IHE Radiology –2007What IHE Delivers 1 Christoph Dickmann IHE Technical Committee March 2007 Cross...

1IHE Radiology –2007 What IHE Delivers

Christoph DickmannChristoph Dickmann

IHE Technical CommitteeIHE Technical Committee

March 2007March 2007

Cross Domain Review Cross Domain Review PCCPCC

2IHE Cross-Domain ReviewIHE Cross-Domain Review

PCC - overviewPCC - overview


Domains used in PCCDomains used in PCC

IT Infrastructure XDS, XDM, XDR, NAV, ATNA, CT XDS-SD


IHE PCC Integration Profile IHE PCC Integration Profile Cross-enterprise Sharing of Medical Summaries (XDS-MS)Cross-enterprise Sharing of Medical Summaries (XDS-MS)

Cross-enterprise Sharing of Medical Summaries

Defines a summary of patient data in narrative and/ or structured way that is used when transferring the patient from one care provider to another one for- general / specific audience - focused / broader range of patient problems.


XDS-MS FeaturesXDS-MS Features

An XDS content profile Uses & constraints the CDA R2 Care Record Summary (CRS)

implementation guide Render CDA R2 for viewing & printing consistently Options to ITI XD* actors:

• Source side– referral/ discharge summary content– support coded entries beyond XDS-MS defined codes

• Consumer side– view/ print document (incl. linked documents)– import document, sections or individual entries

Defines 61 specific IHE CDA modules/ templates Defines 11 specific IHE Act codes

Features similar to Radiology XDS metadata CDA content modules – similar to DICOM SR templates

• Narrative text• Coded text – mainly LOINC and HL7 codes


IHE PCC Integration Profile IHE PCC Integration Profile Basic Patient Privacy Consents (BPPC) - TIBasic Patient Privacy Consents (BPPC) - TI

Basic Patient Privacy Consents

Defines a mechanism to create and enforce patient consent policies for disclosing shared documents, including the necessary data to be used in documents that carry consent information


BPPC FeaturesBPPC Features

An XD* content profile that adds options Privacy Option for XDS Source, Consumer, Registry Privacy Option for XDR Source and Consumer Privacy Option for XDM Media Creator and Importer Uniquely identifiable privacy policy that can be referenced from shared documents Consents can be:

• Scanned paper document (“wet signature” XDS-SD)• CDA consent document that is digitally signed• Implied and not documented in the shared document• Explicit and documented/ referenced in the shared document

Specific CDA template (specific template ID) CDA confidentiality code references the privacy policy OID (configuration issue)

• Document Source sets the value appropriately for all documents• XDS Registry checks the validity of the code, and does code matching for queries• Doc. Consumer may include confidentiality code in queries, uses policy decision logic

Features similar to Radiology XDS metadata HL7 CDA and PDF documents


IHE PCC Integration Profile IHE PCC Integration Profile Emergency Department Referral (EDR) - TIEmergency Department Referral (EDR) - TI

Emergency Department Referral

Defines a referral document that provides summarizing information on a patient’s past medical problems, allergies, medications or assessment plan to the ED physician


EDR FeaturesEDR Features

An XD* content profile Defines 4 CDA section templates for CDA body Re-uses 3 section templates from XDS-MS

Features similar to Radiology Content in the referral similar to DICOM Patient

Medical Module

Note: I think the documentation is difficult to navigate and read (document > section > entry definitions are separate in TF-2)


IHE PCC Integration Profile IHE PCC Integration Profile Exchange of Personal Health Record Content (XPHR)Exchange of Personal Health Record Content (XPHR)

Exchange of Personal Health Record Content

Defines summary information extracted from a PHR system used by a patient for import into healthcare provider information systems, and visa versa.

PHR information typically used is address, telephone numbers, birth date, sex, marital status, emergency contacts, insurance information, a medical and family history, and current medications and allergies.


