1September, 2005 What IHE Delivers

Key Image NotesKey Image NotesEvidence DocumentsEvidence Documents

Simple Image & Numeric ReportSimple Image & Numeric Report Access to Radiology Information Access to Radiology Information

IHE Vendors Workshop 2006IHE Vendors Workshop 2006Rita Noumeir, Ph.D., Rita Noumeir, Ph.D.,

SoftmedicalSoftmedical

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Abstract / ScopeAbstract / Scope

Sharing of Imaging Information across health Sharing of Imaging Information across health enterprisesenterprises

Imaging Information includes Imaging Information includes extensive sets of DICOM instances including images, extensive sets of DICOM instances including images,

evidence documents and presentation states evidence documents and presentation states diagnostic reports provided in a "for display" form diagnostic reports provided in a "for display" form selection of diagnostically significant images associated selection of diagnostically significant images associated

with the report contentwith the report content

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Sharing Radiology Reports and ImagesSharing Radiology Reports and Imagesin a Regional Health Information Networkin a Regional Health Information Network

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

PACS B

PACS A

Radiology-to-radiology

Radiology-to-Physicians

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Sharing Radiology Reports and ImagesSharing Radiology Reports and Imagesin a Regional Health Information Networkin a Regional Health Information Network

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

Cross-Cross-Enterprise Enterprise RegistryRegistry

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

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

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

Query for Query for Documents Documents

Register Imaging Register Imaging Information for Information for

sharingsharing

Priorimaging

Reports & Studies

Cross-Cross-Enterprise Enterprise RegistryRegistry

Register Imaging Register Imaging Information for Information for sharingsharing

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B

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

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

Register Imaging Register Imaging Information for Information for

sharingsharing

Cross-Cross-Enterprise Enterprise RegistryRegistry

Notification of Notification of Doc AvailabilityDoc Availability

Register Imaging Register Imaging Information for Information for sharingsharing

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Physicians and Systems within a Regional Health Physicians and Systems within a Regional Health Network for a Routine Imaging ReferralNetwork for a Routine Imaging Referral

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Prior Imaging Report & Study

Regional Health Regional Health Information Information NetworkNetwork

Query for Query for documents documents

Imaging Report Imaging Report & Study& Study

Cross-Cross-Enterprise Enterprise RegistryRegistry

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 Notification of Doc AvailabilityDoc Availability

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Value PropositionValue PropositionImaging component of the Electronic Health Record:Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc.Shared imaging Record, in a community, region, etc.

Effective means to contribute and accessEffective means to contribute and access imaging imaging documents across health enterprises. documents across health enterprises.

Without XDS-I, access to the radiology report across health Without XDS-I, access to the radiology report across health enterprises is difficultenterprises is difficult

Scalable sharing of imaging documentsScalable sharing of imaging documents between between radiology departments, private physicians, clinics, radiology departments, private physicians, clinics, long term care, acute care with different clinical IT long term care, acute care with different clinical IT systems.systems.

Easy access:Easy access: Care providers are offered means to Care providers are offered means to query and retrieve imaging documents (images and query and retrieve imaging documents (images and reports) of interest reports) of interest

with the same mechanisms used to query other documentswith the same mechanisms used to query other documents

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Value PropositionValue PropositionDistributed:Distributed: Each Care delivery organization Each Care delivery organization “publishes” imaging information for others. Actual “publishes” imaging information for others. Actual images remain in the source/Image Manager.images remain in the source/Image Manager.

Cross-Enterprise:Cross-Enterprise: A Registry provides an index for A Registry provides an index for published information to authorized care delivery published information to authorized care delivery organizations belonging to the same clinical affinity organizations belonging to the same clinical affinity domain. domain.

Document Centric:Document Centric: Published clinical data is organized Published clinical data is organized into “clinical documents”. using agreed standard into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report)document types (DICOM KOS, PDF and/or text report)

Document Content Neutral:Document Content Neutral: Document content is Document content is processed only by source and consumer IT systems.processed only by source and consumer IT systems.

Standardized Registry Attributes:Standardized Registry Attributes: Queries based on Queries based on meaningful attributes ensure deterministic document meaningful attributes ensure deterministic document searchessearches..

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XDS-I DependenciesXDS-I Dependencies

XDS-I depends on IT Infrastructure Cross-XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS)Enterprise Document Sharing (XDS)

Same Actors as in XDSSame Actors as in XDS Document SourceDocument Source Document ConsumerDocument Consumer Document RegistryDocument Registry Document Repository Document Repository

Added extension to support imaging data Added extension to support imaging data (images and reports)(images and reports)

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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 TransactionsXDS-I Actors and Transactions

Image ManagerImage Archive

Retrieve Images

Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve

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XDS-I New Transaction XDS-I New Transaction requirementsrequirements

XDS Actors:XDS Actors: Document ConsumerDocument Consumer

• at least one Retrieve (DICOM C-Move or WADO)at least one Retrieve (DICOM C-Move or WADO)

Document SourceDocument Source• Provide and Register Document Set Provide and Register Document Set

Radiology ActorsRadiology Actors Image Manager / Image ArchiveImage Manager / Image Archive

