1

High Level Health IT (HIT) Standards for Ophthalmologists worldwide

DICOM : the comprehensive ifa Solutions(Digital Imaging and Communication in Medicine)

2

Overview

Introduction and DICOM in ophthalmology

The ifa DICOM solutions

DICOM connectivity with hospital level (HIS/PACS)

DICOM connectivity with modality level (ophthalmic equipment)

1

2

3

4

5

DICOM Quick Specifications for the specialists

Projects with DICOM solutions

Conclusion

6

7

8

3

Introduction and DICOM in Ophtalmology

• DICOM (Digital Imaging and Communication in Medicine) is the most comprehensive open standard in Health IT. DICOM covers digital management of images and related objects: http://medical.nema.org/dicom/geninfo/Strategy.pdf

• DICOM is defined e.g. as the official standard for images and related objects by the US Government. Within IHE(Integrating the Healthcare Enterprise) DICOM covers essential format and work flow components.

• DICOM plays an important role for IT in ophthalmology. The DICOM work group 9 (WG 9) works dedicated to ophthalmology and optometry since 1996. The WG 9 is supported and coordinated by the AAO.

4

The ifa DICOM portfolio

Connectivity is most important for Health IT (HIT) in ophthalmology

The 3 DICOM solutions in the ifa portfolio:

• PREMIUM EMR with the complete DICOMmodules (hospital and modality levels)

• ecPACS the DICOMconnectors between EMRand ophthalmic devices

• net4eyes the back office solution for DICOMservices

5

SOP Classes Images + PDF(1.2.840.10008.5.1.4.1.1)

Secondary Capture Image Storage (7)

VL Photographic Image Storage (77.1.4)

Ultrasound Image Storage (6.1)

Ultrasound Mult-Frame Image Storage (3.1)

Ophthamic 8 bit Photography Image Storage (77.1.5.1)

Ophthalmic Tomography Image Storage (77.1.5.4

Encapsuled PDF Storage (104.1)

Service Object Pairs (SOPs) are Message Service Elements (DIMSE) and Information Object Definition (IOD)

All important Data Objects in Ophthalmology are covered

SOP Classes Ophthalmic Modalities 1.2.840.10008.5.1.4.1.1)

Lensometer Measurements (78.1)

Autorefraction Measurements (78.2)

Keratometry Measurements (78.3)

Subjective Refraction Measurements (78.4)

Visual Acuity Measurements (78.5)

Spectacle Prescription Report (78.6)

6

All in One: the complete portfolio

Images and Instrument Data “All in One” System

The interfaces are based on international standards:

• HL7 to connect Hospital Information Systems

• DICOM to integrate all kind of image systems and laser diagnostic devices

• IHE approved

The Electronic Medical Record: PREMIUM EMR

The paperless hospital: DICOM plays a central role with all related SOPs

IHE Eye Care: Integrating the Healthcare Enterprise

Connectivity with Hospital Level

Product quick facts

– Product name: ifa DICOM Gateway

– First release date: November 2013

– Number of installations: 2

– Product status: Active

– Based on IAG 3rd generation DICOM Connection Module, MultiTech DICOM SDK and LeadTools File Codecs V17 using .Net Framework 3.5x and C++ V10

– Fully integrated into ifa Core

– Executed via Scheduled Tasks

Product Features

Patient Demographics Import• DICOM Modality Worklist can be used to establish a patient

with the ifa Patient Demographics module. This feature is used if the HIS Patient Demographics Provider cannot be configured to only communicate Ophthalmic department related patients. As the patient demographics information received via the DICOM Modality Worklist are not complete the ifa HL7 Patient Demographics Consumer can be configured to ignore patients not established via the DICOM Modality Worklist interface but only update patients already existing in the Demographics DB with all data available from the ADT message.

DICOM Instance Management

If the PACS provides DICOM Study level related information like Accession Nr. and Study Instance UID through the DICOMModality Worklist (MWL)these data are stored by the DCMInstance Management Module.

