Transcript WG-10_SR_CDA_strategy

DICOM SR and CDA Rel 2
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DICOM SR and CDA Rel 2
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DICOM SR and CDA Rel 2
Summary Imaging Report (SIR)
 Patient Personal Record
 Back to Referring Physician
SIR
SIR is extract of
Imaging Report
Specialized
Diagnostics &
Intervention
Images
Evidence
Docs
Specialist
 Evidence = Structured Info
 Images = Structured Info
• Mammo
Imaging • US
Reports • Cardiac
• Ophthalmology
Object reference
Use/create info content
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Strategic process
We had a closer look at one of our main topics:
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Structured reporting objects and templates, relationship
with CDA Release 2
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Actions:
I. Update the Policy Paper on Structured Documents,
also including IHE in discussion.
Kevin, Niki, Charles, Cor.
Review by Lloyd, John, Joel.
II. Have telcon with WG20/WG10/WG6 about Radiology
report workitem: scope, purpose, DICOM’s help in
adoption process, collaboration with HL7.
Also: DICOM encapsulated CDA, sup 114
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Strategic Insights
1. Today in the clinical practice we hardly see any application of
structured and coded reporting beyond the evidence
documents. The expectation and vision is that the need for
structured and coded reporting will emerge the coming years
to facilitate decision support, full integration in the patient’s
EHR, data mining and analysis to improve the theoretical
foundation and practice of medicine.
2. The workload for creation of structured and coded reports is
the most significant acceptance criteria for the reporting
clinician. There should be a direct link between the guidelines
and practice protocol and the template/document structure.
3. The expectation is that given the broad range of clinical
domains, broad scope of the use cases that need to be
supported, and IT infrastructures and applications that are in
place today, there will be a coexistence of both DICOM SR and
HL7 CDA for encoding structured semantics.
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Strategic Insights
4. The reporting use cases identify the need to exactly capture
the report layout. This is legally required in certain
jurisdictions, and because of human perception and
readability, and business presentation and reimbursement.
PDF is well suited to support these requirements.
5. The assumption is that in some/many reporting use cases the
reference to the evidence documents and images from the
report is an important element in the report.
6. The assumption is that the report and the referenced
evidence documents and images have to be incorporated in
the patient's electronic health record.
7. Reaching agreement on clinical templates for specific
applications is a significant challenge to the adoption of
structured and coded reporting, both for the professional
societies to generate and the IT infrastructure in the
practice to be flexible enough to deal with these.
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Proposed Actions
a. In the DICOM community we need to find and
document at least one typical clinical use case
where we believe DICOM SR is ideally suited to
encode the structured report, and efficiently
supports the whole scope of the use case including
the verification, distribution and medical research.
The DICOM standard has all the elements in place
to support such an "all DICOM" structured
reporting use case. [1. Breast Imaging Report, 2.
Echo]
b. DICOM should communicate to the IHE
community it’s acceptance of the coexistence of
DICOM and HL7 constructs for the purpose of
structured and coded reports.
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Proposed Actions
c. WG20 is on the right track with the ongoing effort to
harmonize the structured report content between DICOM SR
and HL7 CDA, because in practice it may well be that it is
more the hospital's IT and application infrastructure that is
the decisive factor for the choice of structured report
encoding, rather than the clinical use case.
WG20 will be supported in their activity to define a
Diagnostic Report template by the activity defined in action a.
d. Because DICOM has a method for encapsulating PDF, IHE is
encouraged to incorporate into the reporting workflow a
mechanism by which DICOM SR is complemented by an
equivalent encoding of the report in PDF.
e. Advise to the DICOM Committee to set-up a liaison with
Physician’s EHR Coalition for the topic of clinical guidelines
and the relationship to structured and coded reporting.
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