rsna 2005 – inforad defining clear and complementary roles for hl7 cda (clinical document...

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RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic Reporting Fred M. Behlen, PhD American College of Radiology Co-Chair, DICOM Working Group 20 & HL7 Imaging Inte grat ion SIG Co-Chair, HL7 Structured Document TC Harry Solomon GE Healthcare Co-Chair, DICOM Working Group 1 Co-Chair, IHE Cardiology Technical Committee

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Page 1: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

RSNA 2005 – infoRAD

Defining Clear and Complementary Roles for

HL7 CDA (Clinical Document Architecture)

and DICOM SR (Structured Reporting)

in Diagnostic Reporting

Fred M. Behlen, PhDAmerican College of Radiology

Co-Chair, DICOM Working Group 20 & HL7 Imaging Integration SIG

Co-Chair, HL7 Structured Document TC

President, LAI Technology, Homewood, IL

Harry SolomonGE Healthcare

Co-Chair, DICOM Working Group 1

Co-Chair, IHE Cardiology Technical Committee

Page 2: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

2

Disclosure• Fred Behlen

– Employee, LAI Technology (Laboratory Automation Inc.)

• Shareholder, Director, Officer• Partner, Migratek Data Migration Services• Consultant, XStor Medical Systems

• Harry Solomon– Employee, GE Healthcare

Page 3: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

3

Acknowledgements• Bob Dolin, Liora Alschuler, Calvin Beebe – co-

chairs of HL7 Structured Documents Technical Committee, and authors of presentations on CDA used in this talk

• Dave Clunie – former co-chair of DICOM Standards Committee, and author of the definitive book on DICOM Structured Reporting

Page 4: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

4

Objectives• Understand the HL7 CDA (Clinical Document

Architecture) and its use cases• Understand DICOM SR (Structured Reporting)

and its use cases, including Key Image Notes, Evidence Documents and CAD (Computer Aided Diagnosis) results

• Understand the workflows for reporting, and the appropriate places for DICOM SR and HL7 CDA in those workflows

• See example implementation scenarios

Page 5: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

5

HL7 Clinical Document

ArchitectureOverview

Page 6: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

6

HL7 Clinical Document

Architecture• The scope of the CDA is the standardization of clinical documents for exchange.

• A clinical document is a documentation of observations and other services with the following characteristics:– Persistence– Stewardship– Potential for authentication– Wholeness– Human readability

• A CDA document is a defined and complete information object that can exist outside of a message, and can include text, images, sounds, and other multimedia content.

Page 7: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

7

CDA History• 1996 – initial discussions

• 1997 – HL7 SGML SIG– Use of Standard Generalized Markup Language for adding metadata to

documents– Later evolved to Extensible Markup Language (XML) subset of SGML– Kona Editorial Group

• 1998 – Patient Record Architecture draft• 2000 – Clinical Document Architecture Release 1 adopted

– Limited to “level 1”• 2000 – SIG becomes HL7 Structured Documents Technical

Committee• 2005 – Clinical Document Architecture Release 2 adopted

– Expanded to “levels 2 & 3”

Page 8: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

8

CDA Use Cases• Diagnostic and therapeutic procedure

reports

• Encounter / discharge summaries

• Patient history & physical

• Referrals / prescriptions

• Uniform format for all clinical documents

Page 9: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

9

Key Aspects of the CDA• CDA documents are encoded in Extensible Markup

Language (XML)• CDA documents derive their meaning from the HL7

Reference Information Model (RIM ) and use HL7 V3 data types

• A CDA document consists of a header and a body– Header is consistent across all clinical documents -

identifies and classifies the document, provides information on patient, provider, encounter, and authentication

– Body contains narrative text / multimedia content (level 1), optionally augmented by coded equivalents (levels 2 & 3)

Page 10: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

10

CDA Standard• Release 1 (2000)

– Standalone standard– Based on draft v3 RIM– Level 1 narrative and multimedia

• Release 2 (2005)– Incorporated into HL7 v3 Standard (Normative Edition

just published on CD)– Level 2 narrative and multimedia, plus coded statements

• Implementation Guide for Care Record Summaries, US Realm (currently in ballot)

Page 11: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

11

CDA Release 2 Information Model

Header Body

ParticipantsSections/Headings

Clinical Statements/Coded Entries

ExtlRefsContext

ID/Type

StartHere

Page 12: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

12

CDA Structured Body

Structured Body

Section

Text

Section

Text

Section

Text

Section

Text

Section

Text

Section

Text

Entry

Coded statement

Entry

Coded statement

Entry

Coded statement

Arrows are Act Relationships • Has component, Derived from, etc.

Entries are coded clinical statements• Observation, Procedure, Substance administration, etc.

