RSNA 2007 – Course 039
Electronic Reports:
HL7 CDA (Clinical Document Architecture)
and DICOM SR (Structured Reporting)
Harry SolomonGE Healthcare
DICOM WG 8 Structured Reporting
HL7 Structured Documents TC
DICOM WG 20 / HL7 Imaging Integration SIG
IHE Cross-Domain Reporting Task Force
2
Disclosure• Harry Solomon
– Employee, GE Healthcare
3
Acknowledgements• Fred Behlen, co-author of a previous version of this
presentation
• Fred Behlen, Bob Dolin, Liora Alschuler, Calvin Beebe – co-chairs of HL7 Structured Documents Technical Committee, and authors of presentations on CDA used in this talk
• Dave Clunie – former co-chair of DICOM Standards Committee, and author of the definitive book on DICOM Structured Reporting
• Kevin O’Donnell – IHE Reporting Task Force
4
Objectives• Understand the key elements for effective radiology
reporting, and issues with electronic reporting• Understand the HL7 CDA (Clinical Document
Architecture) and its use cases• Understand DICOM SR (Structured Reporting) and
its use cases• Understand reporting workflows, the use of
DICOM SR and HL7 CDA in those workflows, and the importance of the IHE (Integrating the Healthcare Enterprise) effort
5
Key Elements ofRadiology Reporting
6
Paper or Electronic Reports• Accurately convey the findings to the referring physician
– Reflect the competence of the radiologist• Timely communication for patient care• Archived in the patient medical record• Legal record of imaging exam
– Radiologist signature• Support ‘secondary’ uses
– Charge capture and billing – Teaching and research– Clinical data registries, clinical trials– Process improvement
• Produced making best use of radiologist’s time
Typical busy radiologist at
Northwestern Memorial Hospital
7
Benefits and challenges of Electronic Reports (1)• Accuracy
+ Drive for quality improvement with quantitative data, CAD and other measurements
+ Possible major benefit with attached key images and graphical analysis (picture = 1000 words)
– Will systems support graphical reports?
• Timely communication+ Probable improvement
• Archived in the patient medical record– Where is the electronic medical record? (distributed,
multiple copies)
8
Benefits and challenges of Electronic Reports (2)• Legal record
– What is a valid electronic signature? – Is an exact visual reproduction required, or only exact
semantic content?
• Secondary uses+ Huge potential improvement, especially with structured
and coded data
• Use of radiologist’s time– Potential negative impact with transition from traditional
dictation workflow– Radiologist pays the cost for improvements downstream
9
This is Process Re-engineering!• Transition to electronic reports is hard
– New systems– New architectures– New policies and procedures– Organizationally disjunct costs/benefits
• Minimize the risk and the effort– A standards-based approach – Incremental evolution from current workflow– Leverage the work of IHE (Integrating the
Healthcare Enterprise)
10
HL7 Clinical Document
ArchitectureOverview
HL7 is a Standards Development Organization
whose domain is clinical and administrative data
11
HL7 Clinical Document
Architecture• The scope of the CDA is the standardization of clinical documents for exchange.
• A clinical document is a record of observations and other services with the following characteristics:– Persistence– Stewardship– Potential for authentication– Wholeness– Human readability
• 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.
