Transcript Complementary Roles: SR and CDA

RSNA 2008 – Course 1029
Electronic Reports:
HL7 CDA (Clinical Document Architecture)
and DICOM SR (Structured Reporting)
for Advanced Reporting
Harry Solomon
GE Healthcare
DICOM WG 8 Structured Reporting
HL7 Structured Documents TC
DICOM WG 20 / HL7 Imaging Integration WG
IHE Cross-Domain Reporting Task Force
Disclosure
• Harry Solomon
– Employee, GE Healthcare
– Instructor, Medical Informatics, Northwestern
University
2
Acknowledgements
• Fred Behlen, co-author of a previous version of this
presentation
• Fred Behlen, Bob Dolin, Liora Alschuler, Calvin Beebe – cochairs of HL7 Structured Documents Technical Committee,
and authors of presentations on CDA used in this talk
• Dave Clunie – former co-chair of DICOM Standards
Committee, and author of the definitive book on DICOM
Structured Reporting
• Kevin O’Donnell – IHE Reporting Task Force
3
Objectives
• Understand the key elements for effective radiology
reporting, and issues with electronic reporting
workflows
• Understand the uses of HL7 CDA (Clinical
Document Architecture) and DICOM SR (Structured
Reporting) for advanced reporting workflows
4
Is this an electronic report?
MSH|^~\&|RIS|GOOD HOSPITAL|||198808181126||ORU^O01^ORU_O01||P|2.6|<cr>
PID|1||PATID1234^5^M11^ADT1^MR^GOOD HOSPITAL~123456789^^^USSSA^SS|
|EVERYMAN^ADAM^A^III||19610615|M||C|2222 HOME
STREET^^GREENSBORO^NC^27401-1020|GL| (555)
555-2004|||S||PATID12345001^2^M10^ADT1^AN^A|987654^NC|<cr>
PV1|1|I|2000^2012^01||||004777^ATTEND^AARON^A|||SUR||||ADM|A0|<cr>
OBR|1|P8754^OE|XR1501^XR|24646-2^CXR PA+LAT^LN|||198703290800|||4010^INTERN^IRVING^I^^^MD^L|...<cr>
OBX|1|TX|24646-2^CXR PA+LAT^LN||Infiltrate probably representing
bronchopneumonia in the right lower lobe. Also pulmonary venous
congestion cardiomegaly and cephalization, indicating early congestive
heart failure. Followup CXR 1 month.|...<cr>
5
For our purposes
• An electronic report is created using
computer based techniques (workflow),
includes some amount of structured and
coded content, and may include “multimedia” (for radiology, images)
• We will look at two technology standards
that apply to electronic reporting
6
Key Elements of
Radiology Reporting
7
Paper or Electronic Reports
• Accurately convey the findings to the referring physician
– Reflect the competence of the radiologist
• Timely communication for patient care
• Archived in the patient medical record
• Legal record of imaging exam
– Radiologist signature
• Support ‘secondary’ uses
–
–
–
–
Charge capture and billing
Teaching and research
Clinical data registries, clinical trials
Process improvement
• Produced making best use of radiologist’s time
8
Typical busy radiologist at
Northwestern Memorial Hospital
Benefits (+) and challenges (-)
of Electronic Reports
• Accuracy
+ Drive for quality improvement with quantitative data,
CAD and other measurements
+ Possible major benefit with attached key images
and graphical analysis (picture = 1000 words)
– Will systems support graphical reports?
• Timely communication
+ Probable improvement
• Archived in the patient medical record
– Where is the electronic medical record? (distributed,
multiple copies)
9
Benefits and challenges
of Electronic Reports (cont’d)
• Legal record
– What is a valid electronic signature?
– Is an exact visual reproduction required, or only exact
semantic content?
• Secondary uses
+ Huge potential improvement, especially with structured
and coded data
+ More accurate billing (avoid undercoding)
• Use of radiologist’s time
– Potential negative impact with transition from traditional
dictation workflow
– Radiologist pays the cost for improvements downstream
10
Planning for
electronic reporting
• What are your goals ?
– Better capture of sonographer measurements into report
– Add key images into reports
– Ability to do research / data mining
• What kinds of reports do you need?
–
–
–
–
–
Text only
Text + image references
Structured text
Structured text + coded content
Multimedia
11
This is Process Re-engineering!
