (PDI)
Post-Processing Workflow (PWF)
Cross-enterprise Document Sharing for Imaging (XDS-I)
Teaching File and Clinical Trial Export (TCE)
Radiology Audit Trail Option
Development:
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Import Reconciliation Workflow (IRWF)
Image Fusion (FUS)
Mammography Image (MAMMO)
Current Intra-Trust/Cluster Image
Sharing Problems
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DICOM C-MOVE problems
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Indexing
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Error correction and cascading
Multi-site studies
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Which trusts hold data for a patient?
Updating
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Network Addressing Issues
Unknown Recipients
Where is “home” for the study ?
Lack of agreement between Vendors on how to go
forward
How to bolt security onto DICOM
The IHE XDS Profile
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“Generic” means of sharing clinical
documents
Part of ITI domain (not Radiology)
Based on clinical and non-clinical standards:
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Transmission:
Indexing:
Documents:
http/https
ebXML
CDA v2
PDF
etc.
XDS Concepts
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Actors
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Document
Document
Document
Document
Source
Repository
Registry
Consumer
Other concepts
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“Submission Set”
XDS Overview
Identity
Source
Document
Registry
Document
Source
Meta-Data Only
User
Document
Repository
Full Document
XDS-I
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Like XDS but based on:
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Uses the same registry
A submission set is a DICOM Key Object Note
(manifest) object
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DICOM (data format)
WADO or native DICOM (retrieval mechanisms)
May include representative sub-sets
Use of WADO permits retrieval either as JPEGs for
simpler browsers or full DICOM images
Compatible with caching but still with integrity
XDS-I Overview
Identity
Source
Image
Registry
Image
Source
Meta-Data Only
User
Image
Repository
Full Images
Selected Manifest
Problems solved by XDS-I
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Use of WADO for retrieval solves C-MOVE problems
One registry solves indexing problems
There is an explicit mechanism to update/delete
registrations (no equivalent in DICOM)
“Submission Sets” are independent of StudyUID, so
mixtures from different trusts are not a problem
New but increasingly supported international standard
(being implemented in Canada and many others)
Uses Standard web security mechanisms
Standardised access allows “web access” to be used
for pre-fetching etc., and integration with other
clinical data
Conclusions
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Virtually all the problems being worked on by
CfH have already got agreed international
IHE solutions which are supported by vendors
XDS & XDS-I in particular provide a
mechanism to provide wide-area area, but
fully controlled access to medical data, with
proper specialisation for images
The Connectathon next week should be
interesting!