12
Clinical Document
Characteristics• Persistence– Documents exist over time and can be used in many contexts
• Stewardship– Documents must be managed, shared by the steward
• Potential for authentication– Intended use as medico-legal documentation
• Wholeness– Document includes its relevant context
• Human readability– Essential for human authentication
13
CDA Use Cases• Diagnostic and therapeutic procedure reports
• Encounter / discharge summaries
• Patient history & physical
• Referrals
• Claims attachments
• Consistent format for all clinical documents
14
Key Aspects of the CDA• CDA documents are encoded in Extensible Markup
Language (XML)• CDA documents derive their meaning from the
HL7 v3 Reference Information Model (RIM ) and use HL7 v3 Data Types
• A CDA document consists of a header and a body– Header is consistent across all clinical documents -
identifies and classifies the document, provides information on patient, provider, encounter, and authentication
– Body contains narrative text / multimedia content (level 1), optionally augmented by coded equivalents (levels 2 & 3)
15
CDA Standard• Release 1 (2000)
– Standalone standard– Based on early draft v3 RIM– Level 1 narrative and multimedia
• Release 2 (2005)– Incorporated into HL7 v3 Standard (Normative Edition)– Level 2 structured narrative and multimedia, plus Level 3
coded statements• Implementation Guides
– HL7 Care Record Summary (CRS)– ASTM/HL7 Continuity of Care Document (CCD)– IHE Patient Care Coordination Templates
16
CDA Release 2 Information Model
Header Body
ParticipantsSections/Headings
Clinical Statements/Coded Entries
ExtlRefsContext
Doc ID&Type
StartHere
17
CDA Structured Body
Structured Body
Section
Text
Section
Text
Section
Text
Section
Text
Section
Text
Section
Text
Entry
Coded statement
Entry
Coded statement
Entry
Coded statement
Arrows are Act Relationships • Has component, Derived from, etc.
Entries are coded clinical statements• Observation, Procedure, Substance administration, etc.
18
Sample CDA
19
Narrative and Coded Info• CDA structured body requires human-readable
“Narrative Block”, all that is needed to reproduce the legally attested clinical content
• CDA allows optional machine-readable coded “Entries”, which drive automated processes
• Narrative may be flagged as derived from Entries – Textual rendering of coded entries’ content, and contains
no clinical content not derived from the entries • General method for coding clinical statements is a hard,
unsolved problem– CDA allows incremental improvement to amount of
coded data without breaking the model
20
Narrative and Coded Entry
Example
21
CDA Non-XML Body• Alternative to XML Structured Body
• Standard CDA header “wraps” existing document
• Any MIME type– Especially PDF (IHE Scanned Document Profile)
22
CDA Implementation Guides
• Published by HL7– Care Record Summary – encounter notes, discharge
summary– Continuity of Care Document – transfer of care
(harmonized with ASTM Continuity of Care Record)• Published by IHE Patient Care Coordination
– Emergency Department Referral– Pre-procedure History and Physical– Scanned Documents– Personal Health Record Extract– Basic Patient Privacy Consents– Antepartum Summary– Emergency Department Encounter Summary
23
DICOM Structured ReportingOverview
DICOM is a Standards Development Organization
whose domain is biomedical imaging
24
DICOM Structured Reporting• The scope of DICOM SR is the standardization of
documents in the imaging environment.• SR documents record observations made for an
imaging-based diagnostic or interventional procedure, particularly those that describe or reference images, waveforms, or specific regions of interest.
25
SR Use Cases• Radiology reports with robust image / ROI references• Measurements/analyses made on images• Computer-aided detection results• Notes about images (QC, flag for specific use, quick
reads)• Procedure logs for imaging-based therapeutic
procedures• Image exchange manifests
26
Use Case Common Features• Structured
– Lists and hierarchies
• Numeric measurements, coded values– Automatically extractable for database, data mining
• Relationships between items– Hierarchical, or arbitrary reference– Power of rich semantic expression
• References to images, waveforms, other objects– Collected in DICOM environment
• Explicit contextual information– Unambiguous documentation of meaning
27
DICOM SR and the FiveClinical Document Characteristics• The five characteristics:
– Persistence: SR objects are persistent– Stewardship: SR objects are managed and can identify their
steward– Potential for authentication: SR has digital signature capability– Wholeness: SR objects include their relevant context– Human readability: DICOM requires SR objects to be rendered
“completely and unambiguously”, but this needs a conformant application
• SR emphasizes coded semantic content (especially in relation to images), while CDA emphasizes human readable text through simple XML style sheets
28
Key Aspects of DICOM SR• SR documents are encoded using DICOM standard
data elements and leverage DICOM network services (storage, query/retrieve)
• SR uses DICOM Patient/Study/Series information model (header), plus hierarchical tree of “Content Items”
• Extensive mandatory use of coded content– Allows use of vocabulary/codes from non-DICOM sources
• Templates define content constraints for specific types of documents / reports
29
SR Content Item Tree
Root Content Item
Document Title
Content Item Content Item Content Item
Content Item Content Item Content Item
Arrows are parent-child relationships• Contains, Has properties, Inferred from, etc.
