DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM...
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Transcript of DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM...
DICOM Anniversary Conference, Monday, September 22, 2003, 1:30
p.m.
The History and Future of
DICOM and HL7
Behlen^Fred^M^^PhDAmerican College of Radiology
Co-Chair, DICOM Working Group 20
Co-Chair, HL7 Imaging Integration SIG
President, LAI Technology, Homewood, IL LAItechnology
1..1 1..1
Today’s talk• History
– What is HL7?– Other SDOs, early connections
• Now– Comparative organizational structures– Connections and collaborations
• Future– Common information models– Information objects and services– CDA and reporting– Congruence, not coalescence
Hospital Enterprise
Radiology
Exam context
Diagnostic Imaging in the
Patient Care Process
Hospital Enterprise
Radiology
Exam context
Results,Images
Diagnostic Imaging in the
Patient Care Process
Hospital Enterprise
Radiology
Exam context
Results,Images
Diagnostic Imaging in the
Patient Care Process
$, £, ¥, etc.
Administrative HIS/RIS
. . .
Medical Informatics
Scope ofDICOM
DiagnosticImaging
Lab Data
. . .
PatientBedside
Monitoring
Scope of Standards
Scope ofHL7
Disagreements in Healthcare
Origins ANSI
HISPP SCAMC (AMIA)
Harmonization SessionsHL7
ACR/NEMA
HISPP MSDS
CEN TC251
ANSI JWGDIC
ISIS
DICOM-HL7 relationship
1996 IMSIG formed1999 DICOM proposes joint WG2000 DICOM WG20 formed, meets in
common with IMSIG (renamed IISIG)2001 DICOM & HL7 execute Memorandum
of Understanding2003 HL7 Version 2.5 Order Message for
Imaging (OMI)
HL7• ANSI-accredited standards development
organization, formed in 1987• 16+ year old membership organization
– 512 organizations– 862 individual members
• 14 Technical Committees (TCs)• 17 Special Interest Groups (SIGs)• 22 international affiliates• A week of working group meetings 3 times
annually, about 400 people attending more than 25 parallel sessions and tutorials
2119 voting members(Nov. 2001)
HL7
• Special projects on drug information, adverse event reporting, genomic encoding, admin simplification, public health surveillance, practice guidelines, EHR and more
• Working relationships with ASTM, CEN, DICOM, ebXML, GEHR, IEEE, LOINC, OASIS, SNOMED, X12, W3C and others
WG6
DSC
WGxx
Board ofDirectors
TSC
TCs
SIGs
1n
11
1
1
1n 1
n
Work items
Ballots
Charters
Ballots
DICOM HL7
WG6
DSC
WGxx
Board ofDirectors
TSC
TCs
SIGs
1n
11
1
1
Work items,Policy
Ballots
Charters
Ballots
IISIGWG20. . . . . .