If the data are missing the module is creating the data on the fly. These data are used later creating the IOD if transferring information to the PACS (together with patient demographics data and Scheduled Procedure Step data).

Workflow Management and DocumentExport

Workflow Management (not yet available)

• If the PACS provides Scheduled Procedure Step information through the DICOM Modality Worklist these data are interfaced with the ifa Workflow Management Module

Document Export

• The app check for changes with the File DB and creates for each new/updated document the corresponding IOD by combining the image or PDF data taken from the document file with data from Patient Demographics, Workflow Mgt. and DICOM Instance Mgt. DBs and uploads the resulting IOD to the PACS.

Connectivity with Modality Level

Product quick facts

– Product: ifa CCS Gateway

– First release date: July 2009

– Number of installations: 5

– Product status: In Transition (needs to be migrated to IAG3rd generation DICOM Connection Module)

– Based on IAG 2nd generation DICOM Connection Module, MultiTech DICOM SDK, using .Net Framework 3.5x and C++ V10

– Mostly integrated into ifa framework

– Executed via Windows Services

Product features and Workflow Management

Patient Demographics Export

• The app uses the Modality Worklist to provide devices with a copy of the patient demographics data from the Patient Demographics DB.

Workflow Management

• The app provide orders to devices based on a flexible configuration linking devices/device groups with Workflow Management Slots/Grouped Slots. The device operator can ask the Application Modality Importer (AMI) software/Device Software to display a Worklist Dialog which shows the patients/orders scheduled for the specific device or for the device group the specific device is contained.

Document Import and Workflow Advance

The app can import results of the device operation into the File DB. The device operator can select the documents related to a patient/order (see Worklist Dialog with Workflow Management description) and ask the Application Modality Importer (AMI) software/Device Software to use the Storage service to upload the data to ifa.

If configured the app will mark the Workflow Management Workflow Step related to the Worklist order related to the document upload as done and has Workflow Management advancing the workflow.

Connectivity with PACS

Product quick facts

– Product: ifa DICOM Query-Retrieve Interface and DICOMDocument Viewer

– First release date: October 2011

– Number of installations: Demonstrator for IHE events (AAO)

– Product status: pilot version

– Based on IAG 3rd generation DICOM Connection Module, MultiTech DICOM SDK, using .Net Framework 3.5x and C++ V10

– Executed via Windows Services

Connectivity with a PACS (e.g. Multispecialty)

DICOM Quick Specifications (1)

• Generell– Supported Transfer Syntaxes

• Verification– Supported SOP Classes

Transfer Syntax Name Transfer Syntax UID Role

LittleEndianImplicit 1.2.840.10008.1.2 SCU/SCP

LittleEndianExplicit 1.2.840.10008.1.2.1 SCU/SCP

BigEndianExplicit 1.2.840.10008.1.2.2 SCU/SCP

SOP Class Name SOP Class UID Role

Verification 1.2.840.10008.1.1 SCU/SCP

DICOM Quick Specifications (2)

• Modality Worklist (C-Find)– Supported SOP Classes

• Retrieve / Send Documents (C-Store)– Additional supported Transfer Syntaxes (Image IODs)

SOP Class Name SOP Class UID Role

Modality Worklist Information Model - Find 1.2.840.10008.5.1.4.31 SCU/SCP

Transfer Syntax Name Transfer Syntax UID Role

JpegBaseline 1.2.840.10008.1.2.4.50 SCU/SCP

Jpeg2kLossless 1.2.840.10008.1.2.4.90 SCU/SCP

Jpeg2kLossy 1.2.840.10008.1.2.4.91 SCU/SCP

DICOM Quick Specifications (3)

• Retrieve/Send Documents (C-Store)– Supported SOP Classes Images IODs

SOP Class Name SOP Class UID Role

Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7 SCU/SCP

VL Photographic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.4 SCU/SCP

Ultrasound Image Storage 1.2.840.10008.5.1.4.1.1.6.1 SCU/SCP

Ultrasound Multi-frame Image Storage 1.2.840.10008.5.1.4.1.1.3.1 SCU/SCP

Ophthalmic 8 bit Photography Image Storage 1.2.840.10008.5.1.4.1.1.77.1.5.1 SCU/SCP