• WADO RetrieveWADO Retrieve

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XDS-IXDS-IOptionsOptions

Document Source must support at least Document Source must support at least one of the following options:one of the following options: Extensive Set of DICOM Instances Extensive Set of DICOM Instances PDF Report PDF Report Text Report Text Report Multipart Text/PDF Report Multipart Text/PDF Report

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Sharing of Sharing of Extensive DICOM Extensive DICOM

Instance SetInstance Set

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Document Registry

Document Repository

Manifest

Reference to image 1

DICOM Manifest

Reference to image 2

Reference to image 3Manifest 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 Images

Register Manifest

Manifest

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Sharing of Sharing of Extensive DICOM Extensive DICOM Instance SetInstance Set

The shared Document is a manifest The shared Document is a manifest a Key Object Selection DICOM Instance a Key Object Selection DICOM Instance

Image Manager/Image Archive is required Image Manager/Image Archive is required to ensure that the referenced images from within a published to ensure that the referenced images from within a published

manifest are available to be retrievedmanifest are available to be retrieved

Document Source is responsible Document Source is responsible for replacing a previously submitted manifest Document for replacing a previously submitted manifest Document

when a change occurs to the manifest content (eg. Change when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the of the DICOM SOP instances referenced within the manifest)manifest)

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Sharing of Sharing of Imaging ReportImaging Report

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Radiology systemReport Source

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Text Report

PDF Report

Text +PDF Report

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Radiology systemReport Source

Document Registry

Document Repository

Report Report

Clinical Encounter

Clinical IT System

Query Registry

Retrieve Report

Register Report

Report

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

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Sharing of Sharing of ReportReportThe shared Report Document format is The shared Report Document format is PDF, Text, or multipart PDF + TextPDF, Text, or multipart PDF + Text

A report can A report can embed selected images in its PDF format embed selected images in its PDF format include fully resolved hyperlinks (interactively clickable) include fully resolved hyperlinks (interactively clickable)

that point to the selected imagesthat point to the selected images

Document Source is responsible Document Source is responsible for formatting the hyperlink to reference relevant images for formatting the hyperlink to reference relevant images

as a DICOM WADO URI or as IHE RID Request for as a DICOM WADO URI or as IHE RID Request for DocumentDocument

Document Source is required Document Source is required to ensure that image references are valid linksto ensure that image references are valid links

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XDS-I Actors / GroupingXDS-I Actors / GroupingSharing of an Extensive DICOM setSharing of an Extensive DICOM set Document Source shall be grouped with an Image Document Source shall be grouped with an Image

Manager/Image Archive Manager/Image Archive

Sharing of a report that references selected Sharing of a report that references selected imagesimages Document Source shall be grouped with an Image Document Source shall be grouped with an Image

Manager/Image ArchiveManager/Image Archive

Sharing of a report that references selected Sharing of a report that references selected images from previously published extensive images from previously published extensive DICOM setDICOM set Document Source can be grouped with a Document Document Source can be grouped with a Document

ConsumerConsumer

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Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images

Document RepositoryDocument Repository

Document RegistryDocument Registry

Study

Manifest

Report

DocumentEntry

DocumentEntry

SubmissionSet

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Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images

Document RepositoryDocument Repository

Document RegistryDocument Registry

DocumentEntry

SubmissionSet 1

Report

DocumentEntry

SubmissionSet 2

Study

Manifest

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Linking Report to Prior Images and Prior ReportLinking Report to Prior Images and Prior Report

Document RepositoryDocument Repository

Document RegistryDocument Registry

DocumentEntry

SubmissionSet 3

Prior Study

Manifest

DocumentEntry

SubmissionSet 1

Prior

Report

DocumentEntry

SubmissionSet 2

Report

DocumentEntry

SubmissionSet 4

Study

Manifest

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Linking Report to Selected Linking Report to Selected ImagesImages

Radiology systemReport Source

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Relevant Image

GestationalAge

...WADO URI

Link to image

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XDS-I MetadataXDS-I Metadata

Radiology specificRadiology specific Acquisition Modality (e.g. CT, MR)Acquisition Modality (e.g. CT, MR) Anatomic Region (e.g. Arm, Elbow, Hand)Anatomic Region (e.g. Arm, Elbow, Hand) Requested procedure (e.g. MRI Knee with Requested procedure (e.g. MRI Knee with

contrast)contrast)

Query example Query example find all “find all “CT of the HeadCT of the Head” of patient John Doe for ” of patient John Doe for

the last 2 yearsthe last 2 years

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More information….More information….

IHE Web site: IHE Web site: http://www.ihe.nethttp://www.ihe.net

http://www.himss.org/IHEhttp://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/http://www.acc.org/quality/iheihe..htmhtm

Technical FrameworksTechnical Frameworks

Technical Framework Supplements Technical Framework Supplements – Trial Implementation– Trial Implementation

Non-Technical Brochures :Non-Technical Brochures :

Calls for ParticipationCalls for Participation IHE Fact Sheet and FAQIHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon ResultsIHE Connect-a-thon Results Vendor Products Integration StatementsVendor Products Integration Statements

Questions?

Questions?