DICOM Structured Reporting Current Status and Role  in the Electronic Patient Record Harry Solomon Co-chair, DICOM WG1 - C...
What is DICOM Structured Reporting? <ul><li>A means of encoding structured information … </li></ul><ul><ul><ul><li>hierarc...
Structured Reporting  is Not... <ul><li>DICOM SR is not just “reports” </li></ul><ul><ul><li>any structured data exchanged...
Where Can Cardiology Use SR? <ul><li>Clinical Reports (cath, echo, nuc, etc.) </li></ul><ul><ul><li>to go along with our p...
Cath Lab Example Hemo Report Baseline Ref waveform Measurements … Post-intervention Ref waveform Measurements … Derived me...
Structured Reporting is the glue  that makes possible construction  of an electronic patient record  for cardiology
DICOM SR Status <ul><li>Work began in 1994 </li></ul><ul><ul><li>Championed by Dr. Dean Bidgood </li></ul></ul><ul><li>Sup...
The Problem of Flexibility <ul><li>A document creator can put in  anything in any structure </li></ul><ul><li>A document r...
DICOM SR Status <ul><li>Supplement 53: Content Mapping Resource -  May 2001 </li></ul><ul><ul><li>Defined general structur...
So Theoretically ... <ul><li>DICOM Structured Reporting is ready to be implemented for cardiology! </li></ul><ul><li>But P...
Issues for Cardiology SR <ul><li>Uses not well covered by “clinical report” model </li></ul><ul><ul><li>Procedure logs, pr...
Cardiology SR Efforts <ul><li>Supplement 66: Cath Lab SR (WG1) </li></ul><ul><ul><li>Procedure Log </li></ul></ul><ul><ul>...
Procedure Log Issues <ul><li>Structure - flat  </li></ul><ul><li>Ordering - strictly time sequential </li></ul><ul><li>Lin...
Hemodynamic Report Issues <ul><li>SOP Class - Cath Lab Measurements (together with QCA, QVA, IVUS measurements, etc.) </li...
Hemo Report Structure Hemo Report CONTAINER Baseline Phase CONTAINER Post-Contrast Phase CONTAINER Arterial Measurements C...
Find out more <ul><li>http://www.pixelmed.com/srbook.html </li></ul><ul><ul><li>David Clunie’s excellent introduction to D...
Thank you Questions? mailto://harry.solomon@med.ge.com
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DICOM Structured Reporting Current Status and Clinical Importance ...

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DICOM Structured Reporting Current Status and Clinical Importance ...