DICOM HL7
Policy
• Version 2.5 – Order Message for Imaging (OMI)
• Version 3– Representing DICOM Procedure Model– Messages for imaging orders and reports
• Clinical Document Architecture (CDA)– Transforming DICOM SR into CDA documents– Diagnostic reporting in CDA format
IISIG/WG20 Work Areas
OMI Message Use Case
OMImessage
used
OrderEntry
Imaging DepartmentInformation System
Imaging DepartmentInformation System
ImagingModality(Device)
ImagingModality(Device)
ImagingModality(Device)
Enterprise
Imaging Department
DICOM
Hierarchy in OMI message
Order[ORC-2 Placer Order Number] – [ORC-3 Filler Order Number]Imaging Service Request[IPC-1 Accession Number]
Requested Procedure 2[IPC-2 RequestedProcedure ID]
Requested Procedure 3[IPC-2 Requested Procedure ID]
Procedure Step 1[IPC-4 RequestedProcedure Step ID]
ProcedureStep 1[IPC-4RequestedProcedureStep ID]
ProcedureStep 2[IPC-4RequestedProcedureStep ID]
Requested Procedure 1[IPC-2 RequestedProcedure ID]
Procedure Step 1[IPC-4 RequestedProcedure Step ID]
HL7 Version 3• First HL7 standard based on explicit information model
(the “RIM”)• Uses automated tooling to manage complexity• Components
– Reference Information Model (RIM)– Clinical Document Architecture (CDA)– Version 3 Messaging
• Uses XML encoding• High degree of compatibility with DICOM• Extensive use of OIDs (cf. UIDs)• Will change I.S. market as much as DICOM 3.0 changed
imaging market, mostly through CDA
Communication
dog
Communication
dog
Patient
Visit
Study
Study ContentNotification
makes has
describes
includes
StudyComponents
Modality PerformedProcedure Steps
Comprisedof
Comprisedof
includes includes contains See Note
Results
contains
Report
LookupTable
StoredPrint
RadiotherapyObjects
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1 1 1
0-n
0-n0-n
1-n
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1
0-1
0-n
Series
Frame ofReference
creates
SpatiallyDefines
Equipment
1-n 1-n 1-n
1-n
1-n
0-1
1
Curve
Overlay
0-n
Image
Ammendment
0-n
contains
1
Patient& visit
Study &acquisition
Storeddata
Patient IOD
Visit IOD
Study IOD
Basic StudyDescriptor IOD
references references
describes
references
Study ComponentIOD
Modality PerformedProc. Step IOD
Comprisedof
Comprisedof
references references references See Note
Results IOD
references
Interpretation IODImage IOD
Standalone CurveIOD
Standalone OverlayIOD
Standalone ModalityLUT IOD
Standalone VOI LUTIOD
Stored Print IODSee Figure 7.2b
Radiotherapy IODsSee Figure 7.2c
1-n
1
0-n
1
1-n
1
1
1-n1
1
1-n
1-n
1-n
1 1 1
0-n 0-n
0-n0-n0-n
1-n
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0-10-n
Patient& visitIODs
Study &acquisitionIODs
StoreddataIODs
Message
Message
Mes
sage
Message
Mes
sage
Mes
sage
Message
Message
Referralauthorized_visits _qty : REALdesc : EDreason_txt : ED
Observation
value : ANYderivation_expr : STmethod_cd : SET<CV>target_s ite_cd : SET<CD>interpretation_cd : SET<CS>
Substance_administration
route_cd : CDdose_qty : IVL<PQ>rate_qty : IVL<PQ>dose_check_qty : SET<RTO>max_dose_qty : SET<RTO>approach_site_cd : SET<CD>substitution_cd : CV
Procedure
approach_site_cd : SET<CD>method_cd : SET<CV>target_site_cd : SET<CD>
Supply
qty : PQ
Dietenergy_qty : PQcarbohydrate_qty : PQ
Consent
Clinical_documentcompletion_cd : CVs et_id : IIs torage_cd : CVvers ion_nbr : INTcopy_time : TSchange_reason_cd : CV
Containercapacity_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseparator_type_cd : CDcap_type_cd : CD
