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Waveform, Workflow, Archiving… Assessment of Standard Interfaces Opportunities for Cooperation.

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Presentation on theme: "Waveform, Workflow, Archiving… Assessment of Standard Interfaces Opportunities for Cooperation."— Presentation transcript:

1 Waveform, Workflow, Archiving… Assessment of Standard Interfaces Opportunities for Cooperation

2 Three Levels for Connectivity Standards Device Connectivity Departmental Integration Hospital/Ambulatory Workflow EMR Integration Radiology Cardiology ICU Imaging Modalities Image proc. CAD, … RIS R-PACS ADT Order Placer EMR, … Captors,Actuators Bed-Side Monitors Cluster Monitor ICU IS Cardiac Monitors Hemodynamics Rest, Stress, Holter ECG Cardiac IS, C- PACS Enterprise Archive 1073 HL7 DICOM SCP ? HL7 ? DICOM ? 1073 ? Three Examples  Overlap  Coordination Needed

3 Three Topics, Three Opportunities ? 1.Persistent Waveform Objects 2.Departmental Workflow Integration 3.Enterprise Archiving of Images & Waveforms

4 DICOM Waveforms Quick Refresher

5 Key Aspects of DICOM DICOM domain is communications for imaging-based care DICOM is an Object-based standard –Persistent objects Inter-object referential capability –Binary tagged data element format –Objects are hierarchically organized Patient / Study / Series (modality) “folders” DICOM: Persistent Object workflow services over TCP/IP –Generally in client-server architecture –Object transfer, storage, storage commitment, query and retrieval Media-Interchange (CD, DVD, Floppy, etc.) with clinical directory. Network Archiving –Departmental workflow management (worklist, performed steps) Broadly used and accepted world-wide for many years.

6 DICOM Waveforms Supplement 30: Waveform – in DICOM 2001 Introduces general structure for waveform composite (persistent) objects –Waveform channels identified by coded-entry triplet Coding Scheme / Code Value / Code Meaning Allows externally defined terminology (e.g., SCP-ECG for leads) Triplets also used in HL7 and DICOM Structured Reporting Triplet values may be constrained by Templates defined in Part 16 Specific waveform Object Definitions (particularly for cardiology) –Hemodynamics –Cardiac Electrophysiology –Electrocardiography (12-lead, ambulatory, general) –Basic Voice Audio –In progress, Ultrasound Doppler Waveform (Suppl 56)

7 Streams of Waveform Samples DICOM Waveform Object Waveform object encodes digital data from a discrete time period –Multiple channels; all channels have common time base –Flexible waveform sample format 8 or 16 bit data; Signed, unsigned, u-law, A-law Separate sampling frequencies for each channel, or multiplexed channels at common frequency –Objects may be temporally contiguous, or temporally selective –“Store and forward” (not for real time monitoring) Waveform object encodes full definition of each channel –Quality being sampled, Sensor location (anatomic),Function (measurement or stimulus), Resolution and range, Technique (e.g., pull-back) –Based on HL7 V2 definition Waveform object encodes DICOM + HL V2 context information in header –Equipment information (manufacturer, serial number, location) –Temporal frame of reference (synchronization with other objects, in particular images) Waveform object encodes optional annotation –Identify features or regions of interest –Generated by acquisition unit –Constructed of label and time or sample reference

8 Waveforms Standardization for Departemental Integration -Key Objectives-

9 Waveforms: why integrated & separated ? Integrated with other persistent objects –Images Supporting the waveforms (e.g., for documentation of EP catheter location) Supported by waveforms (e.g., simultaneous ECG for IVUS post processing) –Various categories of Structured Reports with waveform references. Clinical reports Measurement reports (e.g., hemodynamics, or ECG) Procedure Log documents (full procedural context for waveform acquisition) Key object selection (electronic “Post-It”) Workflow integration: –worklists and status monitoring of scheduled tasks including distribution of patient demographics –Object archiving and retrieval – Key for archiving of recorded vitals signs –Web accessible as persistent objects (presented or original data) Focused on Full Fidelity Acquired Data: –No Presentation: to be addressed independently. –Compression: compact encoding, separate from the object definition –Clearly distinguished from derived measurements and reports –Patient/Visit/Order context driven by HL7