Content Items are units of meaning• Text, Numeric, Code, Image, Spatial coordinates, etc.
Content Item
Content Item Content Item
30
DICOM SR Example
31
DICOM SR Object Classes• Basic Text - Narrative text with image references
• Enhanced and Comprehensive - Text, coded content, numeric measurements, spatial and temporal ROI references
• CAD - Automated analysis results (mammo, chest, colon)
• Key Object Selection (KO) - Flags one or more images – Purpose (for referring physician, for surgery …) and textual note
– Used for key image notes and image manifests (in IHE profiles)
• Procedure Log - For extended duration procedures (e.g., cath)
• Radiation Dose Report - Projection X-ray; CT
32
DICOM Encapsulated Document• Complementary to DICOM Structured Reporting
• Standard DICOM header “wraps” existing document– Allows use of DICOM infrastructure – object exchange,
archive (PACS), query/retrieve
• Only specific document types allowed– PDF– CDA
33
PDF (Adobe®
Portable Document Format)• Neither CDA nor SR guarantee exact visual reproduction
of a displayed document, which may be a legal requirement in some locales
• PDF allows exact visual reproduction, and display software is readily available
• Role for PDF as a presentation-ready equivalent rendering of a coded document
• Both CDA and DICOM support wrapping PDF with their standard header, so a presentation-ready PDF can be managed in the same environment with cross-links to the original coded document– Also supports legacy documents scanned into PDF
34
Radiology ReportingWorkflows
35
Reporting Starts Before the Radiologist Sees the Study
• Reason for exam (from order)• Technical aspects of procedure
– Protocol– Exam notes from tech
• Post-processing results– Measurement and analysis applications (e.g., vascular,
obstetric, cardiac) by tech– Computer Aided Detection results
• These need to get to the radiologist and integrated into the report– Produced on modality or imaging workstation
36
Reporting Integration (1)• Review study evidence
– Order and relevant clinical information– Images and relevant priors– Tech notes and post-processing results
• Radiologist interpretation – on imaging workstation– Annotation (virtual grease pencil)– Key image selection– Measurement and analysis applications by radiologist
• Radiologist findings reporting – on a different system?– Structured data entry (forms-based)– Dictation + transcription
Where’s Waldo going to prepare his report?
37
Reporting Integration (2)• Report assembly
– Findings and selected evidence/interpretation results
• Radiologist signature– Auditable action, or digital encryption-based
• Report communication– To referring physician– To “secondary” users (billing!)
• Report archive– And subsequent access
38
The DICOM Solution?• DICOM was supposed to take care of all this, and has
(almost) all the requisite features and network services
• DICOM SR has found vital uses in key subspecialty areas that produce structured data in the examination or post-processing
– Leveraging the DICOM infrastructure is easy and desirable
– Results managed with other study evidence
• But the end recipients of radiology reports, referring physicians, commonly use systems without DICOM capabilities (imaging or SR)
39
“Evidence” and “Reports”• Evidence Documents
– Includes measurements, procedure logs, CAD results, etc., created in the imaging context, and together with images are interpreted by a radiologist to produce a report
– The radiologist may quote or copy parts of Evidence Documents into the report, but doing so is part of the interpretation process at his discretion
– Appropriate to be stored in PACS as DICOM SR objects, with same (legal/distribution) status as images
• Reports – Become part of the patient’s medical record, with
potentially wide distribution– Ideal match to HL7 CDA, but sometimes SR is appropriate
40
DICOM-HL7 Synergy (1)• SR and CDA developed simultaneously
• DICOM and HL7 working groups recognized the need to work together
• DICOM SR and HL7 CDA are congruent in key areas– Document persistence
– Document identification, versioning and type code
– Document’s relation to the patient and to the authoring physicians
• SR strength in robust image-related semantic content; CDA strength in human readable narrative report
• DICOM WG10 (Strategic Advisory) suggested composing radiology reports directly in CDA format when appropriate
41
DICOM-HL7 Synergy (2)• References to CDA documents from within DICOM
objects, and vice versa• Include CDA documents on DICOM removable disks
– As native CDA files, or encapsulated in a DICOM file– Indexed in DICOMDIR for integration with DICOM applications
• PDF rendering of SR can be wrapped in a CDA document
• Transcoding between SR and CDA feasible for limited subset of reports
• CDA Implementation Guide for Diagnostic Reporting in development
42
The Role of IHE• Industry-wide effort to “make it work”
• Real world use cases drive standards-based approach to integration– Practical evolution from current architectures
• Venue for testing implementations and interoperability
• Reporting is a high priority task for Radiology Domain
• Your participation is welcome!
