Transcript Complementary Roles: SR and CDA

RSNA 2006 – Course 070
Electronic Reports:
HL7 CDA (Clinical Document Architecture)
and DICOM SR (Structured Reporting)
Harry Solomon
GE Healthcare
DICOM WG 8 Structured Reporting
HL7 Structured Documents TC
DICOM WG 20 / HL7 Imaging Integration SIG
IHE Cross-Domain Reporting Task Force
Disclosure
• Harry Solomon
– Employee, GE Healthcare
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
• Understand the HL7 CDA (Clinical Document
Architecture) and its use cases
• Understand DICOM SR (Structured Reporting) and
its use cases
• Understand reporting workflows, the use of
DICOM SR and HL7 CDA in those workflows, and
the importance of the IHE (Integrating the Healthcare
Enterprise) effort
4
Key Elements of
Radiology Reporting
5
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
6
Typical busy radiologist at
Northwestern Memorial Hospital
Benefits and challenges
of Electronic Reports (1)
• 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)
7
Benefits and challenges
of Electronic Reports (2)
• 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
• Use of radiologist’s time
– Potential negative impact with transition from traditional
dictation workflow
– Radiologist pays the cost for improvements downstream
8
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)
9
HL7
Clinical Document Architecture
Overview
HL7 is a Standards Development Organization
whose domain is clinical and administrative data
10
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.
11
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
12
CDA Use Cases
•
•
•
•
•
Diagnostic and therapeutic procedure reports
Encounter / discharge summaries
Patient history & physical
Referrals
Claims attachments
• Consistent format for all clinical documents
14
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)
15
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 Guide for Care Record Summaries,
US Realm (2006)
16
CDA Release 2
Information Model
Header
Participants
Start
Here
Doc ID
&Type
Body
Context
Sections/
Headings
Clinical Statements/
Coded Entries
Extl
17
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
18
Sample CDA
19
Narrative and Coded Info
• 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
• Narrative may be flagged as derived from Entries
– Textual rendering of coded entries’ content, and contains
no clinical content not derived from the entries
• General method for coding clinical statements is a hard,
unsolved problem
– CDA allows incremental improvement to amount of coded
data without breaking the model
20
Narrative and Coded Entry
Example
21
CDA Non-XML Body
• Alternative to XML Structured Body
• Standard CDA header “wraps” existing document
• Any MIME type
– Especially PDF (IHE Scanned Document Profile)
22
CDA Implementation Guides
• Published by HL7
– Care Record Summary – encounter notes,
discharge summary
• Published by IHE Patient Care Coordination
–
–
–
–
–
Emergency Department Referral
Pre-procedure History and Physical
Scanned Documents
Personal Health Records
Basic Patient Privacy Consents
23
DICOM
Structured Reporting
Overview
DICOM is a Standards Development Organization
whose domain is biomedical imaging
24
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.
25
SR Use Cases
•
•
•
•
Radiology reports with robust image / ROI references
Measurements/analyses made on images
Computer-aided detection results
Notes about images (QC, flag for specific use, quick
reads)
• Procedure logs for imaging-based therapeutic
procedures
• Image exchange manifests
27
Use Case Common Features
• Structured
– Lists and hierarchies
• Numeric measurements, coded values
– Automatically extractable for database, data mining
• Relationships between items
– Hierarchical, or arbitrary reference
– Power of rich semantic expression
• References to images, waveforms, other objects
– Collected in DICOM environment
• Explicit contextual information
– Unambiguous documentation of meaning
28
DICOM SR and the Five
Clinical Document Characteristics
• The five characteristics:
– Persistence: SR objects are persistent
– Stewardship: SR objects are managed and can identify their
steward
– Potential for authentication: SR has digital signature capability
– Wholeness: SR objects include their relevant context
– Human readability: DICOM requires SR objects to be rendered
“completely and unambiguously”, but this needs a conformant
application
• SR emphasizes coded semantic content (especially in
relation to images), while CDA emphasizes human
readable text through simple XML style sheets
29
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
30
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
31
DICOM SR Example
32
DICOM SR Object Classes
• Basic Text - Narrative text with image references
• Enhanced and Comprehensive - Text, coded content, numeric
measurements, spatial and temporal ROI references
• 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 (in development)
33
DICOM Encapsulated Document
• Complementary to DICOM Structured Reporting
• Standard DICOM header “wraps” existing
document
– Allows use of DICOM infrastructure – object exchange,
archive (PACS), query/retrieve
• Only specific document types allowed
– PDF (2006)
– CDA (in ballot – completion January 2007)
34
®
PDF (Adobe
Portable Document Format)
• Neither CDA nor SR guarantee exact visual reproduction
of a displayed document, which may be a legal
requirement in some locales
• PDF allows exact visual reproduction, and display
software is readily available
• Role for PDF as a presentation-ready equivalent
rendering of a coded document
• Both CDA and DICOM support wrapping PDF with their
standard header, so a presentation-ready PDF can be
managed in the same environment with cross-links to the
original coded document
35
Radiology Reporting
Workflows
36
Reporting Starts Before
the Radiologist Sees the Study
• Reason for exam (from order)
• 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
• These need to get to the radiologist and integrated
into the report
– Produced on modality or imaging workstation
37
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?