  1. 1. DICOM Structured Reporting Current Status and Role in the Electronic Patient Record Harry Solomon Co-chair, DICOM WG1 - Cardiovascular Information
  2. 2. What is DICOM Structured Reporting? <ul><li>A means of encoding structured information … </li></ul><ul><ul><ul><li>hierarchical tree of content items, using DICOM object syntax </li></ul></ul></ul><ul><li>For vendor-independent exchange between systems … </li></ul><ul><ul><ul><li>leveraging the DICOM object management infrastructure </li></ul></ul></ul><ul><li>Providing unambiguous documentation of meaning … </li></ul><ul><ul><ul><li>text, categorical codes, numeric measurements, inter-item relationships </li></ul></ul></ul><ul><li>For the image-intensive clinical environment </li></ul><ul><ul><ul><li>careful attention to clinical observation context </li></ul></ul></ul><ul><ul><ul><li>robust references to DICOM images, waveforms </li></ul></ul></ul>
  3. 3. Structured Reporting is Not... <ul><li>DICOM SR is not just “reports” </li></ul><ul><ul><li>any structured data exchanged between systems </li></ul></ul><ul><ul><li>measurements, analyses, sonographer notes ... </li></ul></ul><ul><li>DICOM SR is not Structured Data Entry </li></ul><ul><ul><li>Hierarchical pull-down menus to support report creation is often denoted “structured reporting” </li></ul></ul><ul><ul><li>DICOM does not standardize applications or data entry techniques </li></ul></ul><ul><ul><li>Structured data entry is a valuable means of creating SR content in certain circumstances </li></ul></ul>
  4. 4. Where Can Cardiology Use SR? <ul><li>Clinical Reports (cath, echo, nuc, etc.) </li></ul><ul><ul><li>to go along with our pretty DICOM pictures </li></ul></ul><ul><li>Analyses of raw image and waveform data </li></ul><ul><ul><li>backing up the Clinical Report </li></ul></ul><ul><li>Documentation of the procedure </li></ul><ul><ul><li>provide context for the raw data and analyses </li></ul></ul><ul><li>Input to a clinical database </li></ul><ul><ul><li>for patient care over time, or outcomes analysis </li></ul></ul>
  5. 5. Cath Lab Example Hemo Report Baseline Ref waveform Measurements … Post-intervention Ref waveform Measurements … Derived measurements Ref waveform Procedure Log 11:10 Patient prepped Cath Lab Report Patient 67 yr old male, history of … Ref prior ECG report Procedure Ref Log Narrative ... Findings Hemodynamic Ref HD Report Narrative ... Angiographic 70% stenosis ... Ref image Intervention Stent placed in LAD … Ref image Complications Summary Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired 11:27 HD waveform acquired Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired 11:27 HD waveform acquired 11:30 XA image acquired Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired 11:27 HD waveform acquired 11:30 XA image acquired 11:47 PTCA 11:59 XA image acquired Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired 11:27 HD waveform acquired 11:30 XA image acquired 11:47 PTCA 11:59 XA image acquired 12:02 HD waveform acquired Procedure Log 11:10 Patient prepped 11:19 Percutaneous entry 11:23 XA image acquired 11:27 HD waveform acquired 11:30 XA image acquired 11:47 PTCA 11:59 XA image acquired 12:02 HD waveform acquired 12:21 Pt released to holding 12:24 HD Report
  6. 6. Structured Reporting is the glue that makes possible construction of an electronic patient record for cardiology
  7. 7. DICOM SR Status <ul><li>Work began in 1994 </li></ul><ul><ul><li>Championed by Dr. Dean Bidgood </li></ul></ul><ul><li>Supplement 23: Structured Reporting - April 2000 </li></ul><ul><ul><li>Defined general format for SR objects </li></ul></ul><ul><ul><ul><li>DICOM header, hierarchical tree of content items </li></ul></ul></ul><ul><ul><ul><li>Concepts represented by coded terminology using external (non-DICOM) lexicons [e.g., Reed codes, SNOMED anatomy, ICD-9/10 diagnosis or procedure codes, SCP-ECG lead IDs] </li></ul></ul></ul><ul><ul><li>Defined general classes of clinical reports </li></ul></ul><ul><ul><li>Extremely flexible </li></ul></ul>
  8. 8. The Problem of Flexibility <ul><li>A document creator can put in anything in any structure </li></ul><ul><li>A document reader must handle every possible document </li></ul><ul><li>Need to constrain the SR content to enable meaningful receiving applications </li></ul><ul><ul><li>Structure </li></ul></ul><ul><ul><li>Content </li></ul></ul>
  9. 9. DICOM SR Status <ul><li>Supplement 53: Content Mapping Resource - May 2001 </li></ul><ul><ul><li>Defined general structure for templates : document patterns </li></ul></ul><ul><ul><li>Mechanism for terminology context groups : constrained vocabulary subsets </li></ul></ul><ul><ul><li>Fundamental templates for documenting clinical context and for basic reports </li></ul></ul><ul><ul><li>DICOM lexicon for vocabulary not externally available </li></ul></ul>
  10. 10. So Theoretically ... <ul><li>DICOM Structured Reporting is ready to be implemented for cardiology! </li></ul><ul><li>But Pragmatically … </li></ul>
  11. 11. Issues for Cardiology SR <ul><li>Uses not well covered by “clinical report” model </li></ul><ul><ul><li>Procedure logs, preliminary measurement reports </li></ul></ul><ul><li>Many ways to encode the same information </li></ul><ul><ul><li>Need consistent approach for interoperability </li></ul></ul><ul><li>Need tailored subset of SR for developers </li></ul><ul><ul><li>Reduce the learning curve </li></ul></ul>Need Cardiology-specific SR Templates and consensus Terminology
  12. 12. Cardiology SR Efforts <ul><li>Supplement 66: Cath Lab SR (WG1) </li></ul><ul><ul><li>Procedure Log </li></ul></ul><ul><ul><li>Hemodynamics Report </li></ul></ul><ul><ul><li>ECG Report </li></ul></ul><ul><ul><li>Quantitative Analysis Report </li></ul></ul><ul><ul><li>Cath Lab Report </li></ul></ul><ul><li>Supplement 26: Ultrasound SR (WG12) </li></ul><ul><ul><li>Echocardiography Report </li></ul></ul><ul><li>Both to be released for Public Comment this autumn </li></ul>
  13. 13. Procedure Log Issues <ul><li>Structure - flat </li></ul><ul><li>Ordering - strictly time sequential </li></ul><ul><li>Linkage of events - associative Procedure Step / Action ID </li></ul><ul><li>SOP Class - distinct from reports </li></ul><ul><li>Remote entries - new Application Event Logging Service Class </li></ul>
  14. 14. Hemodynamic Report Issues <ul><li>SOP Class - Cath Lab Measurements (together with QCA, QVA, IVUS measurements, etc.) </li></ul><ul><ul><li>Distinction from report titles </li></ul></ul><ul><li>Structure - deep hierarchy </li></ul><ul><li>Terminology - post-coordinated, context from hierarchy </li></ul>
  15. 15. Hemo Report Structure Hemo Report CONTAINER Baseline Phase CONTAINER Post-Contrast Phase CONTAINER Arterial Measurements CONTAINER Ventricular Measurements CONTAINER Gradient Measurements CONTAINER Anatomic Location = L Fem Art Patient State CONTAINER Patient State CONTAINER Systolic Pres Diastolic Pres Mean Pres Arterial Measurements CONTAINER Anatomic Location = Aorta Systolic Pres Diastolic Pres Mean Pres Post-Intervention Phase CONTAINER
  16. 16. Find out more <ul><li>http://www.pixelmed.com/srbook.html </li></ul><ul><ul><li>David Clunie’s excellent introduction to DICOM SR </li></ul></ul><ul><li>ftp://medical.nema.org/medical/dicom/supps </li></ul><ul><ul><li>text of draft supplements </li></ul></ul><ul><li>http://www.dicomwg12.org/structured_reporting </li></ul><ul><ul><li>echocardiography SR </li></ul></ul><ul><li>subscribe to WG1 email list </li></ul><ul><ul><li>send request to how_clark@nema.org </li></ul></ul>
  17. 17. Thank you Questions? mailto://harry.solomon@med.ge.com

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