12/6/2002 RSNA 2002

DICOM & IHE: What Are They, and

Why Do We Need Them?

DICOM & IHE: What Are They, and

Why Do We Need Them?

Sanjay JainDirector, Engineering, Cerner Corporation

Co-Chair, IHE Planning Committee

Sanjay JainDirector, Engineering, Cerner Corporation

Co-Chair, IHE Planning Committee

RSNA 2002RSNA 2002

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What Is DICOMWhat Is DICOM

• Digital Imaging and COmmunications in Medicine

• Began with ACR-NEMA initiative in late 1980s (also known as DICOM 2)

• Defines standard method to transfer images and related information between devices manufactured by various vendors

• DICOM 3.0 was introduced in 1992 with 9 parts, now there are 16 parts

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The DICOM StandardThe DICOM Standard

• Each part has a specific purpose– Part 2 : Conformance Statement– Part 4 : Service Class Specification– Part 6 : Data Dictionary– Part 10 : Media Storage and File Format

for data interchange– Part 14 : Gray Scale Standard Display

Function

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The DICOM Standard (contd.)The DICOM Standard (contd.)

• Defines Communication Protocol and content structure– Service Requested (e.g Modality Worklist)– Message structure and encoding (big

endian, little endian)– Tag Value pair for identifying information,

regardless of the transaction• Patient Name: (0010,0010) – Group 0010,

Element 0010• Patient ID: (0010,0020) – Group 0010, Element

0020

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Why DICOM?Why DICOM?

• Imagine if film from your camera could not be processed by neighborhood store but only a special agency– How timely would your pictures be available?– Will you keep on using the camera?– You want to process it easily and quickly.

• It was the same situation in Imaging • DICOM enabled exchange of digital imaging

and textual information using a Common Communication Protocol

• But left interpretation for implementers, so?

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Where do you use DICOM?Where do you use DICOM?

• Digital Scanners (CT, MR, CR, DR, etc.)

• Picture Archival and Communication System (PACS)

• Softcopy Display and Reading systems (Workstations)

• Film Printers

• Others…

How do you know if your scanner can save to the PACS?

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DICOM Conformance StatementDICOM Conformance Statement

• It is a detail document explaining implementation of DICOM standard in the Product– Defines the service classes implemented

and the role that system plays (SCP or SCU) for each class. E.g. ProVision implements Modality Worklist as an SCP

• Required to compare when reviewing systems for connectivity

• Need a technical staff person

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HL7/ HL7/ DICODICOMM

HLHL77

DICODICOMM

examination ordersfor J Doe

Orders Placed

HIS

imagesretrieved

acquisitioncompleted

acquisitioncompleted

J Doeimagesstored

J Doe

Enter patientas J Doe

EmergencyRegistration

Orders Filled

Image Managerand Archive

modality worklistfor J Doe

Modality

PACS

Reports storedfor Network

Access

RIS

Images and Examdata presented for

diagnosis

report

Patient Care WorkflowPatient Care Workflow

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HL7 and DICOMHL7 and DICOM

• They are both important for healthcare and digital imaging

• The information communicated using HL7 is typically Patient, Encounter, Procedure, Charges

• Same information is useful for Imaging process

But how does information flow between But how does information flow between systems implementing two standards?systems implementing two standards?

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Communication ChallengesCommunication Challenges

Systems need Information other systems have

But, systems communicate poorly or not at all

Result: - tedious, inefficient workflows - data that is inconsistent or unavailable

Responsibility for information flow between systems and between departments, is often unclear

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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise

• It’s an initiative promoting and supporting the integration of systems in the healthcare enterprise

• Integration Goal: Improve the efficiency and effectiveness of clinical practice by:– Improved Information Flow– Advanced Multi-System Functions

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Who is IHE?Who is IHE?

• Participants:– Professional Societies (RSNA/HIMSS/…)– Vendors (over 30 companies)– Standards Group Committee Members

• RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture

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What Does IHE Do?What Does IHE Do?

• Users and vendors work together to identify and design solutions for integration problems

• Intensive process with annual cycles:– Identify key healthcare workflows and integration

problems– Research & select standards to specify a solution– Write, review and publish IHE Technical

Framework– Perform cross-testing at “Connectathon”– Demonstrations and Education at tradeshows

(RSNA/HIMSS)

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Key IHE ConceptsKey IHE Concepts

• Generalized Systems -> Actors

• Interactions between Actors -> Transactions

• Problem/Solution Scenarios-> Integration Profiles

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For each Integration Profile:

• the context is described (which real-world problem)

• the actors are defined (what systems are involved)

• the transactions are defined (what must they do)

Key IHE ConceptsKey IHE Concepts

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Access to Radiology InformationConsistent access to images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag significant images

Simple Image and Numeric Reports

Simple reports with image links and, optionally,

measurements

Basic SecurityAudit 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

IHE Integration ProfilesIHE Integration Profiles

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Where is IHE going?Where is IHE going?

• Further Expansion in Radiology– Handling multiple Archives within the

institution

• Horizontal Expansion to – IT Infrastructure (Enabling EMR)– Desktop Integration– Cardiology

• Geographical Expansion to – Europe (Germany, France, UK, Italy)– Japan– …

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How do You benefit from IHE?How do You benefit from IHE?

• Clinical UsersClinical Users• Greater access to more consistent informationGreater access to more consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking

• BuyersBuyers• Specify/purchase integration capabilities Specify/purchase integration capabilities

easily easily • Freedom to acquire your selection of systemsFreedom to acquire your selection of systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects

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What IHE is NOTWhat IHE is NOT

• It is not a StandardIt is not a Standard• Has produced a FrameworkHas produced a Framework• Defines consistent and unambiguous use of Defines consistent and unambiguous use of

standardstandard

• It is not an OrganizationIt is not an Organization• Is an initiativeIs an initiative

• It is not a ProductIt is not a Product• Can’t buy IHE as a product Can’t buy IHE as a product • Ask for IHE integration profile implemented in Ask for IHE integration profile implemented in

Actors/Products you buyActors/Products you buy• It may be an upgrade, a feature or an option in It may be an upgrade, a feature or an option in

the productthe product

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DICOM & IHE: DICOM & IHE:

Can you have an Can you have an integrated Enterprise integrated Enterprise

Without Them?Without Them?

What Are They, and Why Do We Need Them?

What Are They, and Why Do We Need Them?

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ResourcesResources

• medical.nema.org• www.rsna.org/IHE• FAQs• Integration Profiles• Primer on IHE• Presentations• IHE Technical FrameworkThank

You