Accessgauge_qty : PQapproach_site_cd : CDtarget_site_cd : CD
Devicemanufacturer_model_nm : STlast_calibration_tim e : TSs oftware_nm : STlocal_remote_control_state_cd : CEa lert_ level_cd : CE
Employee
hazard_exposure_txt : EDjob_class_cd : CVjob_title_nm : STprotective_equipment_txt : EDsalary_qty : MOsalary_type_cd : CVjob_cd : CE
Living_subject
birth_time : TSdeceased_time : TSdeceased_ind : BLadminis trative_gender_cd : CEorgan_donor_ind : BLmul tiple_bi rth_ind : BLbirth_order_nbr : INT
Material
form_cd : CVeffective_time : IVL<TS>
Assigned_practitioner
position_cd : CVprimary_care_ind : BL
Certified_practitionerboard_certification_type_cd : CVrecertification_time : TS
Place
gps_txt : STposition_txt : EDaddr : ADdirections_txt : EDmobile_ind : BL
Manufactured_material
expiration_time : TSlot_nm : STstability_time : IVL<TS>
Inpatient_encounter
length_of_stay_qty : PQ
Non_Person_living_subjecttaxonomic_class ification_cd : CEbreed_cd : CEstra in_txt : EDeuthanasia_ ind : BLproduction_class_cd : CEgender_s tatus_cd : CE
Patientconfidentiality_cd : CVvery_important_person_cd : CV
Organizationstandard_industry_class_cd : CEaddr : SET<AD>
Account
allowed_balance_qty : IVL<MO>currency_cd : CVin terest_rate_qty : RTOnm : ST
Qualified_practitioner
fellowship_field_cd : CEresidency_field_cd : CE
Financial_act
net_qty : MO
Persondisability_cd : CEethnic_group_cd : SET<CV>race_cd : SET<CV>ambulatory_status_cd : CVeducation_level_cd : CVliving_arrangement_cd : CVmarital_status_cd : CVreligious_affiliation_cd : CVaddr : SET<AD>special_accommodation_cd : SET<CV>mothers_maiden_nm : ST
Working_list
ownership_level_cd : CV
Public_health_case
detection_method_cd : CEtransmission_mode_cd : CEdisease_imported_cd : CE
Outbreak
time : IVL<TS>
Transportation
Patient_encounterdischarge_disposition_cd : CVacuity_level_cd : CVbirth_encounter_ind : BLstatus_reason_cd : CVvaluables_desc : EDpre_admit_test_ind : BLreferral_source_cd : CVspecial_courtesies_cd : CVvaluables_location_desc : EDadmission_source_cd : CVaccident_cd : CVurgency_cd : CV
Schedulable_resourceslot_size_increment_qty : PQ
Resource_slot
slot_time : GTS
Acts (Financial)
Acts (Services)
Infrastructure (Structured documents)
HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0110Version is basis for first committee-level ballots of Version 3. It was released July 2001, and reflects RIM changes through Harmonization on 07/20/2001
Billboard produced by:Rochester Outdoor Adv ertising
Roles
Guarantorcredit_rating_cd : CV
Diagnostic_image
subject_orientation_cd : CV
Imaging_modalitypixel_padding_qty : PQpixel_intensity_relationship_cd : CVspacial_resolution_qty : PQ
Query_ack
id : IIquery_status_cd : CVmessage_query_cd : CVresult_count_total : INTresult_count_current : INTresult_count_remaining : INT
Get_more_resultsquery_id : IIquantity : INTstart_result_nbr : INT
Query_message_interaction
Table
rules : CScellspacing : STcellpadding : STsummary : STwidth : STborder : INTframe : CS
Table_structure
halign : CSchar : STcharoff : STvalign : CSlocal_id : ST
Table_column_structure
span : INTwidth : ST
Table_cell
rowspan : INTcolspan : INTabbr : STaxis : STheaders : SET<ED>scope : CS
Link
Character_data
value : ST
Local_attr
name : STvalue : ST
Local_markup
ignore_cd : CSdescriptor : STrender : ST
Link_html
title : STname : SThref : EDrel : SET<CE>rev : SET<CE>
Entry
local_id : ST
0..1
0..*
contains0..1
is_contained_in0..*
Context_structure
local_id : ST
