Transcript strategy_RSNA - Dicom

DICOM Strategy
Cor Loef
co-chair DICOM WG10:Strategic Advisory Committee
Philips Medical Systems
Contents
•
•
•
•
•
Scope of DICOM
Charter WG10: Strategic Advisory Cmt
Trends in Imaging-IT
Strategy Planning process
Collaboration with other SDOs
December5, 2002
IHE @ RSNA 2002
2
Scope of DICOM
• Mission of DICOM
– Create and maintain international standards for
communication of bio-medical diagnostic and
therapeutic information
• Goals of DICOM
– Achieve interoperability and improve workflow
efficiency between imaging systems and other
information systems
December5, 2002
IHE @ RSNA 2002
3
Charter of WG10
• To develop and maintain the long-term strategic plan of
the DICOM Standards Committee.
URL: http://medical.nema.org/dicom/geninfo/dicom_strategy
• To review standards and technology trends in healthcare,
biomedical imaging, commerce, telecommunications,
and informatics;
• To consider issues and opportunities related to the
strategic evolution of DICOM;
• To provide liaison to other standards developing
organizations: ISO, HL7, JIRA, CEN
December5, 2002
IHE @ RSNA 2002
4
Overview
•
•
•
•
•
Scope of DICOM
Charter WG10: Strategic Advisory Cmt
Trends in Imaging-IT
Strategy Planning process
Collaboration with other SDOs
December5, 2002
IHE @ RSNA 2002
5
Quality of care improved by information and IT:
All relevant information the care giver and patient
need, anywhere and anytime,
for the best clinical decisions through one common and
simple user interface, adapted for the task.
December5, 2002
IHE @ RSNA 2002
6
December5, 2002
IHE @ RSNA 2002
7
Trends in Imaging-IT:
Other
Clinical
System
HIS
Horizontal Integration
Vertical Integration
Active workflow
RIS
Paradigm shift
Web based PACS
Cardiology
PACS
Radiology
PACS
VL, US, NM
PACS
Web distribution
At the desktop
December5, 2002
IHE @ RSNA 2002
8
Vertical Integration
HIS
ADT
Patient Registration
Patient Registration
Order Placer
IMAGING:
• PACS / Archives
• Workstations
• Modalities
Image Creator
New Order
Image Display
The Healthcare Enterprise
Q /R
Images
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
PPS
In-Progress
/ Completed
RIS
December5, 2002
Storage
Commit
Images
Stored
Acquisition
Modality
Modality Worklist
IHE @ RSNA 2002
9
Active Workflow
December5, 2002
IHE @ RSNA 2002
10
Workflow in Radiology
Registration
Preparation
..010011...
Post Examination
..010011...
Referral
Archiving
..010011...
..010011...
Image Distribution
December5, 2002
..010011...
Demonstration
Transcription
IHE @ RSNA 2002
..010011...
..010011...
Digital
Radiology
..010011...
Reporting
11
Reviewing
..010011...
..010011...
..010011...
Examination
Active Workflow
Personalized
Work list
For each user
December5, 2002
IHE @ RSNA 2002
12
User’s default display protocol
December5, 2002
IHE @ RSNA 2002
13
Paradigm shift in PACS:
Clinical Applications to PACS
Yesterday
December5, 2002
IHE @ RSNA 2002
14
Multi-slice CT: 1000+ images
December5, 2002
IHE @ RSNA 2002
15
Post-Processing everywhere
• Viewing & Advanced Image Processing:
– clinical SW packages
– move towards modalities, PACS and web
3D
Spine
Endo3D
December5, 2002
IHE @ RSNA 2002
Cardiac MR
16
• Analysis tools to enhance clinical decisions:
–
–
–
–
–
Echo measurements & calculations
Left Ventricular Analysis
Quantitative Coronary Analysis
Vascular X-Ray Analysis
Vascular X-Ray Post-Processing
December5, 2002
IHE @ RSNA 2002
17
Horizontal Integration
Hospital Information System, Master Person Index
Radiology
workflow
Cardiology
workflow
Ultrasound
workflow
Pathology
workflow
Radiology
PACS
Cardiology
PACS
Ultrasound
PACS
Visible Light
PACS
One Image Management Infrastructure
December5, 2002
IHE @ RSNA 2002
18
Horizontal Integration
• Image (information) management system supports
archiving/retrieving of all types of clinical objects (incl.
visible light) and Structured Reports
December5, 2002
IHE @ RSNA 2002
19
DICOM SR Creation - Example -Radiology
RIS data
Header:
(DICOM) SR Object
Thorax
Report Type:…..
