September, 2005What IHE Delivers 1 Key Image Notes Evidence Documents Simple Image & Numeric Report Access to Radiology Information IHE Vendors Workshop 2006 Rita Noumeir, Ph.D., Softmedical

2 Abstract / Scope Sharing of Imaging Information across 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

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

4 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

5 Physicians and Systems within a Regional Health Network - Routine Imaging Referral 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

6 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

7 Physicians and Systems within a Regional Health Network for a 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 Notification of Doc Availability

8 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, 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  with the same mechanisms used to query other documents

9 Value Proposition Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain. Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report) Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

10 XDS-I Dependencies XDS-I depends on IT Infrastructure Cross- Enterprise Document Sharing (XDS) Same Actors as in XDS  Document Source  Document Consumer  Document Registry  Document Repository Added extension to support imaging data (images and reports)

11 Document Consumer Retrieve Document Query Documents Patient Identity Source Patient Identity Feed Document Source Document Registry Document Repository Provide & Register Document Set Register Document Set XDS-I Actors and Transactions Image Manager Image Archive Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve

12 XDS-I New Transaction requirements XDS Actors:  Document Consumer at least one Retrieve (DICOM C-Move or WADO) at least one Retrieve (DICOM C-Move or WADO)  Document Source Provide and Register Document Set Provide and Register Document Set Radiology Actors  Image Manager / Image Archive WADO Retrieve WADO Retrieve

13 XDS-I Options Document Source must support at least one of the following options:  Extensive Set of DICOM Instances  PDF Report  Text Report  Multipart Text/PDF Report

14 Sharing of Extensive DICOM Instance Set

15 Document Registry Document Repository Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Manifest Clinical Encounter Clinical IT System Query Registry Manifest Retrieve Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Retrieve ImagesRegister Manifest Manifest

16 Sharing of Extensive DICOM Instance Set The shared Document is a manifest  a Key Object Selection DICOM Instance Image Manager/Image Archive is required  to ensure that the referenced images from within a published manifest are available to be retrieved Document Source is responsible  for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the manifest)

17 Sharing of Imaging Report

18 Radiology system Report Source ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Text Report PDF Report Text +PDF Report

19 Radiology system Report Source Document Registry Document Repository Report Clinical Encounter Clinical IT System Query Registry Retrieve ReportRegister Report Report ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age...

20 Sharing of Report The shared Report Document format is  PDF, Text, or multipart PDF + Text A report can  embed selected images in its PDF format  include fully resolved hyperlinks (interactively clickable) that point to the selected images Document Source is responsible  for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document Document Source is required  to ensure that image references are valid links

21 XDS-I Actors / Grouping Sharing of an Extensive DICOM set  Document Source shall be grouped with an Image Manager/Image Archive Sharing of a report that references selected images  Document Source shall be grouped with an Image Manager/Image Archive Sharing of a report that references selected images from previously published extensive DICOM set  Document Source can be grouped with a Document Consumer

22 Linking Report to Complete Set of Images Document Repository Document Registry Study Manifest Report Document Entry Submission Set

23 Linking Report to Complete Set of Images Document Repository Document Registry Document Entry Submission Set 1 Report Document Entry Submission Set 2 Study Manifest

24 Linking Report to Prior Images and Prior Report Document Repository Document Registry Document Entry Submission Set 3 Prior Study Manifest Document Entry Submission Set 1 Prior Report Document Entry Submission Set 2 Report Document Entry Submission Set 4 Study Manifest

25 Linking Report to Selected Images Radiology system Report Source ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Relevant Image Gestational Age... WADO URI Link to image

26 XDS-I Metadata Radiology specific  Acquisition Modality (e.g. CT, MR)  Anatomic Region (e.g. Arm, Elbow, Hand)  Requested procedure (e.g. MRI Knee with contrast) Query example  find all “CT of the Head” of patient John Doe for the last 2 years

27 More information…. IHE Web site: Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures :  Calls for Participation  IHE Fact Sheet and FAQ  IHE Integration Profiles: Guidelines for Buyers  IHE Connect-a-thon Results  Vendor Products Integration Statements Questions?