Transcript BehlenSolomon_Slides_05

RSNA 2005 – infoRAD
Defining Clear and Complementary Roles for
HL7 CDA (Clinical Document Architecture)
and DICOM SR (Structured Reporting)
in Diagnostic Reporting
Fred M. Behlen, PhD
Harry Solomon
American College of Radiology
GE Healthcare
Co-Chair, DICOM Working Group 20 & HL7 Imaging Integration SIG
Co-Chair, HL7 Structured Document TC
Co-Chair, DICOM Working Group 1
Co-Chair, IHE Cardiology Technical Committee
President, LAI Technology, Homewood, IL
Disclosure
• Fred Behlen
– Employee, LAI Technology (Laboratory
Automation Inc.)
• Shareholder, Director, Officer
• Partner, Migratek Data Migration Services
• Consultant, XStor Medical Systems
• Harry Solomon
– Employee, GE Healthcare
2
Acknowledgements
• Bob Dolin, Liora Alschuler, Calvin Beebe – co-chairs
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
3
Objectives
• Understand the HL7 CDA (Clinical Document
Architecture) and its use cases
• Understand DICOM SR (Structured Reporting)
and its use cases, including Key Image Notes,
Evidence Documents and CAD (Computer
Aided Diagnosis) results
• Understand the workflows for reporting, and the
appropriate places for DICOM SR and HL7 CDA
in those workflows
• See example implementation scenarios
4
HL7
Clinical Document Architecture
Overview
5
HL7 Clinical Document
Architecture
• The scope of the CDA is the standardization of clinical
documents for exchange.
• A clinical document is a documentation 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.
6
CDA History
• 1996 – initial discussions
• 1997 – HL7 SGML SIG
– Use of Standard Generalized Markup Language for adding metadata to
documents
– Later evolved to Extensible Markup Language (XML) subset of SGML
– Kona Editorial Group
• 1998 – Patient Record Architecture draft
• 2000 – Clinical Document Architecture Release 1 adopted
– Limited to “level 1”
• 2000 – SIG becomes HL7 Structured Documents Technical
Committee
• 2005 – Clinical Document Architecture Release 2 adopted
– Expanded to “levels 2 & 3”
7
CDA Use Cases
• Diagnostic and therapeutic procedure
reports
• Encounter / discharge summaries
• Patient history & physical
• Referrals / prescriptions
• Uniform format for all clinical documents
8
Key Aspects of the CDA
• CDA documents are encoded in Extensible Markup
Language (XML)
• CDA documents derive their meaning from the HL7
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)
9
CDA Standard
• Release 1 (2000)
– Standalone standard
– Based on draft v3 RIM
– Level 1 narrative and multimedia
• Release 2 (2005)
– Incorporated into HL7 v3 Standard (Normative Edition
just published on CD)
– Level 2 narrative and multimedia, plus coded statements
• Implementation Guide for Care Record Summaries,
US Realm (currently in ballot)
10
CDA Release 2
Information Model
Header
Participants
Start
Here
ID/
Type
Body
Context
Sections/
Headings
Clinical Statements/
Coded Entries
Extl
11
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
12
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
13
Sample CDA
14
Narrative and Coded Info
• CDA 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
15
Narrative and Coded Entry
Example
16
DICOM
Structured Reporting
Overview
17
DICOM Structured Reporting
• The scope of DICOM SR is the
standardization of documents in the imaging
environment.
• SR documents describe or reference images,
waveforms, or specific regions of interest.
18
SR History
•
•
•
•
•
1994 – initial discussions
1995 – Working Group 8 (Structured Reporting)
1998 – Supplement 23 Structured Reporting draft
1999-2000 – Supplement 23 adopted
2001 – Supplement 53 DICOM Content Mapping
Resource adopted
• 2001-2005 – 12 Supplements defining specific SR
document templates
19
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
20
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
21
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 use of coded content
– Allows use of vocabulary/codes from non-DICOM sources
• Templates define content constraints for specific
types of documents / reports
22
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
23
DICOM SR Objects
• Basic Text
– Narrative text with image references
• Enhanced and Comprehensive
– Text, coded content, and numeric measurements, spatial and
temporal ROI references
• Mammo CAD and Chest CAD
– Automated analysis results
• Key Object Selection (KO)
– Flags one or more images or waveforms with purpose (for
referring physician, for surgery …) and textual note
– Used for key image notes and image manifests (in IHE profiles)
• Procedure Log
– For intravascular / cardiac cath
24
Radiology Reporting
25
Reporting Integration
• Should be high priority
– Economic importance of radiologist
productivity
– Referring physicians (radiology’s customers)
want to see key images
• But, still mostly served by proprietary and
custom integration
26
Reporting integration includes:
• Workflow
– Managing interpretation worklists
– Providing orders and relevant clinical information
– Automatically displaying appropriate images and relevant
priors
• Annotation and measurements
– Key images
– Markings, measurement calipers and other graphical
annotation
– Measurements acquired in the imaging procedure
• Structured reporting
• Narrative reporting
27
The all-DICOM solution
• DICOM SR, along with General Purpose Worklist, was
supposed to take care of all this.