Report Creator
application
Findings:
…..
…..
Mass
…..
…..
Conclusions:
Image data
Daim.
Infiltr.
…..
…..
Image Refs.:(Pointer)
from PACS
select
From DICOM
standard:
December5, 2002
Coding Schemes
Report Templates behind pop-up menus
IHE @ RSNA 2002
20
Web based PACS
Web Viewer
Webserver
PACS Viewing
Station
At Modality
December5, 2002
IHE @ RSNA 2002
21
Web and Security
Web Viewer
Webserver
Security
PACS Viewing
Station
At Modality
December5, 2002
IHE @ RSNA 2002
22
“Electronic Health Record”
• Image Management system and Departmental Information Systems
must be EHR-prepared (Query/Retrieve)
• EHR: emphasis today on visual integration on the desktop, will
become the integrated, secure, patient centric, source of health
information
• Need for coded vocabularies to represent medical knowledge and the
patient’s health condition
• Web front-end:
– viewing not only of images but also waveforms, measurements,
reports, lab results, etc
– need the capability to access the original medical images
– support for (DICOM) Structured Reporting
– XML and XML Schema for the exchange of clinical documents
December5, 2002
IHE @ RSNA 2002
23
EHR: Visual Integation
Efficiency
Back-Office
Clinical
Information
System
messages
Integrated
Clinical Viewing
at the desktop
Front Office
December5, 2002
IHE @ RSNA 2002
Clinical
Information
System
Improve
Clinical
Decisions
24
Overview
•
•
•
•
•
Scope of DICOM
Charter WG10: Strategic Advisory Cmt
Trends in Imaging-IT
Strategy Planning process
Collaboration with other SDOs
December5, 2002
IHE @ RSNA 2002
25
Strategic planning process
• In recent meetings WG10 has identified quite a
number of strategic topics in the following
domains:
–
–
–
–
–
–
data acquisition, imaging technology
post-processing and presentation
object management and archiving
data and result distribution
treatment planning
workflow management
December5, 2002
IHE @ RSNA 2002
26
The (multi-vendor) Integrated Imaging
Solution
Image
Archive
Image
Server
Department
Info Server
CD
Exchange
Diagnostic
Workstation
December5, 2002
Connection to
other Network
and/or
TeleCardiology
IHE @ RSNA 2002
27
Quality of Patient Care
Fast and accurate diagnosis
Effective treatment plan
Reduce Errors
Order
Codes and
vocabularies
Codes and
vocabularies
Measurements
Diagnose
Waveforms
Images
December5, 2002
Structured
Presentation
IHE @ RSNA 2002
Report
Treatment
plan
Persistent
Object Ref
28
Topics in Acquisition domain:
– Workflow outside the Radiology domain: RT, VL,
Cardio. Requires specialized workflow. Refreshing the
worklist, event based.
– Amount of data generated, kind of data generated.
• More, 3D, real-time, grayscale, color, time-sequence, text
• Text really broadens the scope: evidence documents, key
image note, codes, vocabularies, templates. Need for simple,
small documents, e.g. just a few measurements
• Amount of data will impact performance
• Need to manage separate objects that do belong together, SOP
Class future. modeling instead of SOP ( HL7 way), separate
info model from communication
December5, 2002
IHE @ RSNA 2002
29
Topics in Acquisition/Post-processing domain:
– Integration, data from multiple modalities needed
together, fused, merge recipe. Requires synchronization
in time and/or space.
• US + CathLab
• PET + CT
• MR + NM
– Communication technology
• Media for exchange, profiles
• Wireless (TCP/IP is on top of this, should be no issue)
December5, 2002
IHE @ RSNA 2002
30
Topics in Archive domain:
– Delete service. All images come together in central
archive with satellites. Co-operation in a loosely
connected environment.
– Co-operation between multiple loosely connected
workflow managers.
December5, 2002
IHE @ RSNA 2002
31
Topics in Diagnostic Review domain:
– Presentation, have only grayscale presentation currently.
•
•
•
•
color, 3D, waveform, Cine, MR-multiframe
hanging protocols
multi-modality presentation
SR presentation
– Interactive collaboration, tele-radiology
– Data mining, statistics, need for uniform definition.
• Should we organize a workshop on this topic?
