1. Review and update of IHE The Future & XDS–I

2. Overview - IHE Updates IHE Organisational Changes The Infrastructure Domain Radiology Update XDS-I

3. IHE Political Update IHE has moved on from Radiology Cardiology Laboratory Patient Care Coordination (Vetinary) Moved on from US-centric Established Regional and National Committees

4. Current IHE Domains IT Infrastructure Radiology Cardiology Laboratory Nuclear Medicine

5. Profiles of Interest - ITI Established: Patient Synchronized Applications (PSA) Patient Identifier Cross-referencing (PIX) Patient Demographics Query (PDQ) Personnel White Pages (PWP) Audit Trail and Node Authentication (ATNA) Enterprise User Authentication (EUA) Retrieve Information for Display (RID) Cross-Enterprise Document Sharing (XDS) Trial: Document Digital Signature (DSG) Notification of Document Availability (NAV) Development: Cross-enterprise User Authentication (XUA)

6. New Profiles of Interest - Radiology Established: Reporting Workflow (RWF) Portable Data for Imaging (PDI) Post-Processing Workflow (PWF) Trial: Cross-enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE) Radiology Audit Trail Option Development: Import Reconciliation Workflow (IRWF) Image Fusion (FUS) Mammography Image (MAMMO)

7. Current Intra-Trust/Cluster Image Sharing Problems DICOM C-MOVE problems Network Addressing Issues Unknown Recipients Indexing Which trusts hold data for a patient? Updating Error correction and cascading Multi-site studies Where is “home” for the study ? Lack of agreement between Vendors on how to go forward How to bolt security onto DICOM

8. The IHE XDS Profile “Generic” means of sharing clinical documents Part of ITI domain (not Radiology) Based on clinical and non-clinical standards: Transmission:http/https Indexing:ebXML Documents:CDA v2 PDF etc.

9. XDS Concepts Actors Document Source Document Repository Document Registry Document Consumer Other concepts “Submission Set”

10. XDS Overview Document Source Document Repository User Identity Source Document Registry Meta-Data Only Full Document

11. XDS-I Like XDS but based on: DICOM (data format) WADO or native DICOM (retrieval mechanisms) Uses the same registry A submission set is a DICOM Key Object Note (manifest) object May include representative sub-sets Use of WADO permits retrieval either as JPEGs for simpler browsers or full DICOM images Compatible with caching but still with integrity

12. XDS-I Overview Image Source Image Repository User Identity Source Image Registry Full Images Meta-Data Only Selected Manifest

13. Problems solved by XDS-I Use of WADO for retrieval solves C-MOVE problems One registry solves indexing problems There is an explicit mechanism to update/delete registrations (no equivalent in DICOM) “Submission Sets” are independent of StudyUID, so mixtures from different trusts are not a problem New but increasingly supported international standard (being implemented in Canada and many others) Uses Standard web security mechanisms Standardised access allows “web access” to be used for pre-fetching etc., and integration with other clinical data

14. Conclusions Virtually all the problems being worked on by CfH have already got agreed international IHE solutions which are supported by vendors XDS & XDS-I in particular provide a mechanism to provide wide-area area, but fully controlled access to medical data, with proper specialisation for images The Connectathon next week should be interesting!