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Displayable Reports Dirco van Norden

Autumn meeting 2011

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Mission Rogan-Delft

•  Medical market •  International standards (DICOM, HL7, IHE) •  Zillion Suite

o  Independent o  Together with products of other vendors o  Create solutions for specific situations

1988: PACS (1993, 1st in standardization) 2007: XDS-I (2008, IHE profiles Registry/Repository/Source/Consumer) 2009: RIS (2010, IHE profiles PIR/SWF) Q1 2012: VNA

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DICOM SR vs. HL7 CDA

DICOM SR

•  DICOM Structured Reporting

•  The scope of DICOM SR is the standardization of documents in the imaging environment.

•  SR documents are encoded using DICOM standard data elements and leverage DICOM network services (storage, query/retrieve)

•  DICOM SR is used in key subspecialty areas that produce structured data in the course of image acquisition or post-processing, where: –  Leveraging the DICOM infrastructure is easy and desirable

–  Results should be managed with other study evidence

•  Examples –  Sonographer measurements

– Computer-aided detection results

– QC notes about images –  Radiation dose reports

DICOM SR Example

HL7 CDA

•  Clinical Document Architecture

•  The scope of the CDA is the standardization of clinical documents for exchange.

•  A CDA document is a defined and complete information object that can exist outside of a message, and can include text, images, sounds, and other multimedia content.

•  Both machine-readable and human-readable.

•  CDA documents can be displayed using XML-aware Web browsers or wireless applications such as cell phones.

•  Consistent format for all clinical documents

– Diagnostic and therapeutic procedure reports

–  Encounter / discharge summaries

–  Patient history & physical

–  Referrals

– Claims attachments

HL7 CDA Example

DICOM SR vs. HL7 CDA

•  DICOM SR and HL7 CDA –  SR strength in robust image-related semantic content (Evidence Document)

– CDA strength in human readable narrative report (Report)

•  Various methods for integration

– DICOM committee published a document for mapping DICOM SR to CDA for migration (Supplement 135).

–  Referencing CDA documents from within DICOM objects, and vice versa

•  CDA now viewed as a primary format for diagnostic imaging reports.

•  DICOM SR will see continued and expanding use for Evidence Documents created in the imaging setting.

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IHE Profile Displayable Reports

Facts

Displayable Reports (DRPT) •  Specifies transactions supporting creation, transmission and reading of reports.

•  Provides linkage between report, the imaging and evidence of the procedure.

•  Provided for broad distribution.

•  Graphical content support with PDF and CDA.

•  Transcending specialism's (Cardiac, Radiology …).

Benefits

•  Rich data model allows inclusion of previously unavailable info

•  Accurately convey the findings to the referring physician –  Links to images belonging to report (picture = 1000 words) –  Reflect the competence of the radiologist

•  Legal record of imaging exam –  Radiologist signature

•  Structured data makes ‘secondary use’ possible – More accurate billing

–  Teaching and research

•  Consistent approach to handling report creation and management

–  Interoperability Competition Innovation

–  Purchase best of breed reporting applications

•  Mechanism for archiving reports in PACS

Benefits •  Distribution

–  Easy to render reports at browser level – No need to change the client, even when you changed the structure of the report

DRPT Support in PACS/RIS

PACS

Reporting application

RIS

•  Reporting applications on image display workstations create reports in a displayable format (PDF or CDA)

•  RIS systems manage the report signature cycle, storage, and distribution

•  PACS systems may store, manage, and/or display the reports –  f.e. by CDA embedded in DICOM

•  Image display systems may query, retrieve and display reports from the PACS using DICOM

•  Other clinical workstations may retrieve and display reports from the departmental data store (the PACS or RIS)

CDA DICOM

CDA

DRPT Support anywhere

•  Distribution

•  Transcending specialism’s

•  Digital Message Switchboard

–  Tool to convert HL7 ORU into CDA structured document and submit it to XDS

PACS

Digital Message

Switchboard

Affinity Domain

ORU

CDA

XDS

Referrer

Consumer

XDS

Hospital

Source / Consumer

RIS

CDA

CDA

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Questions

Interoperability showcase C68

Rogan-Delft Booth B68