0..*
0.. 1
is_contained_in
0..*
c ontai ns
0.. 1
Infrastructure (Structured documents)
Infrastructure (Message control)
Enitites
Message Control
Covered_party
handicap_cd : CVstudent_ind : BL
Act_relationshiptype_cd : CSinversion_ind : BLsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS
Act_context
level_cd : CVlanguage_cd : CS
File_of_batchcontrol_ id : IIname : STcreation_tim e : TSreference_control_id : IIsending_appl ica tion_id : IIreceiving_application_id : IIsecurity : STfile_batch_count : INTfile_comment : SET<ST>
Act
id : SET<II>mood_cd : CSclass_cd : CStxt : EDstatus_cd : CSactivity_time : GTSeffective_time : GTSconfidentiality_cd : SET<CV>repeat_nbr : IVL<INT>interruptible_ind : BLpriority_cd : SET<CV>independent_ind : BLavailability_time : TScd : CDreason_cd : CVstatus_time : TS
0..*1
has_target
0..*
is_target_for
1
0..*1
has_source
0..*
is_source_for
1
1..*
0..*
originates_in_context_of
1..*
prov ides_context_f or
0..*
Attention_linekey_word_txt : STva lue : ST
Batch
control_id : IIname : STcreation_time : TSreference_control_id : IIsending_application_id : IIreceiving_application_id : IIsecurity : STmessage_count : INTbatch_totals : SET<INT>batch_comment : SET<ST>
0..10..*
contains
0..1
is_contained_by
0..*
Acknowledgementtype_cd : CVnote_txt : EDerror_detail_cd : CVexpected_sequence_nbr : INT
Message_interaction
message_type_id : IIresponse_cd : CS
Participation
type_cd : CStime : IVL<TS>note_txt : EDsignature_cd : CVfunction_cd : CDawareness_cd : CVsignature_txt : EDencounter_accommodation_cd : CVstatus_cd : CSmode_cd : CVsequence_nbr : INT
0..* 1
for
0..*
has
1
Relationship_link
effective_time : IVL<TS>type_cd : CS
Messagesending_application_id : IIid : SET<II>creation_time : TSinteraction_id : IIversion_id : STprofile_id : SET<OID>processing_cd : CVsequence_nbr : INTreply_to_com : TELreceiving_application_id : SET<II>processing_mode_cd : CVattachment_txt : EDaccept_ack_cd : CVapplication_ack_cd : CV
0..*1
c an_ac company
0..*
can_include
1
0..1
0..*
contains
0..1
is_contained_by
0..*
1..*
1
acknowledges1..*
is _acknowledged_by1
0..1
1
occurs_with0..1
has1
0 .. 1
0..*
is_communicated_as0 .. 1
has_payload0..*
Roleclass_cd : CSeffective_time : IVL<TS>id : SET<II>status_cd : CSposition_nbr : LIST<INT>qty : RTOcertificate_txt : EDaddr : SET<AD>telecom : SET<TEL>cd : CE
0..*1
has_as_participant
0..*
participates_in
1
0..*1
has_source
0..*
is_source_f or
1
0..*1
has_target
0..*
is_target_for
1
Entity
id : SET<II>class_cd : CSdeterminer_cd : CSimportance_status_txt : EDqty : SET<PQ>telecom : SET<TEL>desc : EDstatus_cd : CScd : CEnm : SET<EN>risk_cd : CEhandling_cd : CE
1..*
0.. *
shall_receive 1..*
h as_ re cipie nt
0.. *
1..1
0..*
sends 1..1
has_sender
0..*
0..*0 .. 1
played_by
0..*
pla ys
0 .. 1
0..*0 .. 1
is_scoped_by
0..*
scopes
0 .. 1
Language_communication
language_cd : CEpreference_ind : BLmode_cd : CVproficiency_level_cd : CV
10 ..*
communicates_with
1
used_by
0 ..*
Financial_transactionpayment_terms_cd : CVdebit_exchange_rate_qty : RTOcredit_exchange_rate_qty : RTOinterest_rate_qty : RTO
Invoice_elementitem_nbr : REALitem_qualifier_cd : CEgross_qty : MOcoverage_source_cd : CEunit_qty : RTOnotify_subject_ind : BLmodifier_cd : CEfactor_nbr : REALpoints_nbr : REAL
Financial_contract
paym ent_terms_cd : CV
Role_heirEntity_heir
Sort_control
element_name : STsequence_nbr : INTdirection_cd : CV
