DICOM and IHE, Integrating the Healthcare Enterprise Cor Loef Co-chair DICOM Strategic Advisory...
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DICOM and IHE, DICOM and IHE, Integrating the Integrating the Healthcare Enterprise Healthcare Enterprise Cor Loef Co-chair DICOM Strategic Advisory Committee Member IHE Planning and Technical Committee Cor Loef Program Manager Interoperability Philips Medical Systems
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DICOM and IHE,DICOM and IHE,Integrating the Healthcare Integrating the Healthcare
EnterpriseEnterprise
Cor Loef
Co-chair DICOM Strategic Advisory Committee
Member IHE Planning and Technical Committee
Cor Loef
Program Manager Interoperability
Philips Medical Systems
May 5, 2002 2
Contents
• Goal of IHE
• IHE process
• Integration Profiles and the role of standards in IHE
• DICOM’s use in the IHE Integration Profiles
• Current topics
• Questions and answers
May 5, 2002 3
Integration Hell in the Enterprise
Integration Hell in the Enterprise
• Different information islands: Modalities, PACS, HIS, RIS, EPR
• Different standards and information models : DICOM, HL7, XML
• Different (proprietary) interpretations and implementations
• Different information islands: Modalities, PACS, HIS, RIS, EPR
• Different standards and information models : DICOM, HL7, XML
• Different (proprietary) interpretations and implementations
EPR
PACSRIS /
HIS
Modalities
May 5, 2002 4
Goal of IHE
It’s an initiative promoting and supporting the integration of systems in the healthcare enterprise
Integration Goal: Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow Advanced Multi-System Functions With minimal “integration project pain”
May 5, 2002 5
IHE process
• Users and vendors work together to identify and design solutions for integration problems
• Intensive process with annual cycles:– Identify key workflows and integration problems– Research & select standards to specify a solution– Write, review and publish Technical Framework– Perform cross-testing at “Connectathon”– Demonstrations at tradeshows:
RSNA/HIMSS, and also JFR, DRK, JMCP
May 5, 2002 6
ImageServer
CDExchange
Diagnostic Workstation
Connection to other Network
and/or TeleRadiology
Web Distribution
Modalities
The (multi-vendor) Integrated Imaging Solution
Radiology Information
System
May 5, 2002 7
Role of standards in IHE• IHE attacks real world radiology integration
problems
• Standards such as HL7 and DICOM provide dictionaries
• IHE defines a “phrasebook” that solves real world problems by assembling pieces provided by DICOM/HL7
• IHE is also a way to promote and advance the implementaion of standards
May 5, 2002 8
IHE: Relation to Standards
DICOMDICOM HL 7HL 7
IHEIHE Technical FrameworkTechnical Framework
Selection of options
IntegrationIntegrationSolutionSolution
AA
BB
CC
CommonCommoninformationinformation
modelmodel
May 5, 2002 9
Use Case Roles & Interaction Diagrams
Actor 1 Actor 2
TRANSACTIONS
Actor 3
Actor 1 Actor 2 Actor 3
Message 1Message 2
Message 3
• Examples of Actors:Examples of Actors:- ADT / Patient RegistrationADT / Patient Registration- Acquisition ModalityAcquisition Modality
• Examples of Transactions:Examples of Transactions:- Register PatientRegister Patient- Images StoredImages Stored
May 5, 2002 10
• Goal of IHE
• IHE process
• Role of standards in IHE
• DICOM’s use in the IHE Integration Profiles
• Current topics
• Questions and answers
May 5, 2002 11
IHE Integration Profiles
• Integration solution for real-world integration problems
• Set of related transactions among systems
• Allow buyers to focus on high-level integration, cornerstone for defining requirements in RFP’s
• Implementation is defined by the IHE Technical Framework
May 5, 2002 12
Year 4 Integration Profiles
Access to Radiology InformationConsistent access to images and reports
Consistent Presentation of Images
Hardcopy and softcopy grayscale presentation state
Key ImageNotes
Flag significant images
Simple Image and Numeric Reports
Simple reports with image links and, optionally,
measurements
Basic SecurityAudit Trail Consolidation & Node Authentication
Presentation of Grouped Procedures
Subset of a single acquisition
Post- Processing Workflow
Schedule, perform, & notify image processing
& CAD steps
Charge Posting
Collection of billable procedure details
Scheduled Workflow
Admit, order, schedule, acquire images, notify of completed steps
Patient Information Reconciliation
Unknown patients and unscheduled orders
May 5, 2002 13
imagesstored
Filmimagesprinted
reportRegistration
patientinformation
Orders Placed
RISexamination orders
Orders Filled
imagesretrieved
FilmFolder
ReportRepository
HIS
Image Managerand Archive
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
Patient and procedureinformation retrievedby the modality
Modality
DiagnosticWorkstation
report
report
acquisitionin progress
acquisitioncompleted
acquisitioncompleted
1.Scheduled Workflow
FilmLightbox
DICOM:• Modality Worklist Query Requirements, with Acquisition Protocol Setting option• Required attribute mapping from Worklist to Images• Modality Performed Procedure Step, with Exception Management option • Store•Storage Commitment
May 5, 2002 14
updatepatient info
updatepatient info
