1. IHE Workshop: Displayable Reports (DRPT)
IHE Workshop 2006: Changing the Way Healthcare Connects
Authors:
Anand Kumar, Siemens; Harry Solomon, GE Healthcare; Bryan Jennings, Medical Micrographics

2. Purpose of Displayable Reports Profile
DRPT provides a methodology to create, finalize, archive, read, revise and distribute cardiology clinical reports from the department to the enterprise and beyond

3. The Problem
Most existing reporting applications operate with paper paradigm
Print
Scribble (signature)
Fax
“Advanced” apps have some electronic capabilities
Increasing demand for electronic report to central repository
Inconsistent requirements for how to do this

4. Example Displayable Reports

5. Real World Use Case
A Cardiologist reviews the observations and evidence created during an exam. She prepares a report formatted as a PDF (on the Report Creator workstation), verifies it, and submits it to the Cardiology department Information System (Report Manager).
The Report Manager stores it in the Cardiology department Report Repository; it also forwards it in an HL7 message to the hospital’s Enterprise Repository for distribution of the Report outside the department.
Within the department, access to the full procedure data set thus includes the PDF report as well as the images and measurements.
Outside the department, the report as a PDF (through the ITI RID Profile) is also available.

6. Displayable Reports Profile Value Proposition
Many clinical reporting applications already use PDF
Supports graphical content (critical to Cardiology reports)
Including vector graphics for ECGs
Source system controls the “look” of the report
Important for both clinical and business reasons
In some jurisdictions, legal requirement for identical presentation of a report
Image Manager/Image Archive (PACS) may be leveraged as departmental Report Repository
Distributed enterprise report storage architecture supported

7. Real World Use Case 2
A patient has a follow-up appointment with his Cardiologist. When the patient presents for his appointment, the Cardiologist orders a standard ECG to be taken in the office at this time. The Cardiologist also retrieves a previous ECG from the Enterprise Repository (stored in a pdf format) for review. As a result of his review of the results of the in-office and previous ECG’s, the Cardiologist informs the attending nurse to setup a Nuclear Spectroscopy Stress test at the nearby Nuclear Imaging Diagnostic Center.
At the hospital, the Cardiopulmonary department queries and retrieves ECG (in pdf format) information from the hospital’s Enterprise Repository. Both the in-office ECG and the previous ECGs are readily available for re-review by the Cardiologist or consultation with other Cardiologists prior to conducting a diagnostic Cath Procedure Procedure.
All of the above Reports are stored and available for query through the department’s local Report Repository, the Cardiologist’s local Report Repository and the hospital’s Enterprise Repository

8. Summary of R.W. Use Cases
Reports may originate from different sources (Report Creators)
Report Creator may create a preliminary, final, or corrected report. Report Manager manages the release process with application-specific processing rule
Department Report Manager provides local storage and distribution of Reports
Report Management System may use existing PACS capability for long term storage and distribution to Enterprise Repository
The Displayable Reports (DRPT) Profile is a bridge between the Clinical Records stored in the Hospital department and the Longitudinal Record handled by the Cross Domain Sharing (XDS) Profile.

9. Displayable Reports Profile Actors
Report Creator – A system that generates and transmits clinical reports.
Report Manager – A system that manages the status of reporting, and distributes reports to report repositories.
Report Repository – A departmental system that receives reports and stores them for long-term access.
Enterprise Report Repository – A system that receives reports and/or references (pointers) to reports, and stores them for access throughout the healthcare enterprise.
Report Reader – A system that can query/retrieve and view reports encoded as DICOM objects.

10. Displayable Reports Profile Transaction Diagram

11. Report Creator Summary of Requirements
Create PDF report
Send to Report Manager
Does NOT persistently (long-term) store reports
Report Manager is responsible for content of released report, and any local storage on Report Creator may become inconsistent with official report (e.g., on Patient Update)

12. Report Manager Summary of Requirements
Receive PDF Report
Manage release of report
May release preliminary, or only final (per product feature or configured rules)
Optionally manage electronic signatures
Add cover page in PDF with correct demographics and signature/status
Store report in department Report Repository
Forward report to Enterprise Report Repository

13. Enterprise Report Repository Summary of Requirements
Receive encapsulated PDF
or Receive PDF reference in HL7 message
Deliver report to enterprise via unspecified mechanism

14. Displayable Reports Profile
But how can a non-DICOM Report Manager play?
If DICOM option not implemented, Report Manager must be grouped with Report Repository
Allowed to implement proprietary internal communication
DICOM Encapsulated PDF Query/Retrieve is an option for Report Repository
If not implemented, workstations must use HTTP messaging from Retrieve Information for Display Profile to access reports

15. The Report Reader And what about DICOM Image workstations?
Query/Retrieve DICOM Encapsulated PDF
Allows access to report in context of study images and evidence
Retrieve of complete DICOM study will also retrieve report
Render PDF content
Reasonable functionality to add to Image Display (workstation)

16. DRPT and XDS
Displayable Reports Profile specifies production of reports within an organization
Cross-enterprise Document Sharing (XDS) Profile specifies distribution of reports outside the organization
Typically, only a subset of internally generated reports will be shared outside

17. Questions?

18. More information…. IHE Web sites: www.ihe.net
Technical Frameworks, Supplements
Cardiology Technical Framework
IT Infrastructure Technical Framework
Displayable Reports Supplement
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

19. W W W . I H E . N E T Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
In the Enterprise
and Across Care Settings