– Structured data entry (forms-based)
– Dictation + transcription
38
Where’s Waldo going to prepare his report?
Reporting Integration (2)
• Report assembly
– Findings and selected interpretation results
• Radiologist signature
• Report communication
– To referring physician
– To “secondary” users (billing!)
• Report archive
– And subsequent access
39
The DICOM Solution?
• DICOM was supposed to take care of all this, and has
(almost) all the requisite features and network services
• DICOM SR has found vital uses in key subspecialty
areas that produce structured data in the examination or
post-processing
– Leveraging the DICOM infrastructure is easy and desirable
– Results managed with other study evidence
• But the end recipients of radiology reports, referring
physicians, commonly use systems without DICOM
capabilities (imaging or SR)
40
“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
– Ideal match to HL7 CDA, but sometimes SR is appropriate
41
DICOM-HL7 Synergy (1)
• SR and CDA developed simultaneously
• DICOM and HL7 working groups 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
• SR strength in robust image-related semantic content;
CDA strength in human readable narrative report
• DICOM WG10 (Strategic Advisory) suggested composing
radiology reports directly in CDA format when appropriate
42
DICOM-HL7 Synergy (2)
• References to CDA documents from within DICOM
objects, and vice versa
• Include CDA documents on DICOM removable disks
– As native CDA files, or encapsulated in a DICOM file
– Indexed in DICOMDIR for integration with DICOM applications
• PDF rendering of SR can be wrapped in a CDA
document
• Transcoding between SR and CDA feasible for limited
subset of reports
• CDA Implementation Guide for Diagnostic Reporting in
development
43
The Role of IHE
• Industry-wide effort to “make it work”
• Real world use cases drive standards-based
approach to integration
– Practical evolution from current architectures
• Venue for testing implementations and
interoperability
• Reporting is highest priority task for Radiology
Domain in 2007
• Your participation is welcome!
44
Reporting Profiles
• Documented workflow profiles
– IHE Evidence Documents Profile
– IHE Key Image Notes Profile
– DICOM Part 17 Dictation-Based Reporting with Image
References [Supplement 101]
• Ongoing work in IHE Reporting Task Force and
Radiology Technical Committee
– Revise IHE Simple Image and Numeric Report Profile,
consolidate with Post-processing and Reporting Workflow
Profiles
– Align with Retrieve Information for Display and CrossEnterprise Document Sharing Profiles
45
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
PACS
Archive
Orders,
Prior
Reports
Report
Information System
46
Reporting with annotation
(use case)
Image Viewing
Application
Reporting
Application
User
control
Diagnostic
Images
Image
Sources
Viewing
settings
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
47
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
48
Integrated solution
Image Viewing &
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
3
Orders,
Diagnostic images
& Prior reports
Image
Sources
(R19)
Image
references
& annotation
Viewing settings,
Reports, image
references & annotation
Integrated PACS &
Information System
49
Loosely integrated reporting
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
50
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 SCP)
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
• All the basic elements are standardized and ready to be
fit into integrated reporting workflows
– Need consensus approaches to specific use cases (IHE)
• Quantitative measurement intensive reporting with
DICOM SR inputs
– Mammo with CAD input, Obstetric with sonographer
measurements, Cardiac with functional assessments
– DICOM SR as primary report with PDF wrapped in CDA as
distributed version?
• Selected key measurements imported into report (loosely
coupled architecture)
– Similar to Key Image / Annotation workflow
– Possible push model of key measurements to RIS?
52
Conclusions
• CDA now viewed as a primary format for diagnostic
imaging reports
– Definition of CDA DI report to be done in 2007 by a
balloted HL7 Implementation Guide
– Method is extensible to reports with more structure
• 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 being profiled by IHE
– Does not require tight integration of imaging and reporting
workstations
53