HL7-IEEE-DICOM-cooperation.ppt

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  • As Performed Procedure Step, the most recent of the four Service Classes become available, a fully integrated solution for the modalities is on the horizon.
    Implementing Modality Worklist is the first step and can be done today with most recent modality products.
    Closing this loop delivers many benefits to the overall operation efficiency of the radiology department in the context of the overall hospital.
  • Representation includes: healthcare providers, information systems vendors, imaging systems vendors, and standards groups participating
  • As Performed Procedure Step, the most recent of the four Service Classes become available, a fully integrated solution for the modalities is on the horizon.
    Implementing Modality Worklist is the first step and can be done today with most recent modality products.
    Closing this loop delivers many benefits to the overall operation efficiency of the radiology department in the context of the overall hospital.
  • HL7-IEEE-DICOM-cooperation.ppt

    1. 1. Waveform, Workflow, Archiving… Assessment of Standard Interfaces Opportunities for Cooperation
    2. 2. Three Levels for Connectivity Standards Device Connectivity Departmental Integration Hospital/Ambulatory Workflow EMR Integration Radiology Cardiology ICU Imaging Modalities Image proc. CAD, … RIS R-PACS ADT OrderPlacer EMR,… Captors, Actuators Bed-Side Monitors Cluster Monitor ICU IS Cardiac Monitors Hemodynamics Rest, Stress, Holter ECG Cardiac IS, C- PACS EnterpriseArchive 1073 HL7 DICOM DICOM SCP ? HL7 ? DICOM ? 1073 ? Three Examples  Overlap  Coordination Needed
    3. 3. Three Topics, Three Opportunities ? 1. Persistent Waveform Objects 2. Departmental Workflow Integration 3. Enterprise Archiving of Images & Waveforms
    4. 4. DICOM Waveforms Quick Refresher
    5. 5. Key Aspects of DICOM • DICOM domain is communications for imaging-based care • DICOM is an Object-based standard – Persistent objects • Inter-object referential capability – Binary tagged data element format – Objects are hierarchically organized • Patient / Study / Series (modality) “folders” • DICOM: Persistent Object workflow services over TCP/IP – Generally in client-server architecture – Object transfer, storage, storage commitment, query and retrieval • Media-Interchange (CD, DVD, Floppy, etc.) with clinical directory. • Network Archiving – Departmental workflow management (worklist, performed steps) • Broadly used and accepted world-wide for many years.
    6. 6. DICOM Waveforms • Supplement 30: Waveform – in DICOM 2001 • Introduces general structure for waveform composite (persistent) objects – Waveform channels identified by coded-entry triplet • Coding Scheme / Code Value / Code Meaning • Allows externally defined terminology (e.g., SCP-ECG for leads) • Triplets also used in HL7 and DICOM Structured Reporting • Triplet values may be constrained by Templates defined in Part 16 • Specific waveform Object Definitions (particularly for cardiology) – Hemodynamics – Cardiac Electrophysiology – Electrocardiography (12-lead, ambulatory, general) – Basic Voice Audio – In progress, Ultrasound Doppler Waveform (Suppl 56)
    7. 7. Streams of Waveform Samples DICOM Waveform Object • Waveform object encodes digital data from a discrete time period – Multiple channels; all channels have common time base – Flexible waveform sample format • 8 or 16 bit data; Signed, unsigned, u-law, A-law • Separate sampling frequencies for each channel, or multiplexed channels at common frequency – Objects may be temporally contiguous, or temporally selective – “Store and forward” (not for real time monitoring) • Waveform object encodes full definition of each channel – Quality being sampled, Sensor location (anatomic),Function (measurement or stimulus), Resolution and range, Technique (e.g., pull-back) – Based on HL7 V2 definition • Waveform object encodes DICOM + HL V2 context information in header – Equipment information (manufacturer, serial number, location) – Temporal frame of reference (synchronization with other objects, in particular images) • Waveform object encodes optional annotation – Identify features or regions of interest – Generated by acquisition unit – Constructed of label and time or sample reference
    8. 8. Waveforms Standardization for Departemental Integration -Key Objectives-
    9. 9. Waveforms: why integrated & separated ? • Integrated with other persistent objects – Images • Supporting the waveforms (e.g., for documentation of EP catheter location) • Supported by waveforms (e.g., simultaneous ECG for IVUS post processing) – Various categories of Structured Reports with waveform references. • Clinical reports • Measurement reports (e.g., hemodynamics, or ECG) • Procedure Log documents (full procedural context for waveform acquisition) • Key object selection (electronic “Post-It”) • Workflow integration: – worklists and status monitoring of scheduled tasks • including distribution of patient demographics – Object archiving and retrieval – Key for archiving of recorded vitals signs – Web accessible as persistent objects (presented or original data) • Focused on Full Fidelity Acquired Data: – No Presentation: to be addressed independently. – Compression: compact encoding, separate from the object definition – Clearly distinguished from derived measurements and reports – Patient/Visit/Order context driven by HL7
    10. 10. Departmental Workflow Integration DICOM and HL7….. Much more than combining standards !
