Transcript The Role Of DICOM SR And HL7 CDA

Enterprise-Wide Reporting And The
Continuity Of Care:
The Role Of DICOM SR And HL7 CDA
DICOM Anniversary Conference and Workshop 2003
Helmut Koenig, MD
(Co-Chair DICOM WG 20)
Frank Krickhahn
(Chair DICOM WG 8)
Siemens Medical Solutions
Significance of Reporting
Radiology and Clinical Reports are the End-Products of
Diagnostic Processes
Consolidation of current interpretation results that builds on
relevant clinical information
Documents are crucial for cross-boundary, interdisciplinary
and temporal continuity of care in that they convey the
essential clinical diagnoses and facts
Health Information Infrastructure & Informational Continuity
of Care
Health Information Infrastructure:
The Reporting View
Personal
Health Mgmt.
Enterprise
Patient
Referral
Hospital
EPR
Access
Order Entry
Results
Reporting
Internal
Scheduling
Reporting
Interpretation
Interpretation
Results
Access
Acquisition
Quality
Control
PostProcessing
Imaging Dept.
Admission
Discharge
Transfer
Epidemiology
Primary Care
Public Health
Standards Achievements
DICOM
Recent DICOM SR related supplements
 Supplement 65 - Chest CAD SR
 Supplement 66 - Catheterization Lab SR SOP Classes
 Supplement 71 - Vascular Ultrasound SR
 Supplement 72 - Echocardiography Procedure Report
 Supplement 75 - Relevant Patient Information Query Service
Class
 Supplement 79 - Breast Imaging Report Templates
 Supplement xx - Non-invasive Cardiovascular Analysis of CT/MR
Procedures
Workflow Support (Modality and General Purpose Worklist SOP
Classes)
Relevant Patient Information Query Service Class (Suppl. 75)
Web Access to DICOM Persistent Objects (WADO) (Suppl. 85)
Standards Achievements
HL7 / DICOM WG 20 Integration Issues
Order Entry and Results Reporting Messages (Version 2.x and 3)
• Imaging Order Message (Version 2.5)
Clinical Document Architecture (CDA) Document Standard
• Narrative Reports (CDA Release 1)
• Narrative + Structured Reports (CDA Release 2) will contain
imaging specific information
Current Situation & Actions Taken
Reporting needs pose considerable challenges due to the
complexity of combining the required services and systems
integration
How can this put into place in order to provide optimal
support for reporting needs?
Revisit reporting and image interpretation use cases / gap
analysis
Discussion started by DICOM WG10 and 20 which resulted
in use cases which are ordered by complexity level
Hardcopy Image Reading +
Dictation/Transcription (Use Case 1)
Image Reading:
Hardcopy Reading
Hardcopy DICOM Print as Seen at Modality
Reporting:
RIS-Based Transcription / Validation of Narrative Report
RIS-Based Report Storage and Management
Send Reports
Query Prior Reports
Hardcopy Image Reading +
Dictation/Transcription (Use Case 1)
Report Storage / Mgmt.
Electronic Report
RIS
sen
d
Narrative
Info Only
Paper print/
Mail/
Fax/E-mail
Electronic Report
quer
y
Acquisition
Report
Repository
Transcription
& Correction
prin
t
Validation
Filming
Hardcopy
Interpretation
& Dictation
Film Archive
network
DICOM
optional
manual
HL7/other
Hardcopy and Softcopy Image Reading +
Dictation/Transcription (Use Case 2)
Image Reading:
Hardcopy Reading
Hardcopy DICOM Print as Seen at Modality
Softcopy Reading
Hardcopy DICOM Print as Seen During Softcopy Reading
Reporting:
RIS-Based Transcription / Validation of Narrative Report
RIS-Based Report Storage and Management
Send Reports
Query Prior Reports
Hardcopy and Softcopy Image Reading +
Dictation/Transcription (Use Case 2)
stor
e
Selected
Images
Softcopy
Interpretation
& Dictation
Report Storage / Mgmt.
Electronic Report
RIS
sen
d
Paper print/
Mail/
Fax/E-mail
Electronic Report
Narrative
Info Only
quer
y
Acquisition
Report
Repository
Transcription
& Correction
prin
t
Validation
Filming
Hardcopy
Interpretation
& Dictation
Film Archive
network
DICOM
optional
manual
HL7/other
Acquisition Workflow Support +
Burn CD/DVD (Use Case 3)
Image Acquisition:
RIS-based Acquisition Workflow Support (Modality Worklist)
Image Reading:
Hardcopy Reading
Hardcopy DICOM Print as Seen at Modality
Softcopy Reading
Hardcopy DICOM Print as Seen During Softcopy Reading
DICOM Store Images -> Burn CD/DVD
Reporting:
RIS-Based Transcription / Validation of Narrative Report
RIS-Based Report Storage and Management
Send Reports
Query Prior Reports
Optional DICOM Store Reports -> Burn CD/DVD
Hardcopy and Softcopy Image Reading +
Dictation/Transcription (Use Case 3)
Modality Worklist
stor
e
Selected
Images
Softcopy
Interpretation
& Dictation
Report Storage / Mgmt.