• Transition to electronic reports is hard
–
–
–
–
New systems
New architectures
New policies and procedures
Organizationally disjunct costs/benefits
• Minimize the risk and the effort
– A standards-based approach
– Incremental evolution from current workflow
– Leverage the work of IHE (Integrating the
Healthcare Enterprise)
12
Radiology Reporting
Workflows
13
Reporting Starts Before
the Radiologist Sees the Study
• Reason for exam (from order), patient history
• Technical aspects of procedure
– Protocol
– Exam notes from tech
• Post-processing results
– Measurement and analysis applications (e.g., vascular, obstetric,
cardiac) by tech
– Computer Aided Detection results
– Produced on modality, imaging workstation, or CAD server
• These need to get to the radiologist and integrated into
the report
14
Reporting Integration (1)
• Review study evidence
– Order and relevant clinical information
– Images and relevant priors
– Tech notes and post-processing results
• Radiologist interpretation – on imaging workstation
– Annotation (virtual grease pencil)
– Key image selection
– Measurement and analysis applications by radiologist
• Radiologist findings reporting – on a different
system?
– Dictation + transcription / speech recognition
– Structured data entry (forms-based)
15
Where’s Waldo going to prepare his report?
Reporting Integration (2)
• Report assembly
– Findings and selected evidence/interpretation results
• Radiologist signature
– Auditable action, or digital encryption-based
• Report communication
– To referring physician
– To “secondary” users (billing!, quality improvement)
• Report archive
– And subsequent access
16
Diagnostic reporting
Image Viewing
Application
Reporting
Application
User
control
Diagnostic
report
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
Diagnostic
Images
Image
Sources
Viewing settings
(ww/wl, rotation/flip)
PACS
Archive
Orders,
Prior
Reports
Report
Information System
17
Reporting with annotation
(use case - desired)
Image Viewing
Application
Reporting
Application
User
control
Diagnostic
Images
Image
Sources
Viewing
settings (ww/wl)
PACS
Archive
Diagnostic
report
Image
references
& annotation
Orders,
Prior
Reports
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
Report
with image
references &
annotation
Information System
18
Reporting with annotation
(what’s available)
Image Viewing
Application
Reporting
Application
User
control
Image
references
& annotation
Diagnostic
Images
Image
Sources
Viewing settings,
image references
& annotation
PACS
Archive
Diagnostic
report
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
Orders,
Prior
Reports
Report
Information System
19
Reporting with measurements
Image Viewing
Application
Reporting
Application
User
control
Diagnostic
report
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
EDD 0921
BPD 5.2 cm
Diagnostic
images &
measurements
Image
Sources
Viewing settings
& confirmed
measurements
PACS
Archive
Measurement
Sources
Orders,
Prior
Reports
Report
Information System
20
The issues
• How do we bridge the gap between the
imaging side and the reporting side
– Annotations, key images, and
measurements
• How do we include these enhanced
features in reports?
21
HL7
Clinical Document Architecture
Overview
HL7 is a Standards Development Organization
whose domain is clinical and administrative data
22
HL7 Clinical Document
Architecture
• The scope of the CDA is the standardization of clinical
documents for exchange.
• A clinical document is a record of observations and other
services with the following characteristics:
–
–
–
–
–
Persistence
Stewardship
Potential for authentication
Wholeness
Human readability
• A CDA document is a defined and complete information
object that can exist outside of a message, and can include
text, images, sounds, and other multimedia content.
23
Why do you need
to know about CDA?
• Executive Order 13,410 and EHR Safe Harbors
Provision (Stark Act relaxation): certain healthcare
IT systems must comply with federally recognized
interoperability specifications
• January 2008: HHS Secretary Leavitt recognizes first
HITSP* Interoperability Specifications, including
several components using CDA
• While not (yet) specified for interoperability of
radiology reports, HITSP considers CDA as basis for
clinical documentation going forward
*Healthcare IT Standards Panel of American National Standards Institute (ANSI), tasked
24
by Dept of Health & Human Services to recommend harmonized standards
Clinical Document
Characteristics
• Persistence
– Documents exist over time and can be used in many contexts
• Stewardship
– Documents must be managed, shared by the steward
• Potential for authentication
– Intended use as medico-legal documentation
• Wholeness
– Document includes its relevant context
• Human readability
– Essential for human authentication
25
CDA Use Cases
•
•
•
•
•
Diagnostic and therapeutic procedure reports
Encounter / discharge summaries
Patient history & physical
Referrals
Claims attachments
• Consistent format for all clinical documents
26
Key Aspects of the CDA
• CDA documents are encoded in Extensible Markup
Language (XML)
• CDA documents derive their meaning from the
HL7 v3 Reference Information Model (RIM ) and use
HL7 v3 Data Types
• A CDA document consists of a header and a body
– Header is consistent across all clinical documents identifies and classifies the document, provides information
on patient, provider, encounter, and authentication
– Body contains narrative text / multimedia content (level 1),
optionally augmented by coded equivalents (levels 2 & 3)
27
CDA Standard
• Release 1 (2000)
– Standalone standard, based on early draft v3 RIM
– Level 1 narrative and multimedia
• Release 2 (2005)
– Incorporated into HL7 v3 Standard (Normative Edition)
– Level 2 structured narrative and multimedia, plus Level 3 coded
statements
• Implementation Guides
–
–
–
–
–
HL7 Care Record Summary (CRS)
ASTM/HL7 Continuity of Care Document (CCD)
IHE Patient Care Coordination Templates
Common Document Types project (CDA4CDT)
HL7 Diagnostic Imaging Report Implementation Guide
New
28
CDA Release 2
Information Model
Header
Participants
Start
Here
Doc ID
&Type
Body
Context
Sections/
Headings
Clinical Statements/
Coded Entries
Extl
29
Refs
CDA Structured Body
Arrows are Act Relationships
• Has component, Derived from, etc.