    11. 11. Store ImagesStore Images Storage CommitmentStorage Commitment StorageStorage CommitmentCommitment List of ImagesList of Images PACS &PACS & ArchiveArchive RISRIS ModalityModality PerformedPerformed ProcedureProcedure StepStep Performed Step:Performed Step: Status = CompletedStatus = Completed Performed CT HeadPerformed CT Head Pat Name/ID, Dose,Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UID Complete List of ImagesComplete List of Images A Closed LoopA Closed Loop •Update IS SchedulingUpdate IS Scheduling •Match Procedure with OrderMatch Procedure with Order •Support Billing Based on MPPSSupport Billing Based on MPPS •Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality WorklistModality Worklist WorklistWorklist Procedure Scheduled (HL7)Procedure Scheduled (HL7) Patient Registration/UpdatePatient Registration/Update Order Management (HL7)Order Management (HL7)
    12. 12. Acquisition Modality Acquisition Modality Structuring the Departmental Workflow with an Enterprise perspective ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, ActsOne or more series of images Performed Procedure Step P1 Scheduled Procedure Step B Requested Procedure 1 Scheduled Procedure Step A Report One or more series of images Performed Procedure Step P2 DICOM Modality Worklist DICOM Modality Worklist
    13. 13. What is IHE ?  An Initiative Sponsored by Users: HIMSS plus clinical societies (e.g.RSNA)  Active Industry Leadership, shaping direction  Leverage existing standards (HL7, IEFT, DICOM, etc.) in an industry defined integration framework  Proceed in pragmatic incremental steps to deliver easier to integrate product implementations  Proven approach in IT & Radiology (over 100 vendors already participate).
    14. 14. Enterprise Archiving of Images and Waveforms ↓1: Pt registration ↓12: Pt Update Pt Registration: 1 ↓ Pt Update: 12 ↓ ←2: Placer Order Management →3: Filler Order Management ADT ↑14: Query Images ↑15: Query GSPS ↑16: Retrieve Images ↑17: Retrieve GSPS ↑30: Query Key Image Notes ↑31: Retrieve Key Image Notes Image Display Storage Commitment: 10↓ ↑8: Modality Image Stored ↑9: Modality GSPS Stored ↑29: Key Image Notes Stored Storage Commitment: 10 ↑ ↓18: Creator Image Stored ↓19: Creator GSPS Stored ↓29: Key Image Notes Stored ↓4: Procedure Scheduled ↑11: Image Availability Query ↓12: Patient Update ↓13: Procedure Update →5: Modality Worklist Provided Image Creator Performed Procedure Step Manager Image Manager Image Archive ↑6: Modality PPS in Progress ↑7: Modality PPS Completed ↑20: Creator PPS in Progress ↑21: Creator PPS Completed →6: Modality PPS in Progress →7: Modality PPS Completed →20: Creator PPS in Progress →21: Creator PPS Completed ←6: Modality PPS in Progress ←7: Modality PPS Completed ↓20: Creator PPS in Progress ↓21: Creator PPS Completed Order PlacerOrder Filler Print Server Acquisition Modality Print Composer →23: Print Request with presentation LUT ↓24: Report Submission Structured Report Export: 28 ↓ ↓25: Report Issuing Report Creator ↓26: Query Reports ↓27: Retrieve Reports ↓26: Query Reports ↓27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository Charge Processor →36: Account Management ↑35: Charge Posted ↓33: Maintain Time Secure Node Time Server Secure Node ↓32: Authenticate Node Audit Report Repository ↓34: Record Audit Event →34: Record Audit Event Post-Processing Manager←37: GP Worklist Provided →38: GP Workitem Claimed →39: GP Workitem Completed →40: GP PPS In Progress →41: GP PPS Completed Performed Work Status Update: 42↑↓
    15. 15. IHE Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit 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
    16. 16. What is Unique about IHE ?  A User/Vendor Team Effort :  Voluntary and Open to All Vendors. It is not a consortium.  Professional Associations Engaged (e.g. HIMSS leadership)  Starts from concrete user integration needs, selects standards, sets a technical framework, provides a test-bed, and demonstrates/educates marketplace.  Does not define product architectures or features, only the glue between products.  Successful. Benefits both small and large vendors, worldwide : North America, Europe, Asia.