updatepatient images
Patient lateridentified -enter properdata
Registration
examination ordersfor J Doe
Orders Placed
HIS
imagesretrieved
acquisitioncompleted
acquisitioncompleted
J Doeimagesstored
J Doe
Enter patientas J Doe
EmergencyRegistration
Orders Filled
Image Managerand Archive
modality worklistfor J Doe
Modality
PACS
Reports storedfor Network
Access
RIS
Images and Examdata presented for
diagnosis
report
2. Patient Information Reconciliation
May 5, 2002 15
What the Radiologist What the Radiologist Displays:Displays:
What the Reviewing What the Reviewing Physician Sees:Physician Sees:
The Radiologist’s Transformations Are
Saved
Original Image& Presentation State&Grayscale Standard
Original Image
Window Level
Flip
Zoom
Area Of
Interest
Annotate
The Radiologist’s Transformations Are
Lost
Original Image
Area Of
Interest
Prepared Image
Original Image
3. Consistent Presentation of Images
May 5, 2002 16
MODALITY
4. Presentation of Grouped Procedures
Requested Procedure:
HEAD
Report:HEAD
Report:CHEST
Performs a single exam
Operatorgroups
2 procedures
Head Head ViewView
RIS / PACS
Requested Procedure:
CHEST
Head Head ViewView
Chest Chest ViewView
Chest Chest ViewView
DICOM:• Presentation State• Modality Performed Procedure Step
May 5, 2002 17
Report Verification
Goal:Accurate, complete reportaccessible whenever the
referring physician desires
Report and ImageReview for Patient Care
Images retrieved
Verified Report
Report & Images retrieved
Preliminary Report
Report stored for Network Access
Image Managerand Archive
Images and Examdata presented fordiagnosis
5. Simple Image and NumericReport
DICOM:• Basic Text SR• Enhanced SR• Template TID 2000• Codes from DCMR
May 5, 2002 18
RadiologistRadiologistFlags Images:Flags Images:
Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:
for refering physicianThis image showsthe renal rupture.
Note1
for refering physicianThis image has the hematoma.
Note2
For referringphysician:This image showsthe renal rupture.
Note1
For referring physician:This image hasthe hematoma.
Note2
for refering physicianThis image showsthe renal rupture.
Note1
for refering physicianThis image has the hematoma.
Note2
Study & Key Image Notes
6. Key Image Notes
DICOM:• Key Object Selection Document SOP Class
May 5, 2002 19
7. Access to Radiology Information
Radiology Department – Images and
Reports
Emergency Department
Referring Physician
Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.
Remote Clinics
Electronic Medical Record
DICOM:• C-FIND with required matching and return keys• C-MOVE• Images and SR
May 5, 2002 20
8. Charge Posting
DSS/Order Filler
AcquisitionModality
PPS In Progress/Completed
Charge Processor
ReportingCompleted
ReportManager
Charge Posted
ADT
Account Management
DICOM:• required billing info in MPPS
• Film consumption• Procedure Type• Supplies and devices
May 5, 2002 21
9. Basic Security
System A System B
Secured SystemSecure network
• Strong authentication of remote node (digital certificates)• network traffic encryption is not required
Secured System
• Local access control (authentication of user)
• Audit trail with:• Real-time access • Time synchronization
Central Audit TrailRepository
DICOM:• Basic TLS Secure Transport Connection Profile• well-known port 2762
May 5, 2002 22
10. Post-Processing Workflow
Post-Processing Manager
ImageCreator
PP worklistProvided
PP Workitem ClaimedPP Workitem Completed
PP PPS StartedPP PPS CompletedDICOM:
• General Purpose Worklist • Images• Evidence Documents:
• Mammography CAD SR • Basic Text SR• Enhanced SR• Comprehensive SR
May 5, 2002
AcquisitionModality
Image Manager
Department Scheduler/ Post-Processing Manager Image Creator
MPPS CompleteCreate Worklist Item
Query/ Retrieve Images
Post-Processing Task Claimed
Post-Processing PPS Started
Post-Processing Task Completed
Creator Images Stored
Post-Processing WL Provided
Store Images
Post-Processing PPS Completed
10. Post-Processing Workflow:use case
May 5, 2002 24
• Goal of IHE
• IHE process
• Integration Profiles and the role of standards in IHE
• DICOM’s use in the IHE Integration Profiles
• Current topics
• Questions and answers
May 5, 2002 25
• Reporting workflow
• Security Standard for Audit Records
• Extension to other clinical domains: Cardio, NM
• Desktop Integration
Current topics
May 5, 2002 26
Integration: back-office and/or front-office
messagesmessages
ClinicalClinical
InformationInformation
SystemSystem
ClinicalClinical
InformationInformation
SystemSystem
Back-Office
IntegratedIntegrated
Clinical ViewingClinical Viewing
at the desktopat the desktop
Front Office
EfficiencyEfficiency
ImproveImproveClinicalClinical
DecisionsDecisions
May 5, 2002 27
A Federated System of Context-Managed Applications
CCOW approach
May 5, 2002 28
Integration:the EPR approach
Electronic Patient Record
Radiology
PACS
Cardiology
PACS
VL, US, NM
PACS
HIS
RIS
OtherClinicalSystem
Web Viewers
Webserver
Report Type:Findings:
Conclusions: Ima
g
e
R
e
f
s
.
:
Header::ThoraxThorax……....……....……....MassMass……....…….... Daim.Daim.Infiltr.Infiltr.
……....……....(Poi
n
t
e
r
)
URL / URI?
May 5, 2002 29
Questions?Questions?
DICOM and IHE,DICOM and IHE,Integrating the Healthcare Integrating the Healthcare
EnterpriseEnterprise