Entries are coded clinical statements
• Observation, Procedure, Substance administration, etc.
Structured Body
Section
Text
Section
Text
Section
Text
Section
Text
Section
Text
Entry
Coded statement
Section
Text
Entry
Coded statement
Entry
Coded statement
30
Sample CDA
31
Principle of Human Readability:
Narrative and Coded Information
• CDA structured body requires human-readable
“Narrative Block”, all that is needed to reproduce the
legally attested clinical content
• CDA allows optional machine-readable coded “Entries”,
which drive automated processes
• By starting with a base of text, CDA allows incremental
improvement to amount of coded data without breaking
the model
32
Narrative and Coded Entry
Example
33
CDA Non-XML Body
• Alternative to XML Structured Body
• Standard CDA header “wraps” existing document
– Allows document management with consistent
metadata
• Body can be any MIME* type
– Especially PDF (IHE Scanned Document Profile)
*Multi-part Internet Mail Extension
34
CDA Implementation Guides
• Published by HL7
– Care Record Summary – encounter notes, discharge summary
– Continuity of Care Document – transfer of care (harmonized with
ASTM Continuity of Care Record)
– Diagnostic Imaging Report – with robust references to DICOM objects
• Published by IHE Patient Care Coordination
–
–
–
–
–
–
–
Emergency Department Referral
Pre-procedure History and Physical
Scanned Documents
Personal Health Record Extract
Basic Patient Privacy Consents
Antepartum Summary
Emergency Department Encounter Summary
35
Diagnostic Imaging Report
Implementation Guide
Header
Structured Body
Section
DICOM
Object
Catalog
Section
Reason for Study
Section
Findings
Section
Patient History
Entries
DICOM Study,
Series, Image
References
References to DICOM objects in
hierarchical context using native
DICOM or WADO access
References to DICOM images
with optional Presentation
State annotations
Section
Impressions
Section
Procedure Description
Section
Comparison Study
Section
Recommendations
Entries
(Annotated)
Image References
Section
Key Images
36
DICOM
Structured Reporting
Overview
DICOM is a Standards Development Organization
whose domain is biomedical imaging
37
DICOM Structured Reporting
• The scope of DICOM SR is the standardization of
documents in the imaging environment.
• SR documents record observations made for an
imaging-based diagnostic or interventional
procedure, particularly those that describe or
reference images, waveforms, or specific regions of
interest.
38
Why do you need
to know about DICOM SR?
• DICOM SR is used in key subspecialty areas that
produce structured data in the course of image
acquisition or post-processing, where:
– Leveraging the DICOM infrastructure is easy and desirable
– Results should be managed with other study evidence
• Examples
–
–
–
–
–
Sonographer measurements
Computer-aided detection results
QC notes about images
Radiation dose reports
Image exchange manifests
39
Key Aspects of DICOM SR
• SR documents are encoded using DICOM standard
data elements and leverage DICOM network services
(storage, query/retrieve)
• SR uses DICOM Patient/Study/Series information
model (header), plus hierarchical tree of “Content
Items”
• Extensive mandatory use of coded content
– Allows use of vocabulary/codes from non-DICOM sources
• Templates define content constraints for specific
types of documents / reports
40
SR Content Item Tree
Arrows are parent-child relationships
• Contains, Has properties, Inferred from, etc.
Content Items are units of meaning
• Text, Numeric, Code, Image, Spatial coordinates, etc.