Page 13: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

13

Clinical Document

Characteristics• Persistence– Documents exist over time and can be used in many contexts

• Stewardship– Documents must be managed, shared by the steward

• Potential for authentication– Intended use as medico-legal documentation

• Wholeness– Document includes its relevant context

• Human readability– Essential for human authentication

Page 14: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

14

Sample CDA

Page 15: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

15

Narrative and Coded Info• CDA requires human-readable “Narrative Block”, all

that is needed to reproduce the legally attested clinical content

• CDA allows optional machine-readable coded “Entries”, which drive automated processes

• Narrative may be flagged as derived from Entries – Textual rendering of coded entries’ content, and contains

no clinical content not derived from the entries • General method for coding clinical statements is a hard,

unsolved problem– CDA allows incremental improvement to amount of

coded data without breaking the model

Page 16: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

16

Narrative and Coded Entry

Example

Page 17: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

17

DICOM Structured ReportingOverview

Page 18: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

18

DICOM Structured Reporting• The scope of DICOM SR is the

standardization of documents in the imaging environment.

• SR documents describe or reference images, waveforms, or specific regions of interest.

Page 19: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

19

SR History• 1994 – initial discussions

• 1995 – Working Group 8 (Structured Reporting)• 1998 – Supplement 23 Structured Reporting draft• 1999-2000 – Supplement 23 adopted• 2001 – Supplement 53 DICOM Content Mapping

Resource adopted• 2001-2005 – 12 Supplements defining specific SR

document templates

Page 20: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

20

SR Use Cases• Radiology reports with robust image / ROI

references• Measurements/analyses made on images• Computer-aided detection results• Notes about images (QC, flag for specific use, quick

reads)• Procedure logs for imaging-based therapeutic

procedures• Image exchange manifests

Page 21: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

21

Use Case Common Features• Structured

– Lists and hierarchies

• Numeric measurements, coded values– Automatically extractable for database, data mining

• Relationships between items– Hierarchical, or arbitrary reference– Power of rich semantic expression

• References to images, waveforms, other objects– Collected in DICOM environment

• Explicit contextual information– Unambiguous documentation of meaning

Page 22: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

22

Key Aspects of DICOM SR• SR documents are encoded using DICOM standard

data elements and leverage DICOM network services (storage, query/retrieve)

• SR uses DICOM Patient/Study/Series information model (header), plus hierarchical tree of “Content Items”

• Extensive use of coded content– Allows use of vocabulary/codes from non-DICOM sources

• Templates define content constraints for specific types of documents / reports

Page 23: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

23

SR Content Item Tree

Root Content Item

Document Title

Content Item Content Item Content Item

Content Item Content Item Content Item

Arrows are parent-child relationships• Contains, Has properties, Inferred from, etc.

Content Items are units of meaning• Text, Numeric, Code, Image, Spatial coordinates, etc.

Content Item

Content Item Content Item

Page 24: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

24

DICOM SR Objects• Basic Text

– Narrative text with image references• Enhanced and Comprehensive

– Text, coded content, and numeric measurements, spatial and temporal ROI references

• Mammo CAD and Chest CAD – Automated analysis results

• Key Object Selection (KO)– Flags one or more images or waveforms with purpose (for

referring physician, for surgery …) and textual note – Used for key image notes and image manifests (in IHE profiles)

• Procedure Log – For intravascular / cardiac cath

Page 25: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

25

Radiology Reporting

Page 26: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

26

Reporting Integration • Should be high priority

– Economic importance of radiologist productivity

– Referring physicians (radiology’s customers) want to see key images

• But, still mostly served by proprietary and custom integration

Page 27: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

27

Reporting integration includes: • Workflow

– Managing interpretation worklists– Providing orders and relevant clinical information– Automatically displaying appropriate images and relevant

priors• Annotation and measurements

– Key images– Markings, measurement calipers and other graphical

annotation– Measurements acquired in the imaging procedure

• Structured reporting• Narrative reporting

Page 28: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

28

The all-DICOM solution• DICOM SR, along with General Purpose Worklist, was

supposed to take care of all this.• DICOM SR has found vital uses in key subspecialty areas

that produce structured data in the examination or post-processing– Cardiology, both Cath Lab and Echo– Fetal biometry in ultrasound– Computer Aided Detection/Diagnosis results

These SR documents are not necessarily part of the patient’s medical record, but are part of the Evidence Data.

Page 29: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

29

“Evidence” and “Reports”• Evidence Documents

– Include ultrasound measurements, cath lab procedure logs, Computer-Aided Diagnosis results, etc., that are created in the imaging context

– Together with images, are part of the information that a radiologist uses to produce a report

– The reporting physician may quote or copy parts of Evidence Documents into the report, but doing so is part of the interpretation process at the reporting physician’s discretion

– Appropriate to be stored with the images as DICOM SR objects

• Reports – Become part of the patient’s medical record, with potentially wide

distribution– Ideal match to HL7 CDA; structured/coded data requires CDA

Release 2

Page 30: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

30

Reporting is RIS Turf• Diagnostic reporting continues in the province of

information systems that are based primarily on Health Level Seven (HL7) standards.

• Even if diagnostic reports were created as DICOM SR objects, the end recipients of diagnostic reports – referring physicians – commonly use systems with HL7 rather than DICOM capabilities.