    17. 17. Industry is invited to shape and expand IHE  A kick-off meeting in order to :  Review the current state of integration in the healthcare information technology industry  Identify IT Infrastructure priorities necessary for building an EMR  Establish the structure and timeline for implementation.  All vendors are invited :  Product marketing & technical leadership  When & where :  November 4-5, 2002  Malvern, (near Philadelphia, PA)  Respond to invitation : ihe@rsna.org
    18. 18. Store ImagesStore Images Storage CommitmentStorage Commitment StorageStorage CommitmentCommitment List of ImagesList of Images PACS &PACS & ArchiveArchive RISRIS ModalityModality PerformedPerformed ProcedureProcedure StepStep Performed Step:Performed Step: Status = CompletedStatus = Completed Performed CT HeadPerformed CT Head Pat Name/ID, Dose,Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UID Complete List of ImagesComplete List of Images A Closed LoopA Closed Loop •Update IS SchedulingUpdate IS Scheduling •Match Procedure with OrderMatch Procedure with Order •Support Billing Based on MPPSSupport Billing Based on MPPS •Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality WorklistModality Worklist WorklistWorklist Procedure Scheduled (HL7)Procedure Scheduled (HL7) Patient Registration/UpdatePatient Registration/Update Order Management (HL7)Order Management (HL7)
    19. 19. Enterprise Archiving of Images and Waveforms
    20. 20. Enterprise Archiving for complex clinical data: images and waveforms • Large and "specialized" complex clinical data sets call for archiving outside of central EMR database • Images are being handled by PACS (radiology, cardiology, etc.) and hospital wish to also share resource for waveforms • A consistent set of standards is required to achieve this integration of image and waveform enterprise archiving in an EMR driven environment.
    21. 21. Enterprise Archiving DICOM : 10 years of experience Enterprise Persistent Objects Repository Departmental IS System RIS, PACS, CIS, etc. Study/Patient Series Persistent Object Instance Store (Class/Instance UID) Storage Commitment Retrieve (Instance UID) Store (Class/Instance UID) Media Interchange (Inst. + DIR) Query (Study Root) Web Access Native or presented forms Transparent Persistent Object Payload (except for Class)
    22. 22. Web Access to Persistent DICOM Objects Retrieve one "entire document" (either in a presentation view or as a data set) using its "Persistent Document Instance UID" Persistent Objects Repository Client Accessing Healthcare Documents e.g.EPR Retrieve a "presentation view" Retrieve a "Data Set" "Form of the reference" "Form of the reference" Data Set "Retrieve": -Preferred transfer Syntax -Default transfer Syntax ? Presentation View "Retrieve": -Type of encoding for images (JPEG, GIF, etc.) -Type of document presentation format (PDF, HTML, CDA-L1) -Size of Images Intent is not to offer a "Query": - Need is only to get access to an object
    23. 23. Waveforms Standardization for Departemental Integration -Key Objectives-
    24. 24. Waveforms: why integrated & separated ? • Integrated with other persistent objects – Images • Supporting the waveforms (e.g., for documentation of EP catheter location) • Supported by waveforms (e.g., simultaneous ECG for IVUS post processing) – Various categories of Structured Reports with waveform references. • Clinical reports • Measurement reports (e.g., hemodynamics, or ECG) • Procedure Log documents (full procedural context for waveform acquisition) • Key object selection (electronic “Post-It”) • Workflow integration: – worklists and status monitoring of scheduled tasks • including distribution of patient demographics – Object archiving and retrieval – Key for archiving of recorded vitals signs – Web accessible as persistent objects (presented or original data) • Focused on Full Fidelity Acquired Data: – No Presentation: to be addressed independently. – Compression: compact encoding, separate from the object definition – Clearly distinguished from derived measurements and reports – Patient/Visit/Order context driven by HL7

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