Root Content Item
Document Title
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
41
DICOM SR Example
42
DICOM SR Object Classes
• Enhanced and Comprehensive - Text, coded content, numeric
measurements, spatial and temporal ROI references
– Templates for ultrasound, cardiac imaging
• CAD - Automated analysis results (mammo, chest, colon)
• Key Object Selection (KO) - Flags one or more images
– Purpose (for referring physician, for surgery …) and textual note
– Used for key image notes and image manifests (in IHE profiles)
• Procedure Log - For extended duration procedures (e.g., cath)
• Radiation Dose Report - Projection X-ray; CT
43
HL7 CDA and DICOM SR Compare and Contrast
and Collaborate
44
“Evidence” and “Reports”
• Evidence Documents
– Includes measurements, procedure logs, CAD results, etc.,
created in the imaging context, and together with images
are interpreted by a radiologist to produce a report
– The radiologist may quote or copy parts of Evidence
Documents into the report, but doing so is part of the
interpretation process at his discretion
– Appropriate to be stored in PACS as DICOM SR objects,
with same (legal/distribution) status as images
• Reports
– Become part of the patient’s medical record, with
potentially wide distribution
– Good match to HL7 CDA
45
DICOM-HL7 Synergy (1)
• DICOM and HL7 have recognized the need to work
together
• DICOM SR and HL7 CDA are congruent in key areas
–
–
–
–
Document persistence
Document identification, versioning and type code
Document’s relation to the patient and to the authoring physicians
Coded content using external vocabularies
• SR strength in robust image-related semantic content;
CDA strength in human readable narrative report
46
DICOM-HL7 Synergy (2)
•
•
Methods for referencing CDA documents from within DICOM
objects, and vice versa
CDA documents can be included on DICOM exchange disks
– As native CDA files, or encapsulated in a DICOM file
– Indexed in DICOMDIR for integration with DICOM applications
•
•
Transcoding from SR to CDA feasible for measurements, image
references, observations
DICOM WG10 (Strategic Advisory) suggested composing
radiology reports directly in CDA format when appropriate
47
Approaches to integration
• Use these standards! Ask for them from
your IT providers
• Leverage them in new combinations to
achieve desired electronic reporting
capabilities
• Evolve from current workflows – but
recognize there may be process reengineering
48
Loosely integrated reporting –
add key images to reports
Image Viewing
Application
Reporting
Application
User
control
Image
references
& annotation
Viewing settings,
Diagnostic
image references
Images
& annotation
Image references
Image
PACS
& annotation
Sources
Archive
Image retrieval
Diagnostic
report
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
Orders,
Prior
Reports
Report
Information System
Report w/ image ref & annot
49
Image Viewing Application
Image
selection
Annotation
Reporting Application
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
********************************************************************************
342 02/05/96
UNIVERSITY OF CHICAGO HOSPITALS
BHIS #: 1234567
INPATIENT
201-23-90
RADIOLOGY CONSULTATION
Hematology
/ Oncology
CHANDLER, CAROLYN
342 02/05/96
Mitchell-6NE
49
FEMALE 201-23-90
BHIS #: 1234567
INPATIENT
Hematology / Oncology
Admitting
Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Mitchell-6NE
Clinical data: Biliary tube check.
Carl
M. Gompers,
MD
Admitting
Diagnosis:
NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Dictated
report
Clinical data: Biliary tube check.
Change Perc
Drainage
CarlBiliary
M. Gompers,
MD Cath Proced
--
Change Perc Biliary Drainage Cath Proced
COMPARISON: 07/23/95 and 06/27/95
CHANDLER, CAROLYN
49
FEMALE
Exam #46 on 01/08/96
--
Exam #46 on 01/08/96
FINDINGS:
After the
procedure
was explained to the patient and informed
COMPARISON:
07/23/95
and 06/27/95
& Int -- Exam #47 on 02/05/96
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
FINDINGS: As above.
Successful
biliary tube change, and findings consistent with interval tumor
IMPRESSION:
growth.
Successful biliary tube change, and findings consistent with interval tumor
Simon
A. Templar, MD / Richard Nixon, MD (R19)
growth.
Signed 02/9/96 at 8:48 AM
3
Simon A. Templar, MD / Richard Nixon, MD
Signed 02/9/96 at 8:48 AM
(R19)
3
Transcribed
narrative
DICOM
GSPS object
(annotations)
DICOM
KO object
“For Report”
Image Archive
DICOM Query/Retrieve for
all KO objects matching
Accession Number
Reporting System
Validation Functions
Reporting
Integration
Functions
DICOM
Encapsulated CDA object
WADO
Server
WADO URI references to
Images with GSPSs (JPEG rendering)
CDA
Report
Other Use Cases to be Profiled
• Quantitative measurement intensive reporting
with DICOM SR inputs
– Mammo with CAD input, Obstetric with sonographer
measurements, Cardiac with functional assessments,
CT with radiation dose
– DICOM SR used to fill in report template before
radiologist reviews case; radiologist verifies/edits
transferred content, adds key images
• Selected key measurements imported into report
– Similar to Key Image / Annotation workflow
51
Conclusions
• CDA now viewed as a primary format for diagnostic
imaging reports
– Template for CDA DI report in a balloted HL7
Implementation Guide
• DICOM SR will see continued and expanding use for
Evidence Documents created in the imaging setting
– IHE Evidence Documents Integration Profile
• Evolutionary workflows utilizing both standards in
coordination are reasonable in the near term
– Does not require tight integration of imaging and reporting
applications
52