Page 31: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

31

DICOM-HL7 Synergy• SR and CDA developed simultaneously

• DICOM and HL7 working groups recognized the need to work together

DICOM SR and HL7 CDA are congruent in key areas– Document persistence

– Document identification, versioning and type code

– Document’s relation to the patient and to the authoring physicians

• In 2000 DICOM groups were already looking to CDA as a format for exporting DICOM SR content

– Proposal to translate SR documents into CDA, but would have to wait (a long time) for Release 2 Level 3 of CDA

Page 32: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

32

DICOM Interest in CDA• Use cases for varying types and purposes of diagnostic

reporting elaborated at the DICOM 2002 Symposium. • March 2003: DICOM Working Group 10 (Strategic Advisory)

suggested composing the reports directly in CDA format. • Standards solutions were considered against the use cases, and

gaps were identified and subsequently closed through extensions to the standards.

• The efforts have included: – discussions in many working groups of DICOM– continued cooperation with the HL7 Structured Document Technical

Committee, which edits the CDA– the issuance of DICOM Supplement 101 (HL7 Structured Document

Object References)– CDA Implementation Guide for Diagnostic Reports [2006]

Page 33: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

33

Standards Now Ready

• CDA Release 2 is now published [2005], and all needed standards are now in place.

• Additions to DICOM in Supplement 101 – Enable reference to CDA documents from within

DICOM objects– Include CDA documents on DICOM removable disks

• Indexed in DICOMDIR for integration with DICOM storage systems

– Communicate simple image references and annotation from PACS to reporting systems without requiring close integration of the two systems

Page 34: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

34

Usercontrol

Diagnostic reporting

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

PACSArchive

Information System

Diagnosticreport

Report

ImageSources

Orders,Prior

Reports

DiagnosticImages

Viewingsettings

Page 35: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

35

Reportwith imagereferences &annotation

Usercontrol

Reporting with annotation(use case)

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

PACSArchive

Information System

Diagnosticreport

ImageSources

DiagnosticImages

Imagereferences

& annotation

Viewingsettings

Orders,Prior

Reports

Page 36: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

36

Usercontrol

Reporting with annotation(available)

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

PACSArchive

Information System

Diagnosticreport

Report

ImageSources

DiagnosticImages

Viewing settings,image references& annotation

Imagereferences

& annotation

Orders,Prior

Reports

Page 37: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

37

Diagnosticreport

Integrated solutionImage Viewing &

Reporting Application

Integrated PACS &Information System

ImageSources

Orders,Diagnostic images

& Prior reports

Viewing settings,Reports, imagereferences & annotation

Imagereferences

& annotation

******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96

FINDINGS: As above. IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumorgrowth.

Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3

******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96

FINDINGS: As above. IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumorgrowth.

Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3

Usercontrol

Page 38: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

38

Usercontrol

Loosely integrated reporting

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

PACSArchive

Information System

Diagnosticreport

Report

ImageSources

DiagnosticImages

Viewing settings,image references& annotation

Imagereferences

& annotation

Orders,Prior

Reports

Page 39: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

39

Usercontrol

Loosely integrated reporting

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

PACSArchive

Information System

Diagnosticreport

Report

ImageSources

DiagnosticImages

Viewing settings,image references& annotation

Imagereferences

& annotation

Image references& annotation

Image retrieval

Orders,Prior

Reports

Page 40: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

Transcribednarrative

Verification

Imageselection

Annotation

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application Reporting Application

Image Archive(DICOM SCP)

Reporting SystemValidation Functions

Dictatedreport

DICOMKO object“For Report”

DICOM Query/Retrieve for all KO objects matching Accession Number

WADOServer

Reporting Integration Functions

CDAReport

SRReport

DICOM references to Images & GSPSs

WADO URI references to Images with GSPSs

DICOMGSPS object

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41

CDA Implementation Guides• Balloted as HL7 Informative Documents

• Describe what amount to “templates” for CDA Documents.– Specify constraints on CDA content– Provide Schematron validation of instances– Each Implementation Guide has a Template ID attribute

that is included in the root element of the conforming document

• Care Record Summary IG being balloted• WG20/IISIG is preparing an IG for Diagnostic

Imaging Reports

Page 42: RSNA 2005 – infoRAD Defining Clear and Complementary Roles for HL7 CDA (Clinical Document Architecture) and DICOM SR (Structured Reporting) in Diagnostic

42

Conclusions• CDA now being seen as primary format for diagnostic reports

– Supp 101’s definition of SR report and its equivalent CDA is most practical at this time, though the CDA structure is not normative text in DICOM

– Direct definition of CDA report to be done in 2006 by a balloted HL7 Implementation Guide

– Does not require tight integration of imaging and reporting workstations

– Method is extensible to reports with more structure

• DICOM SR will see continued and expanding use for Evidence Documents created in the imaging setting

– IHE Evidence Documents Integration Profile– Work under way for formalizing Evidence Documents as a separate

object class in DICOM