Paper print/
Mail/
Fax/E-mail
RIS
sen
d
Electronic Report
Electronic Report
Narrative
Info Only
quer
y
Report
Repository
Acquisition
Transcription
& Correction
prin
t
Burn CD/DVD
Validation
Off-Line Archive
store
Film Archive
Filming
Hardcopy
Interpretation
& Dictation
network
DICOM
optional
manual
HL7/other
PACS for Management of DICOM Persistent
Objects (Use Case 4)
Image Acquisition:
RIS-based Acquisition Workflow Support (Modality Worklist)
Image Reading:
Hardcopy Reading
Hardcopy DICOM Print as Seen at Modality
Softcopy Reading
Hardcopy DICOM Print as Seen During Softcopy Reading
DICOM Store Images for Burning CD/DVD
PACS-based Storage and Management of DICOM Persistent Objects
Archive Imaging Studies
Query Prior Imaging Studies
Reporting:
RIS-Based Transcription / Validation of Narrative Report
RIS-Based Report Storage and Management
Send Reports
Query Prior Reports
Optional DICOM Store Reports for Burning CD/DVD
PACS for Management of DICOM Persistent
Objects (Use Case 4)
Modality Worklist
stor
e
Object Storage / Mgmt.
Selected
Images
sen
d
Softcopy
Interpretation
& Dictation
Narrative
Info Only
quer
y
Transcription
& Correction
Electronic Report
Paper print/
Mail/
Fax/E-mail
RIS
Report
Repository
Image
Repository
Acquisition
Validation
prin
t
Electronic
Report
PACS
store
store
store
q/
r
Off-Line Archive
Burn CD/DVD
Film Archive
Filming
Hardcopy
Interpretation
& Dictation
network
DICOM
optional
manual
HL7/other
Basic Integration of Report and Image Information
(Use Case 5)
Additions:
Image Reading:
DICOM Store Images for Burning CD/DVD
Selection of Evidence Objects (I.e. Images) and Associated Presentation
States
Reporting:
RIS-Based Report Storage and Management
Send Reports
Query Prior Reports
DICOM Store Reports for Burning CD/DVD
Relate Evidence Objects to Report by Reference
Note: Hardcopy Reading Skipped for Brevity
Basic Integration of Report and Image
Information (Use Case 5)
Modality Worklist
stor
e
Object Storage / Mgmt.
sen
d
Softcopy
Interpretation
& Dictation
quer
y
Transcription
& Correction
Narrative
Info Only
Electronic
Report
Paper print/
Mail/
Fax/E-mail
RIS
Report
Repository
Inclusion of
References to Selected
Objects (I.e. Images)
Image
Repository
Acquisition
Images
Presentation States
Key Image Notes
Electronic Report
Validation
PACS
store
store
store
q/
r
Off-Line Archive
Evidence Documents
Imaging Reports
Burn CD/DVD
network
DICOM
optional
manual
HL7/other
Access to Relevant Information (Use Case 6)
Additions:
Access to Relevant Information:
RIS/PACS-based Storage and Management of DICOM Persistent
Objects
Interfaces/Gateway for Imaging Information Queries
Export Imaging Results/Evidence to EHR (Electronic Health Record)
EHR-Based Management of Patient Clinical History Information
Interfaces/Gateway for EHR Relevant Patient Information Queries
Note: Hardcopy Reading + Burn CD/DVD Skipped for Brevity
Electronic Health Record
/ Financials Management
Access to Relevant Information
(Use Case 6)
CIS
HL7
Interface
Gateway
Relevant Patient Information
Query
DICOM SR Text
DICOM Images
Financial Inf.
Repository
expo
rt
store
Modality Worklist
Clinical Inf.
Repository
HL7 CDA Rel. 1
JPEG Images
FIS
stor
e
Web
Interface
Object Storage / Mgmt.
sen
d
Softcopy
Interpretation
& Dictation
quer
y
Transcription
& Correction
Narrative
Info Only
Electronic
Report
RIS
Report
Repository
Web
Interface
WADO
WADO
Image
Repository
Acquisition
DICOM
Interface
Images
Presentation States
Key Image Notes
store
q/
r
Validation
Web Client
Clinician Access
PACS
Web
Gateway
network
DICOM
optional
manual
HL7/other
Postprocessing Workflow & Structured Reporting
Based on Evidence Documents (Use Case 7)
Additions:
Postprocessing:
Postprocessing Workflow Support (Postprocessing Worklist)
Creation of Evidence Documents Results
Reporting:
RIS-Based Report Storage and Management
Support for Transcription Worklist
Support for Interpretation Worklist
Access to Relevant Information:
RIS/PACS-based Storage and Management of DICOM Persistent
Objects
Interfaces/Gateway for Imaging Information Queries
Export Imaging Results/Evidence to EHR
EHR-Based Management of Patient Clinical History Information
Interfaces/Gateway for EHR Relevant Patient Information Queries
Note: Hardcopy Reading + Burn CD/DVD Skipped for Brevity
Postprocessing Workflow & Structured Reporting
Based on Evidence Documents (Use Case 7)
Modality
Worklist
Narrative
Info Only
Extract
Measurements
&Add Codes
Interpretation +
Validation
Acquisition
store
HL7 CDA Rel. 1
JPEG Images
FIS
Transcriptio
n Worklist
Web
Interface
Object Storage / Mgmt.