Querymessage_query_cd : CVid : IIpriority : CVmodify_indicator : CVexecution_and_delivery_time : TSin itia l_qty : PQres ponse_modality_cd : CVreturn_element_group : SET<CV>
0 ..* 1
is_for
0 ..*
has
1
Relational_expression
element_name : STvalue : STrelational_operator_cd : CV
Query_by_selection
Selection_expression
0..*
1
is_for 0..*
has_ex pression1
Logical_expression
relational_conjunction_cd : CV
1
0..*
has_left_side
1
is_lhs_for0..*
1
0..*
has_right_side
1
is _rhs_for0..*
Query_by_parameter
Parameter_list
Parameter
name : ST
0..*
1
is_parameter_of0..*
has 1
0..1
0..*
may_contain0..1
is_part_of
0..*
A_parameter
value : ANY
Device_task
param eter_value : LIST<ANY>
Entity Role Participation Act
Message Control
Document Structures
Imaging Order R-MIM
Entity
Act
Participation
Act Relationship
Role CMET (Common Message Element Type)
The HL7 Clinical Document
Architecture (CDA)• CDA header– RIM-derived– Ground up compatibility with DICOM SR
• CDA Level One body– Based on subset of XHTML, fits any report type– Has image link, coded vocabulary
• CDA Release 2 body– Permits data representation at various levels of
granularity– Passed first Committee ballot August 2003– Member ballot March 2004
HL7 Clinical Document
Architecture (CDA)• Level 1– Coded header, text content with simple
formatting objects(section, paragraph, list, table)
• Level 2– Standard codes for Level 1 sections
• Level 3– Full structured content derived from RIM
HL7 Clinical Document Architecture (CDA) Release 2• Release 1
– Coded header, text content with simple formatting objects(section, paragraph, list, table)
• Release 2– Standard codes for Level 1 sections
– Full structured content derived from RIM
Release 2 CDA• Release 2, Level One:
– alignment with current RIM, V3 methodology
– minor enhancements to CDA Header– added functionality for CDA Body
• Region of interest (cf. DICOM SCOORD)
• Release 2, Levels Two and Three– templates layered on basic XML spec
• Level Two: templates for headings• Level Three: templates for contents
– enables detailed clinical encoding
CDA Implementations• National & International
– PICNIC (European Union)– SCIPHOX (Germany)– HYGEIAnet/WebOnColl (Greece)– NHS South Staffordshire (United Kingdom)– Satakunta Macro Pilot (Finland)– e-Claims Supporting Document Architecture (Canada)
• Local & Regional– Mayo Clinic (USA)– Buenos Aires project (Argentina)– Dalhousie U, QEII Health Sci Ctr (Canada)
HL7 Templates
• Joint project of Templates SIG, Structured Documents TC, Conformance SIG
• Open template registry/repository– will contain normative and non-normative
templates• Tools for generating and validating
templates will be developed• This will take a while
A Number of Connections
• WG20 / IISIG Other HL7 groups– Technical Committees
• Orders & Observations• Vocabulary• Structured Documents• Laboratory Automation and Point of Care Testing• Patient Care• Control/Query
– Special Interest Groups• Conformance• Electronic Health Records (EHR)• Security & Accountability• Templates
More Connections
• WG14 SASIG NEMA SPC IHE
• IHE Conformance SIG
• DICOM ISO @ HL7 venues– WG10 TC215/WG2
– WADO TC215/WG2• Also WADO Structured Documents TC
A Rewarding Partnership
• No big turf issues– DICOM doesn’t want to define enterprise
communications– HL7 has no ambition or bandwidth to model
specialty domain detail
• Each can learn from the other– DICOM experience with persistent objects– HL7 experience with modeling tools
• HL7 meetings are a good gathering place