Ophthalmic Tomography Image Storage 1.2.840.10008.5.1.4.1.1.77.1.5.4 SCU/SCP

DICOM Quick Specifications (4)

• Retrieve/Send Documents (C-Store)– Supported SOP Classes other IODs

SOP Class Name SOP Class UID Role

Encapsulated PDF Storage 1.2.840.10008.5.1.4.1.1.104.1 SCU/SCP

Lensometry Measurements LEN 1.2.840.10008.5.1.4.1.1.78.1 SCU/SCP

Autorefraction Measurements AR 1.2.840.10008.5.1.4.1.1.78.2 SCU/SCP

Keratometry Measurements KER 1.2.840.10008.5.1.4.1.1.78.3 SCU/SCP

Subjective Refraction Measurements SRF 1.2.840.10008.5.1.4.1.1.78.4 SCU/SCP

Visual Acuity Measurements VA 1.2.840.10008.5.1.4.1.1.78.5 SCU/SCP

Spectacle Prescription Report 1.2.840.10008.5.1.4.1.1.78.6 SCU/SCP

DICOM Quick Specifications (5)

• Query Documents (C-Query)– Supported SOP Classes

• Request Documents (C-Move)– Supported SOP Classes

SOP Class Name SOP Class UID Role

Patient Root Query/Retrieve Information

Model – Find

1.2.840.10008.5.1.4.1.2.1.1 SCU

Study Root Query/Retrieve Information

Model – Find

1.2.840.10008.5.1.4.1.2.2.1 SCU

SOP Class Name SOP Class UID Role

Patient Root Query/Retrieve Information

Model – Move

1.2.840.10008.5.1.4.1.2.1.2 SCU

Study Root Query/Retrieve Information

Model – Move

1.2.840.10008.5.1.4.1.2.2.2 SCU

Conclusion

Health IT Investments are Matter of Trust

The first ifa company for IT in eye care was founded 1984 in Cologne/Germany. Since more than 30 years the ifa product specialists develop, distribute andsupport IT connectivity tools worldwide.

The ifa portfolio covers basic back office interface suites and also completeEMR systems dedicated to ophthalomolgy.

DICOM is an integral part of the ifa product concept since 1996. Together withthe complementary HL7 components the IHE world can be implemented withthe structured ifa product and service portfolio.

How to get started?

The first step is a detailed system and project analysis (see project profile).

Based on the project profiles with detailed information about the modalities (equipment) and HIS infrastructure ifa provides the cost estimation with all technical specifications.

The cost estimation can be based on a license purchase model or on a „RAS“ Rent A Software concept.

The final contract specifies the project plan based on QM driven processes (ISO 9001) and the related DICOM Conformance Statement.

The ifa DICOM solutions are covered by connectivity guarantees for the future. The interface list 2015 offers connectivity for more than 450 modalities in eye care.

The ifa product specialists are active members of DICOM WG9 and the IHE committee.

The ifa group offers DICOM solutions worldwide

DICOM Glossary

Code/Text Description

AAO American Academy for Ophthalmology, DICOM Sponsor WG 9

AMI Application Modality Importer

DIMSE DICOM Message Service Element

HL7 Health Level 7 (HL7 and DICOM are both IHE related Health IT Standards)

IHE Integrating the Healthcare Enterprise

IOD Information Object Definition

Modality Medical Device in the DICOM Dictionary

MWL Modality Worklist

NEMA National Electric Manufactorers Association, official DICOM coordinator

PACS Picture Archive and Communication System

SCP Service Class Provider

SCU Service Class User

SOP Service Object Pair

WG9 DICOM Workgroup 9 Ophthalmology (coordinated by AAO)

VL Visible Light (Term for traditional Photography, e.g. Fundus Photos)

Thank you and please reviewfurther information