XPHR FeaturesXPHR Features

An XD* content profile Create / update PHR extracts

(incl. functional requirement to add/ replace/ remove sections/ entries) Import document/ section/ entry – equal to XDS-MS View individually or consistently a PHR document Use of DSG is recommended (option): Created PHR document should be signed,

consumers should be able to verify a signature Maps AHIM-PHR to ASTM CCR, HL7 CCR/CRS and HL7 PHR Extends HL7 CDA by

• Document section updates (replacementOf) • insurance identifiers, • patient identifiers of different providers

Features similar to Radiology None found (potentially some content)

Note: Options and “bindings” may be difficult to understand, e.g. why can’t I exchange PHR information by using basic XDS?


IHE PCC Integration Profile IHE PCC Integration Profile Pre-procedure History and Physical (PPHP) - TIPre-procedure History and Physical (PPHP) - TI

Pre-procedure History and Physical

Defines patient data necessary to evaluate/ ameliorate the risk for ambulatory procedures that require anesthesia. It is used for preparing the procedure and patient.

Such information can be: diagnoses, proposed procedure, laboratory and imaging studies, history & physical examinations.


PPHP FeaturesPPHP Features

An XD* content profile Defines a CDA template with ~ 50 sections (many

of those optional) No specific behavior defined;

Incorrect reference to “binding” to other (XD*) profiles

Features similar to Radiology None found (potentially some content)


IHE PCC ActorsIHE PCC Actors

Actors that are different

Content Creator – create and provide a • medical summary (XDS-MS)• consent document (BPPC)• ED referral (EDR)

Content Consumer – view, import or process a medical summary, similar as above for XDS-MS, BPPC, EDR

PHR Manager creates and provides a PHR extract; imports/ consumes PHR data/ updates PHR Reviewer consumes PHR extracts, and may be able to update an extract

Actors from non RAD-domains Required grouping of Content Creator with: XDS/ XDR Doc. Source or XDM Media Creator Required grouping of Content Consumer with: XDS/ XDR Doc. Consumer or XDR Media

Importer Optional grouping of Content Creator/ Consumer with: NAV Notif. Sender/ Receiver or DSG

Doc. Source/ Consumer

List of Actors extensively the same as Radiology none

C. Dickmann

Note: PCC names this "binding", and does not explicitly define which actor from an XD* Profile is grouped in all cases.


IHE PCC TransactionsIHE PCC TransactionsNote: Options are documented in Profile descriptions

List of transactions that are different none

List of transactions that are extensively the same Re-use of XDS, XDM, XDR transactions

List of Transactions are extensively the same as Radiology none


Standards Used in PCCStandards Used in PCC

Standard Std. Version Profile(s) Used

HL7 CDA R 2.0 XDS-MS, BPPC, EDR, PPHP

XHTML Basic XDS-MS

DEEDS (CDC) 1.0 (1997) EDR

HL7 CCD/ CRS/ PHR

? XPHR

AHIMA-PHR ? XPHR

LOINC ? XPHR (any CDA)

Note: references to standards may be improved, e.g. PPHP 5.4.1.8.1


Summary of PCCSummary of PCC

Profile Issue Description How to HandleXDS-MS

Relation of RAD reports to medical summaries.Investigate if section contents are usable for IHE/ RAD reporting.

5 (clarify if this is consi-dered a gap by PCC)

BPPC Reference BPPC in XDS-I? Potentially 1

EDR Align patient EDR referral information to OMI when a “SWF 2” is created?

Potentially 2

XPHR Align CDA extensions for Insurance or Other Providers’ identifier for “SWF 2”?

Potentially 2

PPHP Procedure = invasive / surgical CP on missing actor specification ?

3

<code missing ?>


Key to Domain issuesKey to Domain issues

1. Issue should result in CP in Radiology

2. Consider addition in Radiology

3. Conflict between Radiology and other Domain

4. Radiology Profile should be handed-off to other Domain

5. Gap has been identified that may result in New Opportunity

IHE Radiology –2007What IHE Delivers 1 Christoph Dickmann IHE Technical Committee March 2007 Cross...

Documents

Transcript of IHE Radiology –2007What IHE Delivers 1 Christoph Dickmann IHE Technical Committee March 2007 Cross...