Review and update of IHE

The Future & XDS–I

Overview - IHE Updates IHE Organisational Changes The Infrastructure Domain Radiology Update XDS-I

IHE Political Update IHE has moved on from Radiology

Cardiology Laboratory Patient Care Coordination (Vetinary)

Moved on from US-centric Established Regional and National

Committees

Current IHE Domains IT Infrastructure Radiology Cardiology Laboratory Nuclear Medicine

Profiles of Interest - ITI Established:

Patient Synchronized Applications (PSA) Patient Identifier Cross-referencing (PIX) Patient Demographics Query (PDQ) Personnel White Pages (PWP) Audit Trail and Node Authentication (ATNA) Enterprise User Authentication (EUA) Retrieve Information for Display (RID) Cross-Enterprise Document Sharing (XDS)

Trial: Document Digital Signature (DSG) Notification of Document Availability (NAV)

Development: Cross-enterprise User Authentication (XUA)

New Profiles of Interest - Radiology Established:

Reporting Workflow (RWF) Portable Data for Imaging (PDI) Post-Processing Workflow (PWF)

Trial: Cross-enterprise Document Sharing for Imaging

(XDS-I) Teaching File and Clinical Trial Export (TCE) Radiology Audit Trail Option

Development: Import Reconciliation Workflow (IRWF) Image Fusion (FUS) Mammography Image (MAMMO)

Current Intra-Trust/Cluster Image Sharing Problems

DICOM C-MOVE problems Network Addressing Issues Unknown Recipients

Indexing Which trusts hold data for a patient?

Updating Error correction and cascading

Multi-site studies Where is “home” for the study ?

Lack of agreement between Vendors on how to go forward

How to bolt security onto DICOM

The IHE XDS Profile “Generic” means of sharing clinical

documents Part of ITI domain (not Radiology) Based on clinical and non-clinical

standards: Transmission: http/https Indexing: ebXML Documents: CDA v2

PDFetc.

XDS Concepts Actors

Document Source Document Repository Document Registry Document Consumer

Other concepts “Submission Set”

XDS Overview

DocumentSource

DocumentRepository

User

IdentitySource

DocumentRegistry

Meta-Data Only

Full Document

XDS-I Like XDS but based on:

DICOM (data format) WADO or native DICOM (retrieval mechanisms)

Uses the same registry A submission set is a DICOM Key Object Note

(manifest) object May include representative sub-sets

Use of WADO permits retrieval either as JPEGs for simpler browsers or full DICOM images

Compatible with caching but still with integrity

XDS-I Overview

ImageSource

ImageRepository

User

IdentitySource

ImageRegistry

Full Images

Meta-Data Only

Selected Manifest

Problems solved by XDS-I Use of WADO for retrieval solves C-MOVE problems One registry solves indexing problems There is an explicit mechanism to update/delete

registrations (no equivalent in DICOM) “Submission Sets” are independent of StudyUID,

so mixtures from different trusts are not a problem New but increasingly supported international

standard (being implemented in Canada and many others)

Uses Standard web security mechanisms Standardised access allows “web access” to be

used for pre-fetching etc., and integration with other clinical data

Conclusions Virtually all the problems being worked

on by CfH have already got agreed international IHE solutions which are supported by vendors

XDS & XDS-I in particular provide a mechanism to provide wide-area area, but fully controlled access to medical data, with proper specialisation for images

The Connectathon next week should be interesting!