December5, 2002
IHE @ RSNA 2002
32
Topics in Reporting domain:
– Harmonization with CDA L3, XML encoding
– Next versions of TID 2000, templates
– Codes, Vocabulary, Procedure Codes, Diagnostic
Codes, HIPAA induced codes
December5, 2002
IHE @ RSNA 2002
33
Topics in Result Distribution domain:
– DICOM’s document paradigm: Persistent Object
Reference
– Exchange information outside the DICOM domain
– HIPAA, Privacy, Security, Authentication, VPN
– CD/DVD for exchange
December5, 2002
IHE @ RSNA 2002
34
The distribution problem
HIS
Other
Clinical
System
RIS
Cardiology
PACS
Radiology
PACS
Electronic Patient Record
December5, 2002
IHE @ RSNA 2002
VL, US, NM
PACS
Header:
Thorax
Report
Type:
…..
…..
…..
Findings:
Mass
…..
….. Daim.
Conclusions:
Infiltr.
…..
…..
Ima
(Poi
gn
e t
Re
e r
f )
s
.
:
35
Topics in Treatment/Treatment planning domain:
– CAD tools, HPGL standard, templates for implants
– 3D, image guided surgery, contours, locate images in
3D space
• multi modality aspect
– Image fusion
December5, 2002
IHE @ RSNA 2002
36
Strategic planning process
Summary of the statements made:
–We started with the ultimate goal in mind: Quality of
Patient Care, Continuity of Care, and the two contributing
factors: fast and accurate diagnosis, and most effective
treatment plan
–The key persons to support with information are the
technologist, radiologist/cardiologist, and the referring
clinician.
–Images, waveforms, measurement reports are generated and
need an integrated presention to the key decision makers.
–We see this integration and presentation to the diagnostic
decision maker as the top priority.
December5, 2002
IHE @ RSNA 2002
37
Strategic planning process
Statements (continued):
–We have the feeling that much is available in DICOM
which is not deployed in practice to solve integration and
presentation problems
==> Education and promotion task
–There will be gaps as well.
==> Identify the gaps in the Radiology, Cardiology, NM
and US domain
–Imaging (related) information from other domains
(-ologies) needs to be integrated as well
==> Convince other -ologies to use the DICOM paradigm
for their persistent objects.
December5, 2002
IHE @ RSNA 2002
38
Strategic priorities
Radiology
Acquisition
Interpretation
Reporting
Cardiology
Acquisition
1
2
Interpretation
Reporting
Ultrasound
3
NM
3
December5, 2002
Integration from acquisition via
presentation to interpretation and
reporting
IHE @ RSNA 2002
4
Other -ologies
Archiving plus
Object management
39
Overview
•
•
•
•
•
Scope of DICOM
Charter WG10: Strategic Advisory Cmt
Trends in Imaging-IT
Strategy Planning process
Collaboration with other SDOs
December5, 2002
IHE @ RSNA 2002
40
Standards in Imaging-IT
1. Horizontal Integration
2. Vertical Integration
3. Electronic Patient Record
4. Orders and Results
Management
5. Security
6. Freedom of Application
Workspot
DICOM
IHE, DICOM, HL7
ISO/CEN,DICOM,HL7,XML
IHE, DICOM, HL7
IHE,IETF,DICOM,HL7,ASTM
ISO/CEN, CCOW, IETF,
DICOM
When new technology is required, the strategy is to adopt proven
international, industry or de facto standards.
December5, 2002
IHE @ RSNA 2002
41
IHE - Integrating the Healthcare Enterprise
Reducing the Barriers to Optimized Patient Care
• Fostering communication between vendors and users of
medical information technology
• Gaining knowledge of the data required for optimal
patient care decisions, i.e. understanding each others
problems
• Driving the deployment and evolution of existing
standards
• Eliminating the gaps and redundancies in data access.
December5, 2002
IHE @ RSNA 2002
42
Liaison with TC 215
• Good Type A liaison since April 99.
• Procedure
– TC 215 has agreed to rely on DICOM for Medical Imaging
Standardization
– DICOM offers expertise in medical imaging, with world-wide
users and vendors representation.
– Need to ensure coherence with other ISO standards group on
imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)
• New workitem: Web Access to DICOM’s Persistent
Objects, co-operation of ISO TC 215/WG2 and DICOM
– in DICOM a WG6 ad-hoc group is established to work on the
supplement, together with a group of ISO nominated experts
December5, 2002
IHE @ RSNA 2002
43
Collaboration with HL7
• WG20: Integration of Imaging and Information Systems,
common DICOM-HL7 working group.
• Works on the harmonization of the information models,
HL7 RIM and DICOM Real-World model.
• Works on the harmonization of DICOM SR and the HL7
CDA (Clinical Document Architecture) level 1,2,3
– An informative annex to the DICOM standard will be created with
the mapping of DICOM header data element to CDA level 1.
– CDA level 2 and 3 are progressing.
December5, 2002
IHE @ RSNA 2002
44