10 Departmental Workflow Integration DICOM and HL7….. Much more than combining standards !

11 Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality Worklist Worklist Procedure Scheduled (HL7) Patient Registration/Update Order Management (HL7)

12 Acquisition Modality Structuring the Departmental Workflow with an Enterprise perspective ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step P1 Scheduled Procedure Step B Requested Procedure 1 Scheduled Procedure Step A Report One or more series of images Performed Procedure Step P2 DICOM Modality Worklist

13 What is IHE ?  An Initiative Sponsored by Users: HIMSS plus clinical societies (e.g.RSNA)  Active Industry Leadership, shaping direction  Leverage existing standards (HL7, IEFT, DICOM, etc.) in an industry defined integration framework  Proceed in pragmatic incremental steps to deliver easier to integrate product implementations  Proven approach in IT & Radiology (over 100 vendors already participate).

14 Enterprise Archiving of Images and Waveforms

15 IHE Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

16 What is Unique about IHE ?  A User/Vendor Team Effort :  Voluntary and Open to All Vendors. It is not a consortium.  Professional Associations Engaged (e.g. HIMSS leadership)  Starts from concrete user integration needs, selects standards, sets a technical framework, provides a test-bed, and demonstrates/educates marketplace.  Does not define product architectures or features, only the glue between products.  Successful. Benefits both small and large vendors, worldwide : North America, Europe, Asia.

17 Industry is invited to shape and expand IHE  A kick-off meeting in order to :  Review the current state of integration in the healthcare information technology industry  Identify IT Infrastructure priorities necessary for building an EMR  Establish the structure and timeline for implementation.  All vendors are invited :  Product marketing & technical leadership  When & where :  November 4-5, 2002  Malvern, (near Philadelphia, PA)  Respond to invitation : ihe@rsna.orgihe@rsna.org

18 Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality Worklist Worklist Procedure Scheduled (HL7) Patient Registration/Update Order Management (HL7)

19 Enterprise Archiving of Images and Waveforms

20 Enterprise Archiving for complex clinical data: images and waveforms Large and "specialized" complex clinical data sets call for archiving outside of central EMR database Images are being handled by PACS (radiology, cardiology, etc.) and hospital wish to also share resource for waveforms A consistent set of standards is required to achieve this integration of image and waveform enterprise archiving in an EMR driven environment.

21 Enterprise Archiving DICOM : 10 years of experience Enterprise Persistent Objects Repository Departmental IS System RIS, PACS, CIS, etc. Study/Patient Series Persistent Object Instance Store (Class/Instance UID) Storage Commitment Retrieve (Instance UID) Store (Class/Instance UID) Media Interchange (Inst. + DIR) Query (Study Root) Web Access Native or presented forms Transparent Persistent Object Payload (except for Class)

22 Web Access to Persistent DICOM Objects Retrieve one "entire document" (either in a presentation view or as a data set) using its "Persistent Document Instance UID" Persistent Objects Repository Client Accessing Healthcare Documents e.g.EPR Retrieve a "presentation view" Retrieve a "Data Set" "Form of the reference" Data Set "Retrieve": -Preferred transfer Syntax -Default transfer Syntax ? Presentation View "Retrieve": -Type of encoding for images (JPEG, GIF, etc.) -Type of document presentation format (PDF, HTML, CDA-L1) -Size of Images Intent is not to offer a "Query": - Need is only to get access to an object

23 Waveforms Standardization for Departemental Integration -Key Objectives-

24 Waveforms: why integrated & separated ? Integrated with other persistent objects –Images Supporting the waveforms (e.g., for documentation of EP catheter location) Supported by waveforms (e.g., simultaneous ECG for IVUS post processing) –Various categories of Structured Reports with waveform references. Clinical reports Measurement reports (e.g., hemodynamics, or ECG) Procedure Log documents (full procedural context for waveform acquisition) Key object selection (electronic “Post-It”) Workflow integration: –worklists and status monitoring of scheduled tasks including distribution of patient demographics –Object archiving and retrieval – Key for archiving of recorded vitals signs –Web accessible as persistent objects (presented or original data) Focused on Full Fidelity Acquired Data: –No Presentation: to be addressed independently. –Compression: compact encoding, separate from the object definition –Clearly distinguished from derived measurements and reports –Patient/Visit/Order context driven by HL7


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