43
Reporting Profiles• Documented workflow profiles
– IHE Evidence Documents Profile– IHE Key Image Notes Profile– DICOM Part 17 Dictation-Based Reporting with Image
References [Supplement 101]
• Ongoing work in IHE Reporting Task Force and Radiology Technical Committee– Revise IHE Simple Image and Numeric Report Profile,
consolidate with Post-processing and Reporting Workflow Profiles
– Align with Retrieve Information for Display and Cross-Enterprise Document Sharing Profiles
44
Usercontrol
Diagnostic reporting
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
Orders,Prior
Reports
DiagnosticImages
Viewingsettings
45
Reportwith imagereferences &annotation
Usercontrol
Reporting with annotation(use case - desired)
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
ImageSources
DiagnosticImages
Imagereferences
& annotation
Viewingsettings
Orders,Prior
Reports
46
Usercontrol
Reporting with annotation(what’s available)
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
DiagnosticImages
Viewing settings,image references& annotation
Imagereferences
& annotation
Orders,Prior
Reports
47
Diagnosticreport
Integrated solutionImage Viewing &
Reporting Application
Integrated PACS &Information System
ImageSources
Orders,Diagnostic images
& Prior reports
Viewing settings,Reports, imagereferences & annotation
Imagereferences
& annotation
******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96
FINDINGS: As above. IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumorgrowth.
Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3
******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96
FINDINGS: As above. IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumorgrowth.
Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3
Usercontrol
48
Usercontrol
Loosely integrated reporting
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
DiagnosticImages
Viewing settings,image references& annotation
Imagereferences
& annotation
Image references& annotation
Image retrieval
Orders,Prior
Reports
Report w/ image ref & annot
Transcribednarrative
Verification
Imageselection
Annotation
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application Reporting Application
Image Archive(DICOM SCP)
Reporting SystemValidation Functions
Dictatedreport
DICOMKO object“For Report”
DICOM Query/Retrieve for all KO objects matching Accession Number
WADOServer
Reporting Integration Functions
CDAReport
WADO URI references toImages with GSPSs (JPEG rendering)
DICOMGSPS object (annotations)
DICOMEncapsulated CDA object
50
Other Use Cases to be Profiled• All the basic elements are standardized and ready to be
fit into integrated reporting workflows– Need consensus approaches to specific use cases (IHE)
• Quantitative measurement intensive reporting with DICOM SR inputs
– Mammo with CAD input, Obstetric with sonographer measurements, Cardiac with functional assessments
– DICOM SR as primary report with PDF wrapped in CDA as distributed version?
• Selected key measurements imported into report (loosely coupled architecture)
– Similar to Key Image / Annotation workflow– Possible push model of key measurements to RIS?
51
Conclusions• CDA now viewed as a primary format for diagnostic
imaging reports– Definition of CDA DI report to be done in 2008 by a
balloted HL7 Implementation Guide – Method is extensible to reports with more structure
• DICOM SR will see continued and expanding use for Evidence Documents created in the imaging setting– IHE Evidence Documents Integration Profile
• Evolutionary workflows utilizing both standards in coordination are being profiled by IHE – Does not require tight integration of imaging and
reporting workstations
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