Electronic
Report
RIS
quer
y
Transcription
& Correction
Post-Processing
Worklist
Report
Repository
Web
Interface
WADO
DICOM
Interface
Images
Evidence Documents
Presentation States
PACS
Post-Processing
/ CAD
Web Client
Clinician Access
WADO
Image
Repository
store
q/
r
Financial Inf.
Repository
DICOM SR Text
DICOM Images
sen
d
Images
Evidence Documents /
Validated ED
Presentation States
Key Image Notes
SR with References:
- Images, PS, KIN, ED
Images
Evidence Documents
Presentation States
Clinical Inf.
Repository
expo
rt
Interpretation / Sign-Off
Worklist
stor
e
CIS
HL7
Interface
Gateway
Relevant Patient Information
Query
Electronic Health Record
/ Financials Management
Web
Gateway
network
DICOM
optional
manual
HL7/other
Terminology Service & Export of Structured
Documents (Use Case 8)
Additions:
Reporting:
RIS-Based Report Storage and Management
Support for Dictation Worklist (Voice Recognition / NLP Substitutes
Transcription)
Access to Relevant Information:
RIS/PACS-based Storage and Management of DICOM Persistent
Objects
Export Structured Documents to EHR (Rather than Narrative Report)
Note: Hardcopy Reading + Burn CD/DVD Skipped for Brevity
Terminology Service & Export of
Structured Documents (Use Case 8)
Relevant Patient Information
Query
Modality
Worklist
Interpretation / Sign-Off
Worklist
Voice Recognition
/ Natural Language Processing
Terminology
Service
Electronic Health Record
/ Financials Management
CIS
Coding Scheme
Repository
HL7
Interface
Gateway
Clinical Inf.
Repository
Financial Inf.
Repository
expo
rt
HL7 CDA Rel. 2
JPEG Images
store
FIS
DICOM SR
DICOM Images
stor
e
Web
Interface
Object Storage / Mgmt.
Extract
Measurements
&Add Codes
Interpretation,
Correction +
Validation
Acquisition
Post-Processing
Worklist
Web
Interface
WADO
Images
Evidence Documents
Presentation States
PACS
Post-Processing
/ CAD
Web Client
Clinician Access
WADO
DICOM
Interface
store
q/
r
Report
Repository
Image
Repository
Images
Evidence Documents /
Validated ED
Presentation States
Key Image Notes
SR with References:
- Images, PS, KIN, ED
Images
Evidence Documents
Presentation States
RIS
Dictation
Worklist
Web
Gateway
network
DICOM
optional
manual
HL7/other
Conclusions
Use cases 1-4 are well understood and covered by DICOM
Use case 5: “Basic Integration of Report and Image
Information“
Selection of Evidence Objects and Associated Presentation
States at the Interpretation Workplace
Inclusion of these selected references into narrative report and
provision of the integrated information...
Could be the next step we should focus on and fill potential
gaps
Questions
Do the scenarios meet your needs?
Is there anything missing?
Back-up Slides
Significance of Reporting
Radiology and Clinical Reports are the End-Products of
Diagnostic Processes
Consolidation of current interpretation results that builds on
relevant clinical information
Turnaround time and quality are critical factors for clinicians´
satisfaction
Report is the legally authenticated document (by electronic
means or on paper) of the accountable physician
Documents are crucial for cross-boundary, interdisciplinary
and temporal continuity of care in that they convey the
essential clinical diagnoses and facts
Use of DICOM and standards like HL7 for ensuring the
informational continuity of care in the scope of:
Departmental (i.e. Imaging) and Hospital Information
Systems, Electronic Health Record (EHR)
Health Information Infrastructure (Hospital/Primary Care,
Personal Health Management, Public Health)
Critical Factors for Reporting: Continuity
of Information Perspective
Ease of access and availability of relevant information
Study Context: Current + prior imaging studies and reports
Patient Context: Access to relevant clinical information (Procedure
and indication based)
Limitations primarily due to use of hardcopy images and paper
reports
Completeness, diagnostic accuracy and ease of referencing
evidence objects
Dictation/Transcription vs. Structured Reporting
Potential limitations due to use of narrative reports instead of
template-based structured reports which include references to
evidence objects
Workflow Support
HL7 Order Entry and Results Reporting Messages
DICOM Modality Worklist and General Purpose Worklist
Semantic Interoperability
Reference Terminology (Semantic Backbone)