• DICOM SR has found vital uses in key subspecialty areas
that produce structured data in the examination or postprocessing
– Cardiology, both Cath Lab and Echo
– Fetal biometry in ultrasound
– Computer Aided Detection/Diagnosis results
These SR documents are not necessarily part of the
patient’s medical record, but are part of the Evidence Data.
28
“Evidence” and “Reports”
• Evidence Documents
– Include ultrasound measurements, cath lab procedure logs, ComputerAided Diagnosis results, etc., that are created in the imaging context
– Together with images, are part of the information that a radiologist
uses to produce a report
– The reporting physician may quote or copy parts of Evidence
Documents into the report, but doing so is part of the interpretation
process at the reporting physician’s discretion
– Appropriate to be stored with the images as DICOM SR objects
• Reports
– Become part of the patient’s medical record, with potentially wide
distribution
– Ideal match to HL7 CDA; structured/coded data requires CDA
Release 2
29
Reporting is RIS Turf
• Diagnostic reporting continues in the province of
information systems that are based primarily on
Health Level Seven (HL7) standards.
• Even if diagnostic reports were created as DICOM
SR objects, the end recipients of diagnostic reports –
referring physicians – commonly use systems with
HL7 rather than DICOM capabilities.
30
DICOM-HL7 Synergy
• 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
• In 2000 DICOM groups were already looking to CDA as a
format for exporting DICOM SR content
– Proposal to translate SR documents into CDA, but would have to wait (a
long time) for Release 2 Level 3 of CDA
31
DICOM Interest in CDA
• Use cases for varying types and purposes of diagnostic
reporting elaborated at the DICOM 2002 Symposium.
• March 2003: DICOM Working Group 10 (Strategic Advisory)
suggested composing the reports directly in CDA format.
• Standards solutions were considered against the use cases, and
gaps were identified and subsequently closed through
extensions to the standards.
• The efforts have included:
– discussions in many working groups of DICOM
– continued cooperation with the HL7 Structured Document Technical
Committee, which edits the CDA
– the issuance of DICOM Supplement 101 (HL7 Structured Document
Object References)
– CDA Implementation Guide for Diagnostic Reports [2006]
32
Standards Now Ready
• CDA Release 2 is now published [2005], and all
needed standards are now in place.
• Additions to DICOM in Supplement 101
– Enable reference to CDA documents from within
DICOM objects
– Include CDA documents on DICOM removable disks
• Indexed in DICOMDIR for integration with DICOM storage
systems
– Communicate simple image references and annotation
from PACS to reporting systems without requiring close
integration of the two systems
33
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
34
Reporting with annotation
Image Viewing
Reporting
(use
case)
Application
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
35
Reporting with annotation
Image Viewing
Reporting
(available)
Application
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 36
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
37
Loosely integrated reporting
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 38
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 39
Image Viewing Application
Image
selection
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
Annotation
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
DICOM
KO object
“For Report”
Image Archive
(DICOM SCP)
WADO
Server
Reporting System
Validation Functions
DICOM Query/Retrieve for
all KO objects matching
Accession Number
DICOM references
to Images & GSPSs
WADO URI references
to Images with GSPSs
Reporting
Integration
Functions
SR
Report
CDA
Report
CDA Implementation Guides
• Balloted as HL7 Informative Documents
• Describe what amount to “templates” for CDA
Documents.
– Specify constraints on CDA content
– Provide Schematron validation of instances
– Each Implementation Guide has a Template ID attribute
that is included in the root element of the conforming
document
• Care Record Summary IG being balloted
• WG20/IISIG is preparing an IG for Diagnostic
Imaging Reports
41
Conclusions
• CDA now being seen as primary format for diagnostic reports
– Supp 101’s definition of SR report and its equivalent CDA is most
practical at this time, though the CDA structure is not normative text
in DICOM
– Direct definition of CDA report to be done in 2006 by a balloted HL7
Implementation Guide
– Does not require tight integration of imaging and reporting
workstations
– 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
– Work under way for formalizing Evidence Documents as a separate
object class in DICOM
42