June-September 2009www.ihe.net North American 2010 Connectathon & Interoperability Showcase Series Paul Seifert/ Kinson Ho Solution Architects Agfa HealthCare Radiology Technical Committee Radiology Update Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I.b)

Cross-enterprise Document Sharing for Imaging (XDS-I.b) Use case and profile abstract Value proposition Actors and transactions Relation/dependency on other profiles Implementation resources (e.g., Schema, WSDL) Implementation considerations (security, testing, etc.)

XDS-I.b Abstract / Scope Sharing of Imaging Information across affiliated health enterprises Imaging Information includes  extensive sets of DICOM instances including images, evidence documents and presentation states  diagnostic reports provided in a "for display" form  selection of diagnostically significant images associated with the report content

XDS-I.b Value proposition Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc. Effective means to contribute and access imaging documents across health enterprises.  Without XDS-I.b, access to the radiology report across health enterprises is difficult Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems. Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest  using the same mechanisms used to query other documents

Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network PACS B PACS A Radiology-to-radiology Radiology-to- Physicians Sharing Radiology Reports and Images in a Regional Health Information Network

Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Cross- Enterprise Registry Patient Id= 3547F45 Report 5/21/1998 : CT Head  B Study 5/21/1998 : CT Head  B Report 2/18/2005 : Chest Xray  A Study 2/18/2005 : Chest Xray  A PACS B PACS A Sharing Radiology Reports and Images in a Regional Health Information Network

Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Query for Documents Register Imaging Information for sharing Prior imaging Reports & Studies Cross- Enterprise Registry Register Imaging Information for sharing Patient Id= 3547F45 Report 5/21/1998 : CT Head  B Study 5/21/1998 : CT Head  B Physicians and Systems within a Regional Health Network - Routine Imaging Referral

Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Register Imaging Information for sharing Cross- Enterprise Registry Notification of Doc Availability Register Imaging Information for sharing Physicians and Systems within a Regional Health Network - Routine Imaging Referral

Radiology Enterprise A Radiology Enterprise B Physician Office Prior Imaging Report & Study Regional Health Information Network Query for documents Imaging Report & Study Cross- Enterprise Registry Patient Id= 3547F45 Report 5/21/1998 : CT Head  B Study 5/21/1998 : CT Head  B Report 2/18/2005 : Chest Xray  A Study 2/18/2005 : Chest Xray  A Physicians and Systems within a Regional Health Network for a Routine Imaging Referral

XDS-I.b Actors and Transactions

What’s New in XDS-I.b New Provide and Register Imaging Document Set Transaction  Updated to use MTOM/XOP Transport mechanisms  Fully compatible with existing XDS.b Repositories and Registries  More heavily leverages XDS-SD for CDA-wrapped text reports New Retrieve Imaging Document Set Transaction  Web services based retrieval of DICOM images  Based on XDS Retrieve Document Set Transaction Key Actor Requirements  Imaging Document Source is required to support all retrieval types; Imaging Document Consumer can choose “Old” version of XDS-I is simultaneously deprecated  No more “SOAP with attachments” based Provide transaction

XDS-I.b Dependencies XDS-I.b depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS) Profiled XDS metadata with radiology specifics  Acquisition Modality (e.g. CT, MR)  Anatomic Region (e.g. Arm, Elbow, Hand)  Requested procedure (e.g. MRI Knee with contrast) Reuses CDA-wrapper defined by XDS-SD for plain text reports. XDS-I.b specific Actors  Imaging Document Source  Imaging Document Consumer (must be grouped with XDS Document Consumer) XDS Actors reused  Document Consumer, Document Registry, Document Repository

Implementation Considerations XDS-I.b security considerations  XDS-I.b actors must be grouped with ATNA Secure Node or Secure Application Actor  Document retrievals must be capable of being done across a protected (encrypted) channel. Implementation Resources (XML schemas and WSDL)  Will soon be available via link at

Next Steps Review Trial Implementation version of XDS-I.b:  diology diology Sign-up to participate in IHE Connectathon in early 2010

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