Evolution of Image Sharing: A long and winding road

Elliot Silver, M.Sc.Senior Standards Analyst

Evolution of Image SharingProblem Statement

Radiology imaging has been independent of the primary electronic

patient record.

However, clinicians increasingly need access to the patient’s longitudinal record including clinical documents

as well as imaging.

Evolution of Image SharingFocus• DICOM

• XDS-I

• DICOMweb

• FHIR

• A Way Forward

Evolution of Image SharingDICOM®

• For medical imaging, the standard is DICOM (Digital Imaging and Communications in Medicine)

– Specialized file formats and network protocols for storing, querying, retrieving, and managing images and imaging workflows

– Targeted departmental imaging needs

– Requires DICOM-aware viewing systems

– Poor “ad hoc” viewing/sharing capabilities

– Largely independent of the HIS or EHR

DICOM is a registered trademark of the National Electrical Manufacturers Association

Evolution of Image SharingClassical DICOM sharing

• Print and Scan

– Source prints films; recipient may scan

• DICOM media

– CD, USB, etc.

• Reference Web Viewers

– DICOM-aware web applications, typically provided by PACS vendor

• Point-to-Point Sending

– Proprietary solutions to send imaging over the Internet

Evolution of Image Sharing

IHE Cross-Enterprise Document Sharing for Imaging (XDS-I)

• Based on IHE’s Cross-Enterprise Document Sharing (XDS) profile

• Images can be retrieved over web as JPEG, etc.

• Allows imaging to easily cross organizational boundaries

• Still requires consumer to be DICOM aware

Evolution of Image SharingDICOMweb• Additional DICOM capabilities based on popular RESTful paradigm

DICOMobject retrieve

DICOMobject storage

DICOMobject query

DICOMworkflow

WADO-RS STOW-RS QIDO-RS UPS-RS

Evolution of Image Sharing

HL7® FHIR® (Fast Healthcare Interoperable Resources)• Next generation standard from HL7

• Nearing second draft release (DSTU2);targeting normative release in 2017

• Modern, web-friendly design; focus on ease of implementation

• RESTful (plus others) model

• Feeling in community that FHIR will supplant HL7 v2 and v3 within 5-10 years

HL7 and FHIR are registered trademarks of Health Level Seven International.

Evolution of Image SharingHL7 FHIR Imaging Resources• Resources to represent key DICOM study

information (including image references) and selected images

• Image references are (WADO-RS) URLs

– No need to know DICOM to display images, etc.

• Imaging resources like other FHIR resources

– No need to know DICOM query or Key Object Selection file structure to find images

• Allows access to imaging by non-imaging aware applications

Evolution of Image SharingImaging-Integrated Health Record

Influence

How will integrating imaging influence care delivery cost and quality?

AccessWho will access this integrated record, and where?

IntegrateWhat does an integrated record look like?

Evolution of Image SharingThe Road Ahead

• The evolution of FHIR and DICOMweb are giving us a map.

• We are at a critical inflection point.

• As a community, we can define the road we take to integrated imaging.

Thank Youwww.mckesson.com

Elliot Silver, M.